Learning From the Community to Improve Maternal—Child Health and Nutrition: The Positive Deviance/Hearth Approach

Abstract

The "traditional" use of the Positive Deviance approach to behavior change involves studying children who thrive despite adversity, identifying uncommon model behaviors among Positive Deviant families, and then designing and implementing an intervention to replicate these behaviors among mothers of malnourished children. This article presents the results of a literature review designed to gather information on the role of the Positive Deviance/Hearth methodology in social and behavior change. Examples of how the methodology has been applied beyond infant and child malnutrition to address other health areas, such as improving pregnancy outcomes, are explored. An analysis of Positive Deviance programming being carried out by Project Concern International in Guatemala and Indonesia is conducted. The role of cultural context in the design and implementation of Positive Deviance/Hearth, as well as the role of Positive Deviance in affecting social and behavior change, require further exploration. The issues related to cultural context and the challenges for monitoring and evaluation of program outcomes are presented.

A Mixed-Methods Approach to Understanding Barriers to Postpartum Retention in Care Among Low-Income, HIV-Infected Women

“…27 In this study, the women that were retained in care served as ''positive deviants'' and provided information about barriers and facilitators to retention that might also exist for those women that were not retained.…”

The positive deviance/hearth approach to reducing child malnutrition: systematic review

“…There have been a number of non‐systematic reviews and working groups to identify successful practices from existing programs (Zeitlin et al. 1990; Nutrition Working Group, Child Survival Collaborations and Resources Group [CORE] 2002b; Schooley & Morales 2007).…”

Practical limitations to a positive deviance approach for identifying dietary patterns compatible with the reduction of cancer risk

“…(1990) and is now widely used (Ahrari et al. , 2006; Schooley & Morales, 2007; Sethi et al. , 2007).…”

“…The PD approach emerged as a public health education strategy in the early 1990s (Shekar et al, 1992;Guldan et al, 1993;Mattosinho et al, 1996). The approach was embraced in public health nutrition by the United Nations University by the landmark text, Positive Deviance in Child Nutrition -with emphasis on Psychosocial and Behavioural Aspects and Implications for Development, by Zeitlin et al (1990) and is now widely used (Ahrari et al, 2006;Schooley & Morales, 2007;Sethi et al, 2007). To proceed from the survey's tabulations to the selection of the model respondents to use as reference behaviours is an iterative process involving a series of generic data analyses.…”