Positive deviance in health and medical research on individual level outcomes – a review of methodology

Foster, Byron A.; Seeley, Kylie; Davis, Melinda M.; Boone‐Heinonen, Janne

doi:10.1016/j.annepidem.2021.12.001

Cited by 8 publications

(7 citation statements)

References 115 publications

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“…In addition, the none-probability sampling methods used to recruit participants [ 94 ] and the Hawthorne effect, a type of reactivity in which individuals modify an aspect of their behavior in response to their awareness of being observed as positive deviant are included in many articles as limitations in using the approach of PD [ 30 , 32 , 49 , 66 , 71 ]. These limitations highlight the need for careful consideration of a balanced method when using the PD approach [ 146 ].…”

Section: Resultsmentioning

confidence: 99%

“…In line with the above findings, another scoping review paper has indicated that some researchers have used unstandardized and less clear criteria to select PDs and suggested that objective measures of health outcomes should be used whenever possible to reduce the possibility of bias in examining associations [ 146 ]. Furthermore, it is critical to consider the underlying assumption that the identified PDs are contextually comparable with other groups in terms of access to resources and expertise [ 20 ].…”

Section: Discussionmentioning

confidence: 98%

“…Furthermore, it is critical to consider the underlying assumption that the identified PDs are contextually comparable with other groups in terms of access to resources and expertise [ 20 ]. This is because, health workers, health facilities, and/or health systems with better expertise and financial resources could have advantages that can influence their performance and the subsequent outcomes in comparison with their counterparts signifying the need to consider the degree of resources between populations or groups when designing a sampling strategy [ 20 , 146 ]. This challenge can be addressed to some extent in the selection criteria.…”

Section: Discussionmentioning

confidence: 99%

“…The possible reason for this is that the continuous nature of practice improvement over time could affect the selection of positive deviant sites as other comparators may progress as well and top performers might become low-performing at another time [ 85 , 102 ]. This highlights the need to use robust criteria in the selection process of PDs [ 146 ].…”

Section: Discussionmentioning

confidence: 99%

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The use of positive deviance approach to improve health service delivery and quality of care: a scoping review

Kassie,

Eakin,

Abate

et al. 2024

BMC Health Serv Res

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Background Quality has been a persistent challenge in the healthcare system, particularly in resource-limited settings. As a result, the utilization of innovative approaches is required to help countries in their efforts to enhance the quality of healthcare. The positive deviance (PD) approach is an innovative approach that can be utilized to improve healthcare quality. The approach assumes that solutions to problems are already available within the community and identifying and sharing those solutions can help others to resolve existing issues. Therefore, this scoping review aimed to synthesize the evidence regarding the use of the PD approach in healthcare system service delivery and quality improvement programs. Methods Articles were retrieved from six international databases. The last date for article search was June 02, 2023, and no date restriction was applied. All articles were assessed for inclusion through a title and/or abstract read. Then, articles that passed the title and abstract review were screened by reading their full texts. In case of duplication, only the full-text published articles were retained. A descriptive mapping and evidence synthesis was done to present data with the guide of the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews checklist and the results are presented in text, table, and figure formats. Results A total of 125 articles were included in this scoping review. More than half, 66 (52.8%), of the articles were from the United States, 11(8.8%) from multinational studies, 10 (8%) from Canada, 8 (6.4%) from the United Kingdom and the remaining, 30 (24%) are from other nations around the world. The scoping review indicates that several types of study designs can be applied in utilizing the PD approach for healthcare service and quality improvement programs. However, although validated performance measures are utilized to identify positive deviants (PDs) in many of the articles, some of the selection criteria utilized by authors lack clarity and are subject to potential bias. In addition, several limitations have been mentioned in the articles including issues in operationalizing PD, focus on leaders and senior managers and limited staff involvement, bias, lack of comparison, limited setting, and issues in generalizability/transferability of results from prospects perspective. Nevertheless, the limitations identified are potentially manageable and can be contextually resolved depending on the nature of the study. Furthermore, PD has been successfully employed in healthcare service and quality improvement programs including in increasing surgical care quality, hand hygiene practice, and reducing healthcare-associated infections. Conclusion The scoping review findings have indicated that healthcare systems have been able to enhance quality, reduce errors, and improve patient outcomes by identifying lessons from those who exhibit exceptional practices and implementing successful strategies in their practice. All the outcomes of PD-based research, however, are dependent on the first step of identifying true PDs. Hence, it is critical that PDs are identified using objective and validated measures of performance as failure to identify true PDs can subsequently lead to failure in identifying best practices for learning and dissemination to other contextually similar settings.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The use of positive deviance approach to improve health service delivery and quality of care: a scoping review

Kassie,

Eakin,

Abate

et al. 2024

BMC Health Serv Res

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“…In the present study, we used criterion sampling to identify positively deviant adult (>18 years) DR-TB patients who had successfully completed DR-TB treatment without interruption for ≥2 consecutive days. Positive deviants referred to individuals who stand out from their peers in terms of dealing with the challenges they face in common and have better outcome than their peers [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

A Dual Perspective of Psycho-Social Barriers and Challenges Experienced by Drug-Resistant TB Patients and Their Caregivers through the Course of Diagnosis and Treatment: Findings from a Qualitative Study in Bengaluru and Hyderabad Districts of South India

et al. 2022

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Qualitative insights regarding psycho-social barriers and challenges experienced by drug-resistant tuberculosis (DR-TB) patients and their caregivers are understudied in India. We conducted a qualitative study using semi-structured qualitative interviews among treatment-completed DR-TB patients (n = 20) and caregivers (n = 20) in Bengaluru and Hyderabad districts, which represented two different socio-cultural settings in South India. Criterion sampling was used for recruiting the eligible participants who completed treatment with adherence. “Emotional issues and social barriers” were identified to represent a major challenge for patients and caregivers, which occurred acutely after disease diagnosis, characterized by fear and emotional distress due to their perceived loss of life prospects, severity of symptoms, discomfort, and disease denial. Medication intolerance, chronic symptoms, lack of visible signs of treatment progress, loss of weight, and physical concerns caused subsequent fear and distress during the treatment phases for patients along with experiences of stigma. External triggers generated “decisive moments” of hopelessness and life-ending thoughts for patients at the diagnosis and early treatment phase. Medication related challenges included the perceived burden and power of pills which caused emotional distress for patients and intolerance towards caregivers. Pill burden was found as consequential as the side effects of injections. Challenges related to lack of support were another major theme, in which caregivers lacked resources for treatment support and nutrition. Throughout treatment, caregivers and patients expressed concern about a lack of supportive care from family members, sympathy, and intangible social support. Challenges during hospital admission in terms of lack of privacy, quality of services, individual attention, and empathy from health care workers were reported by patients and caregivers. Despite better adherence, DR-TB patients and caregivers experienced considerable emotional and social consequences. Differentiating DR-TB patients and caregivers’ issues at different stages of diagnosis and treatment could help improve patient-centered outcomes in India and other high-burden nations.

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Positive Deviance Leading and Coping with Social Change

Ong,

Sakamoto,

Jimba

2023

The Palgrave Handbook of Global Social Change

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Positive deviance in health and medical research on individual level outcomes – a review of methodology

Cited by 8 publications

References 115 publications

The use of positive deviance approach to improve health service delivery and quality of care: a scoping review

The use of positive deviance approach to improve health service delivery and quality of care: a scoping review

A Dual Perspective of Psycho-Social Barriers and Challenges Experienced by Drug-Resistant TB Patients and Their Caregivers through the Course of Diagnosis and Treatment: Findings from a Qualitative Study in Bengaluru and Hyderabad Districts of South India

Positive Deviance Leading and Coping with Social Change

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