Ti Foyer (Hearth) Community-Based Nutrition Activities Informed by the Positive Deviance Approach in Leogane, Haiti: A Programmatic Description

Abstract

This paper details the steps to design and implement a positive deviance-informed, "Hearth" approach for the nutritional rehabilitation of malnourished children in the district of Leogane, Haiti. Groups of four to five children met daily for two weeks at the home of a local volunteer mother for nutritional and health messages and a well-balanced meal. Health messages and meal components were determined using information gathered from interviews with the mothers of positive deviant children in the community who are well nourished despite their family's limited economic resources. Hearth participants were then followed for six months in their own home by the program "monitrices," women hired from each village and intensively trained to supervise the Hearth program, periodically weigh the children to evaluate their progress, and liaise between the hospital and the community. Monitoring from the first cycle indicated that 100% of children in eight villages and 66% of children in the remaining five villages continued to gain weight as fast or faster than the international standard median six months after participating in a Hearth program. At the conclusion of this cycle, programmers interviewed participant and non-participant families and made six modifications to the model, including the addition of a microcredit option for participating mothers.

Nutritional Recovery Outcome among Moderately Malnourished Under-five Children in Communities Implementing Positive Deviance - Hearth or Community Health Workers’ Nutrition Promotion Approaches in Karusi and Kirundo Provinces, Burundi

“…In the present study, the overall mean weight gain after 120 days was statistically significant in both the PD-H and CHWNP groups. This was similar to Bolles et al's (2002) study that reported a significant increase in weight gain among children less than 5 years enrolled in PD-H in Haiti. The present study also showed more improvement in weight gain in the CHWNP group than the PD-H group.…”

Effectiveness of a community‐based nutrition programme to improve child growth in rural Ethiopia: a cluster randomized trial

“…Nutrition programmes based on PD/Hearth models have been popularly implemented in developing settings with the advantages of cultural appropriateness, sustainable implementation and community participation (Bolles et al . ; Hendrickson et al . ; Aubela et al .…”

Thirty-Six-Month Outcomes of a Generalist Paraprofessional Perinatal Home Visiting Intervention in South Africa on Maternal Health and Child Health and Development

“…Five features distinguish these CHW: 1) they are selected based on being positive peer deviants (Bolles, Speraw, Berggren, & Lafontant, 2002); 2) CHW are trained to address multiple health challenges, not only one; 3) there are clear expectations for performance (e.g., a defined caseload of 40 families) and accountability structures for both interpersonal supervision and monitoring by paper documentation of visits or mobile phones; 4) CHWs are encouraged to leverage their relationship to motivate mothers to care well for their infants; and, 5) the CHW are paid a stipend and only employed half time (as this is the first job for almost all the CHW).…”