The Positive Deviance Approach to Improve Health Outcomes: Experience and Evidence from the Field—Preface

Positive deviance (PD) refers to a phenomenon that exists in many resource-poor communities that is the finding that a few individuals and families employ uncommon beneficial practices that allow them and their children to have better health as compared to their similarly impoverished neighbors. These PD behaviors are likely to be affordable acceptable and sustainable by the wider community because their peers are already practicing them. Programmers who use the PD approach for improving health outcomes work with communities to determine community norms regarding a specific desirable outcome (e.g. good child growth) to identify a few (usually four to six) individuals who have achieved the good outcome (i.e. not the normal or expected outcome) despite high risk to conduct a PD inquiry to learn from these PD individuals the behaviors that are likely to explain the good outcome and be feasible for their neighbors and to design behavior change interventions to enable adoption of these new PD behaviors. Most PD interventions thus far have targeted childhood malnutrition and have provided communal opportunities to observe and practice new behaviors until skills are mastered (e.g. hearth settings). (excerpt)