Positive Deviance

Positive deviance approach and research

What is positive deviance?

Positive deviance (PD) is an unusual behavior that some of the people in a community implicitly exercise, which can be the key to solving a social problem even under scarce resources to mobilize. PD has gained attention in the field of global health and international development as a cutting-edge and sustainable tool of problem solving.

Early examples of positive deviance

One of the landmark PD projects was implemented in Vietnam in 1990s for child malnutrition.

In Vietnam, about 65% of children under the age of five suffered from malnutrition in 1990. In project villages by Save the Children USA in Northern Vietnam, 64% of children under the age of three was identified as malnourished. Instead of implementing a large scale aid project to reduce acute malnutrition, Jerry and Monique Sternin were in collaboration with people in the local community to find well-nourished children from less wealthier households. The team identified three unusual behaviors among villagers:

Unusual food choice: Give children sweet potato leaves and shrimp and crab from paddy fields.
Handwashing: Wash hands of children before eating and after playing outside.
Meal frequency: Ask someone to feed children four or five times a day while parents work in their paddy fields.

These PD behaviors were identified as solutions to child malnutrition, as alternative to the mass distribution of nutrition supplementation. Villagers and experts worked together to elaborate a package of solutions were developed based on these PD behaviors. Villagers that exercised PD behaviors took the role of “teachers” when the solutions were disseminated out of their villages.

Reference:
Positive Deviance Initiatives: https://positivedeviance.org/background
Jimba M. Pojitibu Deviense towa Nani ka (What is Positive Deviance)? Koshu Eisei (Journal of Public Health Practice). 80(11):853-58.

Applications of positive deviance approach

Positive deviance approach has been applied to various social issues, not specific to global health and international development. The book "Power of positive deviance： How Unlikely Innovators Solve the World's Toughest Problems"was published in 2010, which introduced key PD projects in the world as follows:

Child malnutrition (Vietnam)
Female circumcision (Egypt)
Hospital infections (United States)
Marketing in a pharmaceutical company (Mexico)
Reintegration of girl soldiers (Uganda)
Infant mortality (Pakistan)

Positive deviance research in Department of Community and Global Health

In Department of Community and Global Health, master and PhD students learn PD approach in their coursework. Our past research includes:

Opisthorchis viverrini infection status and raw fish dish consumption (Lao PDR)
Intake of snack at school (Nepal)
Male involvement in child rearing (Cambodia)
Dual use of condoms and hormonal contraceptives to prevent unintended pregnancy and sexually transmitted infections (Uganda)
Heterogeneity in the effect of nutrition improvement interventions (Nepal)

Below is the introduction of our study in Uganda for dual use of condoms and hormonal contraceptives.

Unintended pregnancy and sexually transmitted diseases are important public health issues in sub-Saharan African countries. Dual method, or dual use of condoms and hormonal contraceptives, has been proved effective to reduce both unintended pregnancy and sexually transmitted diseases. However, in Uganda, couples do not necessarily exercise the dual method. In this study, out of 150 women surveyed, nine women exercised the dual method (they can be referred to as PD women). In this study, women told that they felt difficult in persuading their partners to use condoms and obtaining condoms. Nevertheless, PD women exercised unique behaviors; such as told their partners messages obtained in public health education, continued to persuade their partners to exercise the dual method, told their partners how to use condoms, and identified multiple places to obtain condoms and contraceptives. The results of this study were used to design the intervention for peer support to enhance the dual method.

PD research, like PD approach in general, identifies people who exercise a good practice even though they live under severe socioeconomic conditions. However, in PD research, researchers tend to take a leading role to identify PD practices while they listen to the voice of people who exercise these practices. PD practices identified in a study area might not always be applicable to other areas. We are working to improve the methods of PD research to improve the ways of identifying PD practices, measuring the outcomes of PD practices, and disseminating the outcomes.