HEP 452 Module 7 Assignment Positive Deviance

1. How does positive deviance work? (200 words, 2 points)

Positive deviance refers to the observation that a few at-risk individuals follow uncommon, beneficial practices in most settings and consequently experience better outcomes than their neighbors who share similar risks (Marsh et al., 2004). Based on this, positive deviant behavior involves the uncommon practice that gives people an advantage compared to those that do not adopt it. Such positive behavior is likely to be affordable, acceptable, and sustainable as at-risk individuals already practice them, do not conflict with local culture, and are proven effective. For example, communities practicing child nutrition programs, providing parents with an opportunity to adopt other new behaviors such as hand washing and hygienic food preparation, aside from benefiting from benefiting from a healthier diet (Marsh et al., 2004). The positive deviance behavior works by partnering with communities to develop case definitions, identify individuals who have achieved unexpected good outcomes despite high risk, interview and observe individuals discover uncommon behaviors, and analyze findings to confirm uncommon behaviors and their accessibility to those who need them. It also involves partnering with communities to design behavior change activities encouraging the community to adopt new behaviors, and also helps in monitoring implementation as well as the evaluation of results.

2. What are the three process of positive deviance? (Name and briefly describe each, 300 words, 3 points)

The three processes of positive deviance behavior include social mobilization, information gathering and behavior change.

i. Social mobilization – Communities have adopted a certain way of living, which is normal to them. However, those at risk have devised new approaches to healthier living which is not adopted by the entire community (Marsh et al., 2004). There is a need for the whole community to adopt the behavior, and this means that they need to be educated on the importance of adopting the new behavior. This process of creating awareness is considered social mobilization; more participants get motivated by learning that they are doing something right and that a successful solution to their problem exists within their community, rather than receiving criticism for their inadequacies.

ii. Information gathering – This process involves in-depth inquiries by studying the community norms and vetting the community to help identify the transferable behaviors and enabling factors that are likely to account for the good outcome of the community (Marsh et al., 2004). Information gathering is dependent on the aims of the project, and therefore, policymakers seek to promote behaviors that will help explain good health status outcomes.

iii. Behavior change – Communities have positive deviance behaviors that are affordable and accessible to all, including using clean blades to cut the baby’s cord. These behaviors call for immediate adoption since they ripple through the community, even before the formal interventions begin (Marsh et al., 2004). While there are behaviors that may take time to adapt to affordability and accessibility, implementing policies and procedures to help these behaviors affordable to the community, especially those at risk, can help increase positive deviant behavior in the community.

3. What is one example of positive deviance from the field? (200 words, 3 points)

An example of positive deviance from the field includes the reduction of childhood malnutrition in Vietnam. According to the article, there was a 74% reduction in severe malnutrition among children younger than three years old in Vietnam in the 1990s (Marsh et al., 2004). These children participated in a positive deviance program. However, after the intervention stopped in 1998, research indicates that children, especially their younger siblings born three years after the program was terminated, had better nutritional status than age and sex-matched children who did not live within the communities that the program had been established prior to termination (Marsh et al., 2004). A major reason for the improved health status can be attributed to the mothers having learned improved practices to health during the program.

4. What are the advantages and disadvantages of positive deviance? (150 words, 2 points)

The advantage of positive deviance is that it promotes equity in that it is formed by the wisdom of disadvantaged doers of healthy behaviors and provides solutions accessible to those with similar socioeconomic constraints (Marsh et al., 2004). Another advantage is that it introduces a generic approach for local problem-solving. Positive deviance also enhances local research capacity for controlling diseases in a relevant, affordable, and sustainable way. Finally, positive deviance reveals at least partial solutions today to challenges rather than waiting for long-term development. The limitation of positive deviance is that it requires discovering uncommon positive examples, typically at a prevalence of 1-10% (Marsh et al., 2004). The approach is inappropriate for settings where positive behaviors is impossible due to the non-availability of relevant services or foods. Scale-up of the programs requires individuals with skills in community mobilization, participatory research, and positive deviance, and this may limit the uptake. Finally, positive deviance programs are subject to the generalization of findings.

References

Marsh, D. R., Schroeder, D. G., Dearden, K. A., Sternin, J., & Sternin, M. (2004). The power of positive deviance. BMJ : British Medical Journal, 329(7475), 1177–1179.