Positive Deviance Research Articles

Exploration of Positive Deviance in Prevention of Underweight in the Under-Five: A Qualitative Study on Low-Income Urban Families

Children under the age of five (the under-five) from low-income families are more vulnerable to experience underweight. This nutritional vulnerability is evident in the preliminary study, where 35.1% of the under-five experience underweight, and 28.48% are low-income families. This study aimed to explore Positive Deviance (PD) behaviors in preventing underweight among the under-five. The study applied a qualitative approach with a case study design. Data collection took place in July-August 2022, focusing on low-income families in the Gunung Brintik area. Data were collected through two focus group discussions, seven in-depth interviews, and five key informant interviews. Coding, subtheme, and theme development were facilitated using the ATLAS.ti trial package. Triangulation of the study results yielded four major themes influencing the prevention of underweight in the under-five: interventions by health workers and cadres, community awareness and concern, family support, and maternal nutrition literacy. The identified PD behaviors practiced by the community in the study location have been shown to contribute to the prevention of underweight in the under-five. Strengthening these identified PD behaviors and their implementation in other areas is essential to support efforts to combat underweight in the under-five.

Effect of Positive Deviance Approach on Promotion of Safe Disposal of Child's Feces in Rural Tamil Nadu: A Community-Based Quasi-Experimental Study.

Safe disposal of feces is ensured when it is deposited into a toilet, whereas unsafe disposal of child's feces plays a crucial role in disease transmission and environmental pollution. These areas are overlooked by many sanitation promotion interventions. To determine the effect of positive deviance (PD) approach on safe disposal of child's feces among households who owned a toilet. A community-based quasi-experimental study was conducted in the four field practice villages of the Urban Health Training Center, Villupuram, for 18 months. Households who owned a toilet and had a child less than 5 years old were included. After IEC clearance, information was collected from a representative sample of 100 households before intervention and another 100 households after intervention. PD approach was applied for 6 months to promote safe disposal practices in the study villages. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software (version 24). The Chi-square test was used to determine the significance of difference between baseline and endline data. The effect size was calculated to estimate the magnitude of difference between baseline and endline data. Before intervention, only 3% of households disposed the feces into a toilet, while after intervention, almost 38% of households disposed in the toilet (χ2 = 37.39; df = 1; P = 0.001). The effect size (Cramer's V) was found to be 0.43. PD approach demonstrated considerable improvements in safe disposal of child's feces in rural settings. Further, to sustain the behavior change, frequent reinforcement of key messages at frequent intervals needs to be emphasized.

610 Environmental exposures and disparities in infant mortality: a positive deviance analysis

610 Environmental exposures and disparities in infant mortality: a positive deviance analysis

Promoting Positive Deviance from PIK POTADS North Sumatra to Improve the Quality of Life of Down Syndrome Children

Down syndrome (DS) is a chromosome 21 condition that leads to abnormalities in a number of organs, unusual facial traits, as well as intellectual and developmental problems. It takes more time, effort, and patience to raise kids with DS, which makes it a hard undertaking. Another challenging difficulty is the significant amounts of stress and sadness that DS parents experience. With the help of strategies and local values, this program seeks to educate parents of DS patients so they may create social change (positive deviation). This service is provided in two stages, socialization and education, as well as genetic counseling, to help influence social change in society, particularly in families with DS children. According to socialization research findings, the biggest health issues for kids with DS are metabolic and dietary issues. During discussion, parents' emotional states were also exposed. In order to learn more about the family history of genetic illnesses and risk factors, parents receive genetic counseling. A variety of experts are involved in this service's education, including psychologists, psychiatrists, and pediatricians, who can give an overview of how to appropriately care for DS.

How important is integration to the successful ‘roll out’ of specialist hospital discharge schemes for people who are homeless?

In 2021, we published research funded by the UK National Institute for Health Research that demonstrated the effectiveness and cost effectiveness of specialist hospital discharge schemes for people who are homeless. A key finding of the research was that areas that had a specialist homeless hospital discharge scheme had fewer delayed discharges and could reduce their emergency readmissions among homeless patients by 14%. This positive outcome attracted the attention of national health policy makers who allocated £16 million funding to 17 local authority areas to “roll out” new schemes. This paper reports the preliminary findings of an implementation evaluation. We assess how important integration was in those areas that successfully translated the evidence about “what works’ into practice. This presentation is targeted at academics and commissioners of integrated care.
 The evaluation employed a positive deviance (appreciative enquiry) methodology. This approach seeks out exceptionally performing sites, investigates the underlying factors contributing to the successful behaviours and strategies, and plans an appropriate means to replicate these with the aim to effect a change. The rationale behind appreciative inquiry is that solutions to common problems mostly exist within clinical/practice communities rather than externally with policy makers or managers.
 The first step of the evaluation was to collect audit (performance) data from the 17 local authorities taking part in the programme. Audit data was then used to select three case studies sites that demonstrated high performance against key metrics such as having a shorter length of stay in ‘step-down’ services (longer stays being indicative of housing shortages and difficulties maintaining flow through the system). In the case study sites, reflective interviews and focus groups then sought to establish what factors underpinned this successful implementation. This included interviews with a range of key stakeholders including people with lived experience of homelessness and transitions out-of-hospital (over sixty stakeholders in total).
 Integration was found to be a key factor in understanding successful implementation at many different levels - from building the initial strategic vision to delivering quality in frontline service delivery. Often this was ‘relational’ integration where building social networks in strategic places was the main factor in determining routinization and sustainability. Often boundary spanning was key where ‘homeless commissioners’ needed to cross the divide into the unfamiliar world of health service commissioning. Relational working required a dedicated project manager with highly developed skills in business planning, evaluation and policy literacy to negotiate the many hurdles that stood in the way of the routinization of specialist care. Successful sites also involved people with lived experience of homeless in meaningful rather than tokenistic activities, integrating their knowledge of services and practice to ensure compassion was at the forefront of practice. Taking an in-depth qualitative perspective on successful implementation is important as very few of the 17 test sites managed to sustain their new services once the initial programme funding had run out.

From “Positive Deviants” to Post-dissident Liberals: A Study of the Transformation of the Concept of “Islands of Positive Deviation”

From “Positive Deviants” to Post-dissident Liberals: A Study of the Transformation of the Concept of “Islands of Positive Deviation”

Multicentre positive deviance seminar to generate best practice recommendations to reduce anastomotic leak and length of stay for patients undergoing oesophagectomy

BackgroundWe describe a novel process using positive deviance (PD) with the Canadian Association of Thoracic Surgeons members, to identify perioperative best practice to minimise anastomotic leak (AL) and length of...

What are the features of high-performing quality improvement collaboratives? A qualitative case study of a state-wide collaboratives programme

ObjectivesDespite their widespread use, the evidence base for the effectiveness of quality improvement collaboratives remains mixed. Lack of clarity about ‘what good looks like’ in collaboratives remains a persistent problem....

Use of the positive deviance approach for healthcare system service improvement: a scoping review protocol

IntroductionHealthcare systems are currently facing challenges in enhancing access and improving the quality of healthcare services around the world, and one of the innovative strategies that have been used to...

Examining Characteristics of Local Public Health Systems With Exceptional Tribal Organization Participation.

To learn feasible ways to increase multisector community partnership with tribal organizations, meaning tribal health authorities or American Indian and Alaska Native (AI/AN)-serving organizations, by examining characteristics of local public health systems with exceptional tribal organization participation. In total, 728 local public health departments were surveyed in 2018 to generate a nationally representative sample of local public health systems in the United States. A positive deviance approach using logistic regression helped identify local public health systems that had tribal organization participation despite characteristics that make such participation statistically unlikely. Local public health systems with exceptional tribal organization participation were compared with systems with conventional participation, examining measures known to impact the formation of public health partnerships. This study used an exploratory logistic regression approach to identify unique characteristics of local public health systems with exceptional tribal organization participation. Of 728 health systems surveyed, 21 were identified as having exceptional tribal organization participation. Across varying thresholds to identify exceptional participation, having a higher network density and prioritizing equity in public health activities were found to consistently distinguish exceptional tribal organization participation in both nonrural and rural areas. Public health partnerships with tribal organizations are possible even in circumstances that make them unlikely. Efforts to build denser networks of collaborating organizations and prioritize equity may help public health systems achieve success with tribal organization partnerships.

Advancing behavioural economics through positive deviance: Attending to the microworld of second-track processes

Behavioral economists interested in solving wicked problems can benefit from a deeper understanding of positive deviance (PD), an approach for spreading innovations by identifying the novel and effective practices of positive outliers—those who have solved the problem against all odds. In this article, we contend that the PD approach (1) represents a vital condition of problem-solving using Second Track Processes, emphasizing conversation, coordination, and collaboration among multiple stakeholders, each accompanied by their lived realities, agendas and constraints; and (2) allows us to focus our attention on the microworld of human interaction—the local context where life is authentically thrashed out by partners and participants amidst complexity.

Food system resilience measurement: principles, framework and caveats

There is growing recognition that a better understanding of how food systems respond to crises is critical to build and protect the food security of local populations. But rigorous and reliable methods to measure food system resilience are still missing. In this paper, we build on the current literature to develop an analytical framework aimed at assessing the resilience of food systems at local level. The novel element of the analysis lies in the levels at which resilience is considered. Combining the individual actor level with the notion of 'emergent properties' of food systems, we argue that the overall resilience of food system results from processes that take place – and need to be measured – at both individual and system levels. The framework is structured around three components: (i) the mapping of the actors and the local food system; (ii) the assessment of the resilience of these actors and that of the food system, and (iii) the outcomes of this resilience, assessed in term of local population’s food security. For each of those components, indicators are proposed and the ways to collect them are discussed. The paper then presents the types of analyses that would be necessary to complete to gain a better understanding of the situation regarding the resilience of the local food system under consideration, including the analysis of “positive deviance” among food system actors. The paper concludes with a series of reflections about the caveats and challenges that one may face when attempting to assess food system resilience.

What made primary health care resilient against COVID-19? A mixed-methods positive deviance study in Nigeria

IntroductionThe SARS-CoV-2 (COVID-19) pandemic overwhelmed some primary health care (PHC) systems, while others adapted and recovered. In Nigeria, large, within-state variations existed in the ability to maintain PHC service volumes....

Theorizing the Use of Performance Enhancing Substances and Methods in Sport as Four Different Types of Deviant Behavior

ABSTRACT The central objective of this paper is to demonstrate that the validity of the Hughes and Coakley (H&C) model of deviance in sport is context specific and depends on the time, place, social groups involved, and the relative power of the audience and deviant(s). H&C argued that performance enhancing substance (PES) use constituted a single type of deviant behavior among athletes (i.e. positive deviance). The Heckert and Heckert (H&H) deviance framework made it possible to theorize performance-enhancing substances and methods (PESM) use as four ideal types of deviant behavior among athletes and in sports collectives. Given the variability in the historical and social contexts where PESM use has occurred in sport, a comprehensive explanatory framework is needed to understand a full range of PESM behaviors. This paper demonstrates that the H&H framework has a clear explanatory advantage over the H&C model.

Strategies of unicorn startups: how these positive deviants compare to early-stage and Fortune 500 ventures

PurposeThe purpose of this paper is to begin to explore the strategic priorities of unicorn ventures as pursuers of market disruption. This study approaches this task by drawing on the positive deviance concept for studying outliers with the intent of understanding the strategic priorities of these ventures.Design/methodology/approachThis is a comparison study of the priorities of 75 unicorn ventures, 37 early-stage ventures and 45 Fortune 500 organizations. The authors use computer-aided text analysis to conduct within-sample and between-sample means comparison tests of 12,487 newswires from 2022.FindingsWhere early-stage ventures emphasize their mission, and Fortune 500 companies emphasize financial results, unicorn ventures, occupy the middle of the spectrum, balancing their priorities between pursuing market disruption and achieving financial results. These high-growth outliers indicate their priorities by using significantly less positive tone, affective and prosocial language, and focusing less on corporate social responsibility initiatives, compared to early-stage ventures (and using more of this language compared to Fortune 500 ventures). An additional finding emphasizes that public Fortune 500 companies focus significantly more on money than their topic of interest.Originality/valueThis work has implications for understanding the strategic priorities of entrepreneurial ventures in different development stages. The results suggest that unicorn ventures actively work to balance their startup mission, which allows them to experience high-growth and achieve market disruption, with the financial demands of venture capital investors. This novel conclusion demonstrates the value of using positively deviant outlier cases, such as unicorn ventures, as a viable sample for studying market disruption.

Sosialiasi Faktor Resiko Perempuan Menjadi Korban Kekerasan Dalam Rumah Tangga Di Kota Sorong

This research aims to determine the risk factors for women becoming victims of domestic violence. This research is qualitative in nature using a case study approach to analyze data based on quality and described using words so that language or explanation is obtained in the form of sentences that are systematic and easy to understand. The research results show that the background of women becoming victims of domestic violence includes family economic factors and family dysfunction, which causes violence against women. Cases of violence against women at the Sorong City Police Station this time have entered into a violence emergency status and there will be 33 cases in 2022. Long-term prevention of violence against women is through the use of Positive Deviance and psychosocial approaches for families in reducing the level of domestic violence.

How a small-town enterprise delivers “worldwide” services: a case from the music production industry

In Rena, a small town (approx. 2,500 inhabitants) in a small municipality (approx. 5,000 inhabitants), there is a rather small enterprise that has not only had a national impact, but also attracts international attention. The company has specialized in music production and developing singer/songwriters and are running a substantial number of “music camps” that are sessions lasting either a weekend or a week with different themes. With increasingly better equipment accessible to “everyone” and digital platforms with short access to the public, the competition regarding being spotted on the different music apps is high and increasing rapidly. In our paper, we have investigated how this company has made a living out of facilitating for the development of music. We have used qualitative methods, and primarily focussed on in-depth interviews with the employees and participants, as well as observations during sessions. Our results show that not only their business model, but also the structure and facilitation, is vital for developing products that may be published. The structure and facilitation have been developed over some time. During this time, the founder and colleagues have shown exceptional learning abilities, and not only developed as music producers, but also as facilitators. We have found some explanations for this success, not only from theory on innovation and entrepreneurship, but also in theory on Positive Deviance, which we will present in the paper. The combination of these directions has provided a richer understanding of how this small-town company has a worldwide customer database. The innovation capacity of the company has supported the development of the organization as they have been able to utilize their dynamic skills, hired staff with complimentary skills and through a leadership and management style managed to engage the staff by involving and including them in the strategic development of the organization and what they offer their customers. Their ability to attract and develop competency and their professionalism have contributed towards turning potential disadvantages to a part of what they offer the customers as a support and positive means to finish or enhance their products.

Rural libraries implementing walking groups or walking groups plus civic engagement for walkability in rural communities: a comparative effectiveness trial study protocol

BackgroundRural residents generally lack adequate physical activity to benefit health and reduce disparities in chronic diseases, such as cardiovascular disease and certain cancers. The Socioecological Model describes physical activity as involving a dynamic and reciprocal interaction between individual, social, and community factors. Community group-based walking programs and civic engagement interventions aimed at enhancing physical activity have been successful in rural communities but have not targeted all three socioecological levels. Public libraries can act as innovative public health partners in rural communities. However, challenges remain because rural libraries often lack the capacity to implement evidence-based health promotion programming. The goals of this study are (1) build the capacity for rural libraries to implement evidence-based health promotion programs, (2) compare changes in physical activity between a group-based walking program and a combined group-based walking and civic engagement program with rural residents, and (3) conduct an implementation evaluation.MethodsWe will conduct a comparative effectiveness study of a group-based walking (standard approach) versus a group-based walking plus civic engagement program (combined approach) aimed at enhancing walkability to increase physical activity among rural adults. Key mediators between the program effects and change in outcomes will also be identified. Finally, we will evaluate program implementation, conduct a cost effectiveness evaluation, and use a positive deviance analysis to understand experiences of high and low changers on key outcomes. Twenty towns will be matched and randomized to one of the two conditions and our aim is to enroll a total of 350–400 rural residents (15–20 per town). Study outcomes will be assessed at baseline, and 6, 12, and 24 months.DiscussionThis study will build the capacity of rural libraries to implement evidence-based walking programs as well as other health promotion programs in their communities. The study results will answer questions regarding the relative effectiveness and cost effectiveness of two multilevel physical activity interventions targeting rural communities. We will learn what works and how these multilevel interventions can be implemented in rural populations.Trial RegistrationClinicalTrials.gov Identifier: NCT05677906.

The impact and implementation of an mHealth intervention to improve infant and young child feeding in Senegal: IIMAANJE protocol for a cluster randomized control trial.

Behavior change communication (BCC) strategies have the potential to improve infant feeding and nutrition outcomes among infants and young children in low- and middle-income countries. More recently, there has been a shift toward the adoption of mHealth interventions-the use of mobile phones to transmit health-related information or direct care-to promote recommended BCC strategies among the caregivers of infants and young children. In Senegal, most infants and young children are not fed according to recommended practices leading to a high prevalence of undernutrition and micronutrient deficiencies. The aims of this cluster randomized control trial, using an effectiveness-implementation (type 1) hybrid design, were to: (1) determine the impact of an mHealth IYCF intervention on IYCF practices and nutrition outcomes; and (2) examine the implementation, costs, and opportunities for scaling up the mHealth messaging intervention. The trial was conducted in three regions in Senegal (Thies, Fatick, Diourbel) with 488 mother, father and children (6-23 months) triads. The intervention included 8 scripted messages, that underwent cognitive testing prior to the intervention implementation, and 8 unscripted messages from positive deviants. One voice message and one text message were sent each week to members of our experimental group for a 16-week period. The impact of the intervention was assessed through a household survey, 24-h dietary recall, and hemoglobin measurements before and after the intervention implementation. The primary outcomes were minimal acceptable diet (MAD) and anemia. We also included a total of 54 participants in nine focus groups held with mothers and fathers and semi-structured interviews with Badienou Gox (i.e., community health workers) (n = 6) and national partners and program implementers (n = 6) to examine the intervention implementation process. The study was registered prior to data collection on Clinicaltrials.gov (Identifier: NCT05374837).

The relationship between institutional climate and constructive deviance

PurposeThis study aims to explore the impact of organizational climates on constructive workplace deviance by examining staff attitudes to four dimensions of institutional climate: academic; administrative; developmental; and financial. Though carried out with exclusively academic staff working in university environments, it has considerable potential as a pilot for adaptation to the needs of managers and carers working with intellectually challenged offenders and their families.Design/methodology/approachData from a purposive (non-probability) sample of 357 academicians used in technical education in public or private organizations were collected electronically using a Likert-type questionnaire. Analytic techniques used in this study include measurement model assessment and structural equation modeling.FindingsRespondents indicated that institutional climate significantly influences employees in how they exhibit constructive deviance in their workplace behavior. Practices such as whistle blowing, prosocial rule-breaking and openly expressing their concerns are common symptoms exhibited in constructive deviant behavior. An employee who is positively influenced by the organization’s climate would stand up against any policy or activity that could disrupt or harm the company’s operations and reputation. Results imply that, of the four climate variables analysed, financial climate has the most influence on positive deviance, followed by developmental and administrative climates, with academic climate having the least influence.Practical implicationsThe current study’s target population is the academicians working as faculty members in the field of technical education, having multiple implications for the management of institutions. The findings of the study emphasize the significance of their workplace policies and ethics. Given the indication that financial climate appeared to be the most influential of the dimensions under study, this would emphasize the need to develop an environment where there is no irrelevant discrimination in pay based solely on gender, caste or creed.Originality/valueTo the best of the authors’ knowledge, this study is the first attempt to understand and describe its four key elements together as contributory factors to constructive deviance in an organization.