 The Drum Beat – 672 – Positive Deviance: Linking Research and Behaviour Change |
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| The Positive Deviance (PD) approach to social, organisational, and individual behaviour change is premised on the belief that, in every community, there are certain individuals or groups whose uncommon behaviours and strategies enable them to find better solutions to problems, while having access to the same resources as those around them. (Editor’s note: Periodically, The Drum Beat focuses on specific organisations, communication tools, or strategies, but this does not imply endorsement by The CI or our Partners.)
Applied to date in over 40 countries around the world, the PD approach can be understood by viewing these introductory videos:
The first section explores PD’s conceptual basis. Then we examine PD in practice in contexts such as childhood malnutrition, neonatal mortality, gender-based violence, school drop-out, and community health. A search of our website currently includes over 50 items exploring the PD approach, so please explore and share your own experiences by contactingkdevries@comminit.com
In addition, here is a bibliography in PDF format of over 100 peer-reviewed publications on the PD approach. |
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| PD’S ROOTS: ADDRESSING MALNUTRITION AND CHILDREN’S HEALTH ISSUES |
1. The Value of Positive Deviations
by Arvind Singhal |
| A part of a project that began in the 1990s in Vietnam where childhood malnutrition was high, Save the Children representatives Jerry and Monique Sternin asked: Are there any well-nourished children who come from extremely economically poor families? Singhal explains that, rather than pursuing the normal curve in social science, which valorises «mediocrity» and dissuades valuation of «outliers», PD flips conventional problem solving thinking on its head, as in Vietnam, where the Sternins designed a 2-week nutrition programme around the behaviours of PD families. Non-PD mothers of malnourished children joined PD families in practicing the behaviours that the PD families had discovered. From the original 4 communities, the project was first expanded to another 10 communities (where research showed that malnutrition decreased by 85%). «Through this lateral expansion, the PD intervention became a nationwide program in Vietnam, helping over 2.2 million people improve their nutritional status, including over 500,000 children.» [June 2013] |
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2. Drivers of Routine Immunization Coverage Improvement in Africa: Findings from District-Level Case Studies
by Anne LaFond, Natasha Kanagat, Robert Steinglass, Jenny Sequeira, and Sangeeta Mookherji |
| To understand what drives improvements in routine immunisation (RI) coverage throughout Africa, the John Snow Inc. (JSI)-managed ARISE (Africa Routine Immunization System Essentials) project applied a PD lens – as opposed to the more familiar gap/barrier/bottleneck analysis – to investigate the experience of 12 districts located in 3 countries: Ethiopia, Cameroon, and Ghana. Six drivers of RI performance improvement emerged. For instance, community-centred health workers «raised awareness of the benefits of immunization and encouraged timely attendance at facilities and outreach sites. The transformational step between intervention and outcome entailed the building of a sense of trust between the health worker and the community…» [Mar 2014] |
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3. Will Rahima’s Firstborn Survive Overwhelming Odds? Positive Deviance for Maternal and Newborn Care in Pakistan
by Muhammad Shafique, Monique Sternin, and Arvind Singhal |
| This case study explores the use of the PD approach to strive for better maternal and newborn health outcomes in 8 villages of Haripur District in Pakistan’s North West Frontier Province (NWFP) from January 2001 to October 2004. In Phase one, activities were initiated to foster community dialogue (separately between male and female groups) about morbidity and mortality of newborns in order to identify PD newborns and their families, discover what were their demonstrably successful strategies, and develop a plan of action. Phase two was dedicated to community action via community-designed neighbourhood activities undertaken by both male and female groups. In conclusion, the authors note that the introduction of the PD approach, which began by building trust with the community’s male elders, led to more open household, neighbourhood, and community discussions on «taboo» topics between men and women – i.e., maternal and newborn health and significantly better odds of survival for newborns. [Jan 2010] |
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| 4. CORE Group, PD/Hearth Technical Advisory Group (TAG) Meeting Report |
| This report examines several experiences with a home/neighbourhood-based nutrition programme for children called PD/Hearth that is being implemented in different contexts around the world. Trained volunteers assist participating parents or caretakers in preparing food for their malnourished children – generally, over a 2-week period – with locally available food, using local knowledge from a PD Inquiry (PDI). A TAG meeting, examining how PD/Hearth works in various countries, collected case studies, specific strategies, and results. Amongst the recommendations for conducting effective PDIs: maintain an inventory of PD/Hearth programmes, develop a set of key indicators for programme quality and related to scale-up methodology, and document and analyse learnings. [Feb 2009] |
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| 5. Basic Field Guide to the Positive Deviance Approach |
| This field guide from the Positive Deviance Initiative is designed to orient newcomers to the PD approach. It includes practical advice, such as: «For the most thoughtful and revealing responses, use open ended questions that ask what, how, why, why now?» [Sept 2010].
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| PD AND GENDER IN SOUTH ASIA |
6. Positive Deviance in Gender: A Grassroots Approach
by Sangeeta Shrestha |
| This paper outlines a method for creating and introducing community messages on gender roles and the potential for expanding the roles of women and girls in Nepali communities: first, 3-4 ethnic groups are selected from which to choose PD families – those with «good performance by male and female members relating to decision making, health and educational opportunities for girls and women and the sharing of household chores and child care between them»; then, a situation analysis of gender roles of women is done in focus groups; a positive deviant observational study is made of selected families; gender equity action planning (GEAP) messages are created based on findings and integrated with existing programmes; and, finally, GEAP discussions and a follow-up impact study of the local women’s situation are carried out. [Jan 2007] |
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| 7. Main Kuch Bhi Kar Sakti Hoon – I, a Woman, Can Achieve Anything |
| Instead of carrying out the traditional «knowledge, attitudes, and practices (KAP) gap» audience needs assessment, organisers of this entertainment-education (EE) initiative purposely used PD as formative research focused on identifying what was working and then bringing these insights to the design of a long-running television soap opera so that these PD behaviours could be modelled for a mass audience. The television serial features protagonist Sneha Mathur from Mumbai, India, a spirited, independent young woman, modern in her thoughts but deeply rooted in her culture. The goal is to increase women’s agency, enhance knowledge, and change perceptions and attitudes on social determinants of health to eventually contribute to improving demand, access, and quality of reproductive health services in India. |
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8. Gender-Based Violence: A Qualitative Exploration of Norms, Experiences and Positive Deviance
by Shireen J. Jejeebhoy, K.G. Santhya, and Shagun Sabarwal |
| This report presents the findings of formative research in the district of Patna, Bihar State, India, that aimed to better explain the context of violence – physical, emotional, and sexual – against women and girls, with a focus on understanding the prevailing norms about men’s entitlement and women’s acquiescence to violence. One finding: «[M]any women and some positive deviant men recognise the injustice and unacceptability of violence against women even in this traditional patriarchal setting, and their perceptions reiterate that programmes intended to change norms and practices relating to violence against women and girls may indeed be effective.» [2013] |
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9. Asia Child Marriage Initiative: Summary of Research in Bangladesh, India and Nepal
by Ravi Verma, Tara Sinha, and Tina Khanna |
| Noting that, in South Asia, 46% of children are married or are in an informal union before they are 18, the Plan Asia Regional Office asked the International Center for Research on Women (ICRW) to carry out a qualitative study designed to help understand the scope of this human rights violation in India, Nepal, and Bangladesh. The study identified cases of young girls and parents who could be seen as cases of PD and role models in their communities. «Parents who delayed their daughter’s marriage in the face of social pressures did so because they did not want a marriage before the girl had completed at least high school or university…. Young girls identified as role models often had to resist parental pressure for an early marriage. These girls held the conviction that they did not want an early marriage and their response to pressure from their parents ranged from confrontation to negotiation. In all these cases, the girls were finally able to bring their parents around to share their point of view.» [Jan 2013] |
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10. Ending Child Marriage in a Generation: What Research Is Needed?
by Margaret E. Greene, PhD |
| Within the «promoting norm change» component of this coordinated research framework: «In the context of child marriage, this might mean families who take steps to keep their daughters in school or who resist the pressures to marry their daughters as early as others.» Priority research questions include: «What values and beliefs held by community members and leaders allow them to champion girls’ rights, education and delayed marriage? At the girl, family, community and gatekeeper level, what do we know about those who resist early marriage compared to those who do not? How might lessons learned contribute to peer-to-peer dissemination of such messaging with the faith-based community, for example? How could the positive deviance approach be applied to other ‘gatekeepers’ including fathers and adult women who were once child brides themselves?» [Jan 2014] |
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| PD: FOCUS ON THE EDUCATIONAL CONTEXT |
11. What Explains Enhanced Psychological Resilience of Students at VMBO Schools in the Netherlands?
by Martine Bouman, Sarah Lubjuhn, and Arvind Singhal |
| This PD project in the Netherlands sought to identify PD practices that enhanced psychological resilience among students of Rotterdam’s lower vocational training (VMBO) schools who hailed from lower socio-economic backgrounds and minority immigrant groups. The question was: What helped them deal better with the stresses and anxieties that are a normal part of life? Some of the PD practices that the Center for Media & Health and partners found: (i) Students (and visitors) are «checked-in» and greeted by name at the school’s entrance door, creating a sense of the school as a safe place; (ii) By intervening with the students at the first signs of a problem and by being always accessible to them, a sense of mutual trust and respect are built; and (iii) Sending birthday cards and by phoning parents when a student excels in academic or extra-curricular activities creates an atmosphere of «we are there for each other».
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12. Uncovering Innovations that Are Invisible in Plain Sight
by Arvind Singhal |
| Singhal here makes the case that educators in the United States (US) and elsewhere need to pay attention to PD in order to discover invisible, in-house, innovative practices. For instance, a PD study of US schools highlighted a 3rd-grade teacher in Velasco Elementary School in Brazosport, Texas, who «was an implausible outlier among her peers. Although 94% of her students lived in poverty, all of her students scored highly on the statewide assessments.» A PD inquiry revealed that she undertook a close examination of all her students’ tests in order to identify problem areas, retooled her classes to plug these gaps, and retested students until they achieved the desired level. Over the next 7 years, her process was shared widely and further refined, honed, and standardised for implementation. [Nov 2013] |
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| 13. Media Resources on Positive Deviance |
| Students taking part in The Media Changemakers programme at the University of Texas at El Paso (UTEP) in the US produce short films on the PD approach in an effort to spur public debate on social equity issues and strengthen community ties, both on and off campus. See this related summary – Nine Web-Accessible Links to Films on the Positive Deviance Approach – where Media Changemakers resources are freely available, such as «PD and reintegration of returned abductees in Uganda: The Music Catches Me and We Rise Again». |
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| PD TO ADDRESS COMMUNITY AND PUBLIC HEALTH |
14. Positive Deviance: An Asset-based Approach to Improve Malaria Outcomes
by Muhammad Shafique and Sue George |
| This learning paper describes and evaluates a pilot project in northwest Cambodia that used PD as a method of behaviour change communication (BCC) for malaria control. In March 2012, surveys were carried out. Qualitatively: «For instance, a network of volunteers was successfully built with individuals from all parts of the community continuing to demonstrate the positive deviance behaviours. The sustainability of the programme now seems sure, due to the levels of community ownership. Positive deviance informal sessions were still taking place a year after the project had formally ended.» The quantitative survey showed an increase in knowledge of malaria prevention methods and an increase in knowledge of transmission modes – especially knowledge of vulnerable groups, i.e., forest-goers. Furthermore, the project was found to have improved health-seeking behaviour such as consulting village malaria workers (VMWs) or visiting the health centre for malaria diagnosis and treatment. [April 2014]
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| 15. Positive-Deviant Health Data Journalism |
| The Solutions Journalism Network (SJN) is partnering with US newsrooms to identify stories that reveal how communities are improving health outcomes. In addition to a pilot training that involves an orientation for health reporters and editors (and other interested staff) to help frame an editorial strategy that incorporates positive health data from the Institute for Health Metrics & Evaluation (IHME) and other sources, SNJ hopes to build a teaching model for PD journalism and to set up a story fund to «catalyze high-quality reporting based on positive-deviant data» through grants to participating newsrooms. |
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16. Evidence-based Public Health: Not Only Whether It Works, but How It Can Be Made to Work Practicably at Scale
by James D. Shelton |
| The core argument of this editorial is that evidence-based public health (EBPH) must go beyond reliance on randomised controlled trial (RCTs) to include other methodologies to arrive at optimal public health programming. The theory of change detailed here is based on the idea that validity often derives from whether things are successful in a particular environment. «Broader applicability emerges when consistent patterns of findings or collective ‘lessons learned’ materialize.» PD is cited as an approach that involves identifying a repeated pattern of success seen across many different situations, providing confidence in the general approach. For instance, the non-governmental organisation Marie Stopes provided more than 700,000 contraceptive implants in 2012 across a variety of countries in sub-Saharan Africa. In a research paper that Dr. Shelton cites, Marie Stopes describes its 3 service delivery modalities, along with operational details including provider training, client outreach, robust supply chains, and quality assurance measures. «A major agenda for EBPH is identifying such common patterns and helping program managers adapt and apply that knowledge.»
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| MANY THANKS TO OUR RENEWING CI ASSOCIATES
Did you find value in what you read above? Perhaps inspiration to introduce PD into your work will motivate you to become part of a group of organisations and individuals who recognise the added value of The CI (with contributions of various amounts, but not at the level of partnership). All of our current supporters are highlighted in a recent Drum Beat.
We thank our renewing CI Associates, which include, among others:
To join, click here or contact vmartin@comminit.com for assistance. |
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| This issue of The Drum Beat was written by Kier Olsen DeVries. |
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| The Drum Beat is the email and web network of The Communication Initiative Partnership – Partners: ANDI, BBC Media Action, Bernard van Leer Foundation, Breakthrough, Calandria, Citurna TV, DFID, FAO, Fundación Imaginario, Fundación Nuevo Periodismo Iberoamericano (FNPI), Inter-American Development Bank, Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, MISA, Oxfam Novib, PAHO, The Panos Institute, Puntos de Encuentro, The Rockefeller Foundation, SAfAIDS, Sesame Workshop, Soul City, STEPS International, UNAIDS, UNDP, UNICEF, USAID, The Wellcome Trust, World Health Organization (WHO), W.K. Kellogg Foundation.
The Drum Beat seeks to cover the full range of communication for development activities. Inclusion of an item does not imply endorsement or support by The Partners.
Chair of the Partners Group: Garth Japhet, Founder, Soul City garth@heartlines.org.za
Executive Director: Warren Feek wfeek@comminit.com |
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| The Editor of The Drum Beat is Kier Olsen DeVries. |
| Please send additional project, evaluation, strategic thinking, and materials information on communication for development at any time. Send to drumbeat@comminit.com
The Drum Beat seeks to cover the full range of communication for development activities. Inclusion of an item does not imply endorsement or support by The Partners.
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