A positive deviance approach for behavior change

Abstract

Background: Behavior change is one of the most important tasks of health education and health promotion. However, even by using established strategies in this field, it is not always easy to change behaviors. This article introduces the positive deviance approach as one of the more effective ways to bring about behavior change.
Contents: A positive deviant is one who can outperform or solve a problem better than others facing the same problem and equipped with the same resources. In 1990, when Save the Children-USA conducted a nutrition survey in four rural villages in Vietnam, they found that 64% of children under 3 years were suffering from malnutrition. Rather than focusing on this high prevalence, they honed in on the remaining 36% who were well nourished and identified positive deviants among them. The characteristic behaviors of the positive deviants' caregivers were as follows: feeding their children with freely available small shrimp and other food from the rice field, washing their children's hands whenever they touched dirty materials, and increasing the feeding frequency from 2 to 4-5 times daily. Based on these findings, the organization took a positive deviance approach and actively disseminated these practices in other villages, as a result of which 50,000 children experienced improved malnutrition status over seven years. Since then, this approach has been effectively applied to realize improvements in in-hospital infection, infant and child mortality, obesity, nutrition of pregnant mothers, and a host of other public health challenges.
Conclusion: The positive deviance approach is an effective way to overcome major public health challenges that require behavior change. Though not yet popular in Japan, this approach may be useful to tackle national issues such as aging, post-disaster response needs, and school-based bullying.