Dataset Information

Predictors of healthy birth outcome in adolescents: a positive deviance approach.

ABSTRACT:

Study objective

Pregnant adolescents experience elevated rates of adverse birth outcomes compared to older mothers. Positive deviance inquiry is the identification of uncommon behaviors and traits that result in better health outcomes for individuals in a population that shares similar risks. The purpose of our study was to utilize a positive deviance framework to identify sociodemographic and behavioral characteristics associated with a healthy birth outcome among adolescents.

Design

This is a retrospective cohort study design.

Setting

We performed a secondary data analysis of vital records data from the State of Louisiana between January 1, 1995 and December 31, 2007.

Participants

Data included birth certificates from 35,013 Louisiana mothers age ?19.

Main outcome measure

A healthy birth was defined as having an infant of weight between 2500 g and 4000 g, delivered vaginally without induction or instrumented delivery and in the absence of pregnancy, obstetric, or neonatal complications and anomalies.

Results

Twenty-one percent of the study population was classified as positive deviants with healthy births. Multivariate log-linear regression was used to model predictors of healthy birth. Adolescents who were older, non-black, multiparous, non-smoking, married, gained a medium amount of weight, had a longer inter-pregnancy interval or received adequate prenatal care were most likely to experience a healthy pregnancy and birth. Ethnicity, alcohol use, father's information on the birth certificate and paternal characteristics did not significantly predict a positive birth outcome.

Conclusion

Characterizing positive deviant adolescents may help identify special populations for targeted intervention and important modifiable behaviors for the promotion of better birth outcomes in all young mothers.

SUBMITTER: Wallace ME

PROVIDER: S-EPMC3444618 | biostudies-literature | 2012 Oct

REPOSITORIES: biostudies-literature

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Publications

Predictors of healthy birth outcome in adolescents: a positive deviance approach.

Wallace Maeve E ME Harville Emily W EW

Journal of pediatric and adolescent gynecology 20120724 5

<h4>Study objective</h4>Pregnant adolescents experience elevated rates of adverse birth outcomes compared to older mothers. Positive deviance inquiry is the identification of uncommon behaviors and traits that result in better health outcomes for individuals in a population that shares similar risks. The purpose of our study was to utilize a positive deviance framework to identify sociodemographic and behavioral characteristics associated with a healthy birth outcome among adolescents.<h4>Design ...[more]

PMID: 22831902

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Project description:Agricultural development must integrate multiple objectives at the same time, including food security, income, and environmental sustainability. To help achieve these objectives, development practitioners need to prioritize concrete livelihood practices to promote to rural households. But trade-offs between objectives can lead to dilemmas in selecting practices. In addition, heterogeneity among farming households requires targeting different strategies to different types of households. Existing diversity of household resources and activities, however, may also bear solutions. We explored a new, empirical research method that identifies promising options for multi-objective development by focusing on existing cases of strong multi-dimensional household performance. The "Positive Deviance" approach signifies identifying locally viable livelihood practices from diverse households that achieve stronger performance than comparable households in the same area. These practices are promising for other local households in comparable resource contexts. The approach has been used in other domains, such as child nutrition, but has not yet been fully implemented for agricultural development with a focus on the simultaneous achievement of multiple objectives. To test our adapted version of the Positive Deviance approach, we used a quantitative survey of over 500 rural households in South-Eastern Tanzania. We identified 54 households with outstanding relative performance regarding five key development dimensions (food security, income, nutrition, environmental sustainability, and social equity). We found that, compared to other households with similar resource levels, these "positive deviants" performed strongest for food security, but only slightly better for social equity. We then re-visited a diverse sub-sample for qualitative interviews, and identified 14 uncommon, "deviant" practices that plausibly contributed to the households' superior outcomes. We illustrate how these practices can inform specific recommendations of practices for other local households in comparable resource contexts. The study demonstrates how, with the Positive Deviance approach, empirical observations of individual, outstanding households can inform discussions about locally viable agricultural development solutions in diverse household context.

Project description:BackgroundQuality has been a persistent challenge in the healthcare system, particularly in resource-limited settings. As a result, the utilization of innovative approaches is required to help countries in their efforts to enhance the quality of healthcare. The positive deviance (PD) approach is an innovative approach that can be utilized to improve healthcare quality. The approach assumes that solutions to problems are already available within the community and identifying and sharing those solutions can help others to resolve existing issues. Therefore, this scoping review aimed to synthesize the evidence regarding the use of the PD approach in healthcare system service delivery and quality improvement programs.MethodsArticles were retrieved from six international databases. The last date for article search was June 02, 2023, and no date restriction was applied. All articles were assessed for inclusion through a title and/or abstract read. Then, articles that passed the title and abstract review were screened by reading their full texts. In case of duplication, only the full-text published articles were retained. A descriptive mapping and evidence synthesis was done to present data with the guide of the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews checklist and the results are presented in text, table, and figure formats.ResultsA total of 125 articles were included in this scoping review. More than half, 66 (52.8%), of the articles were from the United States, 11(8.8%) from multinational studies, 10 (8%) from Canada, 8 (6.4%) from the United Kingdom and the remaining, 30 (24%) are from other nations around the world. The scoping review indicates that several types of study designs can be applied in utilizing the PD approach for healthcare service and quality improvement programs. However, although validated performance measures are utilized to identify positive deviants (PDs) in many of the articles, some of the selection criteria utilized by authors lack clarity and are subject to potential bias. In addition, several limitations have been mentioned in the articles including issues in operationalizing PD, focus on leaders and senior managers and limited staff involvement, bias, lack of comparison, limited setting, and issues in generalizability/transferability of results from prospects perspective. Nevertheless, the limitations identified are potentially manageable and can be contextually resolved depending on the nature of the study. Furthermore, PD has been successfully employed in healthcare service and quality improvement programs including in increasing surgical care quality, hand hygiene practice, and reducing healthcare-associated infections.ConclusionThe scoping review findings have indicated that healthcare systems have been able to enhance quality, reduce errors, and improve patient outcomes by identifying lessons from those who exhibit exceptional practices and implementing successful strategies in their practice. All the outcomes of PD-based research, however, are dependent on the first step of identifying true PDs. Hence, it is critical that PDs are identified using objective and validated measures of performance as failure to identify true PDs can subsequently lead to failure in identifying best practices for learning and dissemination to other contextually similar settings.

Dataset Information

Predictors of healthy birth outcome in adolescents: a positive deviance approach.

Study objective

Design

Setting

Participants

Main outcome measure

Results

Conclusion

Publications

Predictors of healthy birth outcome in adolescents: a positive deviance approach.

Similar Datasets

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