The power of positive deviance.
Ontology highlight
ABSTRACT:
SUBMITTER: Marsh DR
PROVIDER: S-EPMC527707 | biostudies-literature | 2004 Nov
REPOSITORIES: biostudies-literature
Publications
The power of positive deviance.
Marsh David R DR Schroeder Dirk G DG Dearden Kirk A KA Sternin Jerry J Sternin Monique M
BMJ (Clinical research ed.) 20041101 7475
Similar Datasets
Project description:ObjectivesImproving chronic obstructive pulmonary disease (COPD) care and reducing hospital readmissions is an urgent healthcare system priority. However, little is known about the organizational factors that underlie intersite variation in readmission rates. Evidence from other chronic diseases points to care coordination as one such factor.Study designTo understand whether intersite differences in care coordination may be one of the organizational factors contributing to the variation in readmission rates, we examined provider perspectives on COPD care at Veterans Affairs (VA) sites.MethodsIn this mixed-methods positive deviance study, we selected 3 VA sites in the lowest quartile and 3 in the highest quartile for 2016 risk-adjusted COPD readmission rates. During June to October 2017, we conducted semistructured interviews with primary and specialty care providers involved in COPD care at VA sites with low (n = 14) and high (n = 11) readmission rates.ResultsAlthough providers at all sites referenced ongoing readmission reduction initiatives, only providers at low-readmission sites described practice environments characterized by high relational coordination (ie, high-quality work relationships and high-quality communication). They also reported fewer significant structural barriers to collaboration in areas like patient volume.ConclusionsThe most notable differences between high- and low-readmission sites were related to the quality of relational coordination and the presence of structural barriers to coordination, rather than specific readmission reduction initiatives. Implementing organizational reforms aimed at enhancing relational coordination and removing structural barriers would enhance care for COPD and may improve quality of care for other chronic conditions.
| S-EPMC7853407 | biostudies-literature
Project description:ObjectivePositive deviance methodology has been applied in the developing world to address childhood malnutrition and has potential for application to childhood obesity in the United States. We hypothesized that among children at high-risk for obesity, evaluating normal weight children will enable identification of positive outlier behaviors and practices.MethodsIn a community at high-risk for obesity, a cross-sectional mixed-methods analysis was done of normal weight, overweight, and obese children, classified by BMI percentile. Parents were interviewed using a semistructured format in regard to their children's general health, feeding and activity practices, and perceptions of weight.ResultsInterviews were conducted in 40 homes in the lower Rio Grande Valley in Texas with a largely Hispanic (87.5%) population. Demographics, including income, education, and food assistance use, did not vary between groups. Nearly all (93.8%) parents of normal weight children perceived their child to be lower than the median weight. Group differences were observed for reported juice and yogurt consumption. Differences in both emotional feeding behaviors and parents' internalization of reasons for healthy habits were identified as different between groups.ConclusionsWe found subtle variations in reported feeding and activity practices by weight status among healthy children in a population at high risk for obesity. The behaviors and attitudes described were consistent with previous literature; however, the local strategies associated with a healthy weight are novel, potentially providing a basis for a specific intervention in this population.
| S-EPMC4484711 | biostudies-literature
Project description:Study objectivePregnant 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.DesignThis is a retrospective cohort study design.SettingWe performed a secondary data analysis of vital records data from the State of Louisiana between January 1, 1995 and December 31, 2007.ParticipantsData included birth certificates from 35,013 Louisiana mothers age ≤19.Main outcome measureA 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.ResultsTwenty-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.ConclusionCharacterizing 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.
| S-EPMC3444618 | biostudies-literature
Project description:BackgroundAccelerated translation of real-world interventions for hypertension management is critical to improving cardiovascular outcomes and reducing disparities.ObjectiveTo determine whether a positive deviance approach would improve blood pressure (BP) control across diverse health systems.DesignQuality improvement study using 1-year cross sections of electronic health record data over 5 years (2013-2017).ParticipantsAdults ≥ 18 with hypertension with two visits in 2 years with at least one primary care visit in the last year (N = 114,950 at baseline) to a primary care practice in Better Health Partnership, a regional health improvement collaborative.InterventionsIdentification of a "positive deviant" and dissemination of this system's best practices for control of hypertension (i.e., accurate/repeat BP measurement; timely follow-up; outreach; standard treatment algorithm; and communication curriculum) using 3 different intensities (low: Learning Collaborative events describing the best practices; moderate: Learning Collaborative events plus consultation when requested; and high: Learning Collaborative events plus practice coaching).Main measuresWe used a weighted linear model to estimate the pre- to post-intervention average change in BP control (< 140/90 mmHg) for 35 continuously participating clinics.Key resultsBP control post-intervention improved by 7.6% [95% confidence interval (CI) 6.0-9.1], from 67% in 2013 to 74% in 2017. Subgroups with the greatest absolute improvement in BP control included Medicaid (12.0%, CI 10.5-13.5), Hispanic (10.5%, 95% CI 8.4-12.5), and African American (9.0%, 95% CI 7.7-10.4). Implementation intensity was associated with improvement in BP control (high: 14.9%, 95% CI 0.2-19.5; moderate: 5.2%, 95% CI 0.8-9.5; low: 0.2%, 95% CI-3.9 to 4.3).ConclusionsEmploying a positive deviance approach can accelerate translation of real-world best practices into care across diverse health systems in the context of a regional health improvement collaborative (RHIC). Using this approach within RHICs nationwide could translate to meaningful improvements in cardiovascular morbidity and mortality.
| S-EPMC8175516 | biostudies-literature
Project description:Risk factor approaches are often used when implementing programs aimed at enforcing advantageous health care behaviors. A less frequently-used strategy is to identify and capitalize on those who, despite risk factors, exhibit positive behaviors. The aim of our study was to identify positive deviant (PD) mothers for the uptake of skilled maternal services and to explore their characteristics. Data for the study came from two waves of the Ethiopian Demographic and Health Surveys conducted in 2011 and in 2016. PD mothers were defined as those reporting no formal education but with adequate use of antenatal care (ANC) and/or institutional delivery services. Two-level multilevel regression analysis was used to analyze the data. Factors associated with PD for the use of ANC services were: partner's education status, involvement in household decision making, exposure to media, and distance to the health facility. Factors associated with PD for health facility delivery were: partner's education, woman's employment status, ANC visit during index pregnancy, exposure to media, and perceived challenge to reach health facility. Rural-urban and time-related differences were also identified. The positive deviance approach provides a means for local policy makers and program managers to identify factors facilitating improved health behaviour and ultimately better health outcomes while acknowledging adverse risk profiles.
| S-EPMC7084325 | biostudies-literature
Project description:BackgroundDespite the associations of certain beliefs and worldviews (e.g., religiosity and belief in conspiracy theories) with non-vaccination behavior, some individuals who hold these views still choose vaccination, and vice versa. This study aims to explore why individuals choose to be vaccinated against COVID-19, despite holding opposing beliefs and worldviews, or refrain from doing so, when their beliefs align with vaccination. By examining both positive and negative deviant behavior, we seek to identify strategies and barriers for public health officials to develop interventions to improve vaccination uptake.MethodsWe conducted semi-structured online interviews with 21 Dutch adults aged 28-75 years (13 positive deviants and 8 negative deviants) between January and July 2022. Interviewees were recruited on the basis of their response patterns in a survey that was part of a larger project on understanding vaccine hesitancy in the Netherlands. The interviews focused on how they formed their intention toward the COVID-19 vaccine and what could change it in the future. The data were analyzed via semi-inductive coding with Atlas.ti.23.ResultsPositive deviants got vaccinated because they perceived COVID-19 as a threat, wanted to protect (vulnerable) others, or wanted to regain their freedom. Negative deviants did not get vaccinated because they did not perceive the vaccine as appropriate, the disease not as a threat, for religious reasons, or did not trust the authorities. The most important barriers and strategies that were identified that could improve vaccination uptake were unrelated to underlying beliefs and worldviews but related to characteristics of the vaccine such as effectiveness and (potential) side-effects.ConclusionThis study demonstrates the applicability of traditional health psychology models, such as the health belief model, in explaining deviant vaccination behavior. Additionally, leveraging prosocial motivations and imposing restrictions on non-vaccinated individuals have been effective strategies for promoting vaccination uptake, albeit restricted to pandemic contexts. As some individuals will remain resistant to vaccination efforts, tailored interventions for vaccine-hesitant individuals may yield greater success rather than attempting to persuade strict opponents of vaccination.
| S-EPMC11792343 | biostudies-literature
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.
| S-EPMC6388925 | biostudies-literature
Project description:ObjectiveTo provide practical tips for health services researchers considering the use of positive deviance (PD) methods to help explain variations in quality of care or other meaningful parameters.Data sourcesPublished literature and personal experience.Study designNarrative review.Principal findingsThis review includes a discussion of possible applications of PD to health services research, some methodological choices applicable to PD, and some brief tips regarding publishing the results and incorporating them into future interventions.ConclusionsIt is hoped that this article will help health services researchers to use this valuable research method more effectively, especially those who have not done so before.
| S-EPMC5441507 | biostudies-literature
Project description:Dual-method use is the most reliable form of protection against unintended pregnancies and human immunodeficiency virus/sexually transmitted infections (HIV/STIs). Although dual-method use remains uncommon among women in stable relationships, some women do practice it. In this study, we explored the barriers that make dual-method use rare and the behaviors of women who practice dual-method use using a positive deviance framework in Uganda. We screened 150 women using highly effective contraceptives at five health facilities. We identified nine women who practiced dual-method use and 141 women who did not. In a qualitative study, we conducted in-depth interviews with all nine women practicing dual-method use and 10 women randomly selected out of the 141 who did not. We performed a thematic analysis using the positive deviance framework. Regardless of practicing dual-method use or not, women faced perceived barriers against dual-method use, such as partner's objection, distrust, shyness about introducing condoms into marital relationships, and limited access to condoms. However, women practicing dual-method use had higher levels of risk perception about unintended pregnancies and HIV/STIs. They also engaged in unique behaviors, such as influencing their partners' condom use by initiating discussions, educating their partners on sexual risks and condom use, and obtaining condoms by themselves. These findings will be useful in developing effective community-led and peer-based interventions promoting dual-method use to reduce the dual burden of unintended pregnancies and HIV/STIs among women in Uganda.
| S-EPMC7400262 | biostudies-literature
Project description:Numerous NGOs and donors from high-income countries (HICs) offer diverse funding to assist LMICs. A collaborative effort in nutrition programs in urban communities was conducted by an international NGO with a local university, representing the NGO's first mode of partnership with academia. This study used realist evaluation to understand how and why Positive Deviance/Hearth intervention conducted by NGOs collaborated with university work or failed to work in urban population. We uncovered the underlying mechanisms that lead to certain outcomes in different situations of academia-NGO partnership. The initial program theory was formulated after discussions with main program officers from both NGO and academia. We conducted stakeholder interviews and FGD, along with validation and reviewing secondary data. The initial program theory underwent testing and refinement through a series of Focus Group Discussions (FGDs) involving program officers and local government health offices. We adhered to the RAMESES II reporting standards for realist evaluations when presenting the findings. Five Context Mechanism-Outcome (CMO) configurations are identified from three program theories. Our findings illustrate the importance of considering the local context of the population when implementing standardized international NGO interventions. All the CMOs indicate that at the very least, collaborative programs between academia and NGOs should involve more stakeholder involvement and build clearer expectations between stakeholders.
| S-EPMC11681693 | biostudies-literature