BMJ  2004;329:1177-1179 (13 November), doi:10.1136/bmj.329.7475.1177

Education and debate

The power of positive deviance

¹ Save the Children Federation (USA), Westport, Connecticut, USA, ² Rollins School of Public Health, Emory University, Atlanta, Georgia, USA, ³ Brigham Young University, Provo, Utah, USA, ⁴ Positive Deviance Initiative, Tufts University, Medford, Massachusetts, USA, ⁵ Cambridge, Massachusetts, USA

Identifying individuals with better outcome than their peers (positive deviance) and enabling communities to adopt the behaviours that explain the improved outcome are powerful methods of producing change

The first 150 words of the full text of this article appear below.

Introduction

The most efficient way to improve health is to use locally available, sustainable, and effective approaches. In the 1970s policy developers tested the concept that public health interventions could be designed around uncommon, beneficial health behaviours that some community members already practised.^{1 2} This concept—known as positive deviance^{3 4}—was used successfully to improve the nutritional status of children in several settings in the1990s.^5-10 Recently, the approach has also been applied to newborn care, child nutrition, rates of contraception, safe sexual practices, and educational outcomes.^11-13 In this article we describe how the approach works, the evidence that it is effective, and possible future applications.

How does positive deviance work?

Positive deviant behaviour (box) is an uncommon practice that confers advantage to the people who practise it compared with the rest of the community. Such behaviours are likely to be affordable, acceptable, and sustainable because they are already practised by at risk people, they do not conflict with . . . [Full text of this article]

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Experience and evidence from the field

Advantages and disadvantages

Future challenges?

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