The Value of Positive Deviance/Hearth Approaches to Public Health Practicies

Positive Deviance (PD) was created with the idea that solutions to a health problem can be found in the community and can be discovered.  PD can be “strength-based” or “asset-based” dependent on the cultural beliefs of a community.  A "positive deviant" is someone whose behavior varies from the norm in a positive direction (ie a poor mother who has a well-nourished child.) How did this mother learn how to overcome a health problem compared to her neighbors, even though they have the same risk factors.  These community members are identified through a Positive Deviant Inquiry (PDI).

Primary objectives of a PD Approach to decrease malnutrition:

To quickly identify and rehabilitate malnourished children in a community. 
To find a sustainable way to allow family to prevent a relapse in malnutrition in their children.
To prevent future malnutrition among children born into the community through behavior change.

The PD/Hearth Approach adds an additional element to this public health intervention program.  Community volunteers and givers utilize the information from the PDI to create programs/training sessions to teach community members the key PD behaviors found to be successful.

This is often a 12-day period that involves teaching healthy habits such as new cooking, feeding habits, and hygiene. The practices all derive from the PDI; however, they are often augmented by public health experts’ opinions and research done in that country or region.  Upon completion of the 12-day sessions monitoring is continued through home visits to ensure the behavior change is occurring.

This intervention ideal vastly varies from traditional intervention programs.

Questions that would be observed in Traditional Intervention:

1) What are your needs?

2) What is wrong?

3) What can we provide?

4) What is the community lacking?

5) What is missing?

Questions that would be observed in PD/Hearth Approach:

1) What are your strengths?

2) What is working?

3) What are your resources?

4) What is good in your community?

5) What can we build on?

This variance in questions leads to several advantages to a PD/Hearth Approach. It allows for a quick response because of the utilization of resources already available.

Furthermore, the project is more affordable and sustainable because families are not relying on outside sources to implement the change. Since the program is asking for community leadership there is higher participation and culturally accepted because they are taking ownership of the project.  

Steps to Implementing PD/Hearth:

1)   Decide whether PD/Hearth approach will be possible

2)   Begin mobilizing community and select a community resource person.

3)   Prepare PDI

4)   Conduct PDI

5)   Design Hearth Sessions

6)   Conduct Hearth

7)   Have follow-up home visits

8)   Repeat Hearth if needed

9)   Expand PD/Hearth to other areas

References: Positive Deviance/Hearth: A resource guide to sustainably rehabilitating malnourished children. February 2003.