Positive deviance

Positive deviance is the observation that in most settings a few at risk individuals follow uncommon, beneficial practices and consequently experience better outcomes than their neighbours who share similar risks.14

 

Positive deviant behaviour 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 local culture, and they work.15 For example, in Egypt, contrary to custom, parents of poor but well nourished children were found to feed their children a diet that included eggs, beans, and green vegetables. Child nutrition programmes that provided opportunities to parents of malnourished children to follow this and other new behaviours, such as hand washing and hygienic food preparation, improved child growth.

Summary points

Even in the poorest communities, a few individuals or families achieve good health

Positive deviance is a quick, low cost method to identify the strategies used by these people and encourage the rest of the community to adopt them

The approach has been used successfully, mainly to improve child health

The potential for the approach to help communities to gain better health or other social benefits is vast and largely untapped

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7475.1177 (Published 11 November 2004) Cite this as: BMJ 2004;329:1177