Evaluation of mobile phone‐based Positive Deviance/Hearth child undernutrition program in Cambodia

Young, Melissa; Baik, Diane; Reinsma, Kathryn; Gosdin, Lucas; Rogers, Hannah Paige; Oy, Sreymom; Invong, Wuddhika; Heang, Hen; Ouk, Sopheap; Chhea, Chhorvann

doi:10.1111/mcn.13224

Cited by 6 publications

(9 citation statements)

References 11 publications

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“…Furthermore, pre-post interventional designs are important to evaluate how the strategies implemented by top performers lead to improvements over time and in comparison with others who do not implement these strategies [ 148 , 149 ]. An example of this is the study conducted by Curry LA, et al (2018) in 10 hospitals in the USA to enhance improvements in different domains of organizational culture that lead to significant changes in culture between baseline and 24 months, especially with regards to the learning environment and senior management support.…”

Section: Discussionmentioning

confidence: 99%

The use of positive deviance approach to improve health service delivery and quality of care: a scoping review

Kassie,

Eakin,

Abate

et al. 2024

BMC Health Serv Res

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Background Quality 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. Methods Articles 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. Results A 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. Conclusion The 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.

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Section: Discussionmentioning

confidence: 99%

The use of positive deviance approach to improve health service delivery and quality of care: a scoping review

Kassie,

Eakin,

Abate

et al. 2024

BMC Health Serv Res

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“…Le Port et al ( 21 ) stated, “PIP analysis can help identify successes and bottlenecks or constraints to effective implementation that may affect the impact on key outcomes.” A strength of our analysis is that it builds on the quantitative results to further understand the primary outcomes ( 20 ). Our study used a PIP analysis to identify the facilitators, barriers, and contextual factors along the PIP pathway of the PDH-IVC intervention in Cambodia that could have influenced the nutrition outcomes from the impact evaluation that was conducted in the first year ( 20 ). The PIP analysis also helped to identify ways in which other similar programs could be strengthened in design and implementation to maximize the nutritional outcomes and impact.…”

Section: Discussionmentioning

confidence: 99%

“…Given that such contextual factors can restrict program utilization, it is likely that without additional complementary interventions there will be limited improvements in nutrition outcomes, even with good program design and intervention fidelity. These contextual factors may have contributed to the modest improvements in child nutritional status at the 12-mo follow-up ( 20 ). Our findings align with another study by Schneiders et al ( 24 ), which observed that, in migrant households, grandparents are the primary caregivers for children and tend to their nutritional needs.…”

Section: Discussionmentioning

confidence: 99%

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Program Impact Pathway of the Positive Deviance/Hearth Interactive Voice Calling Program in a Peri-Urban Context of Cambodia

Baik¹,

Reinsma

Chhea

et al. 2022

Current Developments in Nutrition

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Background Positive Deviance/Hearth (PDH) is an internationally recognized nutrition rehabilitation program. However, nutritional improvements are inconsistent across contexts. It is unclear if variations are from differences in program design, implementation, utilization, or other contextual factors. Furthermore, few PDH programs have addressed the high time- and work-burden of caregivers and volunteers. To address this, the study integrated interactive voice calls (IVC) with PDH. Objectives A program impact pathway (PIP) analysis was used to evaluate the secondary outcomes of facilitators, barriers, and contextual factors that influence PDH-IVC design, implementation, and utilization to improve the nutritional status of children in Cambodia. Methods The study was registered at clinicaltrials.gov[NCT03399058]. A PIP analysis was done on data collected through in-depth interviews with caregivers (n = 32), key informant interviews with volunteers (n = 16) and project staff (n = 3), and surveys of project staff (n = 5). Results In design phase, facilitators included quality training, technical support and design tools, community mobilization, and linkage to existing health services. Barriers included poor community mobilization. For the implementation phase, facilitators were good volunteer knowledge, follow-up tools and guidance, supervision, and spot checks of volunteers. Barriers were lack of time and overworked, older caregivers. For the utilization phase, facilitators included family and volunteer support and access to phones while barriers were lack of support, time, and financial resources, low levels of education and old age of caregivers, and inconsistent phone use. Contextual factors included food insecurity and increased childcare responsibilities on grandmothers due to migration of mothers. Conclusions The PIP analysis identified facilitators, barriers, and contextual factors that may affect the design, intervention, and utilization and elements to consider when designing and implementing IVC interventions for health and nutrition behavior change. When implementing child nutrition programs in Cambodia, supporting interventions addressing mental health and time and resource constraints of elderly caregivers should also be included.

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“…As a major intervention component of BRDMCN, the PD/Hearth program aimed to rehabilitate underweight children and promote appropriate nutrition and hygiene behaviors among their caregivers (World Vision, 2014). The PD/Hearth programs showed positive impacts on child nutritional status in other program settings (Kang et al, 2017; Roche et al, 2017; Young et al, 2021).…”

Section: Methodsmentioning

confidence: 99%

Impact evaluation of a community nutrition and livelihood program on child nutrition in rural Bangladesh

Kang

Prihartono

Hossain

et al. 2022

Maternal & Child Nutrition

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Given the high prevalence of child undernutrition in Bangladesh, multi-sectoral approaches involving livelihood promotion have potential to mitigate the burden of undernutrition. This study examined the impact of an economic development (ED) program providing poultry assets, gardening skills and saving training added to the Positive Deviant (PD)/Hearth program (PDH/ED), compared to PD/Hearth only (PDH). A total of 1029 children who attended PD/Hearth sessions in September-November 2018 at 6-13 months of age were enrolled in the cohort study in July-August 2019. The cohort, comprised of 532 children in the PDH/ED group and 593 children in the PDH group, was reassessed in November 2020. The program impact on child nutrition, food security, crop production, dietary quality and household income was estimated using a difference-in-differences approach accounting for the sociodemographic differences between PDH/ED and PDH groups. Compared to the PDH group, the PDH/ED group showed increases in child dietary diversity score (DDS) (+0.32), child minimum dietary diversity (13.7 percentage points [pp]), and maternal DDS (+0.28) (all p < 0.05). From 2019 to 2020, the PDH/ED households improved food security by 12.6 pp and diversified crop production (bananas (9.7 pp), papaya (11.1 pp), carrots (3.8 pp) and lemons (5.9 pp)), and increased the proportion of annual income ≥60,000 Taka by 12.4 pp and last month income ≥5000 Taka by 7.8 pp, compared to PDH group (all p < 0.05).However, there was no impact on child nutritional status, morbidity, livestock ownership and total annual/last income. Incorporating an ED program into nutrition programming could benefit food security and dietary diversity in rural Bangladesh.

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Evaluation of mobile phone‐based Positive Deviance/Hearth child undernutrition program in Cambodia

Cited by 6 publications

References 11 publications

The use of positive deviance approach to improve health service delivery and quality of care: a scoping review

The use of positive deviance approach to improve health service delivery and quality of care: a scoping review

Program Impact Pathway of the Positive Deviance/Hearth Interactive Voice Calling Program in a Peri-Urban Context of Cambodia

Impact evaluation of a community nutrition and livelihood program on child nutrition in rural Bangladesh

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