The positive deviance/hearth approach to reducing child malnutrition: systematic review

Abstract

Summaryobjectives The Positive Deviance ⁄ Hearth approach aims to rehabilitate malnourished children using practices from mothers in the community who have well-nourished children despite living in poverty. This study assesses its effectiveness in a range of settings.methods Systematic review of peer reviewed intervention trials and grey literature evaluation reports of child malnutrition programs using the Positive Deviance ⁄ Hearth approach.results Ten peer reviewed studies and 14 grey literature reports met the inclusion criteria. These described results for 17 unique Positive Deviance ⁄ Hearth programs in 12 countries. Nine programs used a pre-and post-test design without a control, which limited the conclusions that could be drawn. Eight used more robust designs such as non-randomized trials, non-randomized cross-sectional sibling studies and randomized controlled trials (RCTs). Of the eight programs that reported nutritional outcomes, five reported some type of positive result in terms of nutritional status -although the improvement was not always as large as predicted, or across the entire target population. Both the two RCTs demonstrated improvements in carer feeding practices. Qualitative results unanimously reported high levels of satisfaction from participants and recipient communities.conclusions Overall this study shows mixed results in terms of program effectiveness, although some Positive Deviance ⁄ Hearth programs have clearly been successful in particular settings. Sibling studies suggest that the Positive Deviance ⁄ Hearth approach may have a role in preventing malnutrition, not just rehabilitation. Further research is needed using more robust study designs and larger sample sizes. Issues related to community participation and consistency in reporting results need to be addressed.

Effectiveness of a community‐based nutrition programme to improve child growth in rural Ethiopia: a cluster randomized trial

“…; Aubela et al . ); however, only a few nutrition programmes that adapted the PD theory were evaluated using robust study design with a control group on child nutritional outcomes (Bisits Bullen ). The programmes were effective in improving food consumption and feeding practices; however, they showed no effect on child growth.…”

Seroadaptive Strategies of Gay & Bisexual Men (GBM) with the Highest Quartile Number of Sexual Partners in Vancouver, Canada

“…For example, in their analysis of injection drug users who remain HIV and HCV infection-free, Friedman and colleagues (50,51) adapted the concept of Positive Deviance, originating in infant/child nutrition studies to identify parental strategies associated with well-nourished children living in communities with high malnutrition rates (52) to explain how “subjects control their personal risk, even though they have engaged in high-risk activities for lengthy periods”. Seroadaptive strategies may therefore provide insights into how GBM with the highest quartile number of male anal sex partners manage their sexual health and prevent seroconversion despite having higher than average rates of partnering.…”

Mixed‐methods study identifies key strategies for improving infant and young child feeding practices in a highly stunted rural indigenous population in Guatemala

“…, p. 94). A positive deviance model, which highlights children who are growing better than their peers, may generate enthusiasm for nutritional programming among caregivers and community leaders (Bisits Bullen ; Chary et al . ).…”