Habits as Building Blocks for the Resilience of Vulnerable Populations: Two Positive Deviance Case Studies From the U.S.-Mexico Border Region.

In this article, we describe habits that lead to resilience. We summarize empirical findings of two projects implemented with people living in the U.S.-Mexico border region that illustrate how when facing adversity, some individuals devise simple, uncommon strategies that through practice become habits and help them adapt positively. The studies discussed used a positive deviance inquiry framework. Positive deviance focuses on finding statistical outliers-those who are successful in the face of intractable problems without the use of special resources. As an inquiry framework, positive deviance enables identification of replicable behaviors that become habits and offer an avenue for behavioral change and the cocreation of sustainable interventions. The positive deviance approach has many potential applications in public health and is a useful framework for health promotion practitioners and researchers working in diverse settings.

Using a Positive Deviance Approach to Influence the Culture of Patient Safety Related to Infection Prevention.

BACKGROUND: Health care-associated infections (HAIs) are a socio-technical problem. We evaluated the impact of a social change intervention on health care personnel (HCP), called "positive deviance" (PD), on patient safety culture related to infection prevention among HCP. METHODS: This observational study was done in 6 medical wards at an 800-bed public academic hospital in the United States. Three of these wards were randomly assigned to receive PD intervention on HCP. After a retrospective 6-month baseline period, PD was implemented over 9 months, followed by 9 months of follow-up. Patient safety culture and social networks among HCP were surveyed at 6, 15, and 24 months. Rates of HAI were measured among patients. RESULTS: The measured patient safety culture was steady over time at 69% aggregate percent positive responses in wards with PD vs decline from 79% to 75% in wards without PD (F statistic 10.55; P = .005). Social network maps suggested that nurses, charge nurses, medical assistants, ward managers, and ward clerks play a key role in preventing infections. Fitted time series of monthly HAI rates showed a decrease from 4.8 to 2.8 per 1000 patient-days (95% confidence interval [CI], 2.1 to 3.5) in wards without PD, and 5.0 to 2.1 per 1000 patient-days (95% CI, -0.4 to 4.5) in wards with PD. CONCLUSIONS: A positive deviance approach appeared to have a significant impact on patient safety culture among HCP who received the intervention. Social network analysis identified HCP who are likely to help disseminate infection prevention information. Systemwide interventions independent of PD resulted in HAI reduction in both intervention and control wards.

What counts? For whom?: Cultural beacons and unexpected areas of programmatic impact.

The present article was motivated by our observations that (1) current methods for gathering data do not wholly capture program-related transformations, and (2) grassroots ways of knowing yield legitimate data and can enrich programmatic efforts and evaluations. Accordingly, our work seeks to leverage grassroots knowledge in order to both recognize and respect cultural beacons (CBs) - culturally embedded, user-defined aids for understanding program-related change. Simply, these inductively gathered, locally identified CBs illuminate what to measure and/or how to measure it. Our analysis of participatory evaluations from four international, social change interventions offers four sites for detecting CBs: material possessions, community landscape features, social behaviors, and community-inspired art. We examine the methodological and relational contexts that facilitate CB discovery, discuss unexpected areas of programmatic impact, and utilize lessons learned across projects to make suggestions for continued exploration of CBs in monitoring and evaluation design and practice.