Effectiveness of Positive Deviance Approach to Promote Exclusive Breastfeeding Practice: A Cluster Randomized Controlled Trial

Effect of positive deviation on the diagnosis and treatment of gestational syphilis, and the prevention of congenital syphilis: A cohort study

Objectives

To describe the application of Positive Deviance (PD) and its outcomes in the diagnosis and treatment of gestational syphilis (GS) and the prevention of congenital syphilis (CS).

Material and methods

A descriptive cohort study was conducted. Women treated at the Subred Sur (SRS) of Bogotá, diagnosed with GS in 2017-2018, were included. The 2018 cohort was exposed to Positive Deviance (PD) to identify useful practices for CS prevention, implement them, and overcome existing barriers. Adherence to the Colombian Guideline for GS management and CS incidence were described.

Results

A total of 284 GS cases were confirmed. Timely treatment initiation increased from 81.8 % to 90.2 %, penicillin sensitivity testing decreased from 38 % to 12.9 %, and complete treatment improved from 43.8 % to 82.6 %. In 2018, 97.5 % received at least one dose of penicillin. The incidence rate of CS decreased from 41.9 % to 29.6 %. Of the patients, 45% were diagnosed with GS in the third trimester, among whom the CS incidence rate was 59 %.

Conclusions

This study describes the effects of applying PD as an innovative approach to improve adherence to timely and appropriate GS treatment and prevent CS. Prospective studies with a control group are needed to more robustly evaluate the benefits of this methodology in process and outcome indicators, as well as its impact on reducing mother to child transmission of syphilis.

Effectiveness of a positive deviance approach to improve mother's nutritional knowledge, attitude, self-efficacy, and child's nutritional status in Maji District, West Omo Zone, South West region, Ethiopia: a cluster randomized control trial

Background

Achieving appropriate feeding for infants and young children continues to be a struggle. These impediments are not only due to limited food availability but also inadequate knowledge, unfavorable attitudes, and low self-efficacy. A positive deviant approach (PDA) addressing positive and possible solutions inherent in a community focusing on problems is applied in Africa and particularly to Ethiopia. Therefore, this trial is aimed at evaluating the effectiveness of PDA in improving mothers' nutritional knowledge, attitudes, self-efficacy, and children's nutritional status.

Method

This was a cluster randomized control trial in which 516 mothers were randomly assigned to either an intervention or control group after collecting baseline data. The trial participants in the intervention cluster received a positive deviant intervention for 6 months, whereas those in the control group received only the usual care. Trained positive deviant mothers (PDM) delivered the intervention. A pretested, structured, interviewer-administered questionnaire was used for data collection. Generalized estimating equation regression analysis adjusted for baseline covariates and clustering was used to test the intervention effect.

Result

The results showed that PDA improved breastfeeding outcomes in the intervention groups compared to their counterparts. A mean difference (MD) of breastfeeding (BF) knowledge (MD = 6.47; 95% CI: 6.45-6.49), BF attitude (MD = 12.68; 95% CI: 11.96-13.40), and BF self-efficacy (MD = 3.13; 95% CI: 3.05-3.21) was observed favoring the intervention. The intervention group showed better improvement in complementary feeding (CF) knowledge, attitude, and self-efficacy among mothers compared to the control group. A mean difference in CF knowledge (MD = 4.53, 95% CI: 4.31-4.75), CF attitude (MD = 9.14, 95% CI: 8.52-9.75), and CF self-efficacy (MD = 11.64, 95% CI: 11.16-12.12) were observed favoring the intervention. At the end of the 6-month follow-up, children in the intervention group showed a lower prevalence of underweight (18.23%) (95% CI: 4.55, 22.54%; p = 0.004) compared with the control group.

Conclusion

PDA was effective in improving mothers' nutritional knowledge, attitude, and self-efficacy and reducing children's underweight in the intervention area.Clinical trial registration:ClinicalTrials.gov, identifier PACTR202108880303760.

How positive deviants helped in fighting the early phase of COVID-19 pandemic? A qualitative study exploring the roles of frontline health workers in Nepal

Positive deviance is an approach wherein learnings from persons who fare better than their peers under similar circumstances are used to enable behavioral and social change. Such behaviors and solutions are likely affordable, acceptable, sustainable, and fit into the socio-cultural milieu. Despite the wide use of positive deviance in many public health programs and research, it has yet to be used to study frontline workers in the context of COVID-19. Therefore, this study aimed to explore the positive deviance traits among frontline health workers during the early days of the COVID-19 pandemic in Nepal. This qualitative study followed a grounded theory approach. The data was collected through in-depth interviews among the 17 identified participants representing different cadres of the health workforce, types of health facilities, and regions across Nepal purposively. The findings are structured around four major themes: challenges, finding solutions and innovations, positive lessons, and motivations. The personal challenges included fear and anxiety about the uncertainties. The professional challenges included stigma, infection control, and changing work style with the use of personal protective equipment. Despite the challenges, they managed available resources and innovated low-cost, technological, and practice-based solutions. They were able to reflect upon the positive lessons learned, such as self-sustainability, teamwork, and policy direction and research, and self-reflection of personal growth and patient care. The intrinsic motivation included their inherent value system, and the extrinsic motivation included appreciation and acknowledgment, family and social support, psychosocial support from peers, and support from higher authorities. This study provides insights into how the positive deviance approach can help identify the solution amid the most challenging circumstances, such as the COVID-19 pandemic in low-resource settings. However, more extensive studies are warranted to explore deeper into positive deviance and its long-term effects in bringing positive outcomes during the pandemic.

End-Users Satisfaction with Positive Deviance Approach as an Intervention to Promote Exclusive Breastfeeding in Jimma, Ethiopia: A Multi-Level Analysis

BACKGROUND

Positive deviance approach (PDA) was implemented as an intervention strategy to address the poor practice of exclusive breastfeeding (EBF) in Jimma town, Ethiopia. Understanding the end-users satisfaction and its drivers is essential to determine whether this approach will be viable in the long run. Therefore, we determined the level of users' satisfaction with the intervention and identified multi-level predictors to explain variability.

METHODS

The data for this follow-up study were collected from September 01 to 25, 2020 among the study participants who were living in the intervention clusters of an earlier trial. A sample of 260 participants were invited to respond to an interviewer-administered structured questionnaire that assessed both individual and community-level variables. The developed tool was refined using experts' view (face validity) and using factor analysis (FA) to validate the satisfaction measurement scales (construct validity). The mean scores were standardized using Percentages Scale Mean Score (PSMS) formulae. Two-level mixed-effects linear regression (linear mixed models) were performed to fit individual, community, and mixed-level variables. All assumptions were checked for each analysis as appropriate and β-estimates at 95% CI and p-value of <0.05 were considered to declare a level of significance.

RESULTS

The overall level of end-users' satisfaction (PSMS) with PDA as an intervention to improve EBF was 50.9% with a maximum score of 99% and a minimum of 8%. Of the emerged satisfaction measuring scales, the standardized mean score for the user empowerment scale was the highest (53.7%). Five scales were emerged with 84.2% of the total variability explained in users' satisfaction. The mixed-effect model revealed that age, occupation, experience of breastfeeding (BF), knowledge, attitude, self-efficacy, main source of BF information, previous home visit/support received from HEPs, participation in any social activities, and perceived community support for BF were independent two-level predictors of satisfaction.

CONCLUSION

As an intermediate outcome, more than half of the end-users of the PDA intervention were satisfied. End-users' satisfaction with PDA as an intervention to promote EBF was predicted by multi-level factors. If they chose to use PDA as an intervention, Health program managers should be mindful of the two-level factors identified in this study.