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Intellect

BYU professor helps demonstrate successful approach to improving lives in developing nations

"Deviance" is a word fraught with negative connotations, but a Brigham Young University professor is part of a team of researchers who have shown it is a key concept in solving a number of intractable problems in developing countries.

Kirk Dearden, associate professor of health sciences, and colleagues elsewhere published an article in the new issue of the "British Medical Journal" advocating the philosophy of "positive deviance." The approach focuses on the members of a troubled community who are succeeding despite their circumstances. Aid workers then encourage others to adopt what works for their neighbors, who have been "deviating positively" from the unsuccessful norm.

"We often assume that we in the United States or Europe have the answers to the world's problems," says Dearden, who headed research at Save the Children and taught at Johns Hopkins University before joining the BYU faculty. "Positive deviance turns that thinking on its head. The locals have the answers that are culturally relevant, applicable, that they can implement now. The challenge is not us sharing our knowledge with them but figuring out a way to facilitate a process that allows the entire community to discover that answer."

For example, if the issue is malnutrition, aid workers will weigh all a community's children under a given age, usually three or five. They then note the few children who are well nourished and observe their behaviors. In Vietnam, aid workers noticed some mothers who supplemented their children's soup with crabs and shrimp from rice paddies. The workers then gather the community members together and facilitate the successful parents sharing of their "secrets to success."

The process is repeated in every community, even within the same country and culture.

"The whole process is one of self discovery and unless they do it themselves, the community feels the answer comes from the outside," Dearden says. "The community members have to feel the answer comes from themselves, not from Save the Children or somewhere else."

The current paper documents successes of the approach as it relates to the problem of malnutrition, but it can also be applied to virtually any social ill. Dearden is still analyzing data gathered as part of a large, randomized trial examining the effectiveness of positive deviance in 12 communities in northern Vietnam, but successful results abound.

Compared to children in randomly selected nonintervention communities, young malnourished intervention children grew better, ate and breastfed more often, ate larger portions, consumed more energy, experienced less respiratory infection, and had mothers who were more likely to confidently share new knowledge about childcare and feeding with their neighbors.

"When I went to these sessions in Vietnam what was immediately apparent was that a light went on over the parents' heads," Dearden says. "They thought, 'Wow, my child can eat more than I ever thought.' That demonstrates to parents that the approach works – if it doesn't work, they aren't going to do it."

Overall, positive deviance has been implemented with 2.5 million people in Vietnam and in 35 countries by many major relief organizations, Dearden says. He thinks it works because it is easy to understand and has broad applicability.

"No matter what the challenge there are always people in every community who found a solution," he says, "even in the United States. Take a different problem – the youth growing up in crime-ridden inner cities. Many grow up and end up in prison. Who are the ones who end up at college? Those are the positive deviants who come out of a life of poverty and violence and somehow figure out how to do it. Let's watch them and encourage others to adopt their approaches."

With the recognition the British Medical Journal article brings, Dearden hopes ministries of health in developing nations see positive deviance as a possible approach. He would also like to help the many well-meaning aid organizations in Utah and elsewhere that conduct annual visits to developing countries in good-faith efforts to help.

"I'm hoping that this will have an effect locally – there are lots of dedicated people trying to do good things," Dearden says. "They create a lot of dependency. But let's look at things in a different way, where the solution comes from the inside, not from us on the outside who don't know the culture."

Dearden's co-authors on the paper are David R. Marsh of Save the Children Federation/USA, Dirk G. Schroeder of Emory University, Jerry Sternin of Tufts University and Monique Sternin.

The paper is available at: http://bmj.bmjjournals.com/cgi/content/full/bmj;329/7475/1177

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