Positive deviance. A literature review about the relevance for health promotion
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The purpose of this paper is to explore if positive deviance can be a relevant concept for health promotion. Health promotion focusses on enabling individuals and communities to increase control over and to improve their health, whereas positive deviance focusses on stimulating the whole community to perform better. Positive deviance is used to develop interventions based on the successful behaviors and strategies of individuals at risk who despite their circumstances perform better than their peers. Attempts have been made to define positive deviance in relation to health. However, there is no universal definition of positive deviance, which includes a description of the positive deviance approach and the positive deviance methodology.
A literature review was carried out, which included two rounds of data collection. A total of 222 publications were collected, which were used to create the positive deviance database. The positive deviance database was used as a guide for this paper.
The concept of positive deviance is relatively new. Deviance was traditionally used to describe negative behaviors, attributes, or conditions. Within sociology, there was a debate about the term positive deviance. Some sociologists argued that the full scope of deviance, including positive and negative deviance, should be taken into account, while others argued that positive deviance was an oxymoron.
The first time that positive deviance was used to tackle a problem was in relation to child malnutrition, with promising results. Positive deviance is also used successfully to tackle other health related problems, such as problems related to health care management, hospital infections, and reproductive health. Limited elaborated health topics for which the positive deviance approach was used are sports and lack of physical activity, weight control, healthy eating, cancer, and smoking.
Salutogenesis, an approach used to promote health, focusses on the conditions leading to wellbeing and on factors associated with successful coping. Antonovsky, the founder of salutogenesis, emphasized the importance of looking at the deviance cases. In contrast to most sociologists, Antonovsky did not see deviants as negative, but as those individuals at risk who have a relatively high health status despite their circumstances.
The main weakness of the positive deviance literature is that researchers have been unclear about their methodologies and findings, which is an important point that needs to be changed before positive deviance can be used as a standard approach in health promotion. Positive deviance has not been elaborately used to tackle health related problems, since it is a relatively new concept. However, the successes of positive deviance cannot be neglected. Therefore, positive deviance seems a relevant concept for health promotion.