In communities where diseases like malaria and pneumonia are highly prevalent, small, positive changes in behaviour can make a huge difference to their prevention and control. But how are these changes identified and how can community leaders and community health workers encourage the adoption of these behaviours?
In every community, there are individuals who find better solutions to an issue than their neighbours, and adopt ‘positive behaviours’ despite facing the same challenges, in the same context and with access to the same resources. By recognising and capturing examples of positive behaviour, solutions can be shared amongst communities for the common good. The individual who formulated a solution to a common problem becomes a role model for their neighbours. This is an approach known as ‘positive deviance’.
Positive deviance has shown to be an effective tool for community engagement in the fight against malaria and a range of other health issues including HIV and AIDS risk reduction, childhood nutrition and maternal care. Malaria Consortium has used positive deviance as an approach to engage communities in good health-seeking behaviours in a number of contexts across Africa and Asia, beginning with a pilot in 2010 through to implementation in our programmes since 2016. The approach helps to increase the impact of interventions as it is low cost and sustainable, making it ideal for use in remote communities.
Through our pilot in Myanmar, we were able to demonstrate the impact of positive deviance on a community at high risk of malaria infection, while also orienting Myanmar’s National Malaria Control Programme and other key partners on the approach. The pilot’s success provided a template for how positive deviance could be implemented in the future.
The positive deviance method
The principal steps include:
Hold a key stakeholder meeting: Orientate key community figures and authorities to gain their buy in for the approach
Community orientation: Meeting with community members to explain the concept through games and stories and begin to understand context and behaviours related to malaria prevention and control
Identification of positive deviance behaviours and role models: Carry out focus group discussions to identify role models and positive behaviours
Recruit volunteers to spread messages: Volunteers run community meetings to share positive solutions identified
Train volunteers: Before community meetings are held, volunteers attend training on malaria knowledge and strategies for communicating to their communities
Volunteers hold regular community meetings: Messages around positive behaviours by role models are disseminated around the community
Monitoring of malaria cases vs positive deviance activities: The coverage of community meetings can be compared against malaria case numbers to understand impact (allowing for confounding factors)
Handover to the community: Further orientations are held with the community to enable the sustainability of the activities