The power of positive deviance

The most efficient way to improve health is to use locally available, sustainable, and effective approaches. In the 1970s policy developers tested the concept that public health interventions could be designed around uncommon, beneficial health behaviours that some community members already practised.(1 2) This concept-known as positive deviance(3 4)-was used successfully to improve the nutritional status of children in several settings in the 1990s.(5-10) Recently, the approach has also been applied to newborn care, child nutrition, rates of contraception, safe sexual practices, and educational outcomes.(11-13) In this article we describe how the approach works, the evidence that it is effective, and possible future applications.