Learning From the Community to Improve Maternal—Child Health and Nutrition: The Positive Deviance/Hearth Approach


  • Janine Schooley MPH,

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    • Janine Schooley, MPH, is Vice President for Technical Services and Program Development at Project Concern International and is adjunct faculty at the University of California San Diego Graduate School of International Relations and Pacific Studies. She serves on CORE's Social and Behavior Changing Working Group and recently conducted consultancies for the World Bank and Helen Keller International. She serves on the Board of Directors of the CORE Group.

  • Linda Morales MA

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    • Linda Morales, MA, is an independent consultant for maternal and child health projects worldwide. From 2000–2006, she worked for Project Concern International as the Maternal and Child Health Technical Officer, providing assistance to programs in Africa, Asia, Latin America, and the United States and at the Monterey Institute of International Studies.

Address correspondence to Janine Schooley, MPH, Project Concern International, 5151 Murphy Canyon Road, Suite 320, San Diego, CA 92123. E-mail: jschooley@projectconcern.org


The “traditional” use of the Positive Deviance approach to behavior change involves studying children who thrive despite adversity, identifying uncommon model behaviors among Positive Deviant families, and then designing and implementing an intervention to replicate these behaviors among mothers of malnourished children. This article presents the results of a literature review designed to gather information on the role of the Positive Deviance/Hearth methodology in social and behavior change. Examples of how the methodology has been applied beyond infant and child malnutrition to address other health areas, such as improving pregnancy outcomes, are explored. An analysis of Positive Deviance programming being carried out by Project Concern International in Guatemala and Indonesia is conducted. The role of cultural context in the design and implementation of Positive Deviance/Hearth, as well as the role of Positive Deviance in affecting social and behavior change, require further exploration. The issues related to cultural context and the challenges for monitoring and evaluation of program outcomes are presented.