Coping Strategies for Postpartum Stress: A Quantitative Positive Deviance Analysis

Positive deviance (PD) methods, initially used to improve health in low-income countries, are now being applied across U.S. health sectors. "Positive deviants" are persons who maintain good outcomes despite facing the same adversity as their neighbors. One strength of PD in intervention development is building on successful local solutions.

The purpose of this study was to illustrate a quantitative approach to conducting a positive deviant analysis of postpartum coping strategies that were associated with good maternal health when stress was high.

We described the process for identifying positive deviants and a normative group with high stress in a cross-sectional survey of 427 persons between 2 and 22 months postpartum. Measures included postpartum stress, physical and mental health, and postpartum coping strategies: self-regulation, spiritual care, self-care, use and seek support, internal and external resources, and health promotion. We used the Mann-Whitney U statistic to compare the coping strategies of positive deviants and a normative group.

Among 163 individuals with high stress, we identified 52 positive deviants with good physical health and 21 with good mental health. Positive deviants with good physical health more often used self-regulation and health promotion than the normative group, but those with good mental health used all coping strategies more often. Positive deviants did not differ significantly from the normative group in terms of demographic variables.

Use of a quantitative PD approach resulted in identifying potentially efficacious coping content for interventions to promote postpartum health during high stress. In community and clinical interventions, the use of PD to identify existing beneficial coping practices could aid populations facing health-related problems.