Leveraging the Positive Deviance Approach to Drive Behavior Change in Noncommunicable Diseases: A Scoping Review

The positive deviance approach (PDA) to behavior and social change has been used to tackle child malnutrition in low-resource settings and has yielded positive health outcomes. Yet, not much is known about its application in noncommunicable disease (NCD) prevention and promotion. We did a scoping review by searching three electronic databases; PubMed (MEDLINE), Scopus (ScienceDirect), and Google Scholar and gray literature websites for primary research studies published in any language, country, and on any date, reporting on the application of the positive deviance (PD) approach to NCDs. A total of 2802 records were retrieved and 26 articles were included in the final analysis. The majority of studies were related to the application of the PDA on physical activity, obesity, weight-loss, and healthy eating, and the majority did not cover all steps of the PD approach and focused mainly on the identification of positive deviants and the identification of underlying PD behaviors and strategies, using a variety of quantitative and qualitative methods. All studies where PD behavior strategies were disseminated to nonpositively deviant communities and organizations yielded positive outcomes, such as clinically significant weight loss, and increased blood pressure control. The results of these studies suggest that positive deviants exhibiting exceptional performance exist in high-risk NCD settings, and therefore researchers and public health practitioners in the field of NCD prevention and promotion can learn from their success.