DOCSLIB.ORG

Learning from Positive Deviants to Improve the Quality and Safety of Healthcare

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Learning from Positive Deviants to Improve the Quality and Safety of Healthcare Learning from positive deviants to improve the quality and safety of healthcare. Ruth Mary Baxter Submitted in accordance with the requirements for the degree of Doctor of Philosophy The University of Leeds School of Psychology November 2016 ii The candidate confirms that the work submitted is her own, except where work which has formed part of jointly authored publications has been included. The contribution of the candidate and the other authors to this work has been explicitly indicated below. The candidate confirms that appropriate credit has been given within the thesis where reference has been made to the work of others. The systematic review reported in Chapter 2 and a protocol paper for the secondary care study (Chapters 3 and 4) have been published: Baxter, R., Taylor, N., Kellar, I., & Lawton, R. (2015). What methods are used to apply positive deviance within healthcare organisations? A systematic review. BMJ Quality and Safety, Published online first 20th November. doi: 10.1136/bmjqs-2015-004386 Baxter, R., Taylor, N., Kellar, I. and Lawton, R. (2015). Learning from positively deviant wards to improve patient safety: an observational study protocol. BMJ Open; 5:e009650. doi:10.1136/bmjopen-2015-009650 All authors developed the concept for the systematic review. RB designed the study and conducted the searches, screening, data extraction and analysis with input from IK, NT and RL. RB drafted the publication and thesis manuscript. All authors provided comments and approved final versions. All authors contributed to the conception of the secondary care study. RB designed the study which was critically assessed and approved by all the other authors. RB set up the study, gained ethical approvals and collected all data. RB drafted the publication and thesis manuscript. All authors provided comments and approved the final versions. This copy has been supplied on the understanding that it is copyright material and that no quotation from the thesis may be published without proper acknowledgement. The right of Ruth Baxter to be identified as Author of this work has been asserted by her in accordance with the Copyright, Designs and Patents Act 1988. © 2016 The University of Leeds and Ruth Baxter i Acknowledgements I would like to start by expressing a huge thank you to my supervisors, Rebecca Lawton, Natalie Taylor, and Ian Kellar. This PhD has been such a wonderful experience and it has been a great privilege to work with you all. Thank you for all of your support and guidance, for helping me to develop confidence in my abilities, and for the opportunities you have provided. I am truly grateful. Thank you to The Health Foundation for funding this PhD and for supporting my development. I am also eternally grateful to all of the staff and patients who have participated in my research. Without you this thesis would not have been possible. Lots of people have supported and guided me along the way. Thank you to everyone in the Yorkshire Quality and Safety Research group who have taught me so much and helped me to navigate through the dynamics of NHS research. I have loved being a part of this wonderful team. Thank you to Ali Cracknell, Robbie Foy, Robert West, Mohammed Mohammed, Victoria Pye, and everyone in the CLAHRC EBT theme. You have all been extremely generous with your time and wisdom. Throughout this PhD I have made some wonderful friends. Firstly to Liz … we’ve only blooming gone and done it! We’ve been through it all - the highs, the lows and a couple of tears, but mainly there have been lots of laughs. Thank you so much for everything - you have been a fantastic friend and this PhD would have been a very different experience without you. Thank you also to Abi, Raginie, Amy, Sarah, and Jack whose friendships have provided a source of motivation, procrastination, coffee, and chocolate exactly at the times when I’ve needed them the most! Thank you to all my amazing friends and family. To the girls near and far – despite not really knowing what it is about (!), your enthusiasm for my PhD has been incredible. Thank you for being there … predominantly with wine or gin! Alice – your phone calls, the London getaways, and of course your drama have kept me going more than you’ll ever know. Mum – your support has always been incredible. Whatever I’ve chosen to do you’ve always believed in me and encouraged me keep going. Thank you for listening to me prattle on, for the cups of tea / glasses of something stronger, and for all the left-over food parcels! My final thanks are saved for Carl. We made it! You have always been there to encourage and motivate me and on many occasion you have given me the strength to carry on. Thank you for sharing this experience with me, and for everything that you have done to get me here – it is truly appreciated! ii Abstract Every day around the globe, patients are harmed within healthcare organisations. Attempts to improve the quality and safety of healthcare traditionally focus on past errors and harm, yet there is little evidence of widespread improvement. In contrast, the positive deviance approach seeks to identify and learn from those who demonstrate exceptional performance despite facing the same constraints as others. Bradley et al. (2009) have proposed a four stage process to apply positive deviance within healthcare organisations: 1) positive deviants are identified using routinely collected data; 2) hypotheses are generated about how they succeed; 3) these are tested within representative samples; and 4) the successful strategies are disseminated. Despite this, limited guidance exists to support applications. This thesis sought to test a robust and pragmatic method for applying the positive deviance approach within multidisciplinary healthcare teams. Study 1 systematically reviewed the methods used to apply positive deviance within healthcare. Previous applications identified positively deviant organisations or individuals and focused on narrow outcomes or processes of care. Applications lacked quality and used extensive resources. Study 2 analysed NHS Safety Thermometer data to identify five positively deviant and five matched comparison elderly medical wards. In the main, staff and patient perceptions of safety on these wards supported their identification. During study 3, multidisciplinary staff focus groups were conducted to explore how these wards delivered exceptionally safe care. In total, 14 behaviours and cultures were hypothesised to facilitate positive deviance at ward level. Study 4 assessed the feasibility of applying positive deviance within a general practice setting. Findings highlighted challenges of selecting data to identify positive deviants, recruiting general practices to participate, and generating hypotheses about success strategies that were unique to positive deviants yet common among them. In combination, these studies generated guidance to support rigorous applications of the positive deviance approach within healthcare organisations. The evidence suggested that, in the future, it may be possible to improve the quality and safety of care by focusing on those that demonstrate exceptional rather than poor outcomes of care. - iii - Table of Contents Chapter 1: Introduction: Overview of the literature, thesis aims and objectives 1.1 Chapter summary .......................................................................................... 1 1.2 The quality and safety of patient care ............................................................ 1 1.3 Improving the quality and safety of care......................................................... 2 1.4 Reframing patient safety................................................................................ 4 1.5 The positive deviance approach .................................................................... 5 1.6 How is the positive deviance approach applied?............................................ 6 1.6.1 Why might it be beneficial to apply the positive deviance approach within healthcare organisations?......................................... 8 1.6.2 What are the challenges to applying the positive deviance approach within healthcare organisations?....................................... 10 1.7 Theoretical, methodological, and epistemological perspective..................... 11 1.8 Thesis aims ................................................................................................. 13 1.9 Thesis overview........................................................................................... 14 Chapter 2: What methods are used to apply positive deviance within healthcare organisations? A systematic review. 2.1 Chapter summary ........................................................................................ 17 2.2 Introduction.................................................................................................. 17 2.2.1 Healthcare applications of positive deviance .................................... 18 2.2.2 Aims and research questions ........................................................... 19 2.3 Methods....................................................................................................... 20 2.3.1 Search strategy ................................................................................ 20 2.3.2 Eligibility criteria and study selection ................................................ 20 2.3.3 Study quality assessment................................................................. 21 2.3.4 Data extraction and synthesis..........................................................
Load more

Recommended publications
  • Combating Malnutrition
    POSITIVE DEVIANCE INITIATIVE Combating Malnutrition CC in the Land of a Thousand Rice Fields com Positive Deviance Grows Roots in Vietnam¹ by Arvind Singhal, Jerry Sternin, & Lucía Durá photo: Modifed from original by Chris Feser @ fickr. @ fromphoto: Modifed Feser original by Chris Rice farmingRice in Vietnam Positive Deviance Wisdom Series, Number 1, 2009 www.positivedeviance.org POSITIVE DEVIANCE enables communities to discover the wisdom they already have, and then to act on it. “Sternin, you have six months to show results,” noted Mr. Nuu, a high-ranking offcial in the Vietnamese Ministry of Foreign Affairs. “What? Six months? Six months to demonstrate impact?” Jerry Sternin could not believe his ears. “Yes, Sternin, six months to show impact, or else, I will not be able to extend your visa.” In December 1990, Jerry Sternin, accompanied by his malnutrition would not yield quick and sustainable wife Monique and ten-year old son Sam, arrived in Hanoi results, the Sternins wondered if the construct of to open an offce for Save the Children, a U.S.-based Positive Deviance, coined a few years previously by NGO. His mission: To implement a large scale program Tufts University nutrition professor Marian Zeitlin,¹ to combat childhood malnutrition in a country where might hold promise. two thirds of all children under the age of fve suffered from malnutrition. Zeitlin broached the notion of PD as she tried to understand why children in some poor households, The Vietnamese government had learned from experience without access to any special resources, were better that results achieved by traditional supplemental feeding nourished than children in other households.
    [Show full text]
  • Impact of Positive Deviance Approach on Breastfeeding Practices Among Tribal Pregnant Women -A Before-After Intervention Study
    See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/333566194 Impact of positive deviance approach on breastfeeding practices among tribal pregnant women -A before-after intervention study Preprint · June 2019 CITATIONS READS 0 6 2 authors, including: Sudip Bhattacharya Himalayan Institute of Medical Sciences 76 PUBLICATIONS 69 CITATIONS SEE PROFILE Some of the authors of this publication are also working on these related projects: Thesis View project Implementation of skill development programme in PGIMER, Dietetics Department through video based training and administrative measures on food handlers to improve personal hygiene. View project All content following this page was uploaded by Sudip Bhattacharya on 23 November 2019. The user has requested enhancement of the downloaded file. [Downloaded free from http://www.cjhr.org on Saturday, November 23, 2019, IP: 139.167.85.198] Original Article Impact of the Positive Deviance Approach on Breastfeeding Practices among Tribal Pregnant Women: A Before – After Intervention Study Abstract Abhay Srivastava, Introduction: Breastfeeding is very important for the infant and for the mother. Breastfeeding Kanchan Gwande1, practices in India and abroad are not up to the mark, and they pose serious health risk to the Sudip Bhattacharya, mothers and the babies. Methodology: This single‑group before–after intervention study was 2 conducted to assess the impact of positive deviance (PD) approach on knowledge about exclusive Vijay Kumar Singh breastfeeding (EBF) practices among tribal pregnant women. The sample size was 376. Data were Department of Community collected using convenient sampling method. At first, we identified eight positive deviants from that Medicine, Himalayan Institute of Medical Sciences, Dehradun, area.
    [Show full text]
  • Positive Deviance and Hand Hygiene of Nurses in a Quebec Hospital: What Can We Learn from the Best?
    ARTICLE IN PRESS American Journal of Infection Control ■■ (2017) ■■-■■ Contents lists available at ScienceDirect American Journal of Infection Control American Journal of Infection Control journal homepage: www.ajicjournal.org Major Article Positive deviance and hand hygiene of nurses in a Quebec hospital: What can we learn from the best? Josiane Létourneau MPH a,b,c,*, Marie Alderson PhD a,b,d, Annette Leibing PhD a,b,c,e,f a Faculté des sciences infirmières, Université de Montréal, Montréal, QC, Canada b Quebec Nursing Intervention Research Network, Montréal, QC, Canada c Institut de recherche en santé publique, Université de Montréal, Montréal, QC, Canada d Centre de recherche de l’Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada e Research group Meos (Le médicament comme objet social), Geneva, Switzerland f CREGÉS (Centre de recherche et d’expertise en gérontologie sociale), Montréal, QC, Canada Key Words: Background: Although it is well known that hand hygiene is the most effective measure to prevent health Positive deviance care–associated infections, hand hygiene adherence is low in Quebec, as it is elsewhere. For this study, hand hygiene an innovative framework was used to explore the clinical practice of nurses regarding hand hygiene and nurses the factors that influence it: positive deviance, or the idea that there are people who find better solu- focused ethnography tions to problems than their peers. This study investigated positive deviance at the level of the care team to shed light on group dynamics. Methods: We conducted focused ethnographies on 2 care units—a medical-surgery unit and a palliative care unit—at a Montreal university hospital.
    [Show full text]
  • Toward a Theory of Positive Deviance
    University of New Hampshire University of New Hampshire Scholars' Repository Doctoral Dissertations Student Scholarship Spring 1985 TOWARD A THEORY OF POSITIVE DEVIANCE DRUANN MARIA HECKERT University of New Hampshire, Durham Follow this and additional works at: https://scholars.unh.edu/dissertation Recommended Citation HECKERT, DRUANN MARIA, "TOWARD A THEORY OF POSITIVE DEVIANCE" (1985). Doctoral Dissertations. 1450. https://scholars.unh.edu/dissertation/1450 This Dissertation is brought to you for free and open access by the Student Scholarship at University of New Hampshire Scholars' Repository. It has been accepted for inclusion in Doctoral Dissertations by an authorized administrator of University of New Hampshire Scholars' Repository. For more information, please contact [email protected]. INFORMATION TO USERS This reproduction was made from a copy of a document sent to us for microfilming. While the most advanced technology has been used to photograph and reproduce this document, the quality of the reproduction is heavily dependent upon the quality of the material submitted. The following explanation of techniques is provided to help clarify markings or notations which may appear on this reproduction. 1.The sign or “target” for pages apparently lacking from the document photographed is “Missing Page(s)”. If it was possible to obtain the missing page(s) or section, they are spliced into the film along with adjacent pages. This may have necessitated cutting through an image and duplicating adjacent pages to assure complete continuity. i i 2. When an image on the film is obliterated with a round black mark, it is an indication of either blurred copy because of movement during exposure, duplicate copy, or copyrighted materials that should not have been filmed.
    [Show full text]
  • Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected]
    Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected] Outline: From Food Insecurity Food Security Sustainability Food Security – Insecurity 47pp Global Nutrition Index – Triple burden of <Mal>nutrition Coping with Food Insecurity – Bélanger & Pilling The Sociotype & >175 experts 576pp Positive Deviance Olivier De Schutter & 250 experts Sustainability and Sustainable Food 112pp Systems What Policy Makers can do… Food Security is a Fundamental Human Right How Positive Deviance Changed my life … COPING: Practical Steps LEARN FROM THE POSITIVE DEVIANTS 1 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected] The P o w e r of Positive Deviance Solutions before our very eyes!! The Premise: Indian Face or Eskimo? In every community there are certain individuals whose uncommon practices/behaviors enable them to find better solutions to problems than their neighbors who have access to the same resources Marsh et al. BMJ 329, 1177, 2004 Positive Deviance (PD) Approach Identifying Solutions to Community Problems Within the Community - Today The Key Question? What enables some members of the community (the “Positive Deviants”) to find these better solutions? 2 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected] [Mal]nutrition in Vietnam PD Inquiry How are some children well-nourished?? Gathering vegetables “Stealing” “TBU” Money from outside “TBU” All family thin…. “TBU” Cf Antonovsky Breast feeding etc Salutogenesis Project aim Setting PD Behaviors Child Vietnam Eating Fruits & Vegs, Shrimp Malnutrition 1999 - snails, Breast milk, beans, 2000 peanuts Boiling Drinking water 5-6 meals/d active feeding Mosquito bed net Immunization Food Nutr Bull 2002, Daily bath 23 suppl 4, 36 Early care seeking for illness 3 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected] AlthoughPD most Enables problems have complex, us to underlying Act causes TODAY .
    [Show full text]
  • 1 Applying a Deviance Framework to Understand How Place Shapes
    Applying a Deviance Framework to Understand How Place Shapes Modern Contraceptive Use in Sub-Saharan Africa Tamar Goldenberg 1, 2 and Rob Stephenson,2, 3 1Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, 48109 2Center for Sexuality & Health Disparities, University of Michigan, Ann Arbor, 48109 3Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, 48109 1 ABSTRACT: Increasing modern contraception use is important for improving maternal and child health and achieving economic growth and development goals. However, high unmet need for modern contraception in Sub-Saharan Africa warrants new understandings of the drivers of modern contraceptive use. Using data from Demographic Health Surveys from 29 Sub-Saharan African countries, we examine how a woman’s deviation from community norms is associated with modern contraception use. Stepwise analysis was conducted and then separate random- effects logistic regression models were fitted to examine relationships between modern contraception use and positive and negative deviance on socioeconomic characteristics, gender and fertility norms, and health knowledge and media exposure. Results suggest that deviance in all three domains is associated with modern contraception use; however, relationships between deviance and modern contraception use vary by variable and by place. Findings highlight the importance of using context-specific deviance approaches for improving public
    [Show full text]
  • Oxford Research Encyclopedia of Communication
    Positive Deviance: A Non-Normative Approach to Health and Risk Messaging Oxford Research Encyclopedia of Communication Positive Deviance: A Non-Normative Approach to Health and Risk Messaging Arvind Singhal and Lucia Dura Subject: Communication Theory, Health and Risk Communication Online Publication Date: Mar 2017 DOI: 10.1093/acrefore/9780190228613.013.248 Summary and Keywords The Positive Deviance (PD) approach is based on the premise that every community has individuals or groups whose uncommon behaviors and strategies enable them to find better solutions to problems than their peers although everyone has access to the same resources and challenges. In contrast to traditional problem-solving approaches that begin with an expert- driven analysis of “what is not working” with people—their explicit needs, deficits, problems, and risks—followed by attempts to plug those gaps, the PD approach focuses on identifying “what is working.” PD offers a systematic framework to identify assets, indigenous knowledge, and home-grown solutions, and to amplify them for wider adoption. The PD approach was operationalized and systematized in the early 1990s in Vietnam to address malnutrition. At the time, 65% of children under five were malnourished. Instead of looking for the causes and applying best practices, PD pioneers looked for children from very poor families who were well-nourished. Through community-led efforts, they determined the existence of positive deviants, identified their behaviors and strategies, and amplified them. The process was replicated across 14 villages—each identifying its own batch of local practices—and malnutrition decreased by 85%. These actions led to PD as we know it today in the form of the “6 Ds”: Define, Determine, Discover, Design, Discern, and Disseminate.
    [Show full text]
  • Chapter 3 Practice Positive Deviance for Extraordinary Social And
    CHAPTER 3 PRACTICE POSITIVE DEVIANCE FOR EXTRAORDINARY SOCIAL AND ORGANIZATIONAL CHANGE Jerry Sternin ABSTRACT In his own words, Jerry Sternin, widely known as "the father of applied Positive Deviance, " explains the story of how an acute crisis led him to the practice of Positive Deviance (PD). He tells how he was propelled, over a twelve-year period to develop and amplify the approach which has enabled communities of more than 2.2 million people in Vietnam to sustain the reduction of childhood malnutrition and has been replicated in 24 other countries around the world. The chapter includes a step-by step approach to positive deviance, a formula for positive deviance, exceptional stories of change within societies, and a "how to" and "what-to-do" approach to positive deviance that could be applied within organizations, institutions, or your own society. SUMMARY Positive Deviance (PD) is based on the belief that in every community there are certain individuals/entities whose special practices or strategies enable them to find a better solution to a pervasive problem than their neighbors who have access to exactly the same resources. We call these individuals "positive deviants". The PD design provides a tool to enable the community to discover the positive deviants' uncommon, but demonstrably successful strategies. The community then analyzes those strategies retaining only those that are accessible to all its members. Finally, the community designs an intervention, enabling all its members to access and practice the newly discovered PD strategies. PRACTICE POSITIVE DEVIANCE FOR EXTRAORDINARY SOCIAL AND ORGANIZATIONAL CHANGE 21 INTRODUCTION Nasirudin, the great Sufi mystic, appears in different guises in different stories.
    [Show full text]
  • PD Hearth Elements Text.Indd
    Positive Deviance/Hearth Essential Elements A Resource Guide for Sustainably Rehabilitating Malnourished Children (Addendum) June 2005 The CORE Group is a membership association of international nongovernmental organizations registered in the United States whose mission is to improve the health and well being of children and women in developing countries through collaborative NGO action and learning. For more information: CORE Group www.coregroup.org Recommended Citation Nutrition Working Group, CORE Group, Positive Deviance / Hearth Essential Elements: A Resource Guide for Sus- tainably Rehabilitating Malnourished Children (Addendum), Washington, D.C: June 2005. Acknowledgements This publication was written by Judiann McNulty, a consultant to the CORE Group. Abstract A Positive Deviance/Hearth Nutrition Program is a home- and neighborhood-based nutrition program for children who are at risk for protein-energy malnutrition in developing countries. The program uses the “positive deviance” approach to identify those behaviors practiced by the mothers or caretakers of well-nourished children from poor families and to transfer such positive practices to others in the community with malnourished children. The “Hearth” or home is the location for the nutrition education and rehabilitation sessions. This Addendum updates the CORE Group’s February 2003 Positive Deviance/Hearth Manual. It gives an overview of appropriate settings for and essential elements of a PD/Hearth intervention. This publication was made possible by support from the Bureau for Global Health, United States Agency for Interna- tional Development (USAID) under cooperative agreement FAO-A-00-98-00030. This publication does not necessarily represent the views or opinion of USAID. It may be reproduced if credit is properly given.
    [Show full text]
  • Positive Deviance Hearth Resource Guide
    Positive Deviance/Hearth: A Resource Guide for Sustainably PPositiveositive DevianceDeviance /Hearth/Hearth Rehabilitating Malnourished Children Positive Deviance/Hearth is a successful home-based & neighborhood-based nutrition program for children who are at risk for malnutrition in developing countries. It has enabled hundreds of communities to reduce their levels of childhood malnutrition and to prevent malnutrition years after the program’s completion. The “positive deviance” approach is used to find uncommon, beneficial practices by mothers or caretakers of well-nourished children from impoverished families. Once identified, ways are sought to spread these practices and behaviours to others in the community with malnourished children. A “Hearth” is the setting of the nutrition education and rehabilitation part of the program. Suggesting a family around a fireplace or kitchen, Hearths are carried out in home settings where caretakers and volunteers prepare “positive deviant foods”. They practice beneficial childcare behaviors and feed malnourished children with extra energy-rich/calorie-dense supplemental meals. Sprinkled with helpful field examples, useful tools and ideas, this guide explains step by step how to: ♥ identify at-risk children AA RResourceesource GuideGuide ♥ conduct a Positive Deviance Inquiry forfor SustainablySustainably RRehabilitatingehabilitating ♥ conduct Hearth sessions and ♥ set up a monitoring and evaluation system MalnourishedMalnourished ChildrenChildren CORE Incorporated 220 I Street, NE Suite 270 Washington DC 20002 (USA) telephone (202) 608-1830 / fax (202) 543-0121 Child Survival Collaborations and Resources Group www.coregroup.org Nutrition Working Group February 2003 The CORE Group he Child Survival Collaborations and Resources Group (The CORE T Group) is a membership association of more than 35 U.S.
    [Show full text]
  • Determinants of Normal Haemoglobin Concentration Among Children In
    www.nature.com/scientificreports OPEN Determinants of normal haemoglobin concentration among children in Ghana: a positive deviance analysis of nationally representative cross-sectional survey data Dickson A. Amugsi Anaemia among children under 5, is a public health problem of serious concern. In Ghana, an estimated 8 out of every 10 children are anaemic. This study employed a novel approach to investigate the determinants of normal haemoglobin (Hb) concentration among children aged 6 to 59 months, using data from the Ghana Demographic and Health Surveys. The results showed that maternal schooling was positively associated with normal Hb concentration among children. Children of non-anaemic mothers were 1.67 (CI = 1.32, 2.10; P < 0.001) times more likely to have normal Hb concentration relative to children of anaemic mothers. Compared to mothers who had less than 4 antenatal care (ANC) visits, mothers who had at least 4 ANC visits increased the odds of their children having a normal Hb concentration by 1.62 (CI = 1.09, 2.40; P < 0.018). Children living in middle and rich households had respectively 1.48 (CI = 1.06, 2.07; p < 0.021) and 1.59 (CI = 1.08, 2.33; p < 0.018) increased odds of having a normal Hb concentration relative to those living in poor households. Maternal education, anaemia, ANC attendance, and household wealth index are strong determinants of normal Hb concentration among children in Ghana. Strategies aimed at addressing childhood anaemia should take into account maternal anaemia, education, poverty and ANC attendance. Anaemia, defned as blood haemoglobin concentration lower than normal1,2 is a pervasive problem among chil- dren under fve years of age.
    [Show full text]
  • Positive Deviance Approach- Nutritional
    ISSN- 2394-5125 VOL 7, ISSUE 14, 2020 POSITIVE DEVIANCE APPROACH- NUTRITIONAL CENTER IN IMPROVING NUTRITIONAL BEHAVIOR TOWARDS TODDLER SURVIVORS OF NATURAL DISASTER AT TEMPORARY SHELTERS IN CENTRAL SULAWESI Sugeng Eko Irianto1, Bohari2, Fahmi Hafid3, Nur Sefa4 1Graduate School, University of Mitra Indonesia Lampung, City of Lampung, Indonesia 2 Nutrition Department, Faculty of Public Health, Tadulako University, City of Palu, Indonesia 3 Nutrition Department, Poltekkes Kemenkes Palu, City of Palu, Indonesia 4 Faculty of Health, University of Mitra Indonesia Lampung, City of Lampung, Indonesia Email: [email protected] Received: 14 March 2020 Revised and Accepted: 8 July 2020 ABSTRACT: Background: The behavior of families victims of natural disasters in Central Sulawesi who have just lived at temporary shelters urgently needs attention, especially efforts to fulfill nutrition for toddlers. This research aims to determine changes in behavior of mothers and toddlers related to nutrition and health by usingpositive deviance - nutrition post approach. Methods: This research was a nutritional intervention research using the Positive Deviance approach. The numbers of toddlers were 92 toddlers. Positive Deviance family includes eating behavior, hygiene behavior, child care behavior, health maintenance behavior. Analysis of changes in nutritional behavior practiced by toddlers during the nutrition post activities. Results: Behavior practiced in shelters is washing hands before eating, reading prayers before eating, eating together, children eating
    [Show full text]