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. They were trained by the investigator regarding EBF practices. They were also motivated to Uttarakhand, 1Department of share their knowledge and practices in the community. Results: It was observed that knowledge Community Medicine, IGMC, regarding initiation of breastfeeding (<1 h of birth) increased from 181 (52.2%) to (67.1%) among Nagpur, 2Department of 347 study participants. Only 81 (23.3%) knew that breastfeeding should be on demand before Community Medicine, Lokmanya intervention, which increased by 21% after the intervention. The majority of the study participants, Tilak Municipal Medical i.e., 286 (82.4%) knew the advantages of breast milk. The proportion of study participants who College, Lokmanya Tilak knew that breastfeeding should not be stopped during mother’s illness was 171 (49.3%) before Municipal General Hospital, and 229 (66%) after intervention. Before intervention, around one‑fourth, that is, 85 (24.5%), Sion, Mumbai, Maharashtra, India knew that if the mother is not producing enough milk, then she should visit a health center which increased to 130 (37.5%) after intervention. The majority of the participants, i.e., 145 (41.8%) knew that bottle feeding should not be done for the babies which increased in proportion to around 55% after intervention. A statistically significant (P < 0.001) increase in knowledge was observed. Conclusion: It is possible to increase the awareness and practice level among the lactating mothers for EBF using the positive deviant approach. Recommendation: The concept of PD approach can be further popularized as they can strengthen our existing health system for better health outcomes in future. Keywords: Exclusive breastfeeding, intervention study, positive deviance Introduction attributed to many factors, for example, insufficient milk production, higher For improvement in the state of maternal socioeconomic status, the influence of and child health, the WHO and UNICEF paternal education, cultural differences, and emphasize on the first 1000 days of life working mothers.[2] beginning with woman’s pregnancy and lasting till the child’s second birthday. A change in behavior of mothers is needed This period offers a unique window of to address this issue. This can play an Submission: 18-Dec-18 opportunity to build healthy mother‑child important role in breastfeeding practice.[3,4] Revised : 26-May-19 [1] Accepted : 25-Jun-19 duo through nutritional interventions. Behavior change is of primary importance One important component of nutritional in low‑and‑middle‑income countries like intervention after birth is breastfeeding India where expenditure on health and its Address for correspondence: Dr. Sudip Bhattacharya, practices. These are affected by various interventions are low. The key question in C5/12, HIHT Campus, factors and can be classified into six such research is how to predict and modify Dehradun, Uttarakhand, India. groups, namely healthcare related, the adoption and maintenance of health E‑mail: [email protected] sociodemographic, psychosocial, cultural, behaviors.[5‑7] community, and policy related. A shorter Even though many well‑established Access this article online duration of breastfeeding has been benefits of exclusive breastfeeding (EBF) Website: www.cjhr.org documented as one of the most common are known, sufficient practices do not reasons for malnutrition in infants. It is exist globally. According to the National DOI: 10.4103/cjhr.cjhr_165_18 Quick Response Code: This is an open access journal, and articles are Family Health Survey‑3 (2005–2006), distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows How to cite this article: Srivastava A, Gwande K, others to remix, tweak, and build upon the work non‑commercially, Bhattacharya S, Singh VK. Impact of the positive as long as appropriate credit is given and the new creations are deviance approach on breastfeeding practices among licensed under the identical terms. tribal pregnant women: A before – After intervention For reprints contact: [email protected] study. CHRISMED J Health Res 2019;6:222‑8. 222 © 2019 CHRISMED Journal of Health and Research | Published by Wolters Kluwer - Medknow [Downloaded free from http://www.cjhr.org on Saturday, November 23, 2019, IP: 139.167.85.198] Srivastava, et al.: Positive deviance approach on breastfeeding practices only 46% of children between the age group of 0 and However, we took 376 participants to compensate the 23 months are breastfed. According to the Rapid Survey dropouts. on Children (2013–2014), only 44.6% of children between Pregnant women in the study area were our sampling 0 and 23 months of age are breastfed immediately within an unit and we used a convenient sampling method. Mixed hour of birth, and 64.9% of infants between 0 and 5 of age methods were used (focus group discussion and survey). months are exclusively breastfed. Since breastfeeding is a social behavior and not a medical practice, the involvement Mothers residing in the local area who were willing to of the health system for promotion, support, and protection participate were included, and mothers who dropped out of breastfeeding is different.[8] any time from initiation to 6 months after delivery due to any reason were excluded from the study. Interested Positive deviance (PD) approach is helpful in improving mothers residing in the study area who were motivated to feeding practices focuses on changing behaviors of those practice EBF were included as positive deviants. who directly (caregivers) or indirectly (extended family members, community members) influence child nutritional During preintervention data collection, subjects who status.[7‑9] uncommon behaviors (positive deviants) had related to the problems faced during breastfeeding were identified. PD is based on the observation that in every community For example, one of the problems which emerged out there are certain individuals or groups whose uncommon after content analysis of focus group discussion was that behaviors and strategies enable them to find better solutions several mothers do not get privacy at their homes. One to problems than their peers, while having access to the of the mothers told us that she used to hide her chest [10,11] same resources and facing similar or worse challenges. and the baby’s body with her “chunni” to overcome this However, the approach has important limitations. It can problem. Another mother told us that she will face the wall only be used to change behavior – not, for example, as of the room and breastfeed her child. These mothers were a substitute for government aid or vaccines. It requires a identified as positive deviants and were separated during high degree of motivation and commitment. Moreover, it the process of data collection. A total of eight positive is by definition restricted to what is already being done; it deviants were found in the study area. [12‑16] excludes brilliant strategies that nobody has tried. Positive deviant mothers were called to the nearby health center and were trained for 2 days by the chief investigator Methodology on various aspects of breastfeeding such as latching This study was conducted to assess the effect of PD technique, duration, and benefits of colostrum with the approach on knowledge about EBF among the study help of a flip chart. Positive deviants were encouraged and participants. motivated to share their knowledge and talk about their deviant behaviors to others so that others can also practice It was conducted in the field practice area under Rural those behaviors to overcome the obstacles confronted Health Training Centre attached to the Department of in their day‑to‑day