If I told you that 97 percent of SLU students majoring in electrical engineering (E.E.) get less than 6 hours of sleep per night, what questions would you ask me? Maybe you would ask, “How do the sleeping habits of electrical engineering majors compare to those of other students? Or, “What behaviors do 97% of E.E. students share that might lead to their collectively poor sleep hygiene?”
Answering these questions would teach you what does not work for these students. You could show a connection, not a causal relationship mind you, between sleeping less and following the typical electrical engineering student’s study, work, and sleep schedule.
How much would this information help? Might we be able to look at the number and the information it provides from a more productive angle?
This article suggests that we could.
Why not see what the 3% of students who get more than 6 hours of sleep per night can teach us? Could we find some lifestyle factor that those three percent who are sleeping more than the majority of their classmates share? If so, we would have one or two ideas for what does work instead of a cluster of information about what fails.
An ounce of prevention is worth a pound of cure. That statement is trite. We already know public health is all about prevention.
What about this idea: A teaspoon of “Yes” is worth a gallon of “No”?
Discovering what already works and figuring out why it is effective is much better than compiling a list of beautiful theories that crumbled under the contextual forces that exist outside of theoretical vacuum. I’m not saying failed experiments are useless. Failure is an excellent teacher. However, public health experts often choose to capitalize on already present successes instead of trudging through the default try-and-fail swamp (see study). This approach looks at Positive Deviants. Positive Deviants are individuals who "differ in a healthy direction from the normative (and less healthy) outcome of their neighbors in the same milieu" (Walker, 2007).
Although it was not until the early 1990s that public health experts at Tufts University formalized this approach (history of Positive Deviance), it is not a new idea. Think back to the development of the small pox vaccine. Edward Jenner looked at the minority of individuals who did not contract small pox—the milk maids—in a community full of individuals who did. He asked a question: What do these women have that everyone else in this town lacks? His answer—cow pox—eventually resulted in the eradication of small pox. (Source).
What do you foresee as limitations to the Positive Deviance approach? Can you think of recent or historic public health successes that took advantage of Positive Deviance research?
If this concept interests you, look into these two books:
I really like this idea of 'Positive Deviance', because it takes a whole new approach to Public Health. It incorporates a completely different way of thinking, which is critical to the advancement of Public Health. People who can think in unoriginal and unique ways are the ones who will shed light on the field and develop new techniques to better our communities.
ReplyDeleteHere is one approach using Positive Deviance that I found:
The 'Positive Deviance' (PD) approach was first utilized in programming by Jerry and Monique Sternin through their work with Save the Children in Vietnam in the 1990s (Tuhus-Dubrow, Sternin, Sternin & Pascale). During their initial studies, they found that 64% of children weighed in the pilot villages were malnourished. Using PD, they discovered that there were a few, select families, who using uncommon but successful strategies, had well-nourished children. These families were collecting foods typically considered inappropriate for children (sweet potato greens, shrimp, and crabs) washed their children’s hands before meals, and actively fed them three to four times a day instead of the typical two meals a day provided to children.
Jerry and Monique Sternin used this discovery to implement nutritional programs about protein, iron, and calcium, within the community. Furthermore, instead of simply telling participants what to do differently, they designed the program to help them act their way into a new way of thinking. To attend a feeding session, parents were required to bring one of the newly identified foods. They brought their children and while sharing nutritious meals, learned to cook the new foods.
By the end of two years, malnutrition fell by 85%. The programs were very successful. I believe that we, as Public Health students, should study and learn to explore the use of PD, because it initiates out-of-the-box thinking that is vital to the survival and success of Public Health, and it turns out (as seen in this example), that there are other indirect ways besides looking at the problem head-on, that can help us understand health disparities and solve them using simpler and more efficient techniques.
I think that's also a really interesting concept. I mean society at large is defined by negative deviance. We only deviate from our normal schedules if we feel a negative deviance. That is to say for example, we only go to the doctor if we feel sick; we only exercise if we feel unhealthy/fat/out-of-shape, etc. But to take a look at the positive deviance would be very interesting. In the two examples above the positive deviance might relate to scheduling a routine check-up or to routine daily exercise in order to maintain a healthy physique.
ReplyDeleteMy qualms in looking a the positive deviance, would be that in the studies today (since they only focus on the negative deviance) the positive deviance would be so small a sample size as to be non-representative. But I definitely think this is an interesting methodology and an smart way to take a new look at data. Amazing that something so simple as looking at the positive deviance is considered this revolutionary.
Kelsi, you make an interesting point about the small sample size of positive deviants. If we are looking at outliers how can we generalize their results to the entire population? The assumption in looking at positive deviants is that some behavior or factor in which they engage, not mere chance, alows them to live against the current.
ReplyDeleteSo the question is: What if someone deviates in the positive direction by mere chance? Closely analyzing positive deviants to discover potential causative factors and applying those factors to a larger sample size for research would answer that question.
Even when we discover a connection between a behavior and an individual's seeming immunity to what is endemic to his or her community, we have to ask if it would be reasonable to expect others to engage in that behavior. It might be that a person goes against the norm because that individual is extraordinary.
In terms of the sampling size being a problem for using positive defiance as an example, it seems like the main benefit of a positive deviant would be seeing the effect that their differences in behavior caused, and then using this information to create a study examining the behavior with a larger study pool.
ReplyDeleteLooking at the specific example discussed of those students who receive more than six hours of sleep, I am one of those students who not only gets six hours, but religiously gets eight. In this sense, I am a positive deviant, but I don't think that it is, as Sara mentioned, entirely reasonable to assume that everyone can learn from the different individual and change their behavior. I get so much sleep because I have always been a morning person, so I get all of my work done in the afternoons or mornings and go to bed early to accommodate this. However, getting up early isn't something that most college students would be open to doing. In other cases though, a positive deviant can be different through something that doesn't even require a significant behavior change, such as the milkmaid exposure to smallpox. I think that this in combination with a large study is the most effective way to utilize positive deviants.