By Kyser Lough
Population Health Scholar
University of Texas System
PhD Student in Journalism
UT Austin Moody College of Communication
Much of health research begins with the question: “what’s the problem?” For Dr. Arvind Singhal, however, sometimes reframing the question can inspire a whole new way of thinking. Singhal, Marston Endowed Professor of Communication and Director of the Social Justice Initiative at the University of Texas at El Paso, promotes the use of an approach called positive deviance (PD), which asks instead: “What IS working, especially among those for whom it shouldn’t be?”
Singhal was trained as a traditional social scientist, meaning he learned traditional gap-analysis framework of studying problems. You find what’s not working—the needs, deficits and gaps—and then use your skills and expertise to creatively fill the gaps. But that’s not, he says, the only way of approaching problems.
“A positive deviance approach begins with a focus on what’s working and with the assets instead. You look for what's working among the most disadvantaged. Look for what’s working amongst the poorest of the poor. Look for what’s working with those whom you least expect would be in a position to make it work,” he said.
By taking this approach, one is able to find the “positive deviants,” the people within the population who have resiliently defied the odds to solve a problem.
“Somebody already figured out the territory. Somebody figured out the path, and if we follow that trail, the answers are there,” Singhal said. “For us—experts—to acknowledge that someone whom we least expect to solve the problem has solved it and we can learn from them, is a statement of deep humility.”
Approaching a problem by looking for those who have overcome it can be a starting point for many types of projects, and Singhal has taught, written and spoken about this technique since 2004, when he first learned about positive deviance. He teaches the only full-length semester-long course on the positive deviance approach in the world at UTEP, and three of his 13 published books are oriented around the positive deviance approach, including two on the reduction of hospital-acquired infections in the U.S. and Colombia. His key learning: the easiest way to get started on positive deviance is to shift the thought process when beginning a project, and make it a habit to always look for those who have succeeded against all odds.
Singhal has used the positive deviance approach to address complex social problems in many sectors, but has especially seen success in the field of health. In the El Paso region in which he operates, he’s guided several health-related positive deviance projects. Working with graduate student Claudia Boyd, for instance, he looked at Hispanic men over 40 at high risk for diabetes. Their first question was: “Who in this population is managing their diabetes well and why?” They found that the positive deviants openly self-disclosed their diabetic status to their family and friends, spurring an ethic of care around them.
With another graduate student, Alexandra Diaz, he looked at the rate of teenage pregnancy in the area, which is one of the highest in the state, and in particular at pregnancy in young Latina women with a mother or sister who became pregnant when they were a teen. They found that mothers of the positive deviants, the young women who themselves didn’t get pregnant, focused more on positive messages about wise choices, for instance around the importance of finishing school, than on negative messages about the costs of teenage pregnancy.
In Billings, Montana, he studied the application of the positive deviance approach to a clinic that wanted to lower healthcare-associated infections by finding those within the system who were already minimizing such infections on their own turf within the clinic. Using this approach, they found constructive strategies for lowering infection among not just doctors and nursing staff, but also patients, chaplains, and housekeepers. They used them to formulate new solutions for the entire clinic. Hospital-acquired infections dropped sharply.
“I think there's a tremendous hunger for people to find strategies, research approaches, that, to quote Abraham Lincoln, ‘speak to our better angels,”’ he said. “Positive deviance does that because it fundamentally believes that there are people whom you least expect who, against all odds in highly difficult situations, have solved a problem. And by its very definition then, it means that if they could solve the problem, others there could as well.”
5 Tips to Using a Positive Deviance Approach
1. Believe the wisdom to solve a problem already exists!
2. Ask a counterintuitive question: what is working, and especially for those who are resource poor—the unusual suspects?
3. Value data, especially outliers!
4. Be patient—go fast by going slow. Build relationships, invite, engage, and involve all concerned. When the work is done they will say they did it themselves.
5. Be ready to be surprised! The solutions to very complex problems are unabashedly simple.