The positive deviance/hearth approach to reducing child malnutrition: systematic review

Trop Med Int Health. 2011 Nov;16(11):1354-66. doi: 10.1111/j.1365-3156.2011.02839.x. Epub 2011 Jul 12.


Objectives: The Positive Deviance/Hearth approach aims to rehabilitate malnourished children using practices from mothers in the community who have well-nourished children despite living in poverty. This study assesses its effectiveness in a range of settings.

Methods: Systematic review of peer reviewed intervention trials and grey literature evaluation reports of child malnutrition programs using the Positive Deviance/Hearth approach.

Results: Ten peer reviewed studies and 14 grey literature reports met the inclusion criteria. These described results for 17 unique Positive Deviance/Hearth programs in 12 countries. Nine programs used a pre- and post-test design without a control, which limited the conclusions that could be drawn. Eight used more robust designs such as non-randomized trials, non-randomized cross-sectional sibling studies and randomized controlled trials (RCTs). Of the eight programs that reported nutritional outcomes, five reported some type of positive result in terms of nutritional status - although the improvement was not always as large as predicted, or across the entire target population. Both the two RCTs demonstrated improvements in carer feeding practices. Qualitative results unanimously reported high levels of satisfaction from participants and recipient communities.

Conclusions: Overall this study shows mixed results in terms of program effectiveness, although some Positive Deviance/Hearth programs have clearly been successful in particular settings. Sibling studies suggest that the Positive Deviance/Hearth approach may have a role in preventing malnutrition, not just rehabilitation. Further research is needed using more robust study designs and larger sample sizes. Issues related to community participation and consistency in reporting results need to be addressed.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Child
  • Child Nutrition Disorders / epidemiology
  • Child Nutrition Disorders / prevention & control*
  • Health Knowledge, Attitudes, Practice
  • Health Promotion*
  • Humans
  • Mothers / education*
  • Program Evaluation
  • Randomized Controlled Trials as Topic