Learning Objective #1: Define steps of the Positive Deviance Approach

Learning Objective #2: Describe useful strategies to improve healthy eating behaviors during pregnancy

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The purpose of this study is to apply positive deviance methodology to answer the study question "How do some low-income pregnant women who seek services of a WIC clinic eat healthy meals while others do not?" The positive deviance approach seeks to optimize existing resources within the community rather than applying external strategies to solve community problems by identifying individuals who demonstrate exceptional behaviors or practices, i.e. "positive deviants", that enable them to get better results than others within the same environment and share their successful strategies leading to positive change within the community. An exploratory design incorporating quantitative assessments of psychosocial variables and focus group interviews was conducted with low-income pregnant women, at least 18 years of age and English-speaking. Prior to the group interview, participants completed measures of depression, stress, self-esteem, social support and knowledge of the food pyramid and a 24-hour dietary recall to assess healthy eating. Four out of 18 women had healthy eating behaviors. No significant difference was noted between women with healthy and unhealthy eating behaviors on any of the psychological assessments. Analysis of the qualitative data revealed that women with healthy eating behaviors had increased awareness of the need for balanced meals, ate foods that met the nutritional requirements of pregnancy, ate more meals at home, and were more willing to prepare meals that may differ from the desires of other household members, whereas women with unhealthy eating behaviors desired others to purchase and prepare their foods. Further research is needed to identify methods that encourage pregnant women to purchase and prepare healthy meals. The positive deviance approach can guide the development of useful nutritional interventions that incorporate community-specific solutions designed to improve the nutritional status in pregnant women.