Project HOPE

Positive Deviance: Locating High-risk, Healthy Families and Discovering Protective Strategies

Funded by Charles Heidelberger Pre-doctoral Scholarship Award in Cancer Research

(Tate, PI)

In the United States, approximately 1 in 6 children between 2 – 17 years are obese. Poor nutrition and lack of physical activity are main risk factors, and parents can play a key role in helping kids get the food and exercise they need. However, low-income families may face greater barriers to meeting health guidelines, such as limited transportation to grocery stores, high-cost food, and unsafe neighborhood parks. Although these challenges can be difficult to overcome, some families may have developed effective strategies to circumvent problems and provide their kids with a variety of fruits and vegetables, plenty of physical activity, and limited sugar-sweetened beverages.

“Positive deviance” is an approach based on locating members of a community who use unique strategies to overcome typical risk factors – or “uncommon strategies for common problems” ( In the 1990s, Marian Zeitlin, a professor at Tufts University originated the idea, and Jerry Sternin, a visiting scholar at Tufts, and his wife Monique put the idea to work with malnourished children in Vietnam. The success of the real-world experience has been backed by evidence from randomized controlled trials investigating positive deviance on improving child nutritional status and child-feeding behavior in malnourished children. However, no published research has yet investigated whether the approach would be useful for investigating child obesity prevention or treatment.

Project HOPE was based on the principals of positive deviance, though it is not strictly a positive deviance approach. A sample of low-income mothers from inner-city Los Angeles were recruited for the study. Mothers whose children met federal guidelines for fruit/vegetable intake, physical activity, and who have low sugar-sweetened beverage consumption were recruited (n = 24) as well as mothers whose children do not (n = 24). Study participants were interviewed for 30 – 60 minutes about their perceptions and behaviors regarding their child’s overall health, weight, diet, and physical activity. The specific aims were: (1) to investigate cognitive, affective and behavioral perceptions of barriers of low-income residents by obtaining in-depth descriptions and comparing those who are positive deviants (whose children meet diet and physical activity guidelines) to those who are not and (2) to examine differences between the positive deviance and non-positive deviance strategies, comparing those who meet guidelines to those who do not. Results of this exploratory study was shared with community members and study participants themselves. In addition, findings increased our understanding of the basic processes influencing these child health behaviors in low-income families, as well as informed program designers of these uncommon, sustainable, successful strategies. Finally, study results built the foundation for future research, policy development, and obesity prevention program design.