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Kostyun RO, Hackett A, Lucchio P, Witmer DK, Solomito MJ. Positive Deviance and Exploring the Role of Mental Health on Early Postoperative Recovery After Total Hip Arthroplasty: A Retrospective Analysis Using the PROMIS-10 Global Health. J Am Acad Orthop Surg 2024:00124635-990000000-00976. [PMID: 38739867 DOI: 10.5435/jaaos-d-23-01230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/29/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Mental illnesses are well-known factors that contribute to poor outcomes among total hip arthroplasty (THA) patients. However, a dichotomized mental illness diagnosis may not reflect the complex biopsychosocial factors contributing to a patient's health. Investigating patients who achieve positive outcomes despite having risk factors, known as positive deviants, may help identify protective characteristics and decrease health disparities among this growing population of patients. Using preoperative Mental Health T-scores (MHT) from the PROMIS-10 Global Health questionnaire among patients with a mental illness diagnosis, the purpose of this study was to explore whether patients with above-average MHT, or positive deviants, experienced a different immediate postoperative recovery path compared with patients with below-average MHT. METHODS This was a retrospective chart review of patients undergoing elective primary THA. Patients with a formal diagnosis of a mental health condition were divided based on their MHT (above average [AA] >50, average [A] 40 to 50, below average [BA] <40). Postsurgical parameters included total opioid consumption, self-reported pain scores, and discharge disposition. RESULTS A total of 299 patients were analyzed. After controlling for length of stay and type of mental illness, patients in the AA-MHT and A-MHT groups used 33.8 and 29.8 morphine milligram equivalents less than patients in the BA-MHT group during the inpatient stay, respectively. Patients in the AA-MHT group reported a 1.0 lower pain with activity score at discharge compared with patients in the BA-MHT group. DISCUSSION The intersection between patients with a mental illness in need of a THA is becoming more commonplace. Data suggest that patients with a mental illness who report AA-MHT on the PROMIS-10 Global Health questionnaire may represent positive deviants or those with a more positive in-hospital recovery path compared with those patients with BA-MHT. LEVEL OF EVIDENCE Diagnostic study-retrospective cohort study.
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Affiliation(s)
- Regina O Kostyun
- From the Hartford Hospital's Bone and Joint Institute, Hartford, CT (Kostyun, Lucchio, Witmer, and Solomito), the University of Connecticut School of Medicine, Farmington, CT (Hackett), and the Orthopedic Associates of Hartford, Hartford, CT (Witmer)
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Safarabadi M, Motallebirad T, Azadi D, Jadidi A. Healthcare-associated infections in Iranian pediatric and adult intensive care units: A comprehensive review of risk factors, etiology, molecular epidemiology, antimicrobial sensitivity, and prevention strategies during the COVID-19 pandemic. J Intensive Care Med 2024:8850666241249162. [PMID: 38711296 DOI: 10.1177/08850666241249162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
The current review article provides a comprehensive analysis of nosocomial infections in pediatric and adult intensive care units (ICUs) in Iran. We examine the risk factors and etiology of nosocomial infections, with a particular focus on molecular epidemiology and antimicrobial sensitivity. In this article, we explore a range of prevention strategies, including hand hygiene, personal protective equipment, environmental cleaning, antibiotic stewardship, education, and training. Moreover, we discuss the impact of the COVID-19 pandemic on infection control measures in ICUs and provide valuable insights for healthcare professionals and policymakers seeking to address this critical public health issue. In conclusion, this review article can serve as a valuable resource for those interested in understanding and improving infection control in ICUs and beyond.
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Affiliation(s)
- Mehdi Safarabadi
- Department of Nursing, Khomein University of Medical Sciences, Khomein, Iran
| | - Tahereh Motallebirad
- Department of Research and Development, Satras Biotechnology Company, Islamic Azad University of Khomein, Khomein, Iran
| | - Davood Azadi
- Department of Research and Development, Satras Biotechnology Company, Islamic Azad University of Khomein, Khomein, Iran
- Department of Biology, Faculty of Basic Sciences, Lorestan University, Khorramabad, Iran
| | - Ali Jadidi
- School of Nursing, Arak University of Medical Sciences, Arak, Iran
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Kassie AM, Eakin E, Abate BB, Endalamaw A, Zewdie A, Wolka E, Assefa Y. The use of positive deviance approach to improve health service delivery and quality of care: a scoping review. BMC Health Serv Res 2024; 24:438. [PMID: 38589897 PMCID: PMC11003118 DOI: 10.1186/s12913-024-10850-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/11/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Quality has been a persistent challenge in the healthcare system, particularly in resource-limited settings. As a result, the utilization of innovative approaches is required to help countries in their efforts to enhance the quality of healthcare. The positive deviance (PD) approach is an innovative approach that can be utilized to improve healthcare quality. The approach assumes that solutions to problems are already available within the community and identifying and sharing those solutions can help others to resolve existing issues. Therefore, this scoping review aimed to synthesize the evidence regarding the use of the PD approach in healthcare system service delivery and quality improvement programs. METHODS Articles were retrieved from six international databases. The last date for article search was June 02, 2023, and no date restriction was applied. All articles were assessed for inclusion through a title and/or abstract read. Then, articles that passed the title and abstract review were screened by reading their full texts. In case of duplication, only the full-text published articles were retained. A descriptive mapping and evidence synthesis was done to present data with the guide of the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews checklist and the results are presented in text, table, and figure formats. RESULTS A total of 125 articles were included in this scoping review. More than half, 66 (52.8%), of the articles were from the United States, 11(8.8%) from multinational studies, 10 (8%) from Canada, 8 (6.4%) from the United Kingdom and the remaining, 30 (24%) are from other nations around the world. The scoping review indicates that several types of study designs can be applied in utilizing the PD approach for healthcare service and quality improvement programs. However, although validated performance measures are utilized to identify positive deviants (PDs) in many of the articles, some of the selection criteria utilized by authors lack clarity and are subject to potential bias. In addition, several limitations have been mentioned in the articles including issues in operationalizing PD, focus on leaders and senior managers and limited staff involvement, bias, lack of comparison, limited setting, and issues in generalizability/transferability of results from prospects perspective. Nevertheless, the limitations identified are potentially manageable and can be contextually resolved depending on the nature of the study. Furthermore, PD has been successfully employed in healthcare service and quality improvement programs including in increasing surgical care quality, hand hygiene practice, and reducing healthcare-associated infections. CONCLUSION The scoping review findings have indicated that healthcare systems have been able to enhance quality, reduce errors, and improve patient outcomes by identifying lessons from those who exhibit exceptional practices and implementing successful strategies in their practice. All the outcomes of PD-based research, however, are dependent on the first step of identifying true PDs. Hence, it is critical that PDs are identified using objective and validated measures of performance as failure to identify true PDs can subsequently lead to failure in identifying best practices for learning and dissemination to other contextually similar settings.
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Affiliation(s)
- Ayelign Mengesha Kassie
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
- School of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia.
| | - Elizabeth Eakin
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Biruk Beletew Abate
- School of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Aklilu Endalamaw
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Anteneh Zewdie
- International Institute for Primary Health Care, Ethiopia, Addis Ababa, Ethiopia
| | - Eskinder Wolka
- International Institute for Primary Health Care, Ethiopia, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Langford BJ, Branch-Elliman W, Nori P, Marra AR, Bearman G. Confronting the Disruption of the Infectious Diseases Workforce by Artificial Intelligence: What This Means for Us and What We Can Do About It. Open Forum Infect Dis 2024; 11:ofae053. [PMID: 38434616 PMCID: PMC10906702 DOI: 10.1093/ofid/ofae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/26/2024] [Indexed: 03/05/2024] Open
Abstract
With the rapid advancement of artificial intelligence (AI), the field of infectious diseases (ID) faces both innovation and disruption. AI and its subfields including machine learning, deep learning, and large language models can support ID clinicians' decision making and streamline their workflow. AI models may help ensure earlier detection of disease, more personalized empiric treatment recommendations, and allocation of human resources to support higher-yield antimicrobial stewardship and infection prevention strategies. AI is unlikely to replace the role of ID experts, but could instead augment it. However, its limitations will need to be carefully addressed and mitigated to ensure safe and effective implementation. ID experts can be engaged in AI implementation by participating in training and education, identifying use cases for AI to help improve patient care, designing, validating and evaluating algorithms, and continuing to advocate for their vital role in patient care.
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Affiliation(s)
- Bradley J Langford
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Hotel Dieu Shaver Health and Rehabilitation Centre, Department of Pharmacy, St Catharines, Ontario, Canada
| | - Westyn Branch-Elliman
- Department of Medicine, Section of Infectious Diseases, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- National Artificial Intelligence Institute, Department of Veterans Affairs, Washington, District of Columbia, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Priya Nori
- Division of Infectious Diseases, Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Alexandre R Marra
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Gonzalo Bearman
- Division of Infectious Diseases, Virginia Commonwealth University Health, Virginia Commonwealth University, Richmond, Virginia, USA
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Kassie AM, Eakin E, Abate BB, Endalamaw A, Zewdie A, Wolka E, Assefa Y. Use of the positive deviance approach for healthcare system service improvement: a scoping review protocol. BMJ Open 2023; 13:e078809. [PMID: 38101832 PMCID: PMC10728976 DOI: 10.1136/bmjopen-2023-078809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Healthcare systems are currently facing challenges in enhancing access and improving the quality of healthcare services around the world, and one of the innovative strategies that have been used to address such challenges is the positive deviance (PD) approach. The approach assumes that identifying, examining, understanding and disseminating solutions to problems that are already available within the community and organisations including the healthcare system can help in bringing improvements at scale. However, to the best of the researcher's knowledge, there is no scoping review, that is, conducted to map and synthesise the available evidence on the use of the PD approach for healthcare system service improvements. Hence, this scoping review aims to map and synthesise resources on the methodologies and reported outcomes and identify gaps and potentials regarding the use of the PD approach in the healthcare system. METHODS AND ANALYSIS Articles will be searched and retrieved in research databases such as PubMed, Embase and Scopus. Retrieved articles will be screened independently for inclusion through a title and, or abstract review. Then, articles that passed the title and abstract review will be screened by reading the full texts. A descriptive mapping and synthesis of the literature will be employed to present data using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews checklist and data will be presented in text, figure and table formats. ETHICS AND DISSEMINATION The results of this scoping review will be published in peer-reviewed reputable international journals. Furthermore, it will also be disseminated through conference presentations, and popular press to the wider community. However, formal ethical approval is not required as primary data will not be collected.
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Affiliation(s)
- Ayelign Mengesha Kassie
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- School of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Elizabeth Eakin
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Biruk Beletew Abate
- School of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Aklilu Endalamaw
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Anteneh Zewdie
- International Institute for Primary Health Care, Addis Ababa, Ethiopia
| | - Eskinder Wolka
- International Institute for Primary Health Care, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Bearman G, Nori P. Implementing behavior change in healthcare epidemiology and antimicrobial stewardship: The worst that can happen is you fail. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e129. [PMID: 37592962 PMCID: PMC10428149 DOI: 10.1017/ash.2023.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 08/19/2023]
Affiliation(s)
- Gonzalo Bearman
- Division of Infectious Diseases, Virginia Commonwealth University Health, Richmond, VA
| | - Priya Nori
- Division of Infectious Diseases, Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, NY
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Cohen R, Gesser-Edelsburg A, Singhal A, Benenson S, Moses AE. Translating a theory-based positive deviance approach into an applied tool: Mitigating barriers among health professionals (HPs) regarding infection prevention and control (IPC) guidelines. PLoS One 2022; 17:e0269124. [PMID: 35657940 PMCID: PMC9165831 DOI: 10.1371/journal.pone.0269124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Although a wide range of intervention programs and methods have been implemented to increase health professionals’ (HPs) adherence with infection prevention and control (IPC) guidelines and decrease the incidence of healthcare associated infections (HAIs), a significant discrepancy remains between the guidelines and their implementation in practice.
Objectives
This study proposes an applied tool based on the integrated theoretical framework of the positive deviance (PD) approach for developing more effective interventions to mitigate this discrepancy.
Methods
A qualitative study guided by the PD approach based on data from two sources: (1) in-depth archival analysis of systematic review articles, and (2) integration and synthesis of findings based on an extensive empirical study we conducted, involving 250 HPs (nurses, physicians, support staff and cleaning staff) from three governmental hospitals in Israel, over 35 months (January 2017 to November 2020).
Results
The barriers faced by HPs were classified into four main categories: (1) individual-motivational, (2) social-cultural, (3) organizational, and (4) work environment and resource-centered. For each barrier, we constructed a set of questions based on the PD approach. For each question, we adapted and applied methodological tools (e.g., in-depth interviews, focus groups, social network maps, video clips and simulations) to help solve the problem.
Conclusion
Translating a theory-based approach into an applied tool that offers step-by-step actions can help researchers and practitioners adopt and implement the approach within intervention programs to mitigate barriers.
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Affiliation(s)
- Ricky Cohen
- School of Public Health, University of Haifa, Haifa, Israel
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
- * E-mail:
| | - Anat Gesser-Edelsburg
- School of Public Health, University of Haifa, Haifa, Israel
- The Health and Risk Communication Research Center, University of Haifa, Haifa, Israel
| | - Arvind Singhal
- Department of Communication, The University of Texas at El Paso, El Paso, Texas, United States of America
- School of Business and Social Sciences, Inland University of Applied Sciences, Hamar, Norway
| | - Shmuel Benenson
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Ein-Kerem, Jerusalem, Israel
| | - Allon E. Moses
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Ein-Kerem, Jerusalem, Israel
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O'Malley R, O'Connor P, Madden C, Lydon S. A systematic review of the use of positive deviance approaches in primary care. Fam Pract 2022; 39:493-503. [PMID: 34849733 DOI: 10.1093/fampra/cmab152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Positive Deviance (PD) approach focuses on identifying and learning from those who demonstrate exceptional performance despite facing similar resource constraints to others. Recently, it has been embraced to improve the quality of patient care in a variety of healthcare domains. PD may offer one means of enacting effective quality improvement in primary care. OBJECTIVE(S) This review aimed to synthesize the extant research on applications of the PD approach in primary care. METHODS Seven electronic databases were searched; MEDLINE, CINAHL, Embase, PsycINFO, Academic Search Complete, Psychology and Behavioral Sciences Collection, and Web of Science. Studies reporting original data on applications of the PD approach, as described by the PD framework, in primary care were included, and data extracted. Thematic analysis was used to classify positively deviant factors and to develop a conceptual framework. Methodological quality was appraised using the Quality Assessment with Diverse Studies (QuADS). RESULTS In total, 27 studies were included in the review. Studies most frequently addressed Stages 1 and 2 of the PD framework, and targeted 5 core features of primary care; effectiveness, chronic disease management, preventative care, prescribing behaviour, and health promotion. In total, 268 factors characteristic of exceptional care were identified and synthesized into a framework of 37 themes across 7 system levels. CONCLUSION Several useful factors associated with exceptional care were described in the literature. The proposed framework has implications for understanding and disseminating best care practice in primary care. Further refinement of the framework is required before its widespread recommendation.
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Affiliation(s)
- Roisin O'Malley
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
| | - Paul O'Connor
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
| | - Caoimhe Madden
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
| | - Sinéad Lydon
- School of Medicine, National University of Ireland Galway, Galway, Ireland
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Cioban S, Lazăr AR, Bacter C, Hatos A. Adolescent Deviance and Cyber-Deviance. A Systematic Literature Review. Front Psychol 2021; 12:748006. [PMID: 34712188 PMCID: PMC8546304 DOI: 10.3389/fpsyg.2021.748006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/09/2021] [Indexed: 11/13/2022] Open
Abstract
Deviance is a complex phenomenon that influences aspects both at the macro and micro levels, extensively studied by social scientists The main objective of this article was to conduct a systematic literature review for clustering the topics on adolescent deviance and online deviance. Grounded in Pickering's and Byrne's guidelines and PRISMA protocol, we identified the most recurrent themes, theories and predictors in the 61 most-cited articles related to the concept of deviance from the database of Web of Science, as well as in 488 abstracts of representative papers. The results emphasized four main clusters of topics, namely, predictors of deviance, online deviance, socio-constructivist theories, and research based theories of deviant behavior. The findings highlighted that researchers frequently use strain theory, social learning, self-control, and social control theories in their studies. Our systematic literature review revealed also the most encountered predictors of deviance, which we have classified into five main categories: family patterns, socio-demographic aspects, socialization, victimization, and school and individual factors. For online deviance, family patterns, socio-demographic aspects, victimization, school and individual factors, and Internet and computer use have been determined to be the main groups of predictors. The present systematic literature review makes an important contribution to the understanding of deviance by presenting an overview of the phenomenon.
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Affiliation(s)
- Smaranda Cioban
- Faculty of Social Humanistic Studies, Doctoral School of Sociology, University of Oradea, Oradea, Romania
| | - Adela Răzvana Lazăr
- Faculty of Social Humanistic Studies, Psychology Department, University of Oradea, Oradea, Romania
| | - Claudia Bacter
- Faculty of Social Humanistic Studies, Doctoral School of Sociology, University of Oradea, Oradea, Romania
| | - Adrian Hatos
- Faculty of Social Humanistic Studies, Doctoral School of Sociology, University of Oradea, Oradea, Romania
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Data-Powered Positive Deviance during the SARS-CoV-2 Pandemic-An Ecological Pilot Study of German Districts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189765. [PMID: 34574701 PMCID: PMC8469362 DOI: 10.3390/ijerph18189765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/09/2021] [Accepted: 09/11/2021] [Indexed: 11/16/2022]
Abstract
We introduced the mixed-methods Data-Powered Positive Deviance (DPPD) framework as a potential addition to the set of tools used to search for effective response strategies against the SARS-CoV-2 pandemic. For this purpose, we conducted a DPPD study in the context of the early stages of the German SARS-CoV-2 pandemic. We used a framework of scalable quantitative methods to identify positively deviant German districts that is novel in the scientific literature on DPPD, and subsequently employed qualitative methods to identify factors that might have contributed to their comparatively successful reduction of the forward transmission rate. Our qualitative analysis suggests that quick, proactive, decisive, and flexible/pragmatic actions, the willingness to take risks and deviate from standard procedures, good information flows both in terms of data collection and public communication, alongside the utilization of social network effects were deemed highly important by the interviewed districts. Our study design with its small qualitative sample constitutes an exploratory and illustrative effort and hence does not allow for a clear causal link to be established. Thus, the results cannot necessarily be extrapolated to other districts as is. However, the findings indicate areas for further research to assess these strategies' effectiveness in a broader study setting. We conclude by stressing DPPD's strengths regarding replicability, scalability, adaptability, as well as its focus on local solutions, which make it a promising framework to be applied in various contexts, e.g., in the context of the Global South.
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