Behavior Change

Tools and Approaches

First Households (Hearth Model)

The concept of positive deviance has been applied in nutrition programs since the 1960s. The basic approach is to identify mothers who, while typically poor, are feeding, caring for, and/or seeking health care for their children in more effective ways than others in the community. By studying these mothers or families, researchers can learn the creative ways in which some people have managed to do "the impossible", (found inexpensive ways of feeding their children nutritious food). (See also Positive Deviance.) The "model" community members can then be involved in teaching others these positive practices.

The approach is appropriate in situations where a majority of families do not require additional food or income to make small improvements in nutrition and/or caring practices. NGO and government programs can use the approach effectively when they are willing to devolve some control to communities.

The Hearth Model is a community-based approach to reducing malnutrition. It was developed as an alternative to nutrition rehabilitation centers that had some success in rehabilitating malnourished children. However, the children too often went back to an unchanged home environment and reverted to malnutrition. The program links mothers of well nourished children with mothers of poorly nourished children in their community. For example, mothers (and/or minimally compensated program workers) might go to the homes of malnourished children and prepare meals jointly with the mothers. Over time, women gain knowledge, skills, and confidence that they too can do something that makes their children visibly healthier. These activities are often linked with a community growth monitoring and promotion program.

In Vietnam, Save the Children used this model to reduce second and third degree malnutrition by 80 percent among tens of thousands of children under three years of age. Caretakers were able to sustain the enhanced nutritional status of these children as long as two years beyond their participation in the program. Younger siblings and other children in the community born after the program ended enjoyed the same enhanced nutritional status.

The Hearth Model has been used mostly by NGOs, starting with Save the Children in Vietnam and by Save and others in Haiti, Bangladesh, and elsewhere. The model has been implemented under safe motherhood, early childhood development, and water and sanitation programs. Save the Children has recently produced Designing a Community-Based Nutrition Program Using the Hearth Model and the Positive Deviance Approach - A Field Guide.