St Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa 22728/1000, Ethiopia.
Faculty of Medicine, University of Oslo, 1078 Oslo, Norway.
Int J Environ Res Public Health. 2020 Mar 5;17(5):1712. doi: 10.3390/ijerph17051712.
Risk factor approaches are often used when implementing programs aimed at enforcing advantageous health care behaviors. A less frequently-used strategy is to identify and capitalize on those who, despite risk factors, exhibit positive behaviors. The aim of our study was to identify positive deviant (PD) mothers for the uptake of skilled maternal services and to explore their characteristics. Data for the study came from two waves of the Ethiopian Demographic and Health Surveys conducted in 2011 and in 2016. PD mothers were defined as those reporting no formal education but with adequate use of antenatal care (ANC) and/or institutional delivery services. Two-level multilevel regression analysis was used to analyze the data. Factors associated with PD for the use of ANC services were: partner's education status, involvement in household decision making, exposure to media, and distance to the health facility. Factors associated with PD for health facility delivery were: partner's education, woman's employment status, ANC visit during index pregnancy, exposure to media, and perceived challenge to reach health facility. Rural-urban and time-related differences were also identified. The positive deviance approach provides a means for local policy makers and program managers to identify factors facilitating improved health behaviour and ultimately better health outcomes while acknowledging adverse risk profiles.
风险因素方法常用于实施旨在强化有利健康行为的项目。一种不太常用的策略是识别和利用那些尽管存在风险因素，但表现出积极行为的人。我们的研究旨在确定积极偏差（PD）母亲以接受熟练的产妇服务，并探索其特征。本研究的数据来自于 2011 年和 2016 年进行的两次埃塞俄比亚人口与健康调查。PD 母亲被定义为那些没有正规教育但充分利用产前护理（ANC）和/或机构分娩服务的人。使用两级多层回归分析来分析数据。与使用 ANC 服务的 PD 相关的因素包括：伴侣的教育状况、参与家庭决策、接触媒体以及到医疗机构的距离。与医疗机构分娩的 PD 相关的因素包括：伴侣的教育、妇女的就业状况、指数妊娠期间的 ANC 访问、接触媒体以及认为难以到达医疗机构。还确定了城乡和时间相关的差异。积极偏差方法为地方政策制定者和项目管理者提供了一种手段，可识别促进改善健康行为的因素，并最终改善健康结果，同时承认不利的风险状况。
