Master of Arts / Department of Sociology, Anthropology, and Social Work / L. Susan Williams / This study builds on a small but growing field of scholarship, arguing that certain nonnormative behavior is also non-negative, a concept referred to as positive deviance. This thesis examines positive behaviors, in the form of altruism, in the top 10 box-office animated movies of all time. Historically, studies focusing on negative, violent, and criminal behaviors garner much attention. Media violence is targeted as a cause for increasing violence, aggression, and antisocial behavior in youth; thousands of studies demonstrate that media violence especially influences children, a vulnerable group. Virtually no studies address the use of positive deviance in children’s movies. Using quantitative and ethnographic analysis, this paper yields three important findings. 1. Positive behaviors, in the form of altruism, are liberally displayed in children’s animated movies. 2. Altruism does not align perfectly with group loyalty. 3. Risk of life is used as a tool to portray altruism and is portrayed at critical, climactic, and memorable moments, specifically as movies draw to conclusion. Previous studies demonstrate that children are especially susceptible to both negativity and optimistic biases, underscoring the importance of messages portrayed in children’s movies. This study recommends that scholars and moviemakers consciously address the appearance and timing of positive deviance.

In lower middle-income economies (LMIE), the nutrition transition from traditional diets to sugary foods and beverages has contributed to widespread early childhood dental caries. This qualitative study explores perceived risk and protective factors, and overall experiences of early childhood nutrition and oral health in indigenous Ecuadorian families participating in a community-based oral health and nutrition intervention. Dental exams of 698 children age 6 months through 6 years determined each child's caries burden. A convenience sample of 18 "outlier" families was identified: low-caries children with <= 2 carious teeth vs. high-caries children with >= 10 carious teeth. Semi-structured in-depth interviews with parents/caregivers explored the child's diet, dental habits, and family factors related to nutrition and oral health. Interviews were transcribed and thematically analyzed using grounded theory. In the high-caries families, proximity to highway and stores, consumption of processed-food, and low parental monitoring of child behavior were identified as risk factors for ECC (early childhood caries). In the low-caries families, protective factors included harvesting and consuming food from the family farm, remote geography, and greater parental monitoring of child behavior. The study results suggest that maintaining traditional family farms and authoritative parenting to avoid processed foods/drinks and ensure tooth brushing could improve early childhood nutrition and oral health.

The concept of positive deviance (PD) has not been studied in the context of nursing. Grounded in narrative inquiry and combined with vocabularies of motive and symbolic interactionism, the purpose of this study was to explore whether PD behaviors existed in nursing, and if so, to develop an operational definition of PD for nursing. The research question addressed what PD behaviors, if any, were present in nurses’ workplace stories. Using posted flyers, eight participants either self-selected or were selected by snowball method to participate. Interviews were conducted in locations decided on by each participant. Interview data were obtained, transcribed, then categorized into the following behaviors: ability to flex with adversity (resilience), accountability for self and others, authenticity, autonomy, clarifying information in a professional way, connectedness, courage, intentional, interdependence, moral empowerment, not driven by a level of authority, political astuteness, responsibility, self-empowerment, speaking up even when it is uncomfortable, strong relationships, vision, and vulnerability. The findings from this study could impact positive social change in the following ways: (a) Nursing has its own definition to use: An intentional and moral behavior that departs or differs from the established norm, containing elements of innovation, creativity, adaptability, moral empowerment, self-empowerment, responsibility, or a combination of these attributes including a level of risk; (b) At the individual level, a way to define and back nurses’ actions in a safe way or be used as a professional nurse expectation; and (c) At the organizational level, the identified PD behaviors and definition can be an expectation for employees of how to express themselves in a professional, honest, and direct manner.

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Kleinbäuerliche Haushalte im Globalen Süden sind zunehmend gefordert, ihre landwirtschaftlichen Aktivitäten an globale Veränderungen anzupassen. Landwirtschaftliche Beratungsdienste (extension services) stoßen vielerorts auf Schwierigkeiten, eine wachsende rurale Bevölkerung mit heterogenen Informationsbedürfnissen adäquat zu erreichen. Die zunehmende Verbreitung moderner Informations- und Kommunikationstechnologien (IKT) hat in jüngster Zeit neue Möglichkeiten geschaffen, Information weitreichend zu verbreiten. Gleichzeitig bietet digitale Kommunikation aber auch Möglichkeiten, große Zahlen von Bäuerinnen und Bauern in der Erzeugung von Wissen und Information einzubinden. Durch digitale Kanäle können landwirtschaftliche Beratungsdienste systematisch Daten-Inputs von ihrer Zielgruppe erheben, sie aggregiert verarbeiten, und auf dieser Grundlage ihre Dienstleistung verbessern. Diese Dissertationsschrift präsentiert drei Machbarkeitsstudien zu verschiedenen Strategien zur Einbindung großer Zahlen von Bäuerinnen und Bauern in der landwirtschaftlichen Beratung mittels moderner IKT. Eine erste Studie untersucht die Machbarkeit und den Nutzen digital unterstützter landwirtschaftlicher „Bürgerwissenschaft“ (citizen science) zur Einbindung von Bäuerinnen und Bauern in der Wissensgenerierung. Eine zweite Studie passt den „Positive Deviance-Ansatz“ an multi-dimensionale kleinbäuerliche Entwicklung an. Eine dritte Studie präsentiert und testet ein Verfahren zur Nutzung von „Zwei-Wege-Kommunikation“ über Mobiltelefone, um die automatisierte, individuelle Priorisierung von Beratungsinhalten in kleinbäuerlichem Kontext zu verbessern. Auf Basis der vorgelegten Erkenntnisse aus drei unabhängigen Machbarkeitsstudien macht die Dissertationsschrift Vorschläge, wie landwirtschaftliche Beratungsdienste im Globalen Süden die Herausforderungen der großen Zahl und starken Heterogenität kleinbäuerlicher Haushalte mit effizienter, systematischer Nutzung digitaler Medien begegnen können. / Smallholder farmers across the Global South increasingly need to adapt their farming activities to fast-paced changes. Worldwide, agricultural extension services face the challenge of reaching a large and growing clientele with highly diverse information needs. In recent years, increased penetration of modern information and communication technology (ICT) has created new opportunities for disseminating agricultural information. At the same time, digital communication can also allow the involvement of large numbers of farmers in the creation and aggregation of relevant knowledge and information. By collecting well-defined data inputs from farmers and processing these data in systematic ways, agricultural advisory services can potentially improve their overall performance towards a large and heterogeneous clientele. Through three proof-of-concept studies, this dissertation delivers empirical evidence on the feasibility of different ways of employing modern ICT to harness large-scale farmer participation in agricultural extension. A first study explores the feasibility and usefulness of digitally-enabled agricultural citizen science for involving large numbers of farmers in knowledge generation. A second study adapts the ‘Positive Deviance approach’ to multi-dimensional agricultural development and delivers evidence on its feasibility. A third study suggests and tests a procedure for employing two-way communication through mobile phone interfaces for improving the targeting of agricultural advisory messages in smallholder context. Based on the empirical evidence from these three independent proof-of-concept studies, the dissertation suggests how agricultural extension services in the Global South can address the challenges of scale and complexity in smallholder farming context through increased methodological pluralism, greater farmer participation, and efficient, systematic use of digital media.

<p><b>Background</b><br></p> <p>More than 90% of individuals aged 65 years or older in the United States (US) are taking at least one prescription medication, and more than 40% are taking five or more prescription medications. The potential for non-adherence and risk of medication therapy problems (MTPs) increases with the use of multiple medications. To enhance patient understanding of appropriate medication use, improve medication adherence, and reduce MTPs, the Centers for Medicare & Medicaid Services (CMS) launched Medication Therapy Management (MTM) services as part of Medicare Prescription Drug (Part D) policy; however, “best practices” for achieving positive MTM outcomes are not well understood.</p><p><br></p> <p> </p> <p><b>Objectives</b></p> <p>This study had two objectives. The first objective was to identify and explain reasons for concordance and discordance between a) consistently high, moderate, and low performing pharmacies and b) pharmacies that improve or worsen in performance overtime. The second objective was to generate hypotheses for strategies that contribute to community pharmacies’ ability to achieve high performance on widely accepted MTM quality measures. </p><p><br></p> <p> </p> <p><b>Methods</b></p> <p>This comparative mixed-methods, case study design incorporated two complementary conceptual models. First, an adaptation of the Positive Deviance (PD) model explains reasons for deviations in MTM quality measure performance among community pharmacies and informs study design. Second, the Chronic Care Model (CCM) guided data collection and analysis. Data consisted of pharmacy/staff demographics and staff interviews. When appropriate, quantitative and qualitative data were analyzed within and across pharmacy MTM performance (i.e., high, moderate, low) or change-in-performance (i.e., consistent, improved, worsened) categories using descriptive statistics and cross-tabulation respectively. MTM performance component measures used to evaluate and rank pharmacy MTM performance mirrored measures under Domain 4 (Drug Safety and Accuracy of Drug Pricing) of the 2017 CMS Medicare Part D Plan’ Star Rating measures. This study was approved by the Institutional Review Board for the Purdue University Human Research Protection Program. </p><p><br></p> <p> </p> <p><b>Results </b></p> <p>Across the sample of eligible pharmacies (N = 56), MTM performance composite scores varied by 21.3%. Of the five component scores, the <i>Comprehensive Medication Review (CMR)</i> component score had the highest percent variation (88.3%). Pharmacy staff at 13 pharmacies of the 18 pharmacies selected as case study sites participated in interviews, yielding a 72.2% case pharmacy participation rate. Of the 13 pharmacies, five were categorized as high performers, four were moderate performers, and four were low performers. Of the 39 pharmacy staff approached across all pharmacies, 25 participated in interviews, yielding a 64.1% participation rate. Interviewees included 11 pharmacists, 11 technicians and three student interns. Eight strategies were hypothesized as positively (7) or negatively (1) contributing to pharmacies’ MTM performance. Hypotheses generated were organized by CCM elements and included: <i>Delivery System Design (DSD)</i> – Having a high degree of technician involvement with MTM activities; Inability to meet cultural, linguistic, and socioeconomic needs of patients (negative); Having sufficient capacity to provide CMRs to patients in person compared to telephone alone; Pharmacy staff placing high priority on addressing MTM activities<i>; Clinical Information Systems (CIS) </i>– Faxing adherence-related MTP recommendations and calling providers on indication-related MTP recommendations; Technicians’ use of CISs to collect/document information for pharmacists; Using maximum number of available CISs to identify eligible MTM patients; <i>Health System Organizations (HSO) </i>– Strong pharmacist-provider relationships and trust. No hypotheses were generated for the remaining three CCM elements.</p><p><br></p> <p> </p> <p><b>Conclusions </b></p> <p></p>A total of eight strategies were hypothesized as contributing to community pharmacies’ ability to achieve high performance on MTM quality measures. Notable strategies were related to three of the six chronic care model elements. Future research should engage stakeholders to assist with prioritizing hypotheses to be statistically tested in a larger representative sample of pharmacies.

Uppsatsen bygger på begreppet ”Positive Deviance” och dess förändringsmetoder till att positivt förändra individers tillvägagångssätt och prestationer på arbetsplatsen. Metoderna förespråkar att befintliga positiva avvikares arbetssätt ska identifieras, analyseras och appliceras på resten av individerna i samma grupp via en ”bottom-up” process. Det med avsikten att skapa en bestående och lönsammare lösning som annars vanliga konventionella förändringsmetoder inte brukar lyckas åstadkomma. Med en abduktiv ansats och en kvalitativ fallstudie som innefattar sex semi-strukturerade intervjuer med ledare på ett kundserviceföretag så har flera likheter liksom skillnader upptäckts gentemot förespråkade förändringsmetoder. Ledarna har uttryckligen identifierat de positiva avvikarna men har sedan i appliceringsstadiet indirekt valt att begränsa sina verktyg. Skulle ledarna ha beslutsamheten och viljan att vidareutveckla och skräddarsy sina nuvarande förändringsmetoder gentemot förespråkade så finns det utrymme till det.

Present-day development theory and practice highlight the potential of micro-entrepreneurship for poverty reduction in least developed countries. Fostered by the seminal writings of microfinance founder Muhammad Yunus and the bottom-of-the-pyramid propagator Krishnarao Prahalad, the new approach is marked by a stress on participation and sustainability, and the new, market-based development models. With the growing popularity of the new approach there has been an increased demand for research on the efficacy and impact of innovations. What has scarcely been addressed, however, is the legitimacy of the new paradigm within its contexts of application. Since engagement and participation have been made the focal point of the new approach, my research investigates how the innovative, mostly market-based models have been received by the local populations on the ground. This doctoral dissertation is looking up-close at the rural populations of Burundi, describing and explaining their perceptions, behaviors and actions in response to the market-based development innovations: microfinance, rural entrepreneurship and community social enterprise. Do the concepts of entrepreneurship, community engagement and participation find a fertile ground among the poorest rural dwellers of sub-Saharan Africa? Can subsistence farmers be entrepreneurs? How to create social value in the context of extreme resource scarcity? It is investigating these and other questions that guided the subsequent stages of my work. I based my dissertation on extensive field research, conducted periodically over the period of four years in the remote areas of rural Burundi.In the first chapter, I question the applicability of entrepreneurship-based interventions to the socio-cultural context of rural Burundi. Basing my quantitative analysis on a unique cross-section dataset from Burundi of over 900 households, I look into the entrepreneurial livelihood strategies at the near-subsistence level: diversifying crops, processing food for sale, supplementary wage work and non-agricultural employment. I find that the farmers living closer to the subsistence level are indeed less likely to pursue innovative entrepreneurial opportunities, unable to break the poverty cycle and move beyond subsistence agriculture. The paper contributes to the ongoing debate on by analyzing its drivers and inhibitors in the context of a subsistence economy. It questions the idea of alleviating rural poverty through the external promotion of entrepreneurship as it constitutes ‘a denial of the poor’s capacity for agency to bring about social change by themselves on their own terms’.Drawing on these findings, the second chapter focusses on the role of local communities as shareholders of projects. The aim of this paper is to investigate the ways in which the agrarian communities in rural Burundi accommodate the model of a community social enterprise. The project understudy, implemented by the UNICEF Burundi Innovation Lab, builds upon the provision of green energy generators to the village child protection committees in the energy-deficient rural regions of the country. The electricity-producing machines are also a new income source for the groups, transforming them into economically viable community enterprises. Since the revenue earned is to directly support the village orphans’ fund, the communities in question engage in a true post-development venture: they gradually assume the role of the development-provisioning organizations.The third chapter of this work focusses on the complex interaction between the microfinance providers and the population of its clients and potential clients: the rural poor. It draws on the existing research on positive deviance among African communities and explores the social entrepreneurial potential of the rule-breaking practices of microfinance programs’ beneficiaries. Using the storyboard methodology, I examine the strategies employed by the poor in Burundi to bypass institutional rules. My results suggest that transgressive practices and nonconformity of development beneficiaries can indeed be seen as innovative, entrepreneurial initiatives to reform the microfinance system from within, postulating a more participatory mode of MFIs’ organizational governance. The three empirical chapters provide concrete examples illustrating the contested nature of the development process. In the last, theoretical, chapter, I examine how the different conceptualizations of social entrepreneurship have been shaped by the disparate socio-political realities in the North and in the South. I then analyze how the process of constructing academic representation has been influenced by the prevalent public discourses.Since doubling or tripling of the external development finance has not sufficed to bring about systemic change, the assumption that technology, managerial efficacy and the leveraging power of financial markets could be applied to solving the problem of persisting global poverty has a lot of appeal. At the same time, my findings point to the fact that if the ultimate objective of development is broadly defined value creation, the definition of what constitutes value should be negotiated among all the stakeholders. The dissertation makes an important contribution to the understanding of participation, entrepreneurship and community engagement in the context of development studies.I strongly believe that development organizations must have a quality understanding of the social and cultural characteristics of the need or problem they are targeting in order to make productive decisions about the application and scaling of interventions. I very much hope that my work can provide some guidance for their work on the ground. / Doctorat en Sciences économiques et de gestion / info:eu-repo/semantics/nonPublished

Large-scale land-use change across the tropics has led to the decline of animal populations and their habitat. With large investments into mining, hydropower dams and industrial agriculture this trend is likely to continue. Consequently, there is a need for systematic land-use planning to set aside areas for protection and allocate scarce conservation funding effectively. Even though primates are relatively well studied, data-driven systematic planning is still rarely implemented. The overall aim of this dissertation was to investigate population parameters needed for evidence-based conservation planning for the critically endangered western chimpanzee (Pan troglodytes verus) in West Africa. To this end, I compiled density datasets covering the entire geographic range of this taxon from the IUCN SSC A.P.E.S. database and modeled chimpanzee densities as a function of 20 social-ecological variables. I found that western chimpanzees seemingly persist within three social-ecological configurations: rainforests with a low degree of anthropogenic threats, steep areas that are less likely to be developed and are harder to access by humans, and areas with a high prevalence of cultural taboos against hunting chimpanzees. The third configuration of reduced hunting pressure is not yet reflected in commonly implemented conservation interventions, suggesting a need for designing new approaches aimed at reducing the threat of hunting. Based on the modeled density distribution, I estimated that 52,811 (95% CI 17,577-96,564) western chimpanzees remain in West Africa, and identified areas of high conservation value to which conservation interventions should be targeted. These results can be used to inform the expansion of the protected area network in West Africa, to quantify the impact of planned industrial projects on western chimpanzees, and to guide the systematic allocation of conservation funding. In addition, this thesis highlights the unique position of taxon-specific databases of providing access to high-resolution data at the scale needed for conservation planning. Data-driven conservation planning has the potential to enable conservationists to respond more proactively to current and emerging threats, and ultimately improve conservation outcomes.

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