Enablers of successful dissemination of uncommon practices in positive deviance studies for nutrition: A scoping review

BACKGROUND: The positive deviance approach identifies uncommon yet successful practices within communities to address malnutrition through context-specific solutions. While it identifies locally effective practices, a critical gap remains in understanding how these practices are translated into structured interventions for broader dissemination. This scoping review aimed to identify key enablers in positive deviance nutrition interventions that support the transition from identifying positive deviant practices to their active dissemination through structured interventions. METHODS: We conducted a systematic search across five electronic databases (PubMed, Web of Science, PsycINFO, Science Direct, CINAHL) and grey literature. We included original research of all study designs published in English from January 1st, 1990, to December 2, 2024. Then, we conducted a narrative synthesis to account for heterogeneity among the studies. RESULTS: Out of 259 positive deviance studies, 13 identified and then disseminated uncommon but successful practices. Among these, twelve studies included comparison groups and demonstrated improved nutrition outcomes. We identified six overarching themes that capture the key enablers of effective dissemination: integration with existing programs, ongoing capacity and skill building, active participant engagement, adaptable and modifiable practices and activities, cost-effective strategies, and cross-sectoral collaboration and partnership. CONCLUSION: This scoping review identified six themes that summarize enablers for effectively disseminating uncommon yet successful practices. These enablers not only align with successful criteria for scaling up conventional interventions but also reflect the principles of positive deviance. They highlight the value of integrating local knowledge and resources with external efforts to design tailored approaches to tackling malnutrition. Cross-sectoral collaboration and partnerships emerged as particularly important for scaling interventions. However, these enablers alone may not guarantee success, highlighting the need for future research to explore additional facilitators and barriers to optimize long-term implementation of positive deviance interventions in nutrition. PROTOCOL REGISTRATION: CRD42020180396.