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The positive deviance (PD) approach involves finding individuals who have solved a problem and spreads their unique solutions to others. While there have been calls for PD to become a standard tool in community health, there has been little research on the approach. This study investigated how PD is used in practice and evidence of its effectiveness by analyzing case studies of 40 PD programs and 32 PD inquiries implemented in a range of high, middle, and low income countries by both national and international organizations. Case studies were developed using data from publicly available documents. Qualitative within-case and cross-case analyses were used to identify common themes and trends using the theory of diffusion of innovations. Results show that the first large scale applications of the PD approach were in child malnutrition in the 1990s. Since then the approach has been applied to other issues in individual behavior change (e.g., HIV/AIDS), organizational change (e.g., health services), and sociocultural change (e.g., female genital mutilation). Current PD approaches can be classified by the level of intervention, and the methods used to identify positive deviants, discover their behaviors, and spread the behaviors to others. Most programs do not fully involve the community at all stages. While there is substantial evidence for the effectiveness of the PD approach in child malnutrition, few high quality outcome evaluations have been conducted in other areas. Implications for positive social change include providing data to encourage practitioners to use the PD approach as a standard tool for child malnutrition, where it has the potential to improve nutritional status and thus contribute to long term outcomes in child health, education and social development.