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Case Study – Methods, Examples and Guide

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A case study is a research method that involves an in-depth examination and analysis of a particular phenomenon or case, such as an individual, organization, community, event, or situation.

It is a qualitative research approach that aims to provide a detailed and comprehensive understanding of the case being studied. Case studies typically involve multiple sources of data, including interviews, observations, documents, and artifacts, which are analyzed using various techniques, such as content analysis, thematic analysis, and grounded theory. The findings of a case study are often used to develop theories, inform policy or practice, or generate new research questions.

Types of Case Study

Types and Methods of Case Study are as follows:

Single-Case Study

A single-case study is an in-depth analysis of a single case. This type of case study is useful when the researcher wants to understand a specific phenomenon in detail.

For Example , A researcher might conduct a single-case study on a particular individual to understand their experiences with a particular health condition or a specific organization to explore their management practices. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as content analysis or thematic analysis. The findings of a single-case study are often used to generate new research questions, develop theories, or inform policy or practice.

Multiple-Case Study

A multiple-case study involves the analysis of several cases that are similar in nature. This type of case study is useful when the researcher wants to identify similarities and differences between the cases.

For Example, a researcher might conduct a multiple-case study on several companies to explore the factors that contribute to their success or failure. The researcher collects data from each case, compares and contrasts the findings, and uses various techniques to analyze the data, such as comparative analysis or pattern-matching. The findings of a multiple-case study can be used to develop theories, inform policy or practice, or generate new research questions.

Exploratory Case Study

An exploratory case study is used to explore a new or understudied phenomenon. This type of case study is useful when the researcher wants to generate hypotheses or theories about the phenomenon.

For Example, a researcher might conduct an exploratory case study on a new technology to understand its potential impact on society. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as grounded theory or content analysis. The findings of an exploratory case study can be used to generate new research questions, develop theories, or inform policy or practice.

Descriptive Case Study

A descriptive case study is used to describe a particular phenomenon in detail. This type of case study is useful when the researcher wants to provide a comprehensive account of the phenomenon.

For Example, a researcher might conduct a descriptive case study on a particular community to understand its social and economic characteristics. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as content analysis or thematic analysis. The findings of a descriptive case study can be used to inform policy or practice or generate new research questions.

Instrumental Case Study

An instrumental case study is used to understand a particular phenomenon that is instrumental in achieving a particular goal. This type of case study is useful when the researcher wants to understand the role of the phenomenon in achieving the goal.

For Example, a researcher might conduct an instrumental case study on a particular policy to understand its impact on achieving a particular goal, such as reducing poverty. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as content analysis or thematic analysis. The findings of an instrumental case study can be used to inform policy or practice or generate new research questions.

Case Study Data Collection Methods

Here are some common data collection methods for case studies:

Interviews involve asking questions to individuals who have knowledge or experience relevant to the case study. Interviews can be structured (where the same questions are asked to all participants) or unstructured (where the interviewer follows up on the responses with further questions). Interviews can be conducted in person, over the phone, or through video conferencing.

Observations

Observations involve watching and recording the behavior and activities of individuals or groups relevant to the case study. Observations can be participant (where the researcher actively participates in the activities) or non-participant (where the researcher observes from a distance). Observations can be recorded using notes, audio or video recordings, or photographs.

Documents can be used as a source of information for case studies. Documents can include reports, memos, emails, letters, and other written materials related to the case study. Documents can be collected from the case study participants or from public sources.

Surveys involve asking a set of questions to a sample of individuals relevant to the case study. Surveys can be administered in person, over the phone, through mail or email, or online. Surveys can be used to gather information on attitudes, opinions, or behaviors related to the case study.

Artifacts are physical objects relevant to the case study. Artifacts can include tools, equipment, products, or other objects that provide insights into the case study phenomenon.

How to conduct Case Study Research

Conducting a case study research involves several steps that need to be followed to ensure the quality and rigor of the study. Here are the steps to conduct case study research:

• Define the research questions: The first step in conducting a case study research is to define the research questions. The research questions should be specific, measurable, and relevant to the case study phenomenon under investigation.
• Select the case: The next step is to select the case or cases to be studied. The case should be relevant to the research questions and should provide rich and diverse data that can be used to answer the research questions.
• Collect data: Data can be collected using various methods, such as interviews, observations, documents, surveys, and artifacts. The data collection method should be selected based on the research questions and the nature of the case study phenomenon.
• Analyze the data: The data collected from the case study should be analyzed using various techniques, such as content analysis, thematic analysis, or grounded theory. The analysis should be guided by the research questions and should aim to provide insights and conclusions relevant to the research questions.
• Draw conclusions: The conclusions drawn from the case study should be based on the data analysis and should be relevant to the research questions. The conclusions should be supported by evidence and should be clearly stated.
• Validate the findings: The findings of the case study should be validated by reviewing the data and the analysis with participants or other experts in the field. This helps to ensure the validity and reliability of the findings.
• Write the report: The final step is to write the report of the case study research. The report should provide a clear description of the case study phenomenon, the research questions, the data collection methods, the data analysis, the findings, and the conclusions. The report should be written in a clear and concise manner and should follow the guidelines for academic writing.

Examples of Case Study

Here are some examples of case study research:

• The Hawthorne Studies : Conducted between 1924 and 1932, the Hawthorne Studies were a series of case studies conducted by Elton Mayo and his colleagues to examine the impact of work environment on employee productivity. The studies were conducted at the Hawthorne Works plant of the Western Electric Company in Chicago and included interviews, observations, and experiments.
• The Stanford Prison Experiment: Conducted in 1971, the Stanford Prison Experiment was a case study conducted by Philip Zimbardo to examine the psychological effects of power and authority. The study involved simulating a prison environment and assigning participants to the role of guards or prisoners. The study was controversial due to the ethical issues it raised.
• The Challenger Disaster: The Challenger Disaster was a case study conducted to examine the causes of the Space Shuttle Challenger explosion in 1986. The study included interviews, observations, and analysis of data to identify the technical, organizational, and cultural factors that contributed to the disaster.
• The Enron Scandal: The Enron Scandal was a case study conducted to examine the causes of the Enron Corporation’s bankruptcy in 2001. The study included interviews, analysis of financial data, and review of documents to identify the accounting practices, corporate culture, and ethical issues that led to the company’s downfall.
• The Fukushima Nuclear Disaster : The Fukushima Nuclear Disaster was a case study conducted to examine the causes of the nuclear accident that occurred at the Fukushima Daiichi Nuclear Power Plant in Japan in 2011. The study included interviews, analysis of data, and review of documents to identify the technical, organizational, and cultural factors that contributed to the disaster.

Application of Case Study

Case studies have a wide range of applications across various fields and industries. Here are some examples:

Business and Management

Case studies are widely used in business and management to examine real-life situations and develop problem-solving skills. Case studies can help students and professionals to develop a deep understanding of business concepts, theories, and best practices.

Case studies are used in healthcare to examine patient care, treatment options, and outcomes. Case studies can help healthcare professionals to develop critical thinking skills, diagnose complex medical conditions, and develop effective treatment plans.

Case studies are used in education to examine teaching and learning practices. Case studies can help educators to develop effective teaching strategies, evaluate student progress, and identify areas for improvement.

Social Sciences

Case studies are widely used in social sciences to examine human behavior, social phenomena, and cultural practices. Case studies can help researchers to develop theories, test hypotheses, and gain insights into complex social issues.

Law and Ethics

Case studies are used in law and ethics to examine legal and ethical dilemmas. Case studies can help lawyers, policymakers, and ethical professionals to develop critical thinking skills, analyze complex cases, and make informed decisions.

Purpose of Case Study

The purpose of a case study is to provide a detailed analysis of a specific phenomenon, issue, or problem in its real-life context. A case study is a qualitative research method that involves the in-depth exploration and analysis of a particular case, which can be an individual, group, organization, event, or community.

The primary purpose of a case study is to generate a comprehensive and nuanced understanding of the case, including its history, context, and dynamics. Case studies can help researchers to identify and examine the underlying factors, processes, and mechanisms that contribute to the case and its outcomes. This can help to develop a more accurate and detailed understanding of the case, which can inform future research, practice, or policy.

Case studies can also serve other purposes, including:

• Illustrating a theory or concept: Case studies can be used to illustrate and explain theoretical concepts and frameworks, providing concrete examples of how they can be applied in real-life situations.
• Developing hypotheses: Case studies can help to generate hypotheses about the causal relationships between different factors and outcomes, which can be tested through further research.
• Providing insight into complex issues: Case studies can provide insights into complex and multifaceted issues, which may be difficult to understand through other research methods.
• Informing practice or policy: Case studies can be used to inform practice or policy by identifying best practices, lessons learned, or areas for improvement.

Advantages of Case Study Research

There are several advantages of case study research, including:

• In-depth exploration: Case study research allows for a detailed exploration and analysis of a specific phenomenon, issue, or problem in its real-life context. This can provide a comprehensive understanding of the case and its dynamics, which may not be possible through other research methods.
• Rich data: Case study research can generate rich and detailed data, including qualitative data such as interviews, observations, and documents. This can provide a nuanced understanding of the case and its complexity.
• Holistic perspective: Case study research allows for a holistic perspective of the case, taking into account the various factors, processes, and mechanisms that contribute to the case and its outcomes. This can help to develop a more accurate and comprehensive understanding of the case.
• Theory development: Case study research can help to develop and refine theories and concepts by providing empirical evidence and concrete examples of how they can be applied in real-life situations.
• Practical application: Case study research can inform practice or policy by identifying best practices, lessons learned, or areas for improvement.
• Contextualization: Case study research takes into account the specific context in which the case is situated, which can help to understand how the case is influenced by the social, cultural, and historical factors of its environment.

Limitations of Case Study Research

There are several limitations of case study research, including:

• Limited generalizability : Case studies are typically focused on a single case or a small number of cases, which limits the generalizability of the findings. The unique characteristics of the case may not be applicable to other contexts or populations, which may limit the external validity of the research.
• Biased sampling: Case studies may rely on purposive or convenience sampling, which can introduce bias into the sample selection process. This may limit the representativeness of the sample and the generalizability of the findings.
• Subjectivity: Case studies rely on the interpretation of the researcher, which can introduce subjectivity into the analysis. The researcher’s own biases, assumptions, and perspectives may influence the findings, which may limit the objectivity of the research.
• Limited control: Case studies are typically conducted in naturalistic settings, which limits the control that the researcher has over the environment and the variables being studied. This may limit the ability to establish causal relationships between variables.
• Time-consuming: Case studies can be time-consuming to conduct, as they typically involve a detailed exploration and analysis of a specific case. This may limit the feasibility of conducting multiple case studies or conducting case studies in a timely manner.
• Resource-intensive: Case studies may require significant resources, including time, funding, and expertise. This may limit the ability of researchers to conduct case studies in resource-constrained settings.

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Case studies are effective research methods that focus on one specific case over time. This gives a detailed view that's great for learning.

Writing a case study is a very useful form of study in the educational process. With real-life examples, students can learn more effectively. 

A case study also has different types and forms. As a rule of thumb, all of them require a detailed and convincing answer based on a thorough analysis.

In this blog, we are going to discuss the different types of case study research methods in detail.

So, let’s dive right in!

• 1. Understanding Case Studies
• 2. What are the Types of Case Study?
• 3. Types of Subjects of Case Study 
• 4. Benefits of Case Study for Students

Understanding Case Studies

Case studies are a type of research methodology. Case study research designs examine subjects, projects, or organizations to provide an analysis based on the evidence.

It allows you to get insight into what causes any subject’s decisions and actions. This makes case studies a great way for students to develop their research skills.

A case study focuses on a single project for an extended period, which allows students to explore the topic in depth.

What are the Types of Case Study?

Multiple case studies are used for different purposes. The main purpose of case studies is to analyze problems within the boundaries of a specific organization, environment, or situation. 

Many aspects of a case study such as data collection and analysis, qualitative research questions, etc. are dependent on the researcher and what the study is looking to address. 

Case studies can be divided into the following categories:

Illustrative Case Study

Exploratory case study, cumulative case study, critical instance case study, descriptive case study, intrinsic case study, instrumental case study.

Let’s take a look at the detailed description of each type of case study with examples. 

An illustrative case study is used to examine a familiar case to help others understand it. It is one of the main types of case studies in research methodology and is primarily descriptive. 

In this type of case study, usually, one or two instances are used to explain what a situation is like. 

Here is an example to help you understand it better:

Illustrative Case Study Example

An exploratory case study is usually done before a larger-scale research. These types of case studies are very popular in the social sciences like political science and primarily focus on real-life contexts and situations.

This method is useful in identifying research questions and methods for a large and complex study. 

Let’s take a look at this example to help you have a better understanding:

Exploratory Case Study Example

A cumulative case study is one of the main types of case studies in qualitative research. It is used to collect information from different sources at different times.

This case study aims to summarize the past studies without spending additional cost and time on new investigations. 

Let’s take a look at the example below:

Cumulative Case Study Example

Critical instances case studies are used to determine the cause and consequence of an event. 

The main reason for this type of case study is to investigate one or more sources with unique interests and sometimes with no interest in general. 

Take a look at this example below:

Critical Instance Case Study Example

When you have a hypothesis, you can design a descriptive study. It aims to find connections between the subject being studied and a theory.

After making these connections, the study can be concluded. The results of the descriptive case study will usually suggest how to develop a theory further.

This example can help you understand the concept better:

Descriptive Case Study Example

Intrinsic studies are more commonly used in psychology, healthcare, or social work. So, if you were looking for types of case studies in sociology, or types of case studies in social research, this is it.

The focus of intrinsic studies is on the individual. The aim of such studies is not only to understand the subject better but also their history and how they interact with their environment.

Here is an example to help you understand;

Intrinsic Case Study Example

This type of case study is mostly used in qualitative research. In an instrumental case study, the specific case is selected to provide information about the research question.

It offers a lens through which researchers can explore complex concepts, theories, or generalizations.

Take a look at the example below to have a better understanding of the concepts:

Instrumental Case Study Example

Review some case study examples to help you understand how a specific case study is conducted.

Types of Subjects of Case Study 

In general, there are 5 types of subjects that case studies address. Every case study fits into the following subject categories. 

• Person: This type of study focuses on one subject or individual and can use several research methods to determine the outcome. 
• Group: This type of study takes into account a group of individuals. This could be a group of friends, coworkers, or family. 
• Location: The main focus of this type of study is the place. It also takes into account how and why people use the place. 
• Organization: This study focuses on an organization or company. This could also include the company employees or people who work in an event at the organization. 
• Event: This type of study focuses on a specific event. It could be societal or cultural and examines how it affects the surroundings. 

Benefits of Case Study for Students

Here's a closer look at the multitude of benefits students can have with case studies:

Real-world Application

Case studies serve as a crucial link between theory and practice. By immersing themselves in real-world scenarios, students can apply theoretical knowledge to practical situations.

Critical Thinking Skills

Analyzing case studies demands critical thinking and informed decision-making. Students cultivate the ability to evaluate information, identify key factors, and develop well-reasoned solutions – essential skills in both academic and professional contexts.

Enhanced Problem-solving Abilities

Case studies often present complex problems that require creative and strategic solutions. Engaging with these challenges refines students' problem-solving skills, encouraging them to think innovatively and develop effective approaches.

Holistic Understanding

Going beyond theoretical concepts, case studies provide a holistic view of a subject. Students gain insights into the multifaceted aspects of a situation, helping them connect the dots and understand the broader context.

Exposure to Diverse Perspectives

Case studies often encompass a variety of industries, cultures, and situations. This exposure broadens students' perspectives, fostering a more comprehensive understanding of the world and the challenges faced by different entities.

So there you have it!

We have explored different types of case studies and their examples. Case studies act as the tools to understand and deal with the many challenges and opportunities around us.

Case studies are being used more and more in colleges and universities to help students understand how a hypothetical event can influence a person, group, or organization in real life. 

Not everyone can handle the case study writing assignment easily. It is even scary to think that your time and work could be wasted if you don't do the case study paper right. 

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• What Is a Case Study? | Definition, Examples & Methods

What Is a Case Study? | Definition, Examples & Methods

Published on May 8, 2019 by Shona McCombes . Revised on November 20, 2023.

A case study is a detailed study of a specific subject, such as a person, group, place, event, organization, or phenomenon. Case studies are commonly used in social, educational, clinical, and business research.

A case study research design usually involves qualitative methods , but quantitative methods are sometimes also used. Case studies are good for describing , comparing, evaluating and understanding different aspects of a research problem .

Table of contents

When to do a case study, step 1: select a case, step 2: build a theoretical framework, step 3: collect your data, step 4: describe and analyze the case, other interesting articles.

A case study is an appropriate research design when you want to gain concrete, contextual, in-depth knowledge about a specific real-world subject. It allows you to explore the key characteristics, meanings, and implications of the case.

Case studies are often a good choice in a thesis or dissertation . They keep your project focused and manageable when you don’t have the time or resources to do large-scale research.

You might use just one complex case study where you explore a single subject in depth, or conduct multiple case studies to compare and illuminate different aspects of your research problem.

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Once you have developed your problem statement and research questions , you should be ready to choose the specific case that you want to focus on. A good case study should have the potential to:

• Provide new or unexpected insights into the subject
• Challenge or complicate existing assumptions and theories
• Propose practical courses of action to resolve a problem
• Open up new directions for future research

TipIf your research is more practical in nature and aims to simultaneously investigate an issue as you solve it, consider conducting action research instead.

Unlike quantitative or experimental research , a strong case study does not require a random or representative sample. In fact, case studies often deliberately focus on unusual, neglected, or outlying cases which may shed new light on the research problem.

Example of an outlying case studyIn the 1960s the town of Roseto, Pennsylvania was discovered to have extremely low rates of heart disease compared to the US average. It became an important case study for understanding previously neglected causes of heart disease.

However, you can also choose a more common or representative case to exemplify a particular category, experience or phenomenon.

Example of a representative case studyIn the 1920s, two sociologists used Muncie, Indiana as a case study of a typical American city that supposedly exemplified the changing culture of the US at the time.

While case studies focus more on concrete details than general theories, they should usually have some connection with theory in the field. This way the case study is not just an isolated description, but is integrated into existing knowledge about the topic. It might aim to:

• Exemplify a theory by showing how it explains the case under investigation
• Expand on a theory by uncovering new concepts and ideas that need to be incorporated
• Challenge a theory by exploring an outlier case that doesn’t fit with established assumptions

To ensure that your analysis of the case has a solid academic grounding, you should conduct a literature review of sources related to the topic and develop a theoretical framework . This means identifying key concepts and theories to guide your analysis and interpretation.

There are many different research methods you can use to collect data on your subject. Case studies tend to focus on qualitative data using methods such as interviews , observations , and analysis of primary and secondary sources (e.g., newspaper articles, photographs, official records). Sometimes a case study will also collect quantitative data.

Example of a mixed methods case studyFor a case study of a wind farm development in a rural area, you could collect quantitative data on employment rates and business revenue, collect qualitative data on local people’s perceptions and experiences, and analyze local and national media coverage of the development.

The aim is to gain as thorough an understanding as possible of the case and its context.

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In writing up the case study, you need to bring together all the relevant aspects to give as complete a picture as possible of the subject.

How you report your findings depends on the type of research you are doing. Some case studies are structured like a standard scientific paper or thesis , with separate sections or chapters for the methods , results and discussion .

Others are written in a more narrative style, aiming to explore the case from various angles and analyze its meanings and implications (for example, by using textual analysis or discourse analysis ).

In all cases, though, make sure to give contextual details about the case, connect it back to the literature and theory, and discuss how it fits into wider patterns or debates.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

• Normal distribution
• Degrees of freedom
• Null hypothesis
• Discourse analysis
• Control groups
• Mixed methods research
• Non-probability sampling
• Quantitative research
• Ecological validity

Research bias

• Rosenthal effect
• Implicit bias
• Cognitive bias
• Selection bias
• Negativity bias
• Status quo bias

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• Case Study | Definition, Examples & Methods

Case Study | Definition, Examples & Methods

Published on 5 May 2022 by Shona McCombes . Revised on 30 January 2023.

A case study is a detailed study of a specific subject, such as a person, group, place, event, organisation, or phenomenon. Case studies are commonly used in social, educational, clinical, and business research.

A case study research design usually involves qualitative methods , but quantitative methods are sometimes also used. Case studies are good for describing , comparing, evaluating, and understanding different aspects of a research problem .

Table of contents

When to do a case study, step 1: select a case, step 2: build a theoretical framework, step 3: collect your data, step 4: describe and analyse the case.

A case study is an appropriate research design when you want to gain concrete, contextual, in-depth knowledge about a specific real-world subject. It allows you to explore the key characteristics, meanings, and implications of the case.

Case studies are often a good choice in a thesis or dissertation . They keep your project focused and manageable when you don’t have the time or resources to do large-scale research.

You might use just one complex case study where you explore a single subject in depth, or conduct multiple case studies to compare and illuminate different aspects of your research problem.

Prevent plagiarism, run a free check.

Once you have developed your problem statement and research questions , you should be ready to choose the specific case that you want to focus on. A good case study should have the potential to:

• Provide new or unexpected insights into the subject
• Challenge or complicate existing assumptions and theories
• Propose practical courses of action to resolve a problem
• Open up new directions for future research

Unlike quantitative or experimental research, a strong case study does not require a random or representative sample. In fact, case studies often deliberately focus on unusual, neglected, or outlying cases which may shed new light on the research problem.

If you find yourself aiming to simultaneously investigate and solve an issue, consider conducting action research . As its name suggests, action research conducts research and takes action at the same time, and is highly iterative and flexible. 

However, you can also choose a more common or representative case to exemplify a particular category, experience, or phenomenon.

While case studies focus more on concrete details than general theories, they should usually have some connection with theory in the field. This way the case study is not just an isolated description, but is integrated into existing knowledge about the topic. It might aim to:

• Exemplify a theory by showing how it explains the case under investigation
• Expand on a theory by uncovering new concepts and ideas that need to be incorporated
• Challenge a theory by exploring an outlier case that doesn’t fit with established assumptions

To ensure that your analysis of the case has a solid academic grounding, you should conduct a literature review of sources related to the topic and develop a theoretical framework . This means identifying key concepts and theories to guide your analysis and interpretation.

There are many different research methods you can use to collect data on your subject. Case studies tend to focus on qualitative data using methods such as interviews, observations, and analysis of primary and secondary sources (e.g., newspaper articles, photographs, official records). Sometimes a case study will also collect quantitative data .

The aim is to gain as thorough an understanding as possible of the case and its context.

In writing up the case study, you need to bring together all the relevant aspects to give as complete a picture as possible of the subject.

How you report your findings depends on the type of research you are doing. Some case studies are structured like a standard scientific paper or thesis, with separate sections or chapters for the methods , results , and discussion .

Others are written in a more narrative style, aiming to explore the case from various angles and analyse its meanings and implications (for example, by using textual analysis or discourse analysis ).

In all cases, though, make sure to give contextual details about the case, connect it back to the literature and theory, and discuss how it fits into wider patterns or debates.

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the ‘Cite this Scribbr article’ button to automatically add the citation to our free Reference Generator.

McCombes, S. (2023, January 30). Case Study | Definition, Examples & Methods. Scribbr. Retrieved 21 August 2024, from https://www.scribbr.co.uk/research-methods/case-studies/

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• Published: 27 June 2011

The case study approach

• Sarah Crowe 1 ,
• Kathrin Cresswell 2 ,
• Ann Robertson 2 ,
• Guro Huby 3 ,
• Anthony Avery 1 &
• Aziz Sheikh 2  

BMC Medical Research Methodology volume  11 , Article number:  100 ( 2011 ) Cite this article

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The case study approach allows in-depth, multi-faceted explorations of complex issues in their real-life settings. The value of the case study approach is well recognised in the fields of business, law and policy, but somewhat less so in health services research. Based on our experiences of conducting several health-related case studies, we reflect on the different types of case study design, the specific research questions this approach can help answer, the data sources that tend to be used, and the particular advantages and disadvantages of employing this methodological approach. The paper concludes with key pointers to aid those designing and appraising proposals for conducting case study research, and a checklist to help readers assess the quality of case study reports.

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Introduction

The case study approach is particularly useful to employ when there is a need to obtain an in-depth appreciation of an issue, event or phenomenon of interest, in its natural real-life context. Our aim in writing this piece is to provide insights into when to consider employing this approach and an overview of key methodological considerations in relation to the design, planning, analysis, interpretation and reporting of case studies.

The illustrative 'grand round', 'case report' and 'case series' have a long tradition in clinical practice and research. Presenting detailed critiques, typically of one or more patients, aims to provide insights into aspects of the clinical case and, in doing so, illustrate broader lessons that may be learnt. In research, the conceptually-related case study approach can be used, for example, to describe in detail a patient's episode of care, explore professional attitudes to and experiences of a new policy initiative or service development or more generally to 'investigate contemporary phenomena within its real-life context' [ 1 ]. Based on our experiences of conducting a range of case studies, we reflect on when to consider using this approach, discuss the key steps involved and illustrate, with examples, some of the practical challenges of attaining an in-depth understanding of a 'case' as an integrated whole. In keeping with previously published work, we acknowledge the importance of theory to underpin the design, selection, conduct and interpretation of case studies[ 2 ]. In so doing, we make passing reference to the different epistemological approaches used in case study research by key theoreticians and methodologists in this field of enquiry.

This paper is structured around the following main questions: What is a case study? What are case studies used for? How are case studies conducted? What are the potential pitfalls and how can these be avoided? We draw in particular on four of our own recently published examples of case studies (see Tables 1 , 2 , 3 and 4 ) and those of others to illustrate our discussion[ 3 – 7 ].

What is a case study?

A case study is a research approach that is used to generate an in-depth, multi-faceted understanding of a complex issue in its real-life context. It is an established research design that is used extensively in a wide variety of disciplines, particularly in the social sciences. A case study can be defined in a variety of ways (Table 5 ), the central tenet being the need to explore an event or phenomenon in depth and in its natural context. It is for this reason sometimes referred to as a "naturalistic" design; this is in contrast to an "experimental" design (such as a randomised controlled trial) in which the investigator seeks to exert control over and manipulate the variable(s) of interest.

Stake's work has been particularly influential in defining the case study approach to scientific enquiry. He has helpfully characterised three main types of case study: intrinsic , instrumental and collective [ 8 ]. An intrinsic case study is typically undertaken to learn about a unique phenomenon. The researcher should define the uniqueness of the phenomenon, which distinguishes it from all others. In contrast, the instrumental case study uses a particular case (some of which may be better than others) to gain a broader appreciation of an issue or phenomenon. The collective case study involves studying multiple cases simultaneously or sequentially in an attempt to generate a still broader appreciation of a particular issue.

These are however not necessarily mutually exclusive categories. In the first of our examples (Table 1 ), we undertook an intrinsic case study to investigate the issue of recruitment of minority ethnic people into the specific context of asthma research studies, but it developed into a instrumental case study through seeking to understand the issue of recruitment of these marginalised populations more generally, generating a number of the findings that are potentially transferable to other disease contexts[ 3 ]. In contrast, the other three examples (see Tables 2 , 3 and 4 ) employed collective case study designs to study the introduction of workforce reconfiguration in primary care, the implementation of electronic health records into hospitals, and to understand the ways in which healthcare students learn about patient safety considerations[ 4 – 6 ]. Although our study focusing on the introduction of General Practitioners with Specialist Interests (Table 2 ) was explicitly collective in design (four contrasting primary care organisations were studied), is was also instrumental in that this particular professional group was studied as an exemplar of the more general phenomenon of workforce redesign[ 4 ].

What are case studies used for?

According to Yin, case studies can be used to explain, describe or explore events or phenomena in the everyday contexts in which they occur[ 1 ]. These can, for example, help to understand and explain causal links and pathways resulting from a new policy initiative or service development (see Tables 2 and 3 , for example)[ 1 ]. In contrast to experimental designs, which seek to test a specific hypothesis through deliberately manipulating the environment (like, for example, in a randomised controlled trial giving a new drug to randomly selected individuals and then comparing outcomes with controls),[ 9 ] the case study approach lends itself well to capturing information on more explanatory ' how ', 'what' and ' why ' questions, such as ' how is the intervention being implemented and received on the ground?'. The case study approach can offer additional insights into what gaps exist in its delivery or why one implementation strategy might be chosen over another. This in turn can help develop or refine theory, as shown in our study of the teaching of patient safety in undergraduate curricula (Table 4 )[ 6 , 10 ]. Key questions to consider when selecting the most appropriate study design are whether it is desirable or indeed possible to undertake a formal experimental investigation in which individuals and/or organisations are allocated to an intervention or control arm? Or whether the wish is to obtain a more naturalistic understanding of an issue? The former is ideally studied using a controlled experimental design, whereas the latter is more appropriately studied using a case study design.

Case studies may be approached in different ways depending on the epistemological standpoint of the researcher, that is, whether they take a critical (questioning one's own and others' assumptions), interpretivist (trying to understand individual and shared social meanings) or positivist approach (orientating towards the criteria of natural sciences, such as focusing on generalisability considerations) (Table 6 ). Whilst such a schema can be conceptually helpful, it may be appropriate to draw on more than one approach in any case study, particularly in the context of conducting health services research. Doolin has, for example, noted that in the context of undertaking interpretative case studies, researchers can usefully draw on a critical, reflective perspective which seeks to take into account the wider social and political environment that has shaped the case[ 11 ].

How are case studies conducted?

Here, we focus on the main stages of research activity when planning and undertaking a case study; the crucial stages are: defining the case; selecting the case(s); collecting and analysing the data; interpreting data; and reporting the findings.

Defining the case

Carefully formulated research question(s), informed by the existing literature and a prior appreciation of the theoretical issues and setting(s), are all important in appropriately and succinctly defining the case[ 8 , 12 ]. Crucially, each case should have a pre-defined boundary which clarifies the nature and time period covered by the case study (i.e. its scope, beginning and end), the relevant social group, organisation or geographical area of interest to the investigator, the types of evidence to be collected, and the priorities for data collection and analysis (see Table 7 )[ 1 ]. A theory driven approach to defining the case may help generate knowledge that is potentially transferable to a range of clinical contexts and behaviours; using theory is also likely to result in a more informed appreciation of, for example, how and why interventions have succeeded or failed[ 13 ].

For example, in our evaluation of the introduction of electronic health records in English hospitals (Table 3 ), we defined our cases as the NHS Trusts that were receiving the new technology[ 5 ]. Our focus was on how the technology was being implemented. However, if the primary research interest had been on the social and organisational dimensions of implementation, we might have defined our case differently as a grouping of healthcare professionals (e.g. doctors and/or nurses). The precise beginning and end of the case may however prove difficult to define. Pursuing this same example, when does the process of implementation and adoption of an electronic health record system really begin or end? Such judgements will inevitably be influenced by a range of factors, including the research question, theory of interest, the scope and richness of the gathered data and the resources available to the research team.

Selecting the case(s)

The decision on how to select the case(s) to study is a very important one that merits some reflection. In an intrinsic case study, the case is selected on its own merits[ 8 ]. The case is selected not because it is representative of other cases, but because of its uniqueness, which is of genuine interest to the researchers. This was, for example, the case in our study of the recruitment of minority ethnic participants into asthma research (Table 1 ) as our earlier work had demonstrated the marginalisation of minority ethnic people with asthma, despite evidence of disproportionate asthma morbidity[ 14 , 15 ]. In another example of an intrinsic case study, Hellstrom et al.[ 16 ] studied an elderly married couple living with dementia to explore how dementia had impacted on their understanding of home, their everyday life and their relationships.

For an instrumental case study, selecting a "typical" case can work well[ 8 ]. In contrast to the intrinsic case study, the particular case which is chosen is of less importance than selecting a case that allows the researcher to investigate an issue or phenomenon. For example, in order to gain an understanding of doctors' responses to health policy initiatives, Som undertook an instrumental case study interviewing clinicians who had a range of responsibilities for clinical governance in one NHS acute hospital trust[ 17 ]. Sampling a "deviant" or "atypical" case may however prove even more informative, potentially enabling the researcher to identify causal processes, generate hypotheses and develop theory.

In collective or multiple case studies, a number of cases are carefully selected. This offers the advantage of allowing comparisons to be made across several cases and/or replication. Choosing a "typical" case may enable the findings to be generalised to theory (i.e. analytical generalisation) or to test theory by replicating the findings in a second or even a third case (i.e. replication logic)[ 1 ]. Yin suggests two or three literal replications (i.e. predicting similar results) if the theory is straightforward and five or more if the theory is more subtle. However, critics might argue that selecting 'cases' in this way is insufficiently reflexive and ill-suited to the complexities of contemporary healthcare organisations.

The selected case study site(s) should allow the research team access to the group of individuals, the organisation, the processes or whatever else constitutes the chosen unit of analysis for the study. Access is therefore a central consideration; the researcher needs to come to know the case study site(s) well and to work cooperatively with them. Selected cases need to be not only interesting but also hospitable to the inquiry [ 8 ] if they are to be informative and answer the research question(s). Case study sites may also be pre-selected for the researcher, with decisions being influenced by key stakeholders. For example, our selection of case study sites in the evaluation of the implementation and adoption of electronic health record systems (see Table 3 ) was heavily influenced by NHS Connecting for Health, the government agency that was responsible for overseeing the National Programme for Information Technology (NPfIT)[ 5 ]. This prominent stakeholder had already selected the NHS sites (through a competitive bidding process) to be early adopters of the electronic health record systems and had negotiated contracts that detailed the deployment timelines.

It is also important to consider in advance the likely burden and risks associated with participation for those who (or the site(s) which) comprise the case study. Of particular importance is the obligation for the researcher to think through the ethical implications of the study (e.g. the risk of inadvertently breaching anonymity or confidentiality) and to ensure that potential participants/participating sites are provided with sufficient information to make an informed choice about joining the study. The outcome of providing this information might be that the emotive burden associated with participation, or the organisational disruption associated with supporting the fieldwork, is considered so high that the individuals or sites decide against participation.

In our example of evaluating implementations of electronic health record systems, given the restricted number of early adopter sites available to us, we sought purposively to select a diverse range of implementation cases among those that were available[ 5 ]. We chose a mixture of teaching, non-teaching and Foundation Trust hospitals, and examples of each of the three electronic health record systems procured centrally by the NPfIT. At one recruited site, it quickly became apparent that access was problematic because of competing demands on that organisation. Recognising the importance of full access and co-operative working for generating rich data, the research team decided not to pursue work at that site and instead to focus on other recruited sites.

Collecting the data

In order to develop a thorough understanding of the case, the case study approach usually involves the collection of multiple sources of evidence, using a range of quantitative (e.g. questionnaires, audits and analysis of routinely collected healthcare data) and more commonly qualitative techniques (e.g. interviews, focus groups and observations). The use of multiple sources of data (data triangulation) has been advocated as a way of increasing the internal validity of a study (i.e. the extent to which the method is appropriate to answer the research question)[ 8 , 18 – 21 ]. An underlying assumption is that data collected in different ways should lead to similar conclusions, and approaching the same issue from different angles can help develop a holistic picture of the phenomenon (Table 2 )[ 4 ].

Brazier and colleagues used a mixed-methods case study approach to investigate the impact of a cancer care programme[ 22 ]. Here, quantitative measures were collected with questionnaires before, and five months after, the start of the intervention which did not yield any statistically significant results. Qualitative interviews with patients however helped provide an insight into potentially beneficial process-related aspects of the programme, such as greater, perceived patient involvement in care. The authors reported how this case study approach provided a number of contextual factors likely to influence the effectiveness of the intervention and which were not likely to have been obtained from quantitative methods alone.

In collective or multiple case studies, data collection needs to be flexible enough to allow a detailed description of each individual case to be developed (e.g. the nature of different cancer care programmes), before considering the emerging similarities and differences in cross-case comparisons (e.g. to explore why one programme is more effective than another). It is important that data sources from different cases are, where possible, broadly comparable for this purpose even though they may vary in nature and depth.

Analysing, interpreting and reporting case studies

Making sense and offering a coherent interpretation of the typically disparate sources of data (whether qualitative alone or together with quantitative) is far from straightforward. Repeated reviewing and sorting of the voluminous and detail-rich data are integral to the process of analysis. In collective case studies, it is helpful to analyse data relating to the individual component cases first, before making comparisons across cases. Attention needs to be paid to variations within each case and, where relevant, the relationship between different causes, effects and outcomes[ 23 ]. Data will need to be organised and coded to allow the key issues, both derived from the literature and emerging from the dataset, to be easily retrieved at a later stage. An initial coding frame can help capture these issues and can be applied systematically to the whole dataset with the aid of a qualitative data analysis software package.

The Framework approach is a practical approach, comprising of five stages (familiarisation; identifying a thematic framework; indexing; charting; mapping and interpretation) , to managing and analysing large datasets particularly if time is limited, as was the case in our study of recruitment of South Asians into asthma research (Table 1 )[ 3 , 24 ]. Theoretical frameworks may also play an important role in integrating different sources of data and examining emerging themes. For example, we drew on a socio-technical framework to help explain the connections between different elements - technology; people; and the organisational settings within which they worked - in our study of the introduction of electronic health record systems (Table 3 )[ 5 ]. Our study of patient safety in undergraduate curricula drew on an evaluation-based approach to design and analysis, which emphasised the importance of the academic, organisational and practice contexts through which students learn (Table 4 )[ 6 ].

Case study findings can have implications both for theory development and theory testing. They may establish, strengthen or weaken historical explanations of a case and, in certain circumstances, allow theoretical (as opposed to statistical) generalisation beyond the particular cases studied[ 12 ]. These theoretical lenses should not, however, constitute a strait-jacket and the cases should not be "forced to fit" the particular theoretical framework that is being employed.

When reporting findings, it is important to provide the reader with enough contextual information to understand the processes that were followed and how the conclusions were reached. In a collective case study, researchers may choose to present the findings from individual cases separately before amalgamating across cases. Care must be taken to ensure the anonymity of both case sites and individual participants (if agreed in advance) by allocating appropriate codes or withholding descriptors. In the example given in Table 3 , we decided against providing detailed information on the NHS sites and individual participants in order to avoid the risk of inadvertent disclosure of identities[ 5 , 25 ].

What are the potential pitfalls and how can these be avoided?

The case study approach is, as with all research, not without its limitations. When investigating the formal and informal ways undergraduate students learn about patient safety (Table 4 ), for example, we rapidly accumulated a large quantity of data. The volume of data, together with the time restrictions in place, impacted on the depth of analysis that was possible within the available resources. This highlights a more general point of the importance of avoiding the temptation to collect as much data as possible; adequate time also needs to be set aside for data analysis and interpretation of what are often highly complex datasets.

Case study research has sometimes been criticised for lacking scientific rigour and providing little basis for generalisation (i.e. producing findings that may be transferable to other settings)[ 1 ]. There are several ways to address these concerns, including: the use of theoretical sampling (i.e. drawing on a particular conceptual framework); respondent validation (i.e. participants checking emerging findings and the researcher's interpretation, and providing an opinion as to whether they feel these are accurate); and transparency throughout the research process (see Table 8 )[ 8 , 18 – 21 , 23 , 26 ]. Transparency can be achieved by describing in detail the steps involved in case selection, data collection, the reasons for the particular methods chosen, and the researcher's background and level of involvement (i.e. being explicit about how the researcher has influenced data collection and interpretation). Seeking potential, alternative explanations, and being explicit about how interpretations and conclusions were reached, help readers to judge the trustworthiness of the case study report. Stake provides a critique checklist for a case study report (Table 9 )[ 8 ].

Conclusions

The case study approach allows, amongst other things, critical events, interventions, policy developments and programme-based service reforms to be studied in detail in a real-life context. It should therefore be considered when an experimental design is either inappropriate to answer the research questions posed or impossible to undertake. Considering the frequency with which implementations of innovations are now taking place in healthcare settings and how well the case study approach lends itself to in-depth, complex health service research, we believe this approach should be more widely considered by researchers. Though inherently challenging, the research case study can, if carefully conceptualised and thoughtfully undertaken and reported, yield powerful insights into many important aspects of health and healthcare delivery.

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Acknowledgements

We are grateful to the participants and colleagues who contributed to the individual case studies that we have drawn on. This work received no direct funding, but it has been informed by projects funded by Asthma UK, the NHS Service Delivery Organisation, NHS Connecting for Health Evaluation Programme, and Patient Safety Research Portfolio. We would also like to thank the expert reviewers for their insightful and constructive feedback. Our thanks are also due to Dr. Allison Worth who commented on an earlier draft of this manuscript.

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AS conceived this article. SC, KC and AR wrote this paper with GH, AA and AS all commenting on various drafts. SC and AS are guarantors.

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Crowe, S., Cresswell, K., Robertson, A. et al. The case study approach. BMC Med Res Methodol 11 , 100 (2011). https://doi.org/10.1186/1471-2288-11-100

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Methodology or method? A critical review of qualitative case study reports

Despite on-going debate about credibility, and reported limitations in comparison to other approaches, case study is an increasingly popular approach among qualitative researchers. We critically analysed the methodological descriptions of published case studies. Three high-impact qualitative methods journals were searched to locate case studies published in the past 5 years; 34 were selected for analysis. Articles were categorized as health and health services ( n= 12), social sciences and anthropology ( n= 7), or methods ( n= 15) case studies. The articles were reviewed using an adapted version of established criteria to determine whether adequate methodological justification was present, and if study aims, methods, and reported findings were consistent with a qualitative case study approach. Findings were grouped into five themes outlining key methodological issues: case study methodology or method, case of something particular and case selection, contextually bound case study, researcher and case interactions and triangulation, and study design inconsistent with methodology reported. Improved reporting of case studies by qualitative researchers will advance the methodology for the benefit of researchers and practitioners.

Case study research is an increasingly popular approach among qualitative researchers (Thomas, 2011 ). Several prominent authors have contributed to methodological developments, which has increased the popularity of case study approaches across disciplines (Creswell, 2013b ; Denzin & Lincoln, 2011b ; Merriam, 2009 ; Ragin & Becker, 1992 ; Stake, 1995 ; Yin, 2009 ). Current qualitative case study approaches are shaped by paradigm, study design, and selection of methods, and, as a result, case studies in the published literature vary. Differences between published case studies can make it difficult for researchers to define and understand case study as a methodology.

Experienced qualitative researchers have identified case study research as a stand-alone qualitative approach (Denzin & Lincoln, 2011b ). Case study research has a level of flexibility that is not readily offered by other qualitative approaches such as grounded theory or phenomenology. Case studies are designed to suit the case and research question and published case studies demonstrate wide diversity in study design. There are two popular case study approaches in qualitative research. The first, proposed by Stake ( 1995 ) and Merriam ( 2009 ), is situated in a social constructivist paradigm, whereas the second, by Yin ( 2012 ), Flyvbjerg ( 2011 ), and Eisenhardt ( 1989 ), approaches case study from a post-positivist viewpoint. Scholarship from both schools of inquiry has contributed to the popularity of case study and development of theoretical frameworks and principles that characterize the methodology.

The diversity of case studies reported in the published literature, and on-going debates about credibility and the use of case study in qualitative research practice, suggests that differences in perspectives on case study methodology may prevent researchers from developing a mutual understanding of practice and rigour. In addition, discussion about case study limitations has led some authors to query whether case study is indeed a methodology (Luck, Jackson, & Usher, 2006 ; Meyer, 2001 ; Thomas, 2010 ; Tight, 2010 ). Methodological discussion of qualitative case study research is timely, and a review is required to analyse and understand how this methodology is applied in the qualitative research literature. The aims of this study were to review methodological descriptions of published qualitative case studies, to review how the case study methodological approach was applied, and to identify issues that need to be addressed by researchers, editors, and reviewers. An outline of the current definitions of case study and an overview of the issues proposed in the qualitative methodological literature are provided to set the scene for the review.

Definitions of qualitative case study research

Case study research is an investigation and analysis of a single or collective case, intended to capture the complexity of the object of study (Stake, 1995 ). Qualitative case study research, as described by Stake ( 1995 ), draws together “naturalistic, holistic, ethnographic, phenomenological, and biographic research methods” in a bricoleur design, or in his words, “a palette of methods” (Stake, 1995 , pp. xi–xii). Case study methodology maintains deep connections to core values and intentions and is “particularistic, descriptive and heuristic” (Merriam, 2009 , p. 46).

As a study design, case study is defined by interest in individual cases rather than the methods of inquiry used. The selection of methods is informed by researcher and case intuition and makes use of naturally occurring sources of knowledge, such as people or observations of interactions that occur in the physical space (Stake, 1998 ). Thomas ( 2011 ) suggested that “analytical eclecticism” is a defining factor (p. 512). Multiple data collection and analysis methods are adopted to further develop and understand the case, shaped by context and emergent data (Stake, 1995 ). This qualitative approach “explores a real-life, contemporary bounded system (a case ) or multiple bounded systems (cases) over time, through detailed, in-depth data collection involving multiple sources of information … and reports a case description and case themes ” (Creswell, 2013b , p. 97). Case study research has been defined by the unit of analysis, the process of study, and the outcome or end product, all essentially the case (Merriam, 2009 ).

The case is an object to be studied for an identified reason that is peculiar or particular. Classification of the case and case selection procedures informs development of the study design and clarifies the research question. Stake ( 1995 ) proposed three types of cases and study design frameworks. These include the intrinsic case, the instrumental case, and the collective instrumental case. The intrinsic case is used to understand the particulars of a single case, rather than what it represents. An instrumental case study provides insight on an issue or is used to refine theory. The case is selected to advance understanding of the object of interest. A collective refers to an instrumental case which is studied as multiple, nested cases, observed in unison, parallel, or sequential order. More than one case can be simultaneously studied; however, each case study is a concentrated, single inquiry, studied holistically in its own entirety (Stake, 1995 , 1998 ).

Researchers who use case study are urged to seek out what is common and what is particular about the case. This involves careful and in-depth consideration of the nature of the case, historical background, physical setting, and other institutional and political contextual factors (Stake, 1998 ). An interpretive or social constructivist approach to qualitative case study research supports a transactional method of inquiry, where the researcher has a personal interaction with the case. The case is developed in a relationship between the researcher and informants, and presented to engage the reader, inviting them to join in this interaction and in case discovery (Stake, 1995 ). A postpositivist approach to case study involves developing a clear case study protocol with careful consideration of validity and potential bias, which might involve an exploratory or pilot phase, and ensures that all elements of the case are measured and adequately described (Yin, 2009 , 2012 ).

Current methodological issues in qualitative case study research

The future of qualitative research will be influenced and constructed by the way research is conducted, and by what is reviewed and published in academic journals (Morse, 2011 ). If case study research is to further develop as a principal qualitative methodological approach, and make a valued contribution to the field of qualitative inquiry, issues related to methodological credibility must be considered. Researchers are required to demonstrate rigour through adequate descriptions of methodological foundations. Case studies published without sufficient detail for the reader to understand the study design, and without rationale for key methodological decisions, may lead to research being interpreted as lacking in quality or credibility (Hallberg, 2013 ; Morse, 2011 ).

There is a level of artistic license that is embraced by qualitative researchers and distinguishes practice, which nurtures creativity, innovation, and reflexivity (Denzin & Lincoln, 2011b ; Morse, 2009 ). Qualitative research is “inherently multimethod” (Denzin & Lincoln, 2011a , p. 5); however, with this creative freedom, it is important for researchers to provide adequate description for methodological justification (Meyer, 2001 ). This includes paradigm and theoretical perspectives that have influenced study design. Without adequate description, study design might not be understood by the reader, and can appear to be dishonest or inaccurate. Reviewers and readers might be confused by the inconsistent or inappropriate terms used to describe case study research approach and methods, and be distracted from important study findings (Sandelowski, 2000 ). This issue extends beyond case study research, and others have noted inconsistencies in reporting of methodology and method by qualitative researchers. Sandelowski ( 2000 , 2010 ) argued for accurate identification of qualitative description as a research approach. She recommended that the selected methodology should be harmonious with the study design, and be reflected in methods and analysis techniques. Similarly, Webb and Kevern ( 2000 ) uncovered inconsistencies in qualitative nursing research with focus group methods, recommending that methodological procedures must cite seminal authors and be applied with respect to the selected theoretical framework. Incorrect labelling using case study might stem from the flexibility in case study design and non-directional character relative to other approaches (Rosenberg & Yates, 2007 ). Methodological integrity is required in design of qualitative studies, including case study, to ensure study rigour and to enhance credibility of the field (Morse, 2011 ).

Case study has been unnecessarily devalued by comparisons with statistical methods (Eisenhardt, 1989 ; Flyvbjerg, 2006 , 2011 ; Jensen & Rodgers, 2001 ; Piekkari, Welch, & Paavilainen, 2009 ; Tight, 2010 ; Yin, 1999 ). It is reputed to be the “the weak sibling” in comparison to other, more rigorous, approaches (Yin, 2009 , p. xiii). Case study is not an inherently comparative approach to research. The objective is not statistical research, and the aim is not to produce outcomes that are generalizable to all populations (Thomas, 2011 ). Comparisons between case study and statistical research do little to advance this qualitative approach, and fail to recognize its inherent value, which can be better understood from the interpretive or social constructionist viewpoint of other authors (Merriam, 2009 ; Stake, 1995 ). Building on discussions relating to “fuzzy” (Bassey, 2001 ), or naturalistic generalizations (Stake, 1978 ), or transference of concepts and theories (Ayres, Kavanaugh, & Knafl, 2003 ; Morse et al., 2011 ) would have more relevance.

Case study research has been used as a catch-all design to justify or add weight to fundamental qualitative descriptive studies that do not fit with other traditional frameworks (Merriam, 2009 ). A case study has been a “convenient label for our research—when we ‘can't think of anything ‘better”—in an attempt to give it [qualitative methodology] some added respectability” (Tight, 2010 , p. 337). Qualitative case study research is a pliable approach (Merriam, 2009 ; Meyer, 2001 ; Stake, 1995 ), and has been likened to a “curious methodological limbo” (Gerring, 2004 , p. 341) or “paradigmatic bridge” (Luck et al., 2006 , p. 104), that is on the borderline between postpositivist and constructionist interpretations. This has resulted in inconsistency in application, which indicates that flexibility comes with limitations (Meyer, 2001 ), and the open nature of case study research might be off-putting to novice researchers (Thomas, 2011 ). The development of a well-(in)formed theoretical framework to guide a case study should improve consistency, rigour, and trust in studies published in qualitative research journals (Meyer, 2001 ).

Assessment of rigour

The purpose of this study was to analyse the methodological descriptions of case studies published in qualitative methods journals. To do this we needed to develop a suitable framework, which used existing, established criteria for appraising qualitative case study research rigour (Creswell, 2013b ; Merriam, 2009 ; Stake, 1995 ). A number of qualitative authors have developed concepts and criteria that are used to determine whether a study is rigorous (Denzin & Lincoln, 2011b ; Lincoln, 1995 ; Sandelowski & Barroso, 2002 ). The criteria proposed by Stake ( 1995 ) provide a framework for readers and reviewers to make judgements regarding case study quality, and identify key characteristics essential for good methodological rigour. Although each of the factors listed in Stake's criteria could enhance the quality of a qualitative research report, in Table I we present an adapted criteria used in this study, which integrates more recent work by Merriam ( 2009 ) and Creswell ( 2013b ). Stake's ( 1995 ) original criteria were separated into two categories. The first list of general criteria is “relevant for all qualitative research.” The second list, “high relevance to qualitative case study research,” was the criteria that we decided had higher relevance to case study research. This second list was the main criteria used to assess the methodological descriptions of the case studies reviewed. The complete table has been preserved so that the reader can determine how the original criteria were adapted.

Framework for assessing quality in qualitative case study research.

Adapted from Stake ( 1995 , p. 131).

Study design

The critical review method described by Grant and Booth ( 2009 ) was used, which is appropriate for the assessment of research quality, and is used for literature analysis to inform research and practice. This type of review goes beyond the mapping and description of scoping or rapid reviews, to include “analysis and conceptual innovation” (Grant & Booth, 2009 , p. 93). A critical review is used to develop existing, or produce new, hypotheses or models. This is different to systematic reviews that answer clinical questions. It is used to evaluate existing research and competing ideas, to provide a “launch pad” for conceptual development and “subsequent testing” (Grant & Booth, 2009 , p. 93).

Qualitative methods journals were located by a search of the 2011 ISI Journal Citation Reports in Social Science, via the database Web of Knowledge (see m.webofknowledge.com). No “qualitative research methods” category existed in the citation reports; therefore, a search of all categories was performed using the term “qualitative.” In Table II , we present the qualitative methods journals located, ranked by impact factor. The highest ranked journals were selected for searching. We acknowledge that the impact factor ranking system might not be the best measure of journal quality (Cheek, Garnham, & Quan, 2006 ); however, this was the most appropriate and accessible method available.

International Journal of Qualitative Studies on Health and Well-being.

Search strategy

In March 2013, searches of the journals, Qualitative Health Research , Qualitative Research , and Qualitative Inquiry were completed to retrieve studies with “case study” in the abstract field. The search was limited to the past 5 years (1 January 2008 to 1 March 2013). The objective was to locate published qualitative case studies suitable for assessment using the adapted criterion. Viewpoints, commentaries, and other article types were excluded from review. Title and abstracts of the 45 retrieved articles were read by the first author, who identified 34 empirical case studies for review. All authors reviewed the 34 studies to confirm selection and categorization. In Table III , we present the 34 case studies grouped by journal, and categorized by research topic, including health sciences, social sciences and anthropology, and methods research. There was a discrepancy in categorization of one article on pedagogy and a new teaching method published in Qualitative Inquiry (Jorrín-Abellán, Rubia-Avi, Anguita-Martínez, Gómez-Sánchez, & Martínez-Mones, 2008 ). Consensus was to allocate to the methods category.

Outcomes of search of qualitative methods journals.

In Table III , the number of studies located, and final numbers selected for review have been reported. Qualitative Health Research published the most empirical case studies ( n= 16). In the health category, there were 12 case studies of health conditions, health services, and health policy issues, all published in Qualitative Health Research . Seven case studies were categorized as social sciences and anthropology research, which combined case study with biography and ethnography methodologies. All three journals published case studies on methods research to illustrate a data collection or analysis technique, methodological procedure, or related issue.

The methodological descriptions of 34 case studies were critically reviewed using the adapted criteria. All articles reviewed contained a description of study methods; however, the length, amount of detail, and position of the description in the article varied. Few studies provided an accurate description and rationale for using a qualitative case study approach. In the 34 case studies reviewed, three described a theoretical framework informed by Stake ( 1995 ), two by Yin ( 2009 ), and three provided a mixed framework informed by various authors, which might have included both Yin and Stake. Few studies described their case study design, or included a rationale that explained why they excluded or added further procedures, and whether this was to enhance the study design, or to better suit the research question. In 26 of the studies no reference was provided to principal case study authors. From reviewing the description of methods, few authors provided a description or justification of case study methodology that demonstrated how their study was informed by the methodological literature that exists on this approach.

The methodological descriptions of each study were reviewed using the adapted criteria, and the following issues were identified: case study methodology or method; case of something particular and case selection; contextually bound case study; researcher and case interactions and triangulation; and, study design inconsistent with methodology. An outline of how the issues were developed from the critical review is provided, followed by a discussion of how these relate to the current methodological literature.

Case study methodology or method

A third of the case studies reviewed appeared to use a case report method, not case study methodology as described by principal authors (Creswell, 2013b ; Merriam, 2009 ; Stake, 1995 ; Yin, 2009 ). Case studies were identified as a case report because of missing methodological detail and by review of the study aims and purpose. These reports presented data for small samples of no more than three people, places or phenomenon. Four studies, or “case reports” were single cases selected retrospectively from larger studies (Bronken, Kirkevold, Martinsen, & Kvigne, 2012 ; Coltart & Henwood, 2012 ; Hooghe, Neimeyer, & Rober, 2012 ; Roscigno et al., 2012 ). Case reports were not a case of something, instead were a case demonstration or an example presented in a report. These reports presented outcomes, and reported on how the case could be generalized. Descriptions focussed on the phenomena, rather than the case itself, and did not appear to study the case in its entirety.

Case reports had minimal in-text references to case study methodology, and were informed by other qualitative traditions or secondary sources (Adamson & Holloway, 2012 ; Buzzanell & D'Enbeau, 2009 ; Nagar-Ron & Motzafi-Haller, 2011 ). This does not suggest that case study methodology cannot be multimethod, however, methodology should be consistent in design, be clearly described (Meyer, 2001 ; Stake, 1995 ), and maintain focus on the case (Creswell, 2013b ).

To demonstrate how case reports were identified, three examples are provided. The first, Yeh ( 2013 ) described their study as, “the examination of the emergence of vegetarianism in Victorian England serves as a case study to reveal the relationships between boundaries and entities” (p. 306). The findings were a historical case report, which resulted from an ethnographic study of vegetarianism. Cunsolo Willox, Harper, Edge, ‘My Word’: Storytelling and Digital Media Lab, and Rigolet Inuit Community Government (2013) used “a case study that illustrates the usage of digital storytelling within an Inuit community” (p. 130). This case study reported how digital storytelling can be used with indigenous communities as a participatory method to illuminate the benefits of this method for other studies. This “case study was conducted in the Inuit community” but did not include the Inuit community in case analysis (Cunsolo Willox et al., 2013 , p. 130). Bronken et al. ( 2012 ) provided a single case report to demonstrate issues observed in a larger clinical study of aphasia and stroke, without adequate case description or analysis.

Case study of something particular and case selection

Case selection is a precursor to case analysis, which needs to be presented as a convincing argument (Merriam, 2009 ). Descriptions of the case were often not adequate to ascertain why the case was selected, or whether it was a particular exemplar or outlier (Thomas, 2011 ). In a number of case studies in the health and social science categories, it was not explicit whether the case was of something particular, or peculiar to their discipline or field (Adamson & Holloway, 2012 ; Bronken et al., 2012 ; Colón-Emeric et al., 2010 ; Jackson, Botelho, Welch, Joseph, & Tennstedt, 2012 ; Mawn et al., 2010 ; Snyder-Young, 2011 ). There were exceptions in the methods category ( Table III ), where cases were selected by researchers to report on a new or innovative method. The cases emerged through heuristic study, and were reported to be particular, relative to the existing methods literature (Ajodhia-Andrews & Berman, 2009 ; Buckley & Waring, 2013 ; Cunsolo Willox et al., 2013 ; De Haene, Grietens, & Verschueren, 2010 ; Gratton & O'Donnell, 2011 ; Sumsion, 2013 ; Wimpenny & Savin-Baden, 2012 ).

Case selection processes were sometimes insufficient to understand why the case was selected from the global population of cases, or what study of this case would contribute to knowledge as compared with other possible cases (Adamson & Holloway, 2012 ; Bronken et al., 2012 ; Colón-Emeric et al., 2010 ; Jackson et al., 2012 ; Mawn et al., 2010 ). In two studies, local cases were selected (Barone, 2010 ; Fourie & Theron, 2012 ) because the researcher was familiar with and had access to the case. Possible limitations of a convenience sample were not acknowledged. Purposeful sampling was used to recruit participants within the case of one study, but not of the case itself (Gallagher et al., 2013 ). Random sampling was completed for case selection in two studies (Colón-Emeric et al., 2010 ; Jackson et al., 2012 ), which has limited meaning in interpretive qualitative research.

To demonstrate how researchers provided a good justification for the selection of case study approaches, four examples are provided. The first, cases of residential care homes, were selected because of reported occurrences of mistreatment, which included residents being locked in rooms at night (Rytterström, Unosson, & Arman, 2013 ). Roscigno et al. ( 2012 ) selected cases of parents who were admitted for early hospitalization in neonatal intensive care with a threatened preterm delivery before 26 weeks. Hooghe et al. ( 2012 ) used random sampling to select 20 couples that had experienced the death of a child; however, the case study was of one couple and a particular metaphor described only by them. The final example, Coltart and Henwood ( 2012 ), provided a detailed account of how they selected two cases from a sample of 46 fathers based on personal characteristics and beliefs. They described how the analysis of the two cases would contribute to their larger study on first time fathers and parenting.

Contextually bound case study

The limits or boundaries of the case are a defining factor of case study methodology (Merriam, 2009 ; Ragin & Becker, 1992 ; Stake, 1995 ; Yin, 2009 ). Adequate contextual description is required to understand the setting or context in which the case is revealed. In the health category, case studies were used to illustrate a clinical phenomenon or issue such as compliance and health behaviour (Colón-Emeric et al., 2010 ; D'Enbeau, Buzzanell, & Duckworth, 2010 ; Gallagher et al., 2013 ; Hooghe et al., 2012 ; Jackson et al., 2012 ; Roscigno et al., 2012 ). In these case studies, contextual boundaries, such as physical and institutional descriptions, were not sufficient to understand the case as a holistic system, for example, the general practitioner (GP) clinic in Gallagher et al. ( 2013 ), or the nursing home in Colón-Emeric et al. ( 2010 ). Similarly, in the social science and methods categories, attention was paid to some components of the case context, but not others, missing important information required to understand the case as a holistic system (Alexander, Moreira, & Kumar, 2012 ; Buzzanell & D'Enbeau, 2009 ; Nairn & Panelli, 2009 ; Wimpenny & Savin-Baden, 2012 ).

In two studies, vicarious experience or vignettes (Nairn & Panelli, 2009 ) and images (Jorrín-Abellán et al., 2008 ) were effective to support description of context, and might have been a useful addition for other case studies. Missing contextual boundaries suggests that the case might not be adequately defined. Additional information, such as the physical, institutional, political, and community context, would improve understanding of the case (Stake, 1998 ). In Boxes 1 and 2 , we present brief synopses of two studies that were reviewed, which demonstrated a well bounded case. In Box 1 , Ledderer ( 2011 ) used a qualitative case study design informed by Stake's tradition. In Box 2 , Gillard, Witt, and Watts ( 2011 ) were informed by Yin's tradition. By providing a brief outline of the case studies in Boxes 1 and 2 , we demonstrate how effective case boundaries can be constructed and reported, which may be of particular interest to prospective case study researchers.

Article synopsis of case study research using Stake's tradition

Ledderer ( 2011 ) used a qualitative case study research design, informed by modern ethnography. The study is bounded to 10 general practice clinics in Denmark, who had received federal funding to implement preventative care services based on a Motivational Interviewing intervention. The researcher question focussed on “why is it so difficult to create change in medical practice?” (Ledderer, 2011 , p. 27). The study context was adequately described, providing detail on the general practitioner (GP) clinics and relevant political and economic influences. Methodological decisions are described in first person narrative, providing insight on researcher perspectives and interaction with the case. Forty-four interviews were conducted, which focussed on how GPs conducted consultations, and the form, nature and content, rather than asking their opinion or experience (Ledderer, 2011 , p. 30). The duration and intensity of researcher immersion in the case enhanced depth of description and trustworthiness of study findings. Analysis was consistent with Stake's tradition, and the researcher provided examples of inquiry techniques used to challenge assumptions about emerging themes. Several other seminal qualitative works were cited. The themes and typology constructed are rich in narrative data and storytelling by clinic staff, demonstrating individual clinic experiences as well as shared meanings and understandings about changing from a biomedical to psychological approach to preventative health intervention. Conclusions make note of social and cultural meanings and lessons learned, which might not have been uncovered using a different methodology.

Article synopsis of case study research using Yin's tradition

Gillard et al. ( 2011 ) study of camps for adolescents living with HIV/AIDs provided a good example of Yin's interpretive case study approach. The context of the case is bounded by the three summer camps of which the researchers had prior professional involvement. A case study protocol was developed that used multiple methods to gather information at three data collection points coinciding with three youth camps (Teen Forum, Discover Camp, and Camp Strong). Gillard and colleagues followed Yin's ( 2009 ) principles, using a consistent data protocol that enhanced cross-case analysis. Data described the young people, the camp physical environment, camp schedule, objectives and outcomes, and the staff of three youth camps. The findings provided a detailed description of the context, with less detail of individual participants, including insight into researcher's interpretations and methodological decisions throughout the data collection and analysis process. Findings provided the reader with a sense of “being there,” and are discovered through constant comparison of the case with the research issues; the case is the unit of analysis. There is evidence of researcher immersion in the case, and Gillard reports spending significant time in the field in a naturalistic and integrated youth mentor role.

This case study is not intended to have a significant impact on broader health policy, although does have implications for health professionals working with adolescents. Study conclusions will inform future camps for young people with chronic disease, and practitioners are able to compare similarities between this case and their own practice (for knowledge translation). No limitations of this article were reported. Limitations related to publication of this case study were that it was 20 pages long and used three tables to provide sufficient description of the camp and program components, and relationships with the research issue.

Researcher and case interactions and triangulation

Researcher and case interactions and transactions are a defining feature of case study methodology (Stake, 1995 ). Narrative stories, vignettes, and thick description are used to provoke vicarious experience and a sense of being there with the researcher in their interaction with the case. Few of the case studies reviewed provided details of the researcher's relationship with the case, researcher–case interactions, and how these influenced the development of the case study (Buzzanell & D'Enbeau, 2009 ; D'Enbeau et al., 2010 ; Gallagher et al., 2013 ; Gillard et al., 2011 ; Ledderer, 2011 ; Nagar-Ron & Motzafi-Haller, 2011 ). The role and position of the researcher needed to be self-examined and understood by readers, to understand how this influenced interactions with participants, and to determine what triangulation is needed (Merriam, 2009 ; Stake, 1995 ).

Gillard et al. ( 2011 ) provided a good example of triangulation, comparing data sources in a table (p. 1513). Triangulation of sources was used to reveal as much depth as possible in the study by Nagar-Ron and Motzafi-Haller ( 2011 ), while also enhancing confirmation validity. There were several case studies that would have benefited from improved range and use of data sources, and descriptions of researcher–case interactions (Ajodhia-Andrews & Berman, 2009 ; Bronken et al., 2012 ; Fincham, Scourfield, & Langer, 2008 ; Fourie & Theron, 2012 ; Hooghe et al., 2012 ; Snyder-Young, 2011 ; Yeh, 2013 ).

Study design inconsistent with methodology

Good, rigorous case studies require a strong methodological justification (Meyer, 2001 ) and a logical and coherent argument that defines paradigm, methodological position, and selection of study methods (Denzin & Lincoln, 2011b ). Methodological justification was insufficient in several of the studies reviewed (Barone, 2010 ; Bronken et al., 2012 ; Hooghe et al., 2012 ; Mawn et al., 2010 ; Roscigno et al., 2012 ; Yeh, 2013 ). This was judged by the absence, or inadequate or inconsistent reference to case study methodology in-text.

In six studies, the methodological justification provided did not relate to case study. There were common issues identified. Secondary sources were used as primary methodological references indicating that study design might not have been theoretically sound (Colón-Emeric et al., 2010 ; Coltart & Henwood, 2012 ; Roscigno et al., 2012 ; Snyder-Young, 2011 ). Authors and sources cited in methodological descriptions were inconsistent with the actual study design and practices used (Fourie & Theron, 2012 ; Hooghe et al., 2012 ; Jorrín-Abellán et al., 2008 ; Mawn et al., 2010 ; Rytterström et al., 2013 ; Wimpenny & Savin-Baden, 2012 ). This occurred when researchers cited Stake or Yin, or both (Mawn et al., 2010 ; Rytterström et al., 2013 ), although did not follow their paradigmatic or methodological approach. In 26 studies there were no citations for a case study methodological approach.

The findings of this study have highlighted a number of issues for researchers. A considerable number of case studies reviewed were missing key elements that define qualitative case study methodology and the tradition cited. A significant number of studies did not provide a clear methodological description or justification relevant to case study. Case studies in health and social sciences did not provide sufficient information for the reader to understand case selection, and why this case was chosen above others. The context of the cases were not described in adequate detail to understand all relevant elements of the case context, which indicated that cases may have not been contextually bounded. There were inconsistencies between reported methodology, study design, and paradigmatic approach in case studies reviewed, which made it difficult to understand the study methodology and theoretical foundations. These issues have implications for methodological integrity and honesty when reporting study design, which are values of the qualitative research tradition and are ethical requirements (Wager & Kleinert, 2010a ). Poorly described methodological descriptions may lead the reader to misinterpret or discredit study findings, which limits the impact of the study, and, as a collective, hinders advancements in the broader qualitative research field.

The issues highlighted in our review build on current debates in the case study literature, and queries about the value of this methodology. Case study research can be situated within different paradigms or designed with an array of methods. In order to maintain the creativity and flexibility that is valued in this methodology, clearer descriptions of paradigm and theoretical position and methods should be provided so that study findings are not undervalued or discredited. Case study research is an interdisciplinary practice, which means that clear methodological descriptions might be more important for this approach than other methodologies that are predominantly driven by fewer disciplines (Creswell, 2013b ).

Authors frequently omit elements of methodologies and include others to strengthen study design, and we do not propose a rigid or purist ideology in this paper. On the contrary, we encourage new ideas about using case study, together with adequate reporting, which will advance the value and practice of case study. The implications of unclear methodological descriptions in the studies reviewed were that study design appeared to be inconsistent with reported methodology, and key elements required for making judgements of rigour were missing. It was not clear whether the deviations from methodological tradition were made by researchers to strengthen the study design, or because of misinterpretations. Morse ( 2011 ) recommended that innovations and deviations from practice are best made by experienced researchers, and that a novice might be unaware of the issues involved with making these changes. To perpetuate the tradition of case study research, applications in the published literature should have consistencies with traditional methodological constructions, and deviations should be described with a rationale that is inherent in study conduct and findings. Providing methodological descriptions that demonstrate a strong theoretical foundation and coherent study design will add credibility to the study, while ensuring the intrinsic meaning of case study is maintained.

The value of this review is that it contributes to discussion of whether case study is a methodology or method. We propose possible reasons why researchers might make this misinterpretation. Researchers may interchange the terms methods and methodology, and conduct research without adequate attention to epistemology and historical tradition (Carter & Little, 2007 ; Sandelowski, 2010 ). If the rich meaning that naming a qualitative methodology brings to the study is not recognized, a case study might appear to be inconsistent with the traditional approaches described by principal authors (Creswell, 2013a ; Merriam, 2009 ; Stake, 1995 ; Yin, 2009 ). If case studies are not methodologically and theoretically situated, then they might appear to be a case report.

Case reports are promoted by university and medical journals as a method of reporting on medical or scientific cases; guidelines for case reports are publicly available on websites ( http://www.hopkinsmedicine.org/institutional_review_board/guidelines_policies/guidelines/case_report.html ). The various case report guidelines provide a general criteria for case reports, which describes that this form of report does not meet the criteria of research, is used for retrospective analysis of up to three clinical cases, and is primarily illustrative and for educational purposes. Case reports can be published in academic journals, but do not require approval from a human research ethics committee. Traditionally, case reports describe a single case, to explain how and what occurred in a selected setting, for example, to illustrate a new phenomenon that has emerged from a larger study. A case report is not necessarily particular or the study of a case in its entirety, and the larger study would usually be guided by a different research methodology.

This description of a case report is similar to what was provided in some studies reviewed. This form of report lacks methodological grounding and qualities of research rigour. The case report has publication value in demonstrating an example and for dissemination of knowledge (Flanagan, 1999 ). However, case reports have different meaning and purpose to case study, which needs to be distinguished. Findings of our review suggest that the medical understanding of a case report has been confused with qualitative case study approaches.

In this review, a number of case studies did not have methodological descriptions that included key characteristics of case study listed in the adapted criteria, and several issues have been discussed. There have been calls for improvements in publication quality of qualitative research (Morse, 2011 ), and for improvements in peer review of submitted manuscripts (Carter & Little, 2007 ; Jasper, Vaismoradi, Bondas, & Turunen, 2013 ). The challenging nature of editor and reviewers responsibilities are acknowledged in the literature (Hames, 2013 ; Wager & Kleinert, 2010b ); however, review of case study methodology should be prioritized because of disputes on methodological value.

Authors using case study approaches are recommended to describe their theoretical framework and methods clearly, and to seek and follow specialist methodological advice when needed (Wager & Kleinert, 2010a ). Adequate page space for case study description would contribute to better publications (Gillard et al., 2011 ). Capitalizing on the ability to publish complementary resources should be considered.

Limitations of the review

There is a level of subjectivity involved in this type of review and this should be considered when interpreting study findings. Qualitative methods journals were selected because the aims and scope of these journals are to publish studies that contribute to methodological discussion and development of qualitative research. Generalist health and social science journals were excluded that might have contained good quality case studies. Journals in business or education were also excluded, although a review of case studies in international business journals has been published elsewhere (Piekkari et al., 2009 ).

The criteria used to assess the quality of the case studies were a set of qualitative indicators. A numerical or ranking system might have resulted in different results. Stake's ( 1995 ) criteria have been referenced elsewhere, and was deemed the best available (Creswell, 2013b ; Crowe et al., 2011 ). Not all qualitative studies are reported in a consistent way and some authors choose to report findings in a narrative form in comparison to a typical biomedical report style (Sandelowski & Barroso, 2002 ), if misinterpretations were made this may have affected the review.

Case study research is an increasingly popular approach among qualitative researchers, which provides methodological flexibility through the incorporation of different paradigmatic positions, study designs, and methods. However, whereas flexibility can be an advantage, a myriad of different interpretations has resulted in critics questioning the use of case study as a methodology. Using an adaptation of established criteria, we aimed to identify and assess the methodological descriptions of case studies in high impact, qualitative methods journals. Few articles were identified that applied qualitative case study approaches as described by experts in case study design. There were inconsistencies in methodology and study design, which indicated that researchers were confused whether case study was a methodology or a method. Commonly, there appeared to be confusion between case studies and case reports. Without clear understanding and application of the principles and key elements of case study methodology, there is a risk that the flexibility of the approach will result in haphazard reporting, and will limit its global application as a valuable, theoretically supported methodology that can be rigorously applied across disciplines and fields.

Conflict of interest and funding

The authors have not received any funding or benefits from industry or elsewhere to conduct this study.

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Robert K. Yin. (2014). Case Study Research Design and Methods (5th ed.). Thousand Oaks, CA: Sage. 282 pages.

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Case Studies

Case studies are a popular research method in business area. Case studies aim to analyze specific issues within the boundaries of a specific environment, situation or organization.

According to its design, case studies in business research can be divided into three categories: explanatory, descriptive and exploratory.

Explanatory case studies aim to answer ‘how’ or ’why’ questions with little control on behalf of researcher over occurrence of events. This type of case studies focus on phenomena within the contexts of real-life situations. Example: “An investigation into the reasons of the global financial and economic crisis of 2008 – 2010.”

Descriptive case studies aim to analyze the sequence of interpersonal events after a certain amount of time has passed. Studies in business research belonging to this category usually describe culture or sub-culture, and they attempt to discover the key phenomena. Example: “Impact of increasing levels of multiculturalism on marketing practices: A case study of McDonald’s Indonesia.”

Exploratory case studies aim to find answers to the questions of ‘what’ or ‘who’. Exploratory case study data collection method is often accompanied by additional data collection method(s) such as interviews, questionnaires, experiments etc. Example: “A study into differences of leadership practices between private and public sector organizations in Atlanta, USA.”

Advantages of case study method include data collection and analysis within the context of phenomenon, integration of qualitative and quantitative data in data analysis, and the ability to capture complexities of real-life situations so that the phenomenon can be studied in greater levels of depth. Case studies do have certain disadvantages that may include lack of rigor, challenges associated with data analysis and very little basis for generalizations of findings and conclusions.

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Writing a Case Study

What is a case study?

A Case study is: 

• An in-depth research design that primarily uses a qualitative methodology but sometimes​​ includes quantitative methodology.
• Used to examine an identifiable problem confirmed through research.
• Used to investigate an individual, group of people, organization, or event.
• Used to mostly answer "how" and "why" questions.

What are the different types of case studies?

Note: These are the primary case studies. As you continue to research and learn

about case studies you will begin to find a robust list of different types. 

Who are your case study participants?

What is triangulation ? 

Validity and credibility are an essential part of the case study. Therefore, the researcher should include triangulation to ensure trustworthiness while accurately reflecting what the researcher seeks to investigate.

How to write a Case Study?

When developing a case study, there are different ways you could present the information, but remember to include the five parts for your case study.

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Case Study Research: Methods and Designs

Case study research is a type of qualitative research design. It’s often used in the social sciences because it involves…

Case study research is a type of qualitative research design. It’s often used in the social sciences because it involves observing subjects, or cases, in their natural setting, with minimal interference from the researcher.

In the case study method , researchers pose a specific question about an individual or group to test their theories or hypothesis. This can be done by gathering data from interviews with key informants.

Here’s what you need to know about case study research design .

What Is The Case Study Method?

Main approaches to data collection, case study research methods, how case studies are used, case study model.

Case study research is a great way to understand the nuances of a matter that can get lost in quantitative research methods. A case study is distinct from other qualitative studies in the following ways:

• It’s interested in the effect of a set of circumstances on an individual or group.
• It begins with a specific question about one or more cases.
• It focuses on individual accounts and experiences.

Here are the primary features of case study research:

• Case study research methods typically involve the researcher asking a few questions of one person or a small number of people—known as respondents—to test one hypothesis.
• Case study in research methodology may apply triangulation to collect data, in which the researcher uses several sources, including documents and field data. This is then analyzed and interpreted to form a hypothesis that can be tested through further research or validated by other researchers.
• The case study method requires clear concepts and theories to guide its methods. A well-defined research question is crucial when conducting a case study because the results of the study depend on it. The best approach to answering a research question is to challenge the existing theories, hypotheses or assumptions.
• Concepts are defined using objective language with no reference to preconceived notions that individuals might have about them. The researcher sets out to discover by asking specific questions on how people think or perceive things in their given situation.

They commonly use the case study method in business, management, psychology, sociology, political science and other related fields.

A fundamental requirement of qualitative research is recording observations that provide an understanding of reality. When it comes to the case study method, there are two major approaches that can be used to collect data: document review and fieldwork.

A case study in research methodology also includes literature review, the process by which the researcher collects all data available through historical documents. These might include books, newspapers, journals, videos, photographs and other written material. The researcher may also record information using video cameras to capture events as they occur. The researcher can also go through materials produced by people involved in the case study to gain an insight into their lives and experiences.

Field research involves participating in interviews and observations directly. Observation can be done during telephone interviews, events or public meetings, visits to homes or workplaces, or by shadowing someone for a period of time. The researcher can conduct one-on-one interviews with individuals or group interviews where several people are interviewed at once.

Let’s look now at case study methodology.

The case study method can be divided into three stages: formulation of objectives; collection of data; and analysis and interpretation. The researcher first makes a judgment about what should be studied based on their knowledge. Next, they gather data through observations and interviews. Here are some of the common case study research methods:

One of the most basic methods is the survey. Respondents are asked to complete a questionnaire with open-ended and predetermined questions. It usually takes place through face-to-face interviews, mailed questionnaires or telephone interviews. It can even be done by an online survey.

2. Semi-structured Interview

For case study research a more complex method is the semi-structured interview. This involves the researcher learning about the topic by listening to what others have to say. This usually occurs through one-on-one interviews with the sample. Semi-structured interviews allow for greater flexibility and can obtain information that structured questionnaires can’t.

3. Focus Group Interview

Another method is the focus group interview, where the researcher asks a few people to take part in an open-ended discussion on certain themes or topics. The typical group size is 5–15 people. This method allows researchers to delve deeper into people’s opinions, views and experiences.

4. Participant Observation

Participant observation is another method that involves the researcher gaining insight into an experience by joining in and taking part in normal events. The people involved don’t always know they’re being studied, but the researcher observes and records what happens through field notes.

Case study research design can use one or several of these methods depending on the context.

Case studies are widely used in the social sciences. To understand the impact of socio-economic forces, interpersonal dynamics and other human conditions, sometimes there’s no other way than to study one case at a time and look for patterns and data afterward.

It’s for the same reasons that case studies are used in business. Here are a few uses:

• Case studies can be used as tools to educate and give examples of situations and problems that might occur and how they were resolved. They can also be used for strategy development and implementation.
• Case studies can evaluate the success of a program or project. They can help teams improve their collaboration by identifying areas that need improvements, such as team dynamics, communication, roles and responsibilities and leadership styles.
• Case studies can explore how people’s experiences affect the working environment. Because the study involves observing and analyzing concrete details of life, they can inform theories on how an individual or group interacts with their environment.
• Case studies can evaluate the sustainability of businesses. They’re useful for social, environmental and economic impact studies because they look at all aspects of a business or organization. This gives researchers a holistic view of the dynamics within an organization.
• We can use case studies to identify problems in organizations or businesses. They can help spot problems that are invisible to customers, investors, managers and employees.
• Case studies are used in education to show students how real-world issues or events can be sorted out. This enables students to identify and deal with similar situations in their lives.

And that’s not all. Case studies are incredibly versatile, which is why they’re used so widely.

Human beings are complex and they interact with each other in their everyday life in various ways. The researcher observes a case and tries to find out how the patterns of behavior are created, including their causal relations. Case studies help understand one or more specific events that have been observed. Here are some common methods:

1. Illustrative case study

This is where the researcher observes a group of people doing something. Studying an event or phenomenon this way can show cause-and-effect relationships between various variables.

2. Cumulative case study

A cumulative case study is one that involves observing the same set of phenomena over a period. Cumulative case studies can be very helpful in understanding processes, which are things that happen over time. For example, if there are behavioral changes in people who move from one place to another, the researcher might want to know why these changes occurred.

3. Exploratory case study

An exploratory case study collects information that will answer a question. It can help researchers better understand social, economic, political or other social phenomena.

There are several other ways to categorize case studies. They may be chronological case studies, where a researcher observes events over time. In the comparative case study, the researcher compares one or more groups of people, places, or things to draw conclusions about them. In an intervention case study, the researcher intervenes to change the behavior of the subjects. The study method depends on the needs of the research team.

Deciding how to analyze the information at our disposal is an important part of effective management. An understanding of the case study model can help. With Harappa’s Thinking Critically course, managers and young professionals receive input and training on how to level up their analytic skills. Knowledge of frameworks, reading real-life examples and lived wisdom of faculty come together to create a dynamic and exciting course that helps teams leap to the next level.

Explore Harappa Diaries to learn more about topics such as Objectives Of Research , What are Qualitative Research Methods , How To Make A Problem Statement and How To Improve your Cognitive Skills to upgrade your knowledge and skills.

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You’re on a business trip in Oakland, CA. You've been working late in downtown and now you're looking for a place nearby to grab a late dinner. You decided to check Zomato to try and find somewhere to eat. (Don't begin searching yet).

• Look around on the home page. Does anything seem interesting to you?
• How would you go about finding a place to eat near you in Downtown Oakland? You want something kind of quick, open late, not too expensive, and with a good rating.
• What do the reviews say about the restaurant you've chosen?
• What was the most important factor for you in choosing this spot?
• You're currently close to the 19th St Bart station, and it's 9PM. How would you get to this restaurant? Do you think you'll be able to make it before closing time?
• Your friend recommended you to check out a place called Belly while you're in Oakland. Try to find where it is, when it's open, and what kind of food options they have.
• Now go to any restaurant's page and try to leave a review (don't actually submit it).

What was the worst thing about your experience?

It was hard to find the bart station. The collections not being able to be sorted was a bit of a bummer

What other aspects of the experience could be improved?

Feedback from the owners would be nice

What did you like about the website?

The flow was good, lots of bright photos

What other comments do you have for the owner of the website?

I like that you can sort by what you are looking for and i like the idea of collections

You're going on a vacation to Italy next month, and you want to learn some basic Italian for getting around while there. You decided to try Duolingo.

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I felt like there could have been a little more of an instructional component to the lesson.

It would be cool if there were some feature that could allow two learners studying the same language to take lessons together. I imagine that their screens would be synced and they could go through lessons together and chat along the way.

Overall, the app was very intuitive to use and visually appealing. I also liked the option to connect with others.

Overall, the app seemed very helpful and easy to use. I feel like it makes learning a new language fun and almost like a game. It would be nice, however, if it contained more of an instructional portion.

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What is a Case Study? Definition, Research Methods, Sampling and Examples

What is a Case Study?

A case study is defined as an in-depth analysis of a particular subject, often a real-world situation, individual, group, or organization. 

It is a research method that involves the comprehensive examination of a specific instance to gain a better understanding of its complexities, dynamics, and context. 

Case studies are commonly used in various fields such as business, psychology, medicine, and education to explore and illustrate phenomena, theories, or practical applications.

In a typical case study, researchers collect and analyze a rich array of qualitative and/or quantitative data, including interviews, observations, documents, and other relevant sources. The goal is to provide a nuanced and holistic perspective on the subject under investigation.

The information gathered here is used to generate insights, draw conclusions, and often to inform broader theories or practices within the respective field.

Case studies offer a valuable method for researchers to explore real-world phenomena in their natural settings, providing an opportunity to delve deeply into the intricacies of a particular case. They are particularly useful when studying complex, multifaceted situations where various factors interact. 

Additionally, case studies can be instrumental in generating hypotheses, testing theories, and offering practical insights that can be applied to similar situations. Overall, the comprehensive nature of case studies makes them a powerful tool for gaining a thorough understanding of specific instances within the broader context of academic and professional inquiry.

Key Characteristics of Case Study

Case studies are characterized by several key features that distinguish them from other research methods. Here are some essential characteristics of case studies:

• In-depth Exploration: Case studies involve a thorough and detailed examination of a specific case or instance. Researchers aim to explore the complexities and nuances of the subject under investigation, often using multiple data sources and methods to gather comprehensive information.
• Contextual Analysis: Case studies emphasize the importance of understanding the context in which the case unfolds. Researchers seek to examine the unique circumstances, background, and environmental factors that contribute to the dynamics of the case. Contextual analysis is crucial for drawing meaningful conclusions and generalizing findings to similar situations.
• Holistic Perspective: Rather than focusing on isolated variables, case studies take a holistic approach to studying a phenomenon. Researchers consider a wide range of factors and their interrelationships, aiming to capture the richness and complexity of the case. This holistic perspective helps in providing a more complete understanding of the subject.
• Qualitative and/or Quantitative Data: Case studies can incorporate both qualitative and quantitative data, depending on the research question and objectives. Qualitative data often include interviews, observations, and document analysis, while quantitative data may involve statistical measures or numerical information. The combination of these data types enhances the depth and validity of the study.
• Longitudinal or Retrospective Design: Case studies can be designed as longitudinal studies, where the researcher follows the case over an extended period, or retrospective studies, where the focus is on examining past events. This temporal dimension allows researchers to capture changes and developments within the case.
• Unique and Unpredictable Nature: Each case study is unique, and the findings may not be easily generalized to other situations. The unpredictable nature of real-world cases adds a layer of authenticity to the study, making it an effective method for exploring complex and dynamic phenomena.
• Theory Building or Testing: Case studies can serve different purposes, including theory building or theory testing. In some cases, researchers use case studies to develop new theories or refine existing ones. In others, they may test existing theories by applying them to real-world situations and assessing their explanatory power.

Understanding these key characteristics is essential for researchers and practitioners using case studies as a methodological approach, as it helps guide the design, implementation, and analysis of the study.

Key Components of a Case Study

A well-constructed case study typically consists of several key components that collectively provide a comprehensive understanding of the subject under investigation. Here are the key components of a case study:

• Provide an overview of the context and background information relevant to the case. This may include the history, industry, or setting in which the case is situated.
• Clearly state the purpose and objectives of the case study. Define what the study aims to achieve and the questions it seeks to answer.
• Clearly identify the subject of the case study. This could be an individual, a group, an organization, or a specific event.
• Define the boundaries and scope of the case study. Specify what aspects will be included and excluded from the investigation.
• Provide a brief review of relevant theories or concepts that will guide the analysis. This helps place the case study within the broader theoretical context.
• Summarize existing literature related to the subject, highlighting key findings and gaps in knowledge. This establishes the context for the current case study.
• Describe the research design chosen for the case study (e.g., exploratory, explanatory, descriptive). Justify why this design is appropriate for the research objectives.
• Specify the methods used to gather data, whether through interviews, observations, document analysis, surveys, or a combination of these. Detail the procedures followed to ensure data validity and reliability.
• Explain the criteria for selecting the case and any sampling considerations. Discuss why the chosen case is representative or relevant to the research questions.
• Describe how the collected data will be coded and categorized. Discuss the analytical framework or approach used to identify patterns, themes, or trends.
• If multiple data sources or methods are used, explain how they complement each other to enhance the credibility and validity of the findings.
• Present the key findings in a clear and organized manner. Use tables, charts, or quotes from participants to illustrate the results.
• Interpret the results in the context of the research objectives and theoretical framework. Discuss any unexpected findings and their implications.
• Provide a thorough interpretation of the results, connecting them to the research questions and relevant literature.
• Acknowledge the limitations of the study, such as constraints in data collection, sample size, or generalizability.
• Highlight the contributions of the case study to the existing body of knowledge and identify potential avenues for future research.
• Summarize the key findings and their significance in relation to the research objectives.
• Conclude with a concise summary of the case study, its implications, and potential practical applications.
• Provide a complete list of all the sources cited in the case study, following a consistent citation style.
• Include any additional materials or supplementary information, such as interview transcripts, survey instruments, or supporting documents.

By including these key components, a case study becomes a comprehensive and well-rounded exploration of a specific subject, offering valuable insights and contributing to the body of knowledge in the respective field.

Sampling in a Case Study Research

Sampling in case study research involves selecting a subset of cases or individuals from a larger population to study in depth. Unlike quantitative research where random sampling is often employed, case study sampling is typically purposeful and driven by the specific objectives of the study. Here are some key considerations for sampling in case study research:

• Criterion Sampling: Cases are selected based on specific criteria relevant to the research questions. For example, if studying successful business strategies, cases may be selected based on their demonstrated success.
• Maximum Variation Sampling: Cases are chosen to represent a broad range of variations related to key characteristics. This approach helps capture diversity within the sample.
• Selecting Cases with Rich Information: Researchers aim to choose cases that are information-rich and provide insights into the phenomenon under investigation. These cases should offer a depth of detail and variation relevant to the research objectives.
• Single Case vs. Multiple Cases: Decide whether the study will focus on a single case (single-case study) or multiple cases (multiple-case study). The choice depends on the research objectives, the complexity of the phenomenon, and the depth of understanding required.
• Emergent Nature of Sampling: In some case studies, the sampling strategy may evolve as the study progresses. This is known as theoretical sampling, where new cases are selected based on emerging findings and theoretical insights from earlier analysis.
• Data Saturation: Sampling may continue until data saturation is achieved, meaning that collecting additional cases or data does not yield new insights or information. Saturation indicates that the researcher has adequately explored the phenomenon.
• Defining Case Boundaries: Clearly define the boundaries of the case to ensure consistency and avoid ambiguity. Consider what is included and excluded from the case study, and justify these decisions.
• Practical Considerations: Assess the feasibility of accessing the selected cases. Consider factors such as availability, willingness to participate, and the practicality of data collection methods.
• Informed Consent: Obtain informed consent from participants, ensuring that they understand the purpose of the study and the ways in which their information will be used. Protect the confidentiality and anonymity of participants as needed.
• Pilot Testing the Sampling Strategy: Before conducting the full study, consider pilot testing the sampling strategy to identify potential challenges and refine the approach. This can help ensure the effectiveness of the sampling method.
• Transparent Reporting: Clearly document the sampling process in the research methodology section. Provide a rationale for the chosen sampling strategy and discuss any adjustments made during the study.

Sampling in case study research is a critical step that influences the depth and richness of the study’s findings. By carefully selecting cases based on specific criteria and considering the unique characteristics of the phenomenon under investigation, researchers can enhance the relevance and validity of their case study.

Case Study Research Methods With Examples

• Interviews:
• Interviews involve engaging with participants to gather detailed information, opinions, and insights. In a case study, interviews are often semi-structured, allowing flexibility in questioning.
• Example: A case study on workplace culture might involve conducting interviews with employees at different levels to understand their perceptions, experiences, and attitudes.
• Observations:
• Observations entail direct examination and recording of behavior, activities, or events in their natural setting. This method is valuable for understanding behaviors in context.
• Example: A case study investigating customer interactions at a retail store may involve observing and documenting customer behavior, staff interactions, and overall dynamics.
• Document Analysis:
• Document analysis involves reviewing and interpreting written or recorded materials, such as reports, memos, emails, and other relevant documents.
• Example: In a case study on organizational change, researchers may analyze internal documents, such as communication memos or strategic plans, to trace the evolution of the change process.
• Surveys and Questionnaires:
• Surveys and questionnaires collect structured data from a sample of participants. While less common in case studies, they can be used to supplement other methods.
• Example: A case study on the impact of a health intervention might include a survey to gather quantitative data on participants’ health outcomes.
• Focus Groups:
• Focus groups involve a facilitated discussion among a group of participants to explore their perceptions, attitudes, and experiences.
• Example: In a case study on community development, a focus group might be conducted with residents to discuss their views on recent initiatives and their impact.
• Archival Research:
• Archival research involves examining existing records, historical documents, or artifacts to gain insights into a particular phenomenon.
• Example: A case study on the history of a landmark building may involve archival research, exploring construction records, historical photos, and maintenance logs.
• Longitudinal Studies:
• Longitudinal studies involve the collection of data over an extended period to observe changes and developments.
• Example: A case study tracking the career progression of employees in a company may involve longitudinal interviews and document analysis over several years.
• Cross-Case Analysis:
• Cross-case analysis compares and contrasts multiple cases to identify patterns, similarities, and differences.
• Example: A comparative case study of different educational institutions may involve analyzing common challenges and successful strategies across various cases.
• Ethnography:
• Ethnography involves immersive, in-depth exploration within a cultural or social setting to understand the behaviors and perspectives of participants.
• Example: A case study using ethnographic methods might involve spending an extended period within a community to understand its social dynamics and cultural practices.
• Experimental Designs (Rare):
• While less common, experimental designs involve manipulating variables to observe their effects. In case studies, this might be applied in specific contexts.
• Example: A case study exploring the impact of a new teaching method might involve implementing the method in one classroom while comparing it to a traditional method in another.

These case study research methods offer a versatile toolkit for researchers to investigate and gain insights into complex phenomena across various disciplines. The choice of methods depends on the research questions, the nature of the case, and the desired depth of understanding.

Best Practices for a Case Study in 2024

Creating a high-quality case study involves adhering to best practices that ensure rigor, relevance, and credibility. Here are some key best practices for conducting and presenting a case study:

• Clearly articulate the purpose and objectives of the case study. Define the research questions or problems you aim to address, ensuring a focused and purposeful approach.
• Choose a case that aligns with the research objectives and provides the depth and richness needed for the study. Consider the uniqueness of the case and its relevance to the research questions.
• Develop a robust research design that aligns with the nature of the case study (single-case or multiple-case) and integrates appropriate research methods. Ensure the chosen design is suitable for exploring the complexities of the phenomenon.
• Use a variety of data sources to enhance the validity and reliability of the study. Combine methods such as interviews, observations, document analysis, and surveys to provide a comprehensive understanding of the case.
• Clearly document and describe the procedures for data collection to enhance transparency. Include details on participant selection, sampling strategy, and data collection methods to facilitate replication and evaluation.
• Implement measures to ensure the validity and reliability of the data. Triangulate information from different sources to cross-verify findings and strengthen the credibility of the study.
• Clearly define the boundaries of the case to avoid scope creep and maintain focus. Specify what is included and excluded from the study, providing a clear framework for analysis.
• Include perspectives from various stakeholders within the case to capture a holistic view. This might involve interviewing individuals at different organizational levels, customers, or community members, depending on the context.
• Adhere to ethical principles in research, including obtaining informed consent from participants, ensuring confidentiality, and addressing any potential conflicts of interest.
• Conduct a rigorous analysis of the data, using appropriate analytical techniques. Interpret the findings in the context of the research questions, theoretical framework, and relevant literature.
• Offer detailed and rich descriptions of the case, including the context, key events, and participant perspectives. This helps readers understand the intricacies of the case and supports the generalization of findings.
• Communicate findings in a clear and accessible manner. Avoid jargon and technical language that may hinder understanding. Use visuals, such as charts or graphs, to enhance clarity.
• Seek feedback from colleagues or experts in the field through peer review. This helps ensure the rigor and credibility of the case study and provides valuable insights for improvement.
• Connect the case study findings to existing theories or concepts, contributing to the theoretical understanding of the phenomenon. Discuss practical implications and potential applications in relevant contexts.
• Recognize that case study research is often an iterative process. Be open to revisiting and refining research questions, methods, or analysis as the study progresses. Practice reflexivity by acknowledging and addressing potential biases or preconceptions.

By incorporating these best practices, researchers can enhance the quality and impact of their case studies, making valuable contributions to the academic and practical understanding of complex phenomena.

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How to conduct types of qualitative research case study.

Home » How to Conduct Types of Qualitative Research Case Study

In the world of qualitative research, the case study methodology stands out for its depth and richness. It allows researchers to explore complex issues in real-world contexts, drawing insights that are often overlooked in broader studies. By focusing on specific instances, case studies provide nuanced understandings that contribute to practical knowledge and informed decision-making.

Understanding the case study methodology is crucial for conducting effective qualitative research. This approach emphasizes the importance of context, offering a detailed examination of phenomena through various lenses. It allows researchers to gather data from multiple sources and viewpoints, enhancing the credibility and applicability of their findings. As we delve deeper into this methodology, we will outline practical steps and considerations for conducting impactful case studies.

Types of Qualitative Research in a Case Study Methodology

Qualitative research within a case study methodology allows researchers to deeply explore specific phenomena. This can provide rich insights into the complexities of human behaviors, motivations, and interactions. Generally, there are several types of qualitative research approaches, each offering unique benefits for case study analysis.

First, an exploratory approach is valuable for generating hypotheses about unfamiliar topics. When researchers adopt this method, they gather data to uncover new insights and understand trends. Second, the descriptive case study focuses on providing detailed accounts of events or situations. This method helps illustrate the context and environment surrounding the subject matter. Finally, an interpretative approach seeks to understand the meanings behind human behavior, often using interviews and observational data. Each type contributes zest to case study methodology, enabling a well-rounded understanding of the subject by incorporating various perspectives and data sources.

Exploratory Case Study Methodology

Exploratory case study methodology provides a structured approach to investigating complex issues in real-world settings. This methodology is especially valuable when researchers seek to understand emerging phenomena where little prior knowledge exists. Exploratory case studies help to uncover patterns, generate insights, and identify potential relationships among variables, making them a powerful tool for qualitative research.

Typically, this methodology involves a thorough examination of a specific instance or case within its context. Researchers often begin by defining their research questions and objectives while considering what information will be most useful. Data collection methods may include interviews, observations, and document analyses. Each of these methods facilitates a deeper understanding of the case, leading to richer insights that are applicable to broader contexts. Ultimately, the exploratory case study methodology situates researchers to explore avenues of inquiry that can inform future studies and practices.

Descriptive Case Study Methodology

Descriptive Case Study Methodology offers a powerful approach to qualitative research. This method emphasizes detailed exploration, helping researchers capture rich, contextual data about specific phenomena. By focusing on real-world cases, it allows for an in-depth understanding of complex issues, illuminating the intricacies of human behavior in varied settings.

In employing this methodology, researchers often follow key stages to ensure thorough data collection. First, they identify a compelling case, which serves as the focal point of their investigation. Next, they gather various data types, such as interviews, observations, and documents, to build a comprehensive picture. Analyzing and interpreting this data enables them to draw meaningful insights and conclusions. By embracing a descriptive case study approach, researchers can paint a vivid portrait of the subject matter, leading to valuable findings that contribute significantly to their fields.

Steps to Conducting a Qualitative Research Case Study

To conduct a qualitative research case study, start by defining a clear research question. This question guides your entire study and helps you focus your investigation. Next, select a relevant case study subject that can provide deep insight into the topic you are studying. Once the case is chosen, gather data through interviews, observations, or document analysis, ensuring that your methods align with case study methodology.

After data collection, organize and analyze the data systematically. Look for patterns, themes, and insights that emerge from the information gathered. Finally, present your findings in a structured report or presentation, highlighting key insights and implications. Throughout this process, it’s crucial to maintain a reflective stance, considering how your biases might influence your interpretations and conclusions. Engaging in these steps will ensure a thorough and effective qualitative research case study.

Defining the Research Questions in the Case Study Methodology

Research questions are crucial in the case study methodology as they guide the entire study. These questions should be clear, focused, and relevant to the case being investigated. By framing well-defined research questions, researchers can effectively narrow down the vast field of inquiry into specific areas that warrant deeper examination. This focus helps in determining the appropriate data collection methods and identifying the necessary participants involved in the study.

When developing research questions, it is essential to consider several elements. First, questions should align with the case's objectives, addressing what researchers hope to explore or understand. Second, they should be open-ended to allow for rich, detailed responses, providing insights into participants' experiences and perspectives. Lastly, questions should be flexible enough to adapt to findings as the study progresses, ensuring that new insights can emerge organically from the research process. This adaptability fosters a more comprehensive understanding of the case.

Data Collection Techniques in Case Study Methodology

Data collection techniques in a case study methodology play a pivotal role in ensuring comprehensive insights. Researchers typically employ various methods, including interviews, observations, and document analyses, to gather rich qualitative data. Each technique can provide different perspectives and depths of understanding of the case at hand.

Interviews facilitate direct engagement with participants, allowing researchers to explore personal experiences and opinions. Observations enable researchers to capture real-time interactions and contextual nuances. Document analysis involves reviewing existing records, which can unveil historical insights and trends. Effectively combining these techniques enhances the study's validity and reliability by triangulating data from multiple sources. Emphasizing a diverse set of data collection methods is crucial for robust case study research. By carefully selecting and implementing these techniques, researchers can better illuminate complex issues and contribute to a deeper understanding of their subjects.

Conclusion: Mastering the Case Study Methodology in Qualitative Research

Mastering the Case Study Methodology in qualitative research unlocks the potential for in-depth exploration of complex phenomena. By carefully selecting cases, researchers can delve into unique contexts and gather rich, contextual data. This process not only enhances understanding but also cultivates valuable insights that may inform practices in various fields.

In conclusion, the significance of the case study methodology lies in its capacity to bridge theory and real-world application. Researchers equipped with the skills to conduct effective case studies are better positioned to provide nuanced recommendations based on evidence. Ultimately, embracing this methodology enriches qualitative research and contributes to the development of informed strategies.

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Cohort study a nonexperimental design that can be prospective or retrospective. In a prospective cohort study, participants are enrolled before the potential causal event has occurred. In a retrospective cohort study, the study begins after the dependent event occurs. See also "longitudinal study."

Cross-sectional design study an experimental design in which multiple measures are collected over a period of time from two or more groups of different ages (birth cohorts), ethnicities, or other factos. These designs combine aspects of longitudinal design and cohort-sequential design.

Literature review a narrative summary and evaluation of the findings or theories within a literature base. Also known as "narrative literature review."

Longitudinal study a study that involves the observation of a variable or group of variables in the same cases or individuals using the same set of measurements (or attributes) over a period of time (i.e., at multiple times or occasions). A longitudinal study that evaluates a group of randomly chosen individuals is referred to as a panel study, whereas a longitudinal study that evaluates a group of individuals possessing some common characteristic (usually age) is referred to as a cohort study. This multiple observational structure may be combined with almost any other research design—ones with and without experimental manipulations, randomized clinical trials, or any other study type. Also known as "longitudinal research," "longitudinal design."

Prospective sampling (cohort) a sampling method in which cases are selected for inclusion in experiments or other research based on their exposure to a risk factor. Participants are then followed to see if a condition of interest develops.

Qualitatiive research study approaches to research used to generate knowledge about human experience and/or action, including social processes. These research methods typically produce descriptive (non-numerical) data, such as observations of behavior or personal accounts of experiences. The goal of gathering qualitative data is to examine how individuals perceive the world from different vantage points. Also known as "qualitative design," "qualitative inquiry," "qualitative method," "qualitative study." more... less... Qualitative methods share four central characteristics: Involve the analysis of natural language and other forms of human expression rather than the translation of meaning into numbersCentralize an iterative process in which data are analyzed and meanings are generated in a circular and self-correcting process of checking and refining findingsSeek to present findings in a manner that emphasizes the study's context and situation in timeRecursively combine inquiry with methods that require researchers' reflexivity (i.e., self-examination) about their influence upon the research process.

Qualitative meta analysis study a form of inquiry in which qualitative research findings about a process or experience are aggregated or integrated across research studies. Aims can involve synthesizing qualitative findings across primary studies, generating new theoretical or conceptual models, identifying gaps in research, or generating new questions.

Quantitative research study approaches to research in which observed outcomes are numerically represented. These research methods rely on measuring variables using a numerical system, analyzing measurements using statistical models, and reporting relationships and associations among the studied variables. The goal of gathering quantitative data is to understand, describe, and predict the nature of a phenomenon, particularly through the development of models and theories. Also known as "quantitative design," "quantitative inquiry," "quantitative method," "quantitative study."

Quantitative Meta analysis a technique for synthesizing the results of multiple studies of a phenomenon by combining the effect size estimates from each study into a single estimate of the combined effect size or into a distribution of effect sizes. Effect size estimates from individual studies are the inputs to the analyses. Although meta-analyses are ideally suited for summarizing a body of literature in terms of impact, limitations, and implications, they are limited by having no required minimum number of studies or participants. Information of potential interest may also be missing from the original research reports upon which the procedure must rely.

Randomized controlled (clinical) trial an experimental design in which patients are randomly assigned to a group that will receive an experimental treatment, such as a new drug, or to one that will receive a comparison treatment, a standard-of-care treatment, or a placebo. The random assignment occurs after recruitment and assessment of eligibility but before the intervention. There may be multiple experimental and comparison groups, but each patient is assigned to one group only.

Retrospective cohort study (sampling) the study begins after the dependent event occurs; a technique in which participants or cases from the general population are selected for inclusion in experiments or other research based on their previous exposure to a risk factor or the completion of some particular process. Participants are then examined in the present to see if a particular condition or state exists, often in comparison to others who were not exposed to the risk or who did not complete the particular process.

Please consult the following sources for more information on these types of studies and terminology related to the studies.

• APA Style JARS Supplemental Glossary This webpage provides supplemental information on the terms used in APA Style JARS. This glossary is meant to supplement Chapter 3 of the Publication Manual of the American Psychological Association, Seventh Edition. It is not an exhaustive list of all terms employed in quantitative, qualitative, or mixed methods research, nor does it include all possible definitions for each term; definitions in addition to or different from those reported in this glossary may be found in other sources.
• APA Dictionary of Psychology More than 25,000 authoritative entries across 90 subfields of psychology.
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Accessing silence : research methods into sexual harassment : a case study of the Committee of Enquiry into Sexual Harassment at the University of Cape Town

dc.contributor.advisor	Marv Simons and Pam Reynolds
Sutherland, Carla
2024-08-16T13:14:37Z
2024-08-16T13:14:37Z
1994
2024-08-15T12:55:40Z
Biological extinction rates have escalated by as much as 1000 times the background extinction rate over the last 1500 years, causing concern over the long-term survival of many species. Avian extinctions since 1600 have been well documented relative to other taxa, as have current levels of avian threat. This study analyses avian extinctions post-1600 and current threats in an attempt to develop some predictive capacity about which avian taxa should be awa,rded the highest conservation priority. Analyses performed include examinations of the causes of avian extinction and threat, geographical location of extinct and threatened species, prehistoric and historical extinction rates, endemicity, migration, bird body size and phylogenetic diversity. An analysis dealing with historical and phylogenetic aspects of endangered and critically threatened species was performed, from which the world's most threatened species were identified. Factors which were the primary cause of historical extinctions are generally not the primary factors threatening today's extant avifauna. Whilst introduced predators and exploitation were primary causes of historical extinctions, habitat destruction poses the greatest threat to extant birds. Species predisposed to extinction typically have restricted ranges, and, compounded by habitat loss, these ranges are becoming more restricted. This has resulted in mainland-dwelling species becoming as prone to extinction as island-dwelling species have been historically. IIltroduced predators, however, do still threaten many of the world's most threatened species and their potential effects are highlighted in the phylogenetic analysis. Already, many extinctions may be inevitable over the next 25 years as a result of habitat loss. The magnitude of extinctions across all animal and plant species in the next few decades could be comparable with that of previous mass extinctions unless immediate conservation action is taken. However, future conservation efforts will have to be prioritized, and this study is intended as a contribution towards such a prioritization exercise.
Sutherland, C. (1994). <i>Accessing silence : research methods into sexual harassment : a case study of the Committee of Enquiry into Sexual Harassment at the University of Cape Town</i>. (). ,Faculty of Science ,Department of Biological Sciences. Retrieved from http://hdl.handle.net/11427/40521	en_ZA
Sutherland, Carla. <i>"Accessing silence : research methods into sexual harassment : a case study of the Committee of Enquiry into Sexual Harassment at the University of Cape Town."</i> ., ,Faculty of Science ,Department of Biological Sciences, 1994. http://hdl.handle.net/11427/40521	en_ZA
Sutherland, C. 1994. Accessing silence : research methods into sexual harassment : a case study of the Committee of Enquiry into Sexual Harassment at the University of Cape Town. . ,Faculty of Science ,Department of Biological Sciences. http://hdl.handle.net/11427/40521	en_ZA
TY - Thesis / Dissertation AU - Sutherland, Carla AB - Biological extinction rates have escalated by as much as 1000 times the background extinction rate over the last 1500 years, causing concern over the long-term survival of many species. Avian extinctions since 1600 have been well documented relative to other taxa, as have current levels of avian threat. This study analyses avian extinctions post-1600 and current threats in an attempt to develop some predictive capacity about which avian taxa should be awa,rded the highest conservation priority. Analyses performed include examinations of the causes of avian extinction and threat, geographical location of extinct and threatened species, prehistoric and historical extinction rates, endemicity, migration, bird body size and phylogenetic diversity. An analysis dealing with historical and phylogenetic aspects of endangered and critically threatened species was performed, from which the world's most threatened species were identified. Factors which were the primary cause of historical extinctions are generally not the primary factors threatening today's extant avifauna. Whilst introduced predators and exploitation were primary causes of historical extinctions, habitat destruction poses the greatest threat to extant birds. Species predisposed to extinction typically have restricted ranges, and, compounded by habitat loss, these ranges are becoming more restricted. This has resulted in mainland-dwelling species becoming as prone to extinction as island-dwelling species have been historically. IIltroduced predators, however, do still threaten many of the world's most threatened species and their potential effects are highlighted in the phylogenetic analysis. Already, many extinctions may be inevitable over the next 25 years as a result of habitat loss. The magnitude of extinctions across all animal and plant species in the next few decades could be comparable with that of previous mass extinctions unless immediate conservation action is taken. However, future conservation efforts will have to be prioritized, and this study is intended as a contribution towards such a prioritization exercise. DA - 1994 DB - OpenUCT DP - University of Cape Town KW - Ornithology LK - https://open.uct.ac.za PY - 1994 T1 - Accessing silence : research methods into sexual harassment : a case study of the Committee of Enquiry into Sexual Harassment at the University of Cape Town TI - Accessing silence : research methods into sexual harassment : a case study of the Committee of Enquiry into Sexual Harassment at the University of Cape Town UR - http://hdl.handle.net/11427/40521 ER -	en_ZA
http://hdl.handle.net/11427/40521
Sutherland C. Accessing silence : research methods into sexual harassment : a case study of the Committee of Enquiry into Sexual Harassment at the University of Cape Town. []. ,Faculty of Science ,Department of Biological Sciences, 1994 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/40521	en_ZA
eng
Department of Biological Sciences
Faculty of Science
Ornithology
Accessing silence : research methods into sexual harassment : a case study of the Committee of Enquiry into Sexual Harassment at the University of Cape Town
Thesis / Dissertation
Masters
dc.type.qualificationlevel	Masters

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Evaluating the impact of the global evidence, local adaptation (GELA) project for enhancing evidence-informed guideline recommendations for newborn and young child health in three African countries: a mixed-methods protocol

• Tamara Kredo   ORCID: orcid.org/0000-0001-7115-9535 1 , 2 , 3 , 4 ,
• Emmanuel Effa 5 ,
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• Denny Mabetha 1 ,
• Bey-Marrié Schmidt 1 , 7 ,
• Anke Rohwer 2 ,
• Michael McCaul 2 ,
• Idriss Ibrahim Kallon 2 ,
• Susan Munabi-Babigumira 8 ,
• Claire Glenton 8 ,
• Taryn Young 2 ,
• Simon Lewin 1 , 9 ,
• Per Olav Vandvik 10 , 11 &
• Sara Cooper 2 , 4 , 12  

Health Research Policy and Systems volume  22 , Article number:  114 ( 2024 ) Cite this article

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Poverty-related diseases (PRD) remain amongst the leading causes of death in children under-5 years in sub-Saharan Africa (SSA). Clinical practice guidelines (CPGs) based on the best available evidence are key to strengthening health systems and helping to enhance equitable health access for children under five. However, the CPG development process is complex and resource-intensive, with substantial scope for improving the process in SSA, which is the goal of the Global Evidence, Local Adaptation (GELA) project. The impact of research on PRD will be maximized through enhancing researchers and decision makers’ capacity to use global research to develop locally relevant CPGs in the field of newborn and child health. The project will be implemented in three SSA countries, Malawi, South Africa and Nigeria, over a 3-year period. This research protocol is for the monitoring and evaluation work package of the project. The aim of this work package is to monitor the various GELA project activities and evaluate the influence these may have on evidence-informed decision-making and guideline adaptation capacities and processes. The specific project activities we will monitor include (1) our ongoing engagement with local stakeholders, (2) their capacity needs and development, (3) their understanding and use of evidence from reviews of qualitative research and, (4) their overall views and experiences of the project.

We will use a longitudinal, mixed-methods study design, informed by an overarching project Theory of Change. A series of interconnected qualitative and quantitative data collections methods will be used, including knowledge translation tracking sheets and case studies, capacity assessment online surveys, user testing and in-depth interviews, and non-participant observations of project activities. Participants will comprise of project staff, members of the CPG panels and steering committees in Malawi, South Africa and Nigeria, as well as other local stakeholders in these three African countries.

Ongoing monitoring and evaluation will help ensure the relationship between researchers and stakeholders is supported from the project start. This can facilitate achievement of common goals and enable researchers in South Africa, Malawi and Nigeria to make adjustments to project activities to maximize stakeholder engagement and research utilization. Ethical approval has been provided by South African Medical Research Council Human Research Ethics Committee (EC015-7/2022); The College of Medicine Research and Ethics Committee, Malawi (P.07/22/3687); National Health Research Ethics Committee of Nigeria (01/01/2007).

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Sub-Saharan Africa (SSA) has the highest under-five mortality rate in the world [ 1 ]. Although the global under-five mortality rate declined from 76 to 38 per 1000 live births between 2000 and 2019, more than half of the deaths in children and youth in 2019 were among children under 5 years, approximately 5.2 million deaths [ 1 ]. Poverty-related diseases including pneumonia, diarrhoea and malaria remain amongst the leading causes of death in children under-5 years [ 2 ].Thus, despite progress in the health of young children globally, most countries in SSA fall below the average gains and do not meet maternal and child health targets set by the United Nations Sustainable Development Goal 3 to ‘ensure healthy lives and promote wellbeing’ (1). As of December 2021, under-five mortality rates were reported as 113.8, 38.6 and 32.2 per 1000 live births for Nigeria, Malawi and South Africa, respectively [ 3 ]. Factors accounting for regional disparities in child mortality rates include poverty, socioeconomic inequities, poor health systems and poor nutrition, with coronavirus disease 2019 (COVID-19) adding substantially to the burden [ 4 ].

Addressing healthcare issues such as these requires an evidence-informed approach, where intervention design and implementation are based on the best available evidence, to ensure that scarce resources are used effectively and efficiently, avoid harm, maximize good and improve healthcare delivery and outcomes [ 5 , 6 , 7 ]. Evidence-informed practices have been growing in SSA [ 6 ], and evidence ecosystems are becoming stronger. The evidence ecosystem reflects the formal and informal linkages and interactions between different actors (and their capacities and resources) involved in the production, translation and use of evidence [ 6 , 8 , 9 ]. Guidance that can be developed through this ecosystem includes evidence-based health technology assessments (HTA) and clinical practice guidelines (CPGs). CPGs include recommendations that are actionable statements that are informed by systematic reviews of evidence, and an assessment of the benefits and harms of alternative care options and are intended to optimize patient care [ 10 ]. They can help bridge the gap between research evidence and practice and are recognized as important quality-improvement tools that aim to standardize care, inform funding decisions and improve access to care, among others.

CPG method advancements, challenges and research gaps

Over the past decade, internationally and in SSA, there has been a rapid growth of CPGs developed for a range of conditions [ 11 ]. In particular, rapid evidence syntheses and guideline development methods has advanced in response to urgent evidence needs, especially during COVID [ 12 , 13 ]. For example, WHO has developed guidelines for all key infectious conditions that cause most deaths. This development has been accompanied by a growing volume of research evidence around CPGs, including the processes for their rapid development, adaptation, contextualization, implementation and evaluation, and further spurred on by COVID. For example, global knowledge leaders, such as the WHO and the GRADE Working Group, have set standards for CPG development, outlining the steps of what is known as ‘de novo’ (from scratch) CPG development [ 14 ]. Another global group, the Guidelines International Network (G-I-N), is a network dedicated to leading, strengthening and supporting collaboration in CPG development, adaptation and implementation. They have published minimum standards and the G-I-N McMaster guideline checklist, which contains a comprehensive list of topics and items outlining the practical steps to consider for developing CPGs [ 15 ].

As CPG standards have evolved, however, so has the complexity of development and adaptation. In the context of poorer settings, such as sub-Saharan Africa (SSA), CPG development is prohibitively human and finance resource intensive. It requires scarce skills, even in the growing evidence-based healthcare (EBHC) community, and financial investments by government where resources are often directed to healthcare services, rather than policymaking processes. Against this backdrop, several studies have found that CPGs in the region often perform poorly on reporting on their rigour of development and editorial independence [ 16 , 17 , 18 ]. Other, more resource-efficient methods for guideline development in SSA are, therefore, essential and urgently needed. Moreover, investment in the overall management of the process is needed, including convening the guideline group and moving stepwise through a rigorous process.

Approaches for and challenges of guideline adaptation

There is also increased international recognition of the value of taking guidelines developed in one country and applying them to other countries. This can avoid duplication of effort and research waste in de novo guideline development, when useful guidelines may exist elsewhere [ 12 , 19 ]. Against this backdrop, several adaptation methods are emerging for contextualization of recommendations to country needs (e.g. ADAPTE, adolopment and SNAP-it, amongst others) [ 19 , 20 , 21 ]. For example, WHO is developing strategies for adapting and implementing their CPGs at country level. One example is the WHO Antenatal Care Recommendations Adaptation Toolkit lead by the Department of Sexual and Reproductive Health and Research [ 22 ]. Their approach is pragmatic and transparent. Another approach is so-called ‘adolopment’, a GRADE method, in which the original guideline evidence is used, either adopted or adapted, considering contextual evidence such as costs and feasibility and local values [ 20 ]. Adolopment involves convening a guideline panel, reviewing available evidence and local contextual evidence and weighing up the panel’s judgements to make recommendations that are fit for purpose [ 20 ].

Despite these advances in CPG adaptation methods, many countries and professional associations in sub-Saharan Africa still use expert opinion-based approaches or proceed to prepare their own systematic reviews and guidelines, ultimately perpetuating resource wastage and duplication of efforts [ 23 ]. Moreover, when countries do adapt and contextualize other countries’ guidelines, there is frequently a lack of transparency and reporting on changes, without clarity on why or by whom. This in turn casts doubts on the recommendation’s credibility. For example, guidelines for child health in sub-Saharan Africa are usually derived from the WHO and UNICEF. However, adaptation of such guidelines and recommendations to national contexts is not well described [ 24 ]. Transparency in guideline adaptation is critical for creating trustworthy, context-sensitive recommendations. What guideline adaptation methods work best and how these can be transparently implemented in the context of lower resource settings, remain key research questions. Therefore, despite the emergence of several guideline adaptation approaches, we need to explore and understand how best to adapt recommendations from one context to another [ 25 ].

Qualitative evidence to inform guideline panels decisions

Another major advancement within guideline research has been growing recognition of the potential contribution of qualitative research evidence [ 26 , 27 ]. Traditionally, guidelines have been informed by systematic reviews of the effectiveness of specific interventions [ 14 ]. Such reviews provide robust evidence about which interventions ‘work’. However, there is appreciation that evidence regarding the potential effectiveness of an intervention is not sufficient for making recommendations or decisions. Policymakers also need to consider other issues, including how different stakeholders’ value different outcomes, the intervention’s acceptability to those affected by it and the feasibility of implementing the intervention [ 28 , 29 , 30 ]. Evidence from qualitative research is particularly well suited to exploring factors that influence an intervention’s acceptability and feasibility [ 31 , 32 ]. The use of qualitative research to inform recommendations by guidelines has become easier in recent years as systematic reviews of qualitative studies have become more common, and the methods for these reviews are now well developed [ 33 ]. The first WHO guideline to systematically incorporate reviews of qualitative studies was published in 2012 in the field of task-shifting for maternal and child health [ 31 ]. The inclusion of this qualitative evidence helped shape the panel’s recommendations [ 32 ], and this approach is now included in the WHO Handbook for Guideline Development and has been applied in many other WHO CPGs [ 34 , 35 ].

However, a key challenge in using findings from systematic reviews of qualitative evidence is communicating often complex findings to users such as guideline panel members to facilitate effective knowledge translation. While there is now considerable research on communicating findings from reviews of intervention effectiveness [ 36 ], there is limited experience on the usefulness of different options for packaging and presenting findings from systematic reviews of qualitative evidence to CPG panels. To make best use of this evidence, we need presentation formats that are accessible to users who may be unfamiliar with qualitative methods, are concise and simple while retaining sufficient detail to inform decisions and clearly present ‘confidence in the evidence from systematic reviews of qualitative evidence’ (GRADE-CERQual) assessments of how much confidence users should place in each finding [ 37 ]. In addition, we need to understand how qualitative evidence included in global guidelines, such as those produced by WHO, is interpreted and used in country-level guideline adaptation processes.

Communicating clinical practice guidelines to end-users

A final key guideline method advancement has been around the development of multi-layered and digitally structured communication formats for end users [ 38 , 39 ]. Guidelines are not an end in themselves. Recommendations may lack impact if not adequately communicated and disseminated to those who need to implement them, namely healthcare providers, managers and the public. Indeed, in a South African study of primary care guideline national policymakers, subnational health managers and healthcare providers agreed that dissemination is a particular gap [ 40 ]. While guidelines typically are produced as static documents (e.g. PDF formats), information technology is needed to enhance dissemination. The MAGIC authoring and publication Platform (MAGICapp/) was developed for this purpose ( https://magicevidence.org/magicapp/ ). MAGICapp is a web-based tool that enables evidence synthesizers and guideline organizations to create, publish and dynamically update trustworthy and digitally structured evidence summaries, guidelines and decision aids in user-friendly formats on all devices. Such digital multi-layered formats allow different users to rapidly find recommendations, while having the supporting evidence for them one click away [ 41 ]. MAGICapp, used by WHO, NICE and professional societies across the world, holds potential to enhance the impact of evidence-informed guideline recommendations in practice, in an enhanced evidence ecosystem [ 9 ]. However, the usability of the MAGICapp in sub-Saharan Africa, based on local user preferences for different communication formats, are key research questions.

Against this backdrop, the Global Evidence, Local Adaptation (GELA) project will maximize the impact of research on poverty-related diseases through enhancing researchers and decision makers’ capacity to use global research to develop locally relevant guidelines for newborn and child health in Malawi, Nigeria and South Africa. These guidelines will build on and add value to the large-scale programme of child health guideline development from agencies such as the WHO, to support adaptation and implementation led by national ministries in collaboration with WHO Afro regional office.

Brief overview of the GELA project aim, objectives and approach

The overarching aim of GELA is to bridge the gap between current processes and global advances in evidence-informed decision-making and guideline development, adaptation and dissemination by building skills and sharing resources in ways that can be sustained beyond the project period. The project has seven linked and related work packages (WPs) to support delivery of the planned project deliverables. Table 1 provides a brief summary of the activities of each WP. This protocol outlines our approach for the monitoring and overall evaluation of the project activities and impact (WP 6).

The project will be implemented in three SSA countries: Malawi, South Africa and Nigeria over a 3-year period. The project adopts a multi-faceted multidisciplinary research and capacity strengthening programme using primary and secondary research, guideline adaptation methodology and digital platforms to support authoring delivery and dynamic adaptation. These processes will offer bespoke capacity strengthening opportunities for policy makers, researchers and civil society. Throughout the project, we plan for innovations in the tools we use, accompanied by comprehensive evaluation of all aspects of the research, research uptake into policy and capacity strengthening.

This current proposal is for WP6: monitoring and evaluation

Ongoing monitoring and evaluation of project processes and activities will help facilitate ongoing engagement between researchers and stakeholders throughout the research project. This will in turn help ensure that the project is centred on a common goal, with clear understandings of the different research activities and potential impact. This can also promote research uptake and enable researchers to make adjustments to project activities, maximizing stakeholder engagement and research utilization.

M&E aims & objectives

The overarching aim of the monitoring and evaluation work package is to monitor and evaluate the various GELA project activities and processes, including whether, how and why activities took place or if goals were met.

The specific monitoring and evaluation objectives are to:

Monitor ongoing engagement with local stakeholders across work packages and explore what worked and didn’t and why;

Assess the capacity development needs of guideline panels and steering group committees and explore their views and experiences of the project’s capacity development activities;

Explore guideline panelists’ experiences with reading and using evidence from reviews of qualitative research, including their preferences regarding how qualitative review findings are summarized and presented;

Evaluate guideline panelists’, steering group committees’ and project team members’ overall views and experiences of the project, including the what works or not, to influence evidence-informed decision-making and guideline adaptation processes

Overall approach

We will use a longitudinal, mixed-methods study design, informed by an overarching project Theory of Change (Table  2 ). The theoretical underpinning for the GELA project across all work packages is related to the three-layered behaviour change wheel comprising opportunity, capability and motivation [ 42 ]. The design, delivery and implementation of multi-stakeholder integrated activities based on identified priority areas and needs is expected to lead to guideline related improved capacity, practice and policy within each country’s health system. Certain objectives also have specific underpinning theoretical frameworks, in addition to the overarching project Theory of Change, which are explained under the respective objectives below. A series of interconnected qualitative and quantitative data collections methods will be used to address each objective.

In what follows, we describe each objective and the methods we will use to achieve it, separately. However, in many cases the qualitative data collection cuts across objectives, with the same interviews and observations being used to explore multiple issues simultaneously (e.g. knowledge translation, capacity, overall views and experiences of the project, etc.). The relationship between the different objectives and associated methods are depicted in Tables 3 and 4 . Table 3 outlines the stakeholder groups included in the monitoring and evaluation work package, including their composition and for which objectives they are targeted. Table 4 provides the timeline for the different data collection methods and how they relate to each across the objectives.

1. Objective 1: monitor ongoing engagement with local stakeholders across work packages and explore what worked and did not work and why

Overall approach for this objective.

This objective will be guided by an integrated knowledge translation (IKT) approach. IKT focuses on the important role of stakeholder engagement in enhancing evidence-informed decision-making [ 43 ]. As part of work package 4 (‘dissemination and communication’), knowledge translation (KT) champions have been identified in each of the three countries and will work together to develop and implement country-level KT strategies. This will include defining KT objectives, identifying and mapping relevant stakeholders, prioritizing those we will actively engage and developing a strategy for engaging each priority stakeholder. We will monitor these engagements through the development and implementation of a tracking sheet, qualitative case studies and semi-structured interviews.

Participants

Participants will comprise of knowledge translation (KT) champions and relevant country-level stakeholders. KT champions are GELA project staff who have dedicated time to work on the communication, dissemination and engagement aspects at a country-level. At least one KT champion has been identified for each of Malawi, Nigeria and South Africa.

Relevant country-level stakeholders will be identified as part of the KT strategy development (WP4) and will comprise any health decision-makers, e.g. health practitioners, community groups, health system managers, policy-makers, researchers and media.

Tracking sheet and qualitative case studies

A tracking sheet will be used to capture information for each stakeholder related to the purpose, message, medium or forum, messenger, timing and resources for engagement. KT champions in each country will be responsible for tracking these details on a continuous basis, and the tracking sheet will be monitored bi-monthly at a meeting with KT champions from the three country teams. This will help us monitor whether and how engagement activities are taking place, as well as the strategies for implementation. The tracking sheets will consist of different in-country stakeholders (e.g. government officers, health professional associations, researchers, media, etc.), and there may be several goals for engaging each individual stakeholder. The engagement strategy will be reviewed and updated as priority stakeholders change over the research stages and project period. As such, the sample size will be determined iteratively.

We will analyse information with descriptive statistics. For example, we will group and count by categories: number and type of stakeholders, type of engagement activities, type of KT products produced, type of forum or medium used for dissemination, frequency and duration of engagement, follow-ups, intensive engagement period and resources required for engagement.

We will also develop case stories (or impact stories) describing engagement activities and processes between project staff and relevant stakeholders. The case studies will help us monitor successful engagement, disseminate best practice scenarios and draw out lessons for future engagements. We will identify case stories through the tracking sheet and at bi-monthly meetings with the KT co-ordinator, where KT champions will be asked to share success stories or learning moments. KT champions will not know which ‘case’ will be selected for the case study in advance. The information will be collected by the KT co-ordinator, who is not involved in any of the country strategy implementation. The information collected from the KT champions (and messenger, if the messenger is not the KT champion) will be via a standard case story template, including aim of engagement, what the engagement was, experiences from both sides (quotes to be included in stories), success of engagement, lessons learnt and any future engagement plans. The number of cases will be determined iteratively. The intention is to develop one case story from each country annually, showcasing different cases, e.g. type of KT goal, type of stakeholder, type of KT medium/forum, etc.

Semi-structured interviews

At project close (month 30), we will conduct semi-structured interviews to explore if, why and how project KT goals were met and what planned stakeholder engagements worked (and did not work) and why. The interviews will be conducted with KT champions, other messengers (e.g. communication officers), country leads and selected stakeholders. At least two people from each county (KT champion and messenger and/or stakeholder) will be interviewed, and so there will be six to eight interviews in total. Participants will be selected purposively for information-rich cases that can help yield insights and in-depth understanding of the nature and success (or not) of our stakeholder engagements [ 44 ].

These interviews will form part of the interviews conducted with project team members more broadly as part of objective 4, the methods of which are therefore described in more detail below.

2. Objective 2: assess the capacity development needs of guideline panels and steering group committees and explore their views and experiences of the project’s capacity development activities.

Overarching theoretical lens.

We will draw on the Kirkpatrick model [ 45 ] as the underpinning theoretical framework for this objective. This model evaluates training effectiveness across four levels: (1) reaction, (2) learning, (3) behaviour and (4) results. The ‘reaction level’ assesses the degree of satisfaction of participants with the training event. The ‘learning level’ examines learning among participants both before and after the training event to determine any change in knowledge [ 46 , 47 ]. The ‘behaviour level’ assesses whether the training event has provided any favourable change in behaviour among participants. The final ‘results level’ assesses the use of knowledge gained through the training event within the workplace [ 46 , 47 ].

To assess the potential difference that project capacity development activities make, the outcomes of interest will be those related to training in evidence-based healthcare (EBHC). An overview of systematic reviews by Young and colleagues identified that EBHC training often aims to ‘improve critical appraisal skills and integration of results into decisions, and improved knowledge, skills, attitudes and behaviour among practising health professionals’ [ 48 , 49 ].

We will employ mixed methods to achieve this objective, including three rounds of online surveys (at baseline, mid-line and at the project close) as well as semi-structured interviews (at project close) and non-participant observations of meetings (various). The first online survey at baseline will assess the capacity needs of the guideline panels and steering group committees in South Africa, Malawi and Nigeria, and the two subsequent online surveys will assess the potential difference project capacity development activities make on these groups across all the four levels of the Kirkpatrick model, i.e. reaction, learning, behaviour and results. The capacity needs and progress of these groups will also be explored qualitatively through semi-structured interviews and observations of meetings.

Details of the project capacity development activities that will be implemented as part of work package 5 (‘capacity strengthening and sharing’) of the GELA project are outlined in Table  1 (above). All members of the guideline panels and steering group committees in South Africa, Malawi and Nigeria will be invited and encouraged to attend all project capacity development activities. ‘On the job’ capacity building will also take place during the various meetings convened with these groups, as they are supported to identify priority topics, to appraise and discuss the evidence used to inform the recommendations and to formulate the final recommendations.

Participants will comprise members of the guideline panels and steering group committees in South Africa, Malawi and Nigeria. Table 3 (above) provides details of the composition of the guideline panels and steering group committees.

Online surveys

Procedures and data collection tools.

At baseline (at approximately 6 months before engagement in any project training activities), at mid-line (month 18) and at the project close (month 30), all members of the guideline panels and steering group committees in South Africa, Malawi and Nigeria will be invited, via email, to participate in a survey. In each of the three countries the guideline development group and steering group committees will include approximately 20 and 10 members, respectively; we will therefore aim to have 90 participants in total complete the survey. The email invitation to all three survey rounds will inform participants about the nature of the study and direct them to an online survey. The landing page of the survey will provide information about the purpose of the research project and what is being requested from the participants, with a consent statement at the end which the participant will be required to agree to before being able to continue with the survey. Data will only be collected from participants who consent to freely participate in the study. The survey will be carried out using a secure online survey platform (such as Microsoft Forms) where all cookies and IP address collectors will be disabled to protect the confidentiality of the participants and to avoid tracking of the participant activities online. Unique identifiers (last six numbers of their ID) will be used to track participants responses over time and link data from baseline to project close.

The baseline survey will be a short (10–25 min) form that will ask participants about their capacity needs and knowledge/skills in evidence-based healthcare (EBHC) and decision-making. The survey will capture demographic variables of participants at baseline, mid-term and at the end of the project. It will assess the training needs of participants at baseline, participants’ satisfaction at the end of each training activity, the knowledge and skills at baseline, mid-term and at the end of the project. Participants’ behaviour will also be assessed using open-ended questions and vignettes. The surveys will focus on all four levels (i.e. reaction, learning, behaviour and results) of the Kirkpatrick model.

Data management and analysis

All data collected on the secure online survey platform will be coded, cleaned and entered into STATA. Data collected for the baseline survey will be analysed using descriptive statistics to determine the frequency of the various training needs and qualitative data gathered using the open-ended questions will be analysed thematically using manual coding (or if available and dataset is large), and NVivo or a similar tool will be used to identify the recurring themes which emerge in the data collected about the key training needs of participants.

Data collected for the surveys conducted at midpoint and at project close will be analysed using descriptive statistics to determine if there has been a change in the learning, knowledge gained and behaviours over time, as well as the extent of the potential application of evidence-based practice, while the data collected using the open-ended questions will be analysed using thematic analysis outlining how project capacity development activities informed particular outcomes and results in the participant’s workplace. To determine change in skills (and trends over time such as confidence improvement or decay), the descriptive statistics will be supplemented by appropriate inferential statistics for repeated measures (paired data) such as McNemar or paired t -tests, reporting change in percentages as mean differences (such as self-reported confidence) with 95% confidence intervals or/and frequencies. Descriptive trends over time will also be presented graphically using line graphs or other visual aids as appropriate. However, these will be interpreted with caution as the primary analysis is descriptive. Statistical significance will be set at a p value of 0.05.

At project close (month 30), we will conduct semi-structured interviews with a sample of members from the guideline panels and steering group committees in South Africa, Malawi and Nigeria. Sampling will be purposive, with the aim of understanding the broad range of needs, experiences and perspectives and ensuring that the sample reflects a range of socio-demographic characteristics and stakeholder categories. We will begin with a sample size of 10–15 participants in each country; however, sampling will continue if we have not reached saturation of the data through the initial sample size [ 44 ].

Participants will be contacted, either by telephone or via email, and invited to participate in an interview. Interviews will be conducted face-to-face or electronically (e.g. using Microsoft Teams) at a date and time chosen by participants. Face-to-face interviews will take place at a location convenient to participants, which is conducive to a confidential exchange. The interviews will last between 45 and 60 min and will be conducted by researchers trained in qualitative research methodologies and interviewing techniques. The interviews will be guided by a semi-structured topic guide and will include questions informed by the four levels (i.e. reaction, learning, behaviour and results) of the Kirkpatrick model. Specifically, the questions will explore participants’ views and experiences regarding their capacity development needs and expectations of the project; whether and why these expectations were met (or not), the project capacity development activities, what they learned (or not) from these activities and what impact participants believe they have had (or may have) on their practices.

Verbal and written information about the study will be provided to all participants taking part in interviews. Written informed consent will be obtained from all participants before proceeding with the interview. With the permission of participants, all interviews will be digitally recorded.

Non-participant observations

We will conduct non-participant observations of guideline panel and steering group committee meetings. Observational methods can provide useful data on what people do, how they interact with each other and how they engage with particular artefacts in situ (rather than their accounts of these) [ 50 ]. The steering group committees in each country will meet approximately twice over the project duration (with the option for additional meetings): an initial meeting for project orientation (month 2/3) and again to identify priority topics and guideline gaps (month 6). Guideline panels in each country will meet approximately three times over the project duration (with the option for additional meetings): an initial meeting for project orientation and outcome prioritization (month 6/7), another potential meeting if necessary to finalize outcome prioritization and a final meeting to draft recommendations for the guideline (months 17–20). Meetings for both groups will be held virtually or in person, informed by preferences of the committee.

With the exception of the initial steering group committee (month 2/3), at least one researcher will be present to observe guideline panel and steering group committee meetings. The observer will aim to identify any capacity-related needs, expectations, gaps, strengths, achievements and challenges and the contexts in which these occur. He or she will also pay particular attention to group dynamics and the interactions between members and different stakeholder groups, and the potential impact of these on capacity-related issues. Observations will be informed by Lofland’s [ 51 ] criteria for organizing analytical observations (acts, activities, meanings, participation, relationships and settings). The observer will take detailed observational notes. With consent of the attendees, all meetings will also be digitally recorded. The recordings will be used to identify further issues not identified and to deepen or clarify issues noted, through the real-time observations of verbal engagements.

Data management and analysis: semi-structured interviews and observations

Interview and meeting recordings will be transcribed verbatim, and all personal identifying information will be removed from transcripts. The anonymized transcripts, together with observational notes, will be downloaded into Nvivo, a software programme that aids with the management and analysis of qualitative data. Analysis of the qualitative data will proceed in several rounds. First, as with all qualitative data analysis, an ongoing process of iterative analysis of the data will be conducted throughout the data collection period. Second, we will use a thematic analysis approach, using the phases described by Braun and Clarke [ 52 ], to identify key themes pertaining to participants’ capacity development needs and expectations and whether, how and why project capacity development activities met (or not) these needs and expectations. Finally, findings from the surveys (as described above) will also be integrated with the findings from the thematic analysis using a ‘narrative synthesis’ approach, a technique recommended by the Cochrane Collaboration as a way of synthesizing diverse forms of qualitative and quantitative evidence in mixed methods studies [ 53 , 54 ]. This approach will allow for both robust triangulation, and a more comprehensive interpretation of the difference project capacity development activities may have made on the guideline panels and steering group committees.

3. Objective 3: explore guideline panelists’ experiences with reading and using evidence from reviews of qualitative research, including their preferences regarding how qualitative review findings are summarized and presented.

Objective 3 of the monitoring and evaluation stakeholder matrix work package explores how guideline panels view and experience evidence from the review(s) of qualitative research, including how it is summarized and presented. Here, we will employ a user testing approach, drawing on the methods and guidance of the SURE user test package 2022 developed by Cochrane Norway ( https://www.cochrane.no/our-user-test-package ) and which has been used to test various evidence-related products [ 55 , 56 , 57 , 58 ]. User testing involves observing people as they engage with a particular product and listening to them ‘think-aloud’. The goal is to gain an understanding of users’ views and experiences, the problems they face and to obtain suggestions for how a product may be improved [ 55 , 56 , 57 , 58 ].

We will begin by identifying or preparing relevant reviews of qualitative research. We will then develop review summary formats and explore guideline panel members’ views and experiences of these formats. We will revise the formats in multiple iterative cycles.

Identifying or preparing relevant reviews of qualitative research

As part of WP2 of the project (‘evidence synthesis’), we will identify relevant review(s) of qualitative research, including reviews exploring how people affected by the interventions of interest value different outcomes, the acceptability and feasibility of the intervention and potential equity, gender and human rights implications of the intervention. These reviews need to be assessed as sufficiently recent and of a sufficient quality. They also need to have applied GRADE-CERQual assessments to the review findings. Where necessary, we will update existing reviews or prepare reviews ourselves.

Developing the review summaries

In WP3 of the project (‘decision-making’) the evidence from these reviews will be provided to guideline panels as part of the evidence-to-decision (‘EtD’) frameworks that will inform the recommendations they develop (see Table  1 for further details about project work packages 2 and 3). Our next step will therefore be to prepare summaries of the reviews in a format that can easily be included in the EtD frameworks.

Each summary needs to present review findings that are relevant to specific parts of the EtD framework (typically the ‘values’, ‘acceptability’, ‘feasibility’ and ‘equity’ components). It also needs to include information about our confidence in these findings. Finally, the summary needs to indicate where this evidence comes from and to allow guideline panels to move from the summary to more detailed information about the evidence.

Most of this information is found in the review’s Summary of Qualitative Findings tables. However, these tables are usually too large for EtD frameworks and are not tailored to each framework component. We will, therefore, start by creating new summaries, using a format that we have previously used in EtD frameworks [ 59 , 60 , 61 ] but that we have not user tested. As opposed to the Summary of Qualitative Findings tables, where each finding and our confidence in the finding, is presented individually in separate rows, this format involves pulling the findings and confidence assessments together in short, narrative paragraphs.

User testing the summary format

For our first set of user tests, we will observe guideline panels participating in the CPG panel simulation workshops. For our second round of user tests, we will observe how the guideline panels experience and interact with this qualitative evidence during the real guideline processes. Third, we will then test a potentially refined format with a selection of guideline panel members using a semi-structured interview guide. Finally, at the end of the project, we will conduct semi-structured interviews with a selection of guideline panel members to explore their broader views and experiences of interpreting and using evidence from reviews of qualitative studies in their deliberation processes. Figure  1 provides a visual depiction of this iterative process.

Iterative approach for user testing evidence from reviews of qualitative research

We will draw on the adapted version of Peter Morville’s original honeycomb model of user experience [ 62 ] as the underpinning theoretical framework for this objective [ 63 ] (Fig.  1 ). This adapted version extends and revises the meaning of the facets of user experience depicted in the original model. It includes eight facets: accessibility, findability, usefulness, usability, understandability, credibility, desirability and affiliation. Accessibility involves whether there are physical barriers to gaining access; findability is about whether the person can locate the product or the content that they are looking for; usefulness is about whether the product has practical value for the person; usability comprises how easy and satisfying the product is to use; understandability is about whether the person comprehends correctly both what kind of product it is and the content of the product (and includes both user's subjective perception of her own understanding and an objective measure of actual/correct understanding); credibility comprises whether the product/content is experienced as trustworthy; desirability is about whether the product is something the person wants and has a positive emotional response to it; affiliation involves whether the person identifies with the product, on a personal or a social level, or whether it is alienating and experienced as being not designed for ‘someone like me’. The adapted model also adds to the original model a dimension of user experience over time, capturing the chronological and contingent nature of the different facets.

Participants will comprise members of the guideline panels in South Africa, Malawi and Nigeria. Table 3 (above) provides details of the composition of the guideline panels.

Non-participant observations: guideline panel simulation workshops and guideline panel meetings

We will conduct non-participant observations of the CPG panel simulation workshops and the subsequent guideline panel meetings for developing the recommendations. The CPG panel simulation workshops will run a simulation of a real guideline process and give guideline panels an opportunity to understand how the guideline process works before they participate in real panel meetings. The guideline panels in all three countries will be invited and encouraged to attend these workshops, which will form part of the project capacity development activities of WP5 (Table  1 ).

With the participants’ consent, both the simulation workshops and meetings will be digitally recorded and at least two observers will observe and take notes. The observations will focus on how guideline panel members refer to and interact with the summaries of qualitative evidence. Drawing on a user testing approach ( https://www.cochrane.no/our-user-test-package ), we will also look specifically for both problems and facilitators in the way the qualitative evidence is formatted, including ‘show-stoppers’ (the problem is so serious that it hindered participants from correct understanding or from moving forward), ‘big problems/frustrations’ (participants were confused or found something difficult but managed to figure it out or find a way around the problem eventually), ‘minor issues/cosmetic things’ (small irritations, frustrations and small problems that do not have serious consequences, as well as likes/dislikes), ‘positive/negative feedback’, ‘specific suggestions’, ‘preferences’ and any other ‘notable observations’, e.g. feelings of ‘uncertainty’.

Structured user testing interviews

Based on the insights gained from the non-participant observations (above), we may make changes or refinements to our original summary format (Fig.  1 ). Once the guideline panel meetings have concluded (approximately by month 20), we will then conduct structured user testing interviews to test the potentially refined summary format. These interviews will be conducted with a sample of members from the guideline panels in South Africa, Malawi and Nigeria. Sampling will be purposive, with the aim of understanding the broad range of experiences and perspectives and ensuring the sample reflects a range of socio-demographic characteristics and stakeholder categories. As recommended ( https://www.cochrane.no/our-user-test-package ), we will begin with a sample size of six to eight participants in each country; however, sampling will continue until saturation is achieved [ 44 ].

Participants will be contacted, either telephonically or via email, and invited to participate in an interview. Interviews will be conducted face-to-face or electronically (e.g. using Skype or Teams) at a date and time chosen by participants. Face-to-face interviews will take place at a location convenient to participants, which is conducive to a confidential exchange. In line with the SURE user test package 2022 guidance, the interviews will last approximately 60 min ( https://www.cochrane.no/our-user-test-package ). They will be facilitated by a test leader, who will accompanied by at least one observer who will take notes. Both the test leader and observer(s) will be trained in user testing interviewing methodology and techniques. Verbal and written information about the study will be provided to all participants taking part in interviews. Written informed consent will be obtained from all participants before proceeding with the interview. With the permission of participants, all interviews will be video recorded.

For these interviews we will show panel members the latest version of the format, explore immediate first impressions, and then opinions about different elements of the summary. We may also show panel members different formats where we think this may be helpful. We will use a structured interview guide which draws heavily on other interview guides that been developed to user test evidence-related products [ 55 , 56 , 57 , 58 ]. It will include questions related the participant’s background; their immediate first impressions of the summary format(s); in-depth walk-through of the summary format(s), with prompts to think aloud what they are looking at, thinking, doing and feeling; and suggestions for improving the way the summary is formatted and for improving the user testing itself. We may ask follow-up questions to specific issues we observed in the simulation workshops and guideline panel meetings and/or create scenarios that resemble issues we observed in the workshops/meetings. This will be decided upon based on the findings that emerge from these workshops/meetings. The guide will be finalized once the relevant qualitative evidence (from WP2) has been produced and we have gained insights from the workshops and meetings.

As with the non-participant observations of meetings and workshops, throughout the interview, the observers will make notes about the participant’s experience as heard, observed and understood. Drawing on a user testing approach, they will look specifically for both problems and facilitators, specific suggestions, preferences and any other notable observations (as described above under ‘non-participant observations’).

At project close (month 30), we will also conduct semi-structured interviews with a sample of members from the guideline panels in South Africa, Malawi and Nigeria. These will be the same interviews with guideline panel members as described in objective 2. In addition to exploring participants’ capacity development needs, expectations and achievements, the semi-structured topic guide will also explore their views and experiences of (and specific capacity in) interpreting and using evidence from reviews of qualitative studies in guideline processes. More specifically, questions will investigate participants’ familiarity/experience with qualitative evidence; their perceptions of different types of evidence, what constitutes qualitative evidence and the role of qualitative evidence in guideline processes; and their experiences of using the qualitative evidence in their deliberations as part of the project, including what influenced its use and whether they found it useful. Details pertaining to sampling, data collection procedures and collection tools are described in objective 2.

All interview and meeting recordings will be transcribed verbatim, and all personal identifying information will be removed from transcripts. The anonymized transcripts, together with observational notes (from the workshops, meetings and interviews), will be downloaded into a software programme that aids with the management and analysis of qualitative data. Analysis of the data will be guided by the user testing analysis methods described in the SURE user test package 2022 ( https://www.cochrane.no/our-user-test-package ). The analysis will proceed in several, iterative rounds to develop and revise the summary format and to inform the focus of subsequent data collection. After each user test, we will review our notes, first separately and then together. In line with the SURE user test package 2022 guidance, we will look primarily for barriers and facilitators related to correct interpretation of the summary’s contents, ease of use and favourable reception, drawing on the facets of the revised honeycomb model of user experience (Fig.  2 ). We will trace findings back to specific elements or characteristics of the summaries that appeared to facilitate or hinder problems. Before the next set of user tests, we will discuss possible changes that could address any identified barriers and make changes to the summary format.

Adapted version of Peter Morville’s honeycomb model of user experience

4. Objective 4: evaluate guideline panelists’, steering group committees’ and project team members’ overall views and experiences of the project, including what works or not, to influence evidence-informed decision-making and guideline adaptation processes.

This objective explores overall views and experiences of the project, with a focus on guideline panelists, steering group committees and project team members. Specifically, it seeks to gain an understanding of these three stakeholder groups’ more general views and experiences of the project activities they were involved with and whether, why and how these activities may influence (or not) evidence-informed decision-making and guideline adaptation processes. This will be achieved through semi-structured interviews.

Participants will comprise members of the guideline panels and steering group committees in South Africa, Malawi and Nigeria, as well as members of the project team (as described in Table  3 above).

At project close (month 30), we will conduct semi-structured interviews with a sample of members from the guideline panels and steering group committees in South Africa, Malawi and Nigeria. These will be the same interviews and participants as described in objective 2. In addition to exploring issues around capacity development and qualitative evidence, the interviews will also investigate participants’ views and experiences of the various project activities they were involved with, and whether, why and how these activities may influence (or not) evidence-informed decision-making and guideline adaptation processes. Details pertaining to sampling, data collection procedures and collection tools are described in objective 2.

At project close (month 30), we will also conduct semi-structured interviews with members of the project team (see Table  3 for details of project team composition). We will begin by interviewing all project management team members, WP leads and KT champions. Additional participants will be determined iteratively (depending on what emerges from initial interviews) and purposively, with the aim of understanding the broad range of experiences and perspectives and ensuring the sample reflects the various groups which make up the project team. Interviews will be conducted face-to-face or electronically (e.g. using Skype or Teams) at a date and time chosen by the interviewee. The interviews will last between 45 and 60 min and will be guided by a semi-structured topic guide. The questions will explore participants’ views and experiences of the respective work packages in which they were involved, including what the primary goals of the work package were; if, why and how these goals were met; and what worked and what did not work and why.

The same qualitative data analysis procedures and methods will be used as described in objective 2. For this objective, the thematic analysis will identify key themes pertaining to views and experiences of project activities, including what worked (or not) and why, whether, why and how the project may (or not) influence evidence-informed decision-making and guideline development, adaptation and dissemination processes in South Africa, Malawi and Nigeria and potential barriers and facilitators to the sustainability of this influence.

Evidence-based guideline development is a multi-stakeholder, multi-perspective, complex set of tasks. There is limited, if any, research that has followed these steps from the perspectives of policymakers or researchers from start to end. The GELA project protocol sets out to monitor and evaluate various key steps in the process, using in-depth qualitative methods alongside appropriate surveys not only to inform the project as it progresses but also to understand the overall impact of all steps on development of transparent and contextually-rich guideline recommendations. Following WHO’s guideline steps, the tasks range from scoping stakeholder-informed priority topics to conducting relevant data gathering and evidence synthesis, followed by guideline panel meetings to reach consensus decisions and finally to produce recommendations that can be useful to end-users and improve health and care outcomes. The GELA project is undertaking a 3-year project to conduct these tasks in the context of newborn and child health priorities. We are doing this in collaboration with national ministries of health, academics, non-governmental partners and civil society groups in Malawi, Nigeria and South Africa. Overall, we aim build capacity across all collaborators for evidence-informed guideline development, while producing fit for context guideline recommendations, in accessible formats that benefit children, caregivers and health care providers.

As such, this is a practical research project, in that the products should directly impact care decisions at the national level but with the added benefit of being able to learn about what works or does not work for collaborative guideline development in country. We will also be applying emergent guideline adaptation methods to explore reducing duplication of expensive guideline development efforts in our lower resource settings. Our project addresses newborn and child health, keeping this most vulnerable population in our focus, hoping that producing sound evidence-based recommendations has the potential to impact care.

Through some of our formative work, we have completed a landscape analysis identifying and describing all available newborn and child health guidelines in each of the partner countries. In all countries there were similar findings, (1) there is no easy access to guidelines for end-users, thus locating a guideline requires effort and screening through multiple sources; (2) considering national priority conditions in this age group, there were often gaps in available current guidelines for managing children; and (3) when we appraised the guidelines using the global standard, AGREE II tool, we found that the reporting of guideline methods were poor, leaving it uncertain whether the recommendations were credible or whether any influences or interests had determined the direction of a recommendation. Finally, we expected to find many adapted guidelines, based on WHO or UNICEF or similar guidance available globally; however, very few of the identified guidelines stated clearly whether they had been adapted from other sources and, if so, which recommendations were adopted and which adapted.

Given progress globally in methods for guideline development, the continued poor reporting on guideline methods at the country level speak to a breakdown in skills-sharing globally, for example, WHO produces guidelines that are recognized as rigorous and follow good practice and reporting, but the same standards are not supported in country. Overall, GELA aims to address these key gaps in national guideline approaches for adaptation, but we need to recognize that this will be a long term process and that we need to learn from each other about what works and what may not serve us. Therefore, this protocol outlines our approach for monitoring several aspects of the project in our efforts to move closer to trustworthy and credible guidelines that all can use and trust for countries like ours.

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Abbreviations

Poverty-related diseases

Sub-Saharan Africa

• Clinical practice guidelines

Evidence-informed decision-making

Evidence-based healthcare

Global Evidence Local Adaptation

Knowledge translation

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Acknowledgements

We gratefully acknowledge the representatives from the National Ministries of Health in Nigeria, Malawi and South Africa for their support and partnership. We would also like to thank the appointed Steering Committees who have been providing input for the research project and guiding the prioritization of topics. We would also like to thank Joy Oliver and Michelle Galloway for their contribution an support of the project.

The GELA project is funded by EDCTP2 programme supported by the European Union (grant number RIA2020S-3303-GELA). The funding will cover all the activities for this Monitoring and Evaluation work package, including costs for personnel and publication of papers.

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T.K., S.C., T.Y., S.L., C.G. and P.O.V. conceptualized the protocol idea and S.C. drafted the protocol with input from TK, D.M., A.R., B.M., M.M., I.I., C.G., T.Y., S.L. and P.O.V.; all authors approved the final version for submission for publication.

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Correspondence to Tamara Kredo .

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Ethics approval and consent to participate.

Ethics approval has been obtained in each partner country (South Africa, Malawi and Nigeria) from the respective Health Research Ethics Committees or Institutional Review Boards. Information about the project will be provided to, and consent obtained from, all participants completing the online surveys and interviews and all participants taking part in the meetings. The consent forms will make explicit the voluntary nature of participation, that there will be no negative consequences if they decide not to participate and in the case of the interviews and meetings observations will ask explicitly for permission for the interview or meeting to be recorded. The online surveys will ask participants to provide the last six numbers of their ID as a unique identifier to track their capacity development needs and progress throughout the project. To help protect their confidentiality, the information they provide will be private, deidentified and no names will be used. In addition, all cookies and IP address collectors will be disabled to ensure confidentiality. All interview and meeting recordings on the digital recorders will be destroyed following safe storage and transcription, and any identifying information will be redacted from all transcripts. All study data, including recordings, will be stored electronically using password-controlled software only accessible to key project members and project analysts. Reports of study findings will not identify individual participants. We do not anticipate any specific harms or serious risks to participants. However, there is a risk of breaches of confidentiality for participants who take part in guideline panel and steering group committee project meetings. At the start of all meetings, participants will be introduced to each other. The member names of these groups will not be anonymous as they will play an ongoing role in the GELA project. At the start of each meeting, we will discuss the importance of maintaining confidentiality by everyone. As part of guideline development processes, all guideline members will need to declare conflicts of interests and sign a confidentiality agreement. We will explain, however, that while the researchers undertake to maintain confidentiality, we cannot guarantee that other meeting participants will, and there is, thus, a risk of breaches of confidentiality. We will ensure participants are aware of this risk. Participants may also feel anxiety or distress expressing negative views about project activities. Where there is this potential and where participants identify concerns, we will reassure participants of the steps that will be taken to ensure confidentiality.

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Kredo, T., Effa, E., Mbeye, N. et al. Evaluating the impact of the global evidence, local adaptation (GELA) project for enhancing evidence-informed guideline recommendations for newborn and young child health in three African countries: a mixed-methods protocol. Health Res Policy Sys 22 , 114 (2024). https://doi.org/10.1186/s12961-024-01189-5

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Received : 02 June 2023

Accepted : 20 July 2024

Published : 19 August 2024

DOI : https://doi.org/10.1186/s12961-024-01189-5

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• Related diseases
• Newborn and child health
• Saharan Africa (SSA)
• Informed decision
• Capacity development
• Monitoring and evaluation;
• Research impact

Health Research Policy and Systems

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