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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 June 22, 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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What is case study research?

Last updated

8 February 2023

Reviewed by

Cathy Heath

Suppose a company receives a spike in the number of customer complaints, or medical experts discover an outbreak of illness affecting children but are not quite sure of the reason. In both cases, carrying out a case study could be the best way to get answers.

Organization

Case studies can be carried out across different disciplines, including education, medicine, sociology, and business.

Most case studies employ qualitative methods, but quantitative methods can also be used. Researchers can then describe, compare, evaluate, and identify patterns or cause-and-effect relationships between the various variables under study. They can then use this knowledge to decide what action to take. 

Another thing to note is that case studies are generally singular in their focus. This means they narrow focus to a particular area, making them highly subjective. You cannot always generalize the results of a case study and apply them to a larger population. However, they are valuable tools to illustrate a principle or develop a thesis.

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  • What are the different types of case study designs?

Researchers can choose from a variety of case study designs. The design they choose is dependent on what questions they need to answer, the context of the research environment, how much data they already have, and what resources are available.

Here are the common types of case study design:

Explanatory

An explanatory case study is an initial explanation of the how or why that is behind something. This design is commonly used when studying a real-life phenomenon or event. Once the organization understands the reasons behind a phenomenon, it can then make changes to enhance or eliminate the variables causing it. 

Here is an example: How is co-teaching implemented in elementary schools? The title for a case study of this subject could be “Case Study of the Implementation of Co-Teaching in Elementary Schools.”

Descriptive

An illustrative or descriptive case study helps researchers shed light on an unfamiliar object or subject after a period of time. The case study provides an in-depth review of the issue at hand and adds real-world examples in the area the researcher wants the audience to understand. 

The researcher makes no inferences or causal statements about the object or subject under review. This type of design is often used to understand cultural shifts.

Here is an example: How did people cope with the 2004 Indian Ocean Tsunami? This case study could be titled "A Case Study of the 2004 Indian Ocean Tsunami and its Effect on the Indonesian Population."

Exploratory

Exploratory research is also called a pilot case study. It is usually the first step within a larger research project, often relying on questionnaires and surveys . Researchers use exploratory research to help narrow down their focus, define parameters, draft a specific research question , and/or identify variables in a larger study. This research design usually covers a wider area than others, and focuses on the ‘what’ and ‘who’ of a topic.

Here is an example: How do nutrition and socialization in early childhood affect learning in children? The title of the exploratory study may be “Case Study of the Effects of Nutrition and Socialization on Learning in Early Childhood.”

An intrinsic case study is specifically designed to look at a unique and special phenomenon. At the start of the study, the researcher defines the phenomenon and the uniqueness that differentiates it from others. 

In this case, researchers do not attempt to generalize, compare, or challenge the existing assumptions. Instead, they explore the unique variables to enhance understanding. Here is an example: “Case Study of Volcanic Lightning.”

This design can also be identified as a cumulative case study. It uses information from past studies or observations of groups of people in certain settings as the foundation of the new study. Given that it takes multiple areas into account, it allows for greater generalization than a single case study. 

The researchers also get an in-depth look at a particular subject from different viewpoints.  Here is an example: “Case Study of how PTSD affected Vietnam and Gulf War Veterans Differently Due to Advances in Military Technology.”

Critical instance

A critical case study incorporates both explanatory and intrinsic study designs. It does not have predetermined purposes beyond an investigation of the said subject. It can be used for a deeper explanation of the cause-and-effect relationship. It can also be used to question a common assumption or myth. 

The findings can then be used further to generalize whether they would also apply in a different environment.  Here is an example: “What Effect Does Prolonged Use of Social Media Have on the Mind of American Youth?”

Instrumental

Instrumental research attempts to achieve goals beyond understanding the object at hand. Researchers explore a larger subject through different, separate studies and use the findings to understand its relationship to another subject. This type of design also provides insight into an issue or helps refine a theory. 

For example, you may want to determine if violent behavior in children predisposes them to crime later in life. The focus is on the relationship between children and violent behavior, and why certain children do become violent. Here is an example: “Violence Breeds Violence: Childhood Exposure and Participation in Adult Crime.”

Evaluation case study design is employed to research the effects of a program, policy, or intervention, and assess its effectiveness and impact on future decision-making. 

For example, you might want to see whether children learn times tables quicker through an educational game on their iPad versus a more teacher-led intervention. Here is an example: “An Investigation of the Impact of an iPad Multiplication Game for Primary School Children.” 

  • When do you use case studies?

Case studies are ideal when you want to gain a contextual, concrete, or in-depth understanding of a particular subject. It helps you understand the characteristics, implications, and meanings of the subject.

They are also an excellent choice for those writing a thesis or dissertation, as they help keep the project focused on a particular area when resources or time may be too limited to cover a wider one. You may have to conduct several case studies to explore different aspects of the subject in question and understand the problem.

  • What are the steps to follow when conducting a case study?

1. Select a case

Once you identify the problem at hand and come up with questions, identify the case you will focus on. The study can provide insights into the subject at hand, challenge existing assumptions, propose a course of action, and/or open up new areas for further research.

2. Create a theoretical framework

While you will be focusing on a specific detail, the case study design you choose should be linked to existing knowledge on the topic. This prevents it from becoming an isolated description and allows for enhancing the existing information. 

It may expand the current theory by bringing up new ideas or concepts, challenge established assumptions, or exemplify a theory by exploring how it answers the problem at hand. A theoretical framework starts with a literature review of the sources relevant to the topic in focus. This helps in identifying key concepts to guide analysis and interpretation.

3. Collect the data

Case studies are frequently supplemented with qualitative data such as observations, interviews, and a review of both primary and secondary sources such as official records, news articles, and photographs. There may also be quantitative data —this data assists in understanding the case thoroughly.

4. Analyze your case

The results of the research depend on the research design. Most case studies are structured with chapters or topic headings for easy explanation and presentation. Others may be written as narratives to allow researchers to explore various angles of the topic and analyze its meanings and implications.

In all areas, always give a detailed contextual understanding of the case and connect it to the existing theory and literature before discussing how it fits into your problem area.

  • What are some case study examples?

What are the best approaches for introducing our product into the Kenyan market?

How does the change in marketing strategy aid in increasing the sales volumes of product Y?

How can teachers enhance student participation in classrooms?

How does poverty affect literacy levels in children?

Case study topics

Case study of product marketing strategies in the Kenyan market

Case study of the effects of a marketing strategy change on product Y sales volumes

Case study of X school teachers that encourage active student participation in the classroom

Case study of the effects of poverty on literacy levels in children

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A case study research paper examines a person, place, event, condition, phenomenon, or other type of subject of analysis in order to extrapolate  key themes and results that help predict future trends, illuminate previously hidden issues that can be applied to practice, and/or provide a means for understanding an important research problem with greater clarity. A case study research paper usually examines a single subject of analysis, but case study papers can also be designed as a comparative investigation that shows relationships between two or more subjects. The methods used to study a case can rest within a quantitative, qualitative, or mixed-method investigative paradigm.

Case Studies. Writing@CSU. Colorado State University; Mills, Albert J. , Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010 ; “What is a Case Study?” In Swanborn, Peter G. Case Study Research: What, Why and How? London: SAGE, 2010.

How to Approach Writing a Case Study Research Paper

General information about how to choose a topic to investigate can be found under the " Choosing a Research Problem " tab in the Organizing Your Social Sciences Research Paper writing guide. Review this page because it may help you identify a subject of analysis that can be investigated using a case study design.

However, identifying a case to investigate involves more than choosing the research problem . A case study encompasses a problem contextualized around the application of in-depth analysis, interpretation, and discussion, often resulting in specific recommendations for action or for improving existing conditions. As Seawright and Gerring note, practical considerations such as time and access to information can influence case selection, but these issues should not be the sole factors used in describing the methodological justification for identifying a particular case to study. Given this, selecting a case includes considering the following:

  • The case represents an unusual or atypical example of a research problem that requires more in-depth analysis? Cases often represent a topic that rests on the fringes of prior investigations because the case may provide new ways of understanding the research problem. For example, if the research problem is to identify strategies to improve policies that support girl's access to secondary education in predominantly Muslim nations, you could consider using Azerbaijan as a case study rather than selecting a more obvious nation in the Middle East. Doing so may reveal important new insights into recommending how governments in other predominantly Muslim nations can formulate policies that support improved access to education for girls.
  • The case provides important insight or illuminate a previously hidden problem? In-depth analysis of a case can be based on the hypothesis that the case study will reveal trends or issues that have not been exposed in prior research or will reveal new and important implications for practice. For example, anecdotal evidence may suggest drug use among homeless veterans is related to their patterns of travel throughout the day. Assuming prior studies have not looked at individual travel choices as a way to study access to illicit drug use, a case study that observes a homeless veteran could reveal how issues of personal mobility choices facilitate regular access to illicit drugs. Note that it is important to conduct a thorough literature review to ensure that your assumption about the need to reveal new insights or previously hidden problems is valid and evidence-based.
  • The case challenges and offers a counter-point to prevailing assumptions? Over time, research on any given topic can fall into a trap of developing assumptions based on outdated studies that are still applied to new or changing conditions or the idea that something should simply be accepted as "common sense," even though the issue has not been thoroughly tested in current practice. A case study analysis may offer an opportunity to gather evidence that challenges prevailing assumptions about a research problem and provide a new set of recommendations applied to practice that have not been tested previously. For example, perhaps there has been a long practice among scholars to apply a particular theory in explaining the relationship between two subjects of analysis. Your case could challenge this assumption by applying an innovative theoretical framework [perhaps borrowed from another discipline] to explore whether this approach offers new ways of understanding the research problem. Taking a contrarian stance is one of the most important ways that new knowledge and understanding develops from existing literature.
  • The case provides an opportunity to pursue action leading to the resolution of a problem? Another way to think about choosing a case to study is to consider how the results from investigating a particular case may result in findings that reveal ways in which to resolve an existing or emerging problem. For example, studying the case of an unforeseen incident, such as a fatal accident at a railroad crossing, can reveal hidden issues that could be applied to preventative measures that contribute to reducing the chance of accidents in the future. In this example, a case study investigating the accident could lead to a better understanding of where to strategically locate additional signals at other railroad crossings so as to better warn drivers of an approaching train, particularly when visibility is hindered by heavy rain, fog, or at night.
  • The case offers a new direction in future research? A case study can be used as a tool for an exploratory investigation that highlights the need for further research about the problem. A case can be used when there are few studies that help predict an outcome or that establish a clear understanding about how best to proceed in addressing a problem. For example, after conducting a thorough literature review [very important!], you discover that little research exists showing the ways in which women contribute to promoting water conservation in rural communities of east central Africa. A case study of how women contribute to saving water in a rural village of Uganda can lay the foundation for understanding the need for more thorough research that documents how women in their roles as cooks and family caregivers think about water as a valuable resource within their community. This example of a case study could also point to the need for scholars to build new theoretical frameworks around the topic [e.g., applying feminist theories of work and family to the issue of water conservation].

Eisenhardt, Kathleen M. “Building Theories from Case Study Research.” Academy of Management Review 14 (October 1989): 532-550; Emmel, Nick. Sampling and Choosing Cases in Qualitative Research: A Realist Approach . Thousand Oaks, CA: SAGE Publications, 2013; Gerring, John. “What Is a Case Study and What Is It Good for?” American Political Science Review 98 (May 2004): 341-354; Mills, Albert J. , Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010; Seawright, Jason and John Gerring. "Case Selection Techniques in Case Study Research." Political Research Quarterly 61 (June 2008): 294-308.

Structure and Writing Style

The purpose of a paper in the social sciences designed around a case study is to thoroughly investigate a subject of analysis in order to reveal a new understanding about the research problem and, in so doing, contributing new knowledge to what is already known from previous studies. In applied social sciences disciplines [e.g., education, social work, public administration, etc.], case studies may also be used to reveal best practices, highlight key programs, or investigate interesting aspects of professional work.

In general, the structure of a case study research paper is not all that different from a standard college-level research paper. However, there are subtle differences you should be aware of. Here are the key elements to organizing and writing a case study research paper.

I.  Introduction

As with any research paper, your introduction should serve as a roadmap for your readers to ascertain the scope and purpose of your study . The introduction to a case study research paper, however, should not only describe the research problem and its significance, but you should also succinctly describe why the case is being used and how it relates to addressing the problem. The two elements should be linked. With this in mind, a good introduction answers these four questions:

  • What is being studied? Describe the research problem and describe the subject of analysis [the case] you have chosen to address the problem. Explain how they are linked and what elements of the case will help to expand knowledge and understanding about the problem.
  • Why is this topic important to investigate? Describe the significance of the research problem and state why a case study design and the subject of analysis that the paper is designed around is appropriate in addressing the problem.
  • What did we know about this topic before I did this study? Provide background that helps lead the reader into the more in-depth literature review to follow. If applicable, summarize prior case study research applied to the research problem and why it fails to adequately address the problem. Describe why your case will be useful. If no prior case studies have been used to address the research problem, explain why you have selected this subject of analysis.
  • How will this study advance new knowledge or new ways of understanding? Explain why your case study will be suitable in helping to expand knowledge and understanding about the research problem.

Each of these questions should be addressed in no more than a few paragraphs. Exceptions to this can be when you are addressing a complex research problem or subject of analysis that requires more in-depth background information.

II.  Literature Review

The literature review for a case study research paper is generally structured the same as it is for any college-level research paper. The difference, however, is that the literature review is focused on providing background information and  enabling historical interpretation of the subject of analysis in relation to the research problem the case is intended to address . This includes synthesizing studies that help to:

  • Place relevant works in the context of their contribution to understanding the case study being investigated . This would involve summarizing studies that have used a similar subject of analysis to investigate the research problem. If there is literature using the same or a very similar case to study, you need to explain why duplicating past research is important [e.g., conditions have changed; prior studies were conducted long ago, etc.].
  • Describe the relationship each work has to the others under consideration that informs the reader why this case is applicable . Your literature review should include a description of any works that support using the case to investigate the research problem and the underlying research questions.
  • Identify new ways to interpret prior research using the case study . If applicable, review any research that has examined the research problem using a different research design. Explain how your use of a case study design may reveal new knowledge or a new perspective or that can redirect research in an important new direction.
  • Resolve conflicts amongst seemingly contradictory previous studies . This refers to synthesizing any literature that points to unresolved issues of concern about the research problem and describing how the subject of analysis that forms the case study can help resolve these existing contradictions.
  • Point the way in fulfilling a need for additional research . Your review should examine any literature that lays a foundation for understanding why your case study design and the subject of analysis around which you have designed your study may reveal a new way of approaching the research problem or offer a perspective that points to the need for additional research.
  • Expose any gaps that exist in the literature that the case study could help to fill . Summarize any literature that not only shows how your subject of analysis contributes to understanding the research problem, but how your case contributes to a new way of understanding the problem that prior research has failed to do.
  • Locate your own research within the context of existing literature [very important!] . Collectively, your literature review should always place your case study within the larger domain of prior research about the problem. The overarching purpose of reviewing pertinent literature in a case study paper is to demonstrate that you have thoroughly identified and synthesized prior studies in relation to explaining the relevance of the case in addressing the research problem.

III.  Method

In this section, you explain why you selected a particular case [i.e., subject of analysis] and the strategy you used to identify and ultimately decide that your case was appropriate in addressing the research problem. The way you describe the methods used varies depending on the type of subject of analysis that constitutes your case study.

If your subject of analysis is an incident or event . In the social and behavioral sciences, the event or incident that represents the case to be studied is usually bounded by time and place, with a clear beginning and end and with an identifiable location or position relative to its surroundings. The subject of analysis can be a rare or critical event or it can focus on a typical or regular event. The purpose of studying a rare event is to illuminate new ways of thinking about the broader research problem or to test a hypothesis. Critical incident case studies must describe the method by which you identified the event and explain the process by which you determined the validity of this case to inform broader perspectives about the research problem or to reveal new findings. However, the event does not have to be a rare or uniquely significant to support new thinking about the research problem or to challenge an existing hypothesis. For example, Walo, Bull, and Breen conducted a case study to identify and evaluate the direct and indirect economic benefits and costs of a local sports event in the City of Lismore, New South Wales, Australia. The purpose of their study was to provide new insights from measuring the impact of a typical local sports event that prior studies could not measure well because they focused on large "mega-events." Whether the event is rare or not, the methods section should include an explanation of the following characteristics of the event: a) when did it take place; b) what were the underlying circumstances leading to the event; and, c) what were the consequences of the event in relation to the research problem.

If your subject of analysis is a person. Explain why you selected this particular individual to be studied and describe what experiences they have had that provide an opportunity to advance new understandings about the research problem. Mention any background about this person which might help the reader understand the significance of their experiences that make them worthy of study. This includes describing the relationships this person has had with other people, institutions, and/or events that support using them as the subject for a case study research paper. It is particularly important to differentiate the person as the subject of analysis from others and to succinctly explain how the person relates to examining the research problem [e.g., why is one politician in a particular local election used to show an increase in voter turnout from any other candidate running in the election]. Note that these issues apply to a specific group of people used as a case study unit of analysis [e.g., a classroom of students].

If your subject of analysis is a place. In general, a case study that investigates a place suggests a subject of analysis that is unique or special in some way and that this uniqueness can be used to build new understanding or knowledge about the research problem. A case study of a place must not only describe its various attributes relevant to the research problem [e.g., physical, social, historical, cultural, economic, political], but you must state the method by which you determined that this place will illuminate new understandings about the research problem. It is also important to articulate why a particular place as the case for study is being used if similar places also exist [i.e., if you are studying patterns of homeless encampments of veterans in open spaces, explain why you are studying Echo Park in Los Angeles rather than Griffith Park?]. If applicable, describe what type of human activity involving this place makes it a good choice to study [e.g., prior research suggests Echo Park has more homeless veterans].

If your subject of analysis is a phenomenon. A phenomenon refers to a fact, occurrence, or circumstance that can be studied or observed but with the cause or explanation to be in question. In this sense, a phenomenon that forms your subject of analysis can encompass anything that can be observed or presumed to exist but is not fully understood. In the social and behavioral sciences, the case usually focuses on human interaction within a complex physical, social, economic, cultural, or political system. For example, the phenomenon could be the observation that many vehicles used by ISIS fighters are small trucks with English language advertisements on them. The research problem could be that ISIS fighters are difficult to combat because they are highly mobile. The research questions could be how and by what means are these vehicles used by ISIS being supplied to the militants and how might supply lines to these vehicles be cut off? How might knowing the suppliers of these trucks reveal larger networks of collaborators and financial support? A case study of a phenomenon most often encompasses an in-depth analysis of a cause and effect that is grounded in an interactive relationship between people and their environment in some way.

NOTE:   The choice of the case or set of cases to study cannot appear random. Evidence that supports the method by which you identified and chose your subject of analysis should clearly support investigation of the research problem and linked to key findings from your literature review. Be sure to cite any studies that helped you determine that the case you chose was appropriate for examining the problem.

IV.  Discussion

The main elements of your discussion section are generally the same as any research paper, but centered around interpreting and drawing conclusions about the key findings from your analysis of the case study. Note that a general social sciences research paper may contain a separate section to report findings. However, in a paper designed around a case study, it is common to combine a description of the results with the discussion about their implications. The objectives of your discussion section should include the following:

Reiterate the Research Problem/State the Major Findings Briefly reiterate the research problem you are investigating and explain why the subject of analysis around which you designed the case study were used. You should then describe the findings revealed from your study of the case using direct, declarative, and succinct proclamation of the study results. Highlight any findings that were unexpected or especially profound.

Explain the Meaning of the Findings and Why They are Important Systematically explain the meaning of your case study findings and why you believe they are important. Begin this part of the section by repeating what you consider to be your most important or surprising finding first, then systematically review each finding. Be sure to thoroughly extrapolate what your analysis of the case can tell the reader about situations or conditions beyond the actual case that was studied while, at the same time, being careful not to misconstrue or conflate a finding that undermines the external validity of your conclusions.

Relate the Findings to Similar Studies No study in the social sciences is so novel or possesses such a restricted focus that it has absolutely no relation to previously published research. The discussion section should relate your case study results to those found in other studies, particularly if questions raised from prior studies served as the motivation for choosing your subject of analysis. This is important because comparing and contrasting the findings of other studies helps support the overall importance of your results and it highlights how and in what ways your case study design and the subject of analysis differs from prior research about the topic.

Consider Alternative Explanations of the Findings Remember that the purpose of social science research is to discover and not to prove. When writing the discussion section, you should carefully consider all possible explanations revealed by the case study results, rather than just those that fit your hypothesis or prior assumptions and biases. Be alert to what the in-depth analysis of the case may reveal about the research problem, including offering a contrarian perspective to what scholars have stated in prior research if that is how the findings can be interpreted from your case.

Acknowledge the Study's Limitations You can state the study's limitations in the conclusion section of your paper but describing the limitations of your subject of analysis in the discussion section provides an opportunity to identify the limitations and explain why they are not significant. This part of the discussion section should also note any unanswered questions or issues your case study could not address. More detailed information about how to document any limitations to your research can be found here .

Suggest Areas for Further Research Although your case study may offer important insights about the research problem, there are likely additional questions related to the problem that remain unanswered or findings that unexpectedly revealed themselves as a result of your in-depth analysis of the case. Be sure that the recommendations for further research are linked to the research problem and that you explain why your recommendations are valid in other contexts and based on the original assumptions of your study.

V.  Conclusion

As with any research paper, you should summarize your conclusion in clear, simple language; emphasize how the findings from your case study differs from or supports prior research and why. Do not simply reiterate the discussion section. Provide a synthesis of key findings presented in the paper to show how these converge to address the research problem. If you haven't already done so in the discussion section, be sure to document the limitations of your case study and any need for further research.

The function of your paper's conclusion is to: 1) reiterate the main argument supported by the findings from your case study; 2) state clearly the context, background, and necessity of pursuing the research problem using a case study design in relation to an issue, controversy, or a gap found from reviewing the literature; and, 3) provide a place to persuasively and succinctly restate the significance of your research problem, given that the reader has now been presented with in-depth information about the topic.

Consider the following points to help ensure your conclusion is appropriate:

  • If the argument or purpose of your paper is complex, you may need to summarize these points for your reader.
  • If prior to your conclusion, you have not yet explained the significance of your findings or if you are proceeding inductively, use the conclusion of your paper to describe your main points and explain their significance.
  • Move from a detailed to a general level of consideration of the case study's findings that returns the topic to the context provided by the introduction or within a new context that emerges from your case study findings.

Note that, depending on the discipline you are writing in or the preferences of your professor, the concluding paragraph may contain your final reflections on the evidence presented as it applies to practice or on the essay's central research problem. However, the nature of being introspective about the subject of analysis you have investigated will depend on whether you are explicitly asked to express your observations in this way.

Problems to Avoid

Overgeneralization One of the goals of a case study is to lay a foundation for understanding broader trends and issues applied to similar circumstances. However, be careful when drawing conclusions from your case study. They must be evidence-based and grounded in the results of the study; otherwise, it is merely speculation. Looking at a prior example, it would be incorrect to state that a factor in improving girls access to education in Azerbaijan and the policy implications this may have for improving access in other Muslim nations is due to girls access to social media if there is no documentary evidence from your case study to indicate this. There may be anecdotal evidence that retention rates were better for girls who were engaged with social media, but this observation would only point to the need for further research and would not be a definitive finding if this was not a part of your original research agenda.

Failure to Document Limitations No case is going to reveal all that needs to be understood about a research problem. Therefore, just as you have to clearly state the limitations of a general research study , you must describe the specific limitations inherent in the subject of analysis. For example, the case of studying how women conceptualize the need for water conservation in a village in Uganda could have limited application in other cultural contexts or in areas where fresh water from rivers or lakes is plentiful and, therefore, conservation is understood more in terms of managing access rather than preserving access to a scarce resource.

Failure to Extrapolate All Possible Implications Just as you don't want to over-generalize from your case study findings, you also have to be thorough in the consideration of all possible outcomes or recommendations derived from your findings. If you do not, your reader may question the validity of your analysis, particularly if you failed to document an obvious outcome from your case study research. For example, in the case of studying the accident at the railroad crossing to evaluate where and what types of warning signals should be located, you failed to take into consideration speed limit signage as well as warning signals. When designing your case study, be sure you have thoroughly addressed all aspects of the problem and do not leave gaps in your analysis that leave the reader questioning the results.

Case Studies. Writing@CSU. Colorado State University; Gerring, John. Case Study Research: Principles and Practices . New York: Cambridge University Press, 2007; Merriam, Sharan B. Qualitative Research and Case Study Applications in Education . Rev. ed. San Francisco, CA: Jossey-Bass, 1998; Miller, Lisa L. “The Use of Case Studies in Law and Social Science Research.” Annual Review of Law and Social Science 14 (2018): TBD; Mills, Albert J., Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010; Putney, LeAnn Grogan. "Case Study." In Encyclopedia of Research Design , Neil J. Salkind, editor. (Thousand Oaks, CA: SAGE Publications, 2010), pp. 116-120; Simons, Helen. Case Study Research in Practice . London: SAGE Publications, 2009;  Kratochwill,  Thomas R. and Joel R. Levin, editors. Single-Case Research Design and Analysis: New Development for Psychology and Education .  Hilldsale, NJ: Lawrence Erlbaum Associates, 1992; Swanborn, Peter G. Case Study Research: What, Why and How? London : SAGE, 2010; Yin, Robert K. Case Study Research: Design and Methods . 6th edition. Los Angeles, CA, SAGE Publications, 2014; Walo, Maree, Adrian Bull, and Helen Breen. “Achieving Economic Benefits at Local Events: A Case Study of a Local Sports Event.” Festival Management and Event Tourism 4 (1996): 95-106.

Writing Tip

At Least Five Misconceptions about Case Study Research

Social science case studies are often perceived as limited in their ability to create new knowledge because they are not randomly selected and findings cannot be generalized to larger populations. Flyvbjerg examines five misunderstandings about case study research and systematically "corrects" each one. To quote, these are:

Misunderstanding 1 :  General, theoretical [context-independent] knowledge is more valuable than concrete, practical [context-dependent] knowledge. Misunderstanding 2 :  One cannot generalize on the basis of an individual case; therefore, the case study cannot contribute to scientific development. Misunderstanding 3 :  The case study is most useful for generating hypotheses; that is, in the first stage of a total research process, whereas other methods are more suitable for hypotheses testing and theory building. Misunderstanding 4 :  The case study contains a bias toward verification, that is, a tendency to confirm the researcher’s preconceived notions. Misunderstanding 5 :  It is often difficult to summarize and develop general propositions and theories on the basis of specific case studies [p. 221].

While writing your paper, think introspectively about how you addressed these misconceptions because to do so can help you strengthen the validity and reliability of your research by clarifying issues of case selection, the testing and challenging of existing assumptions, the interpretation of key findings, and the summation of case outcomes. Think of a case study research paper as a complete, in-depth narrative about the specific properties and key characteristics of your subject of analysis applied to the research problem.

Flyvbjerg, Bent. “Five Misunderstandings About Case-Study Research.” Qualitative Inquiry 12 (April 2006): 219-245.

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The Ultimate Guide to Qualitative Research - Part 1: The Basics

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  • Introduction and overview
  • What is qualitative research?
  • What is qualitative data?
  • Examples of qualitative data
  • Qualitative vs. quantitative research
  • Mixed methods
  • Qualitative research preparation
  • Theoretical perspective
  • Theoretical framework
  • Literature reviews

Research question

  • Conceptual framework
  • Conceptual vs. theoretical framework

Data collection

  • Qualitative research methods
  • Focus groups
  • Observational research

What is a case study?

Applications for case study research, what is a good case study, process of case study design, benefits and limitations of case studies.

  • Ethnographical research
  • Ethical considerations
  • Confidentiality and privacy
  • Power dynamics
  • Reflexivity

Case studies

Case studies are essential to qualitative research , offering a lens through which researchers can investigate complex phenomena within their real-life contexts. This chapter explores the concept, purpose, applications, examples, and types of case studies and provides guidance on how to conduct case study research effectively.

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Whereas quantitative methods look at phenomena at scale, case study research looks at a concept or phenomenon in considerable detail. While analyzing a single case can help understand one perspective regarding the object of research inquiry, analyzing multiple cases can help obtain a more holistic sense of the topic or issue. Let's provide a basic definition of a case study, then explore its characteristics and role in the qualitative research process.

Definition of a case study

A case study in qualitative research is a strategy of inquiry that involves an in-depth investigation of a phenomenon within its real-world context. It provides researchers with the opportunity to acquire an in-depth understanding of intricate details that might not be as apparent or accessible through other methods of research. The specific case or cases being studied can be a single person, group, or organization – demarcating what constitutes a relevant case worth studying depends on the researcher and their research question .

Among qualitative research methods , a case study relies on multiple sources of evidence, such as documents, artifacts, interviews , or observations , to present a complete and nuanced understanding of the phenomenon under investigation. The objective is to illuminate the readers' understanding of the phenomenon beyond its abstract statistical or theoretical explanations.

Characteristics of case studies

Case studies typically possess a number of distinct characteristics that set them apart from other research methods. These characteristics include a focus on holistic description and explanation, flexibility in the design and data collection methods, reliance on multiple sources of evidence, and emphasis on the context in which the phenomenon occurs.

Furthermore, case studies can often involve a longitudinal examination of the case, meaning they study the case over a period of time. These characteristics allow case studies to yield comprehensive, in-depth, and richly contextualized insights about the phenomenon of interest.

The role of case studies in research

Case studies hold a unique position in the broader landscape of research methods aimed at theory development. They are instrumental when the primary research interest is to gain an intensive, detailed understanding of a phenomenon in its real-life context.

In addition, case studies can serve different purposes within research - they can be used for exploratory, descriptive, or explanatory purposes, depending on the research question and objectives. This flexibility and depth make case studies a valuable tool in the toolkit of qualitative researchers.

Remember, a well-conducted case study can offer a rich, insightful contribution to both academic and practical knowledge through theory development or theory verification, thus enhancing our understanding of complex phenomena in their real-world contexts.

What is the purpose of a case study?

Case study research aims for a more comprehensive understanding of phenomena, requiring various research methods to gather information for qualitative analysis . Ultimately, a case study can allow the researcher to gain insight into a particular object of inquiry and develop a theoretical framework relevant to the research inquiry.

Why use case studies in qualitative research?

Using case studies as a research strategy depends mainly on the nature of the research question and the researcher's access to the data.

Conducting case study research provides a level of detail and contextual richness that other research methods might not offer. They are beneficial when there's a need to understand complex social phenomena within their natural contexts.

The explanatory, exploratory, and descriptive roles of case studies

Case studies can take on various roles depending on the research objectives. They can be exploratory when the research aims to discover new phenomena or define new research questions; they are descriptive when the objective is to depict a phenomenon within its context in a detailed manner; and they can be explanatory if the goal is to understand specific relationships within the studied context. Thus, the versatility of case studies allows researchers to approach their topic from different angles, offering multiple ways to uncover and interpret the data .

The impact of case studies on knowledge development

Case studies play a significant role in knowledge development across various disciplines. Analysis of cases provides an avenue for researchers to explore phenomena within their context based on the collected data.

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This can result in the production of rich, practical insights that can be instrumental in both theory-building and practice. Case studies allow researchers to delve into the intricacies and complexities of real-life situations, uncovering insights that might otherwise remain hidden.

Types of case studies

In qualitative research , a case study is not a one-size-fits-all approach. Depending on the nature of the research question and the specific objectives of the study, researchers might choose to use different types of case studies. These types differ in their focus, methodology, and the level of detail they provide about the phenomenon under investigation.

Understanding these types is crucial for selecting the most appropriate approach for your research project and effectively achieving your research goals. Let's briefly look at the main types of case studies.

Exploratory case studies

Exploratory case studies are typically conducted to develop a theory or framework around an understudied phenomenon. They can also serve as a precursor to a larger-scale research project. Exploratory case studies are useful when a researcher wants to identify the key issues or questions which can spur more extensive study or be used to develop propositions for further research. These case studies are characterized by flexibility, allowing researchers to explore various aspects of a phenomenon as they emerge, which can also form the foundation for subsequent studies.

Descriptive case studies

Descriptive case studies aim to provide a complete and accurate representation of a phenomenon or event within its context. These case studies are often based on an established theoretical framework, which guides how data is collected and analyzed. The researcher is concerned with describing the phenomenon in detail, as it occurs naturally, without trying to influence or manipulate it.

Explanatory case studies

Explanatory case studies are focused on explanation - they seek to clarify how or why certain phenomena occur. Often used in complex, real-life situations, they can be particularly valuable in clarifying causal relationships among concepts and understanding the interplay between different factors within a specific context.

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Intrinsic, instrumental, and collective case studies

These three categories of case studies focus on the nature and purpose of the study. An intrinsic case study is conducted when a researcher has an inherent interest in the case itself. Instrumental case studies are employed when the case is used to provide insight into a particular issue or phenomenon. A collective case study, on the other hand, involves studying multiple cases simultaneously to investigate some general phenomena.

Each type of case study serves a different purpose and has its own strengths and challenges. The selection of the type should be guided by the research question and objectives, as well as the context and constraints of the research.

The flexibility, depth, and contextual richness offered by case studies make this approach an excellent research method for various fields of study. They enable researchers to investigate real-world phenomena within their specific contexts, capturing nuances that other research methods might miss. Across numerous fields, case studies provide valuable insights into complex issues.

Critical information systems research

Case studies provide a detailed understanding of the role and impact of information systems in different contexts. They offer a platform to explore how information systems are designed, implemented, and used and how they interact with various social, economic, and political factors. Case studies in this field often focus on examining the intricate relationship between technology, organizational processes, and user behavior, helping to uncover insights that can inform better system design and implementation.

Health research

Health research is another field where case studies are highly valuable. They offer a way to explore patient experiences, healthcare delivery processes, and the impact of various interventions in a real-world context.

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Case studies can provide a deep understanding of a patient's journey, giving insights into the intricacies of disease progression, treatment effects, and the psychosocial aspects of health and illness.

Asthma research studies

Specifically within medical research, studies on asthma often employ case studies to explore the individual and environmental factors that influence asthma development, management, and outcomes. A case study can provide rich, detailed data about individual patients' experiences, from the triggers and symptoms they experience to the effectiveness of various management strategies. This can be crucial for developing patient-centered asthma care approaches.

Other fields

Apart from the fields mentioned, case studies are also extensively used in business and management research, education research, and political sciences, among many others. They provide an opportunity to delve into the intricacies of real-world situations, allowing for a comprehensive understanding of various phenomena.

Case studies, with their depth and contextual focus, offer unique insights across these varied fields. They allow researchers to illuminate the complexities of real-life situations, contributing to both theory and practice.

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Understanding the key elements of case study design is crucial for conducting rigorous and impactful case study research. A well-structured design guides the researcher through the process, ensuring that the study is methodologically sound and its findings are reliable and valid. The main elements of case study design include the research question , propositions, units of analysis, and the logic linking the data to the propositions.

The research question is the foundation of any research study. A good research question guides the direction of the study and informs the selection of the case, the methods of collecting data, and the analysis techniques. A well-formulated research question in case study research is typically clear, focused, and complex enough to merit further detailed examination of the relevant case(s).

Propositions

Propositions, though not necessary in every case study, provide a direction by stating what we might expect to find in the data collected. They guide how data is collected and analyzed by helping researchers focus on specific aspects of the case. They are particularly important in explanatory case studies, which seek to understand the relationships among concepts within the studied phenomenon.

Units of analysis

The unit of analysis refers to the case, or the main entity or entities that are being analyzed in the study. In case study research, the unit of analysis can be an individual, a group, an organization, a decision, an event, or even a time period. It's crucial to clearly define the unit of analysis, as it shapes the qualitative data analysis process by allowing the researcher to analyze a particular case and synthesize analysis across multiple case studies to draw conclusions.

Argumentation

This refers to the inferential model that allows researchers to draw conclusions from the data. The researcher needs to ensure that there is a clear link between the data, the propositions (if any), and the conclusions drawn. This argumentation is what enables the researcher to make valid and credible inferences about the phenomenon under study.

Understanding and carefully considering these elements in the design phase of a case study can significantly enhance the quality of the research. It can help ensure that the study is methodologically sound and its findings contribute meaningful insights about the case.

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Conducting a case study involves several steps, from defining the research question and selecting the case to collecting and analyzing data . This section outlines these key stages, providing a practical guide on how to conduct case study research.

Defining the research question

The first step in case study research is defining a clear, focused research question. This question should guide the entire research process, from case selection to analysis. It's crucial to ensure that the research question is suitable for a case study approach. Typically, such questions are exploratory or descriptive in nature and focus on understanding a phenomenon within its real-life context.

Selecting and defining the case

The selection of the case should be based on the research question and the objectives of the study. It involves choosing a unique example or a set of examples that provide rich, in-depth data about the phenomenon under investigation. After selecting the case, it's crucial to define it clearly, setting the boundaries of the case, including the time period and the specific context.

Previous research can help guide the case study design. When considering a case study, an example of a case could be taken from previous case study research and used to define cases in a new research inquiry. Considering recently published examples can help understand how to select and define cases effectively.

Developing a detailed case study protocol

A case study protocol outlines the procedures and general rules to be followed during the case study. This includes the data collection methods to be used, the sources of data, and the procedures for analysis. Having a detailed case study protocol ensures consistency and reliability in the study.

The protocol should also consider how to work with the people involved in the research context to grant the research team access to collecting data. As mentioned in previous sections of this guide, establishing rapport is an essential component of qualitative research as it shapes the overall potential for collecting and analyzing data.

Collecting data

Gathering data in case study research often involves multiple sources of evidence, including documents, archival records, interviews, observations, and physical artifacts. This allows for a comprehensive understanding of the case. The process for gathering data should be systematic and carefully documented to ensure the reliability and validity of the study.

Analyzing and interpreting data

The next step is analyzing the data. This involves organizing the data , categorizing it into themes or patterns , and interpreting these patterns to answer the research question. The analysis might also involve comparing the findings with prior research or theoretical propositions.

Writing the case study report

The final step is writing the case study report . This should provide a detailed description of the case, the data, the analysis process, and the findings. The report should be clear, organized, and carefully written to ensure that the reader can understand the case and the conclusions drawn from it.

Each of these steps is crucial in ensuring that the case study research is rigorous, reliable, and provides valuable insights about the case.

The type, depth, and quality of data in your study can significantly influence the validity and utility of the study. In case study research, data is usually collected from multiple sources to provide a comprehensive and nuanced understanding of the case. This section will outline the various methods of collecting data used in case study research and discuss considerations for ensuring the quality of the data.

Interviews are a common method of gathering data in case study research. They can provide rich, in-depth data about the perspectives, experiences, and interpretations of the individuals involved in the case. Interviews can be structured , semi-structured , or unstructured , depending on the research question and the degree of flexibility needed.

Observations

Observations involve the researcher observing the case in its natural setting, providing first-hand information about the case and its context. Observations can provide data that might not be revealed in interviews or documents, such as non-verbal cues or contextual information.

Documents and artifacts

Documents and archival records provide a valuable source of data in case study research. They can include reports, letters, memos, meeting minutes, email correspondence, and various public and private documents related to the case.

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These records can provide historical context, corroborate evidence from other sources, and offer insights into the case that might not be apparent from interviews or observations.

Physical artifacts refer to any physical evidence related to the case, such as tools, products, or physical environments. These artifacts can provide tangible insights into the case, complementing the data gathered from other sources.

Ensuring the quality of data collection

Determining the quality of data in case study research requires careful planning and execution. It's crucial to ensure that the data is reliable, accurate, and relevant to the research question. This involves selecting appropriate methods of collecting data, properly training interviewers or observers, and systematically recording and storing the data. It also includes considering ethical issues related to collecting and handling data, such as obtaining informed consent and ensuring the privacy and confidentiality of the participants.

Data analysis

Analyzing case study research involves making sense of the rich, detailed data to answer the research question. This process can be challenging due to the volume and complexity of case study data. However, a systematic and rigorous approach to analysis can ensure that the findings are credible and meaningful. This section outlines the main steps and considerations in analyzing data in case study research.

Organizing the data

The first step in the analysis is organizing the data. This involves sorting the data into manageable sections, often according to the data source or the theme. This step can also involve transcribing interviews, digitizing physical artifacts, or organizing observational data.

Categorizing and coding the data

Once the data is organized, the next step is to categorize or code the data. This involves identifying common themes, patterns, or concepts in the data and assigning codes to relevant data segments. Coding can be done manually or with the help of software tools, and in either case, qualitative analysis software can greatly facilitate the entire coding process. Coding helps to reduce the data to a set of themes or categories that can be more easily analyzed.

Identifying patterns and themes

After coding the data, the researcher looks for patterns or themes in the coded data. This involves comparing and contrasting the codes and looking for relationships or patterns among them. The identified patterns and themes should help answer the research question.

Interpreting the data

Once patterns and themes have been identified, the next step is to interpret these findings. This involves explaining what the patterns or themes mean in the context of the research question and the case. This interpretation should be grounded in the data, but it can also involve drawing on theoretical concepts or prior research.

Verification of the data

The last step in the analysis is verification. This involves checking the accuracy and consistency of the analysis process and confirming that the findings are supported by the data. This can involve re-checking the original data, checking the consistency of codes, or seeking feedback from research participants or peers.

Like any research method , case study research has its strengths and limitations. Researchers must be aware of these, as they can influence the design, conduct, and interpretation of the study.

Understanding the strengths and limitations of case study research can also guide researchers in deciding whether this approach is suitable for their research question . This section outlines some of the key strengths and limitations of case study research.

Benefits include the following:

  • Rich, detailed data: One of the main strengths of case study research is that it can generate rich, detailed data about the case. This can provide a deep understanding of the case and its context, which can be valuable in exploring complex phenomena.
  • Flexibility: Case study research is flexible in terms of design , data collection , and analysis . A sufficient degree of flexibility allows the researcher to adapt the study according to the case and the emerging findings.
  • Real-world context: Case study research involves studying the case in its real-world context, which can provide valuable insights into the interplay between the case and its context.
  • Multiple sources of evidence: Case study research often involves collecting data from multiple sources , which can enhance the robustness and validity of the findings.

On the other hand, researchers should consider the following limitations:

  • Generalizability: A common criticism of case study research is that its findings might not be generalizable to other cases due to the specificity and uniqueness of each case.
  • Time and resource intensive: Case study research can be time and resource intensive due to the depth of the investigation and the amount of collected data.
  • Complexity of analysis: The rich, detailed data generated in case study research can make analyzing the data challenging.
  • Subjectivity: Given the nature of case study research, there may be a higher degree of subjectivity in interpreting the data , so researchers need to reflect on this and transparently convey to audiences how the research was conducted.

Being aware of these strengths and limitations can help researchers design and conduct case study research effectively and interpret and report the findings appropriately.

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Research Method

Home » Case Study – Methods, Examples and Guide

Case Study – Methods, Examples and Guide

Table of Contents

Case Study Research

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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What the Case Study Method Really Teaches

  • Nitin Nohria

in this case research

Seven meta-skills that stick even if the cases fade from memory.

It’s been 100 years since Harvard Business School began using the case study method. Beyond teaching specific subject matter, the case study method excels in instilling meta-skills in students. This article explains the importance of seven such skills: preparation, discernment, bias recognition, judgement, collaboration, curiosity, and self-confidence.

During my decade as dean of Harvard Business School, I spent hundreds of hours talking with our alumni. To enliven these conversations, I relied on a favorite question: “What was the most important thing you learned from your time in our MBA program?”

  • Nitin Nohria is a professor and former dean at Harvard Business School and the chairman of Thrive Capital, a venture capital firm based in New York.

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Trump asks appeals court to lift gag order imposed on him in 2020 election interference case

Former President Donald Trump asked a federal appeals court on Thursday to lift a gag order restricting his speech about potential witnesses, prosecutors and court staff in the case that accuses him of scheming to overturn his 2020 election loss.

Trump’s attorneys urged the U.S. Court of Appeals for the D.C. Circuit to block the gag order ruling from U.S. District Judge Tanya Chutkan while the Republican former president pursues his appeals.

Trump’s lawyers say they will seek relief from the U.S. Supreme Court if the appeals court denies his request, arguing that the gag order violates Trump’s First Amendment rights and those of “over 100 million Americans who listen to him.”

“The prosecution’s request for a Gag Order bristles with hostility to President Trump’s viewpoint and his relentless criticism of the government — including of the prosecution itself,” Trump’s lawyers wrote in court papers. “The Gag Order embodies this unconstitutional hostility to President Trump’s viewpoint.”

Chutkan, an appointee of former President Barack Obama, reimposed the gag order on Sunday after denying Trump’s request to let him speak freely while he challenges the restrictions in higher courts.

The order bars Trump from making public statements targeting special counsel Jack Smith and his team, court employees and possible witnesses. It does not prohibit Trump from airing general complaints, even incendiary ones, about the case against him. The judge has explicitly said Trump is still allowed to assert his claims of innocence and his claims that the case is politically motivated.

Trump has made verbal attacks on those involved in the criminal cases against him a central part of his bid to reclaim the White House in 2024. Trump has denied any wrongdoing in the case, and cast himself as the victim of a politically motivated justice system working to deny him another term.

In pushing to reinstate the gag order , prosecutors pointed to Trump’s recent social media comments about his former chief of staff Mark Meadows, which they said represented an attempt to influence and intimidate a likely witness in the case.

Trump’s lawyers say the gag order unfairly prevents him from responding to broadsides from potential witnesses. who themselves are public figures.

“The ‘witnesses’ who supposedly might be ‘intimidated’ by President Trump’s speech are former officials from the highest echelons of government who have repeatedly attacked President Trump and his fitness for the Presidency in public statements, national media interviews, and books,” Trump’s attorneys wrote.

Also on Thursday, the judge set rules around conducting research on possible jurors, who will be brought to the courthouse in Washington on Feb. 9 to fill out a questionnaire that will help the sides narrow down the jury pool before the trial. The trial is scheduled to begin on March 4.

Prosecutors had raised concerns about what Trump might do with research on possible jurors, citing the former president’s “continued use of social media as a weapon of intimidation in court proceedings.”

Trump’s lawyers have said the former president “has no intention of publicizing the names or other contact information of jurors.”

Chutkan said in her order on Thursday that while prosecutors and the defense can do open-source research into potential jurors, they cannot use non-public databases or have direct contact with them.

She ordered the sides not to reveal potential jurors’ names or any other identifying information. And she said that juror information can not be given to other entities not involved in the case — like Trump’s 2024 presidential campaign.

Richer reported from Boston.

Investigators are being sent to US research base on Antarctica to look into sexual violence concerns

The watchdog office overseeing the National Science Foundation is sending investigators to Antarctica’s McMurdo Station after hearing concerns about the prevalence of sexual violence at the U.S. research base

This undated image supplied by the National Science Foundation, shows Renée Ferranti. The NSF announced Friday, Nov. 3, 2023 it is appointing Ferranti as a new special assistant to the NSF director to focus on sexual assault and harassment prevention, as well as response implementation. (National Science Foundation via AP)

WELLINGTON, New Zealand -- The watchdog office overseeing the National Science Foundation is sending investigators to Antarctica 's McMurdo Station after hearing concerns about the prevalence of sexual violence at the U.S. research base.

Meanwhile the NSF, a federal agency, said it's furthering its own efforts to address the “pervasive problem." It announced Friday it is appointing Renée Ferranti as a special assistant to the NSF director to focus on sexual assault and harassment prevention and response.

An Associated Press investigation in August uncovered a pattern of women at McMurdo Station who said their claims of harassment or assault were minimized by their employers, often leading to them or others being put in further danger.

Internal communications obtained by the AP indicated the NSF Office of Inspector General would send investigators for a site visit from Monday through Nov. 17.

“We are in the process of expanding our investigative mission to include the investigation of criminal violations that occur in Antarctica,” Lisa Vonder Haar, the chief of staff for the OIG, wrote in an email to the AP confirming the visit. “Such violations include aggravated sexual abuse, sexual abuse, abusive sexual contact, and stalking.”

Vonder Haar said its special agents have been responding remotely to complaints from workers in Antarctica since July and it plans to have a presence on the ice during future summers.

The AP investigation detailed the lack of support many women felt from those running the Antarctic program. One woman felt compelled to carry a hammer with her at all times for protection. Another woman who reported a colleague had groped her was made to work alongside him again.

In another case, a woman who told her employer she was sexually assaulted was fired two months later. A fourth woman said that bosses at the base downgraded her allegations from rape to harassment.

A 2022 NSF report found 59% of women said they’d experienced harassment or assault while on the ice. Alcohol was a factor in some cases.

In October, the NSF decided to stop serving alcohol at McMurdo Station's bars, although workers can still buy a weekly alcohol ration from the station store. The NSF told the AP the alcohol changes were related to morale and welfare, and were not aimed at preventing sexual harassment or assault.

On Friday, NSF Director Sethuraman Panchanathan said he was delighted to welcome Ferranti, who had more than 25 years of experience in sexual assault prevention.

“Addressing this pervasive problem remains a top priority for me and the agency, and with Renée’s expertise we will continue to adapt and further accelerate our efforts to address the evolving landscape of sexual assault prevention and response,” Panchanathan said in a statement.

Ferranti said in the release she hopes “to make a meaningful impact to advance NSF's progress in addressing sexual violence.”

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Mpox vaccine prepared at a pop-up vaccination clinic in Los Angeles, California, in 2022.

Mpox circulated for five years before global explosion in 2022, research finds

Discovery of hidden transmission of disease formerly know as monkeypox leads to calls for improved surveillance

The disease formerly known as monkeypox, which spread around the world in an unprecedented outbreak in 2022, was circulating in humans for more than five years before the explosion of cases triggered a global public health emergency, researchers say.

The discovery of longstanding, hidden transmission between humans has led to calls for improved global surveillance of the MPXV virus to eliminate the disease, renamed mpox last year, from humans and prevent it from re-emerging.

“Any new or nascent outbreak may have potential to go global,” said Dr Áine O’Toole, an evolutionary biologist at the University of Edinburgh, who studied the virus’s evolution. “We need to focus on detecting outbreaks even when case numbers are low, and find a way of stamping it out before it establishes in the human population.”

Mpox was first discovered in the 1950s when outbreaks of the disease struck monkeys held in laboratories for research. The first human case was recorded in 1970 in the Democratic Republic of the Congo (DRC). Sporadic cases over the next 50 years were largely in the DRC and Nigeria.

Before 2020, most human mpox infections were blamed on contact with rodents that can carry the virus in countries where the disease is endemic. On the rare occasions that people passed the infection on, those affected were typically family members living under the same roof.

The global mpox outbreak was different, however. Writing in the journal Science , O’Toole and her colleagues describe how viruses collected from patients in 2022 carried far more mutations than expected. The mpox virus is expected to pick up one mutation every three years, but compared with virus collected in Nigeria in 2018, mpox from patients in 2022 had a whopping 42 mutations.

A closer look revealed that the majority of mutations were caused by skirmishes with the human immune system, in particular an antiviral enzyme called apobec3. The finding means that the human immune system is driving the evolution of the virus, marking the switch to its sustained spread in humans. Based on the rate of mutations, the scientists estimate that mpox has been circulating in humans since at least 2016.

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The global mpox outbreak was driven by a lineage called B.1, and cases have been in decline following public health advice and vaccination programs largely aimed at men who have sex with men, who accounted for the vast majority of cases. But the researchers point out that countries such as the UK, the US, Portugal, India and Thailand, continue to report other lineages of the virus, almost all of which trace back to Nigeria, suggesting that the human epidemic that sparked the 2022 outbreak continues “unabated”.

Dr Emma Hodcroft, principal investigator at the Swiss Tropical and Public Health Institute in Switzerland, who was not involved in the study, said circulation of the virus in humans long before 2022 likely set the stage for the virus to be able cause a global outbreak.

“Knowing [that the virus] has been, and still is, circulating in a sustained fashion in humans changes how we should approach prevention and eradication strategies, and serves as a reminder that undetected changes in viral behaviour can lead to later changes in virulence or transmissibility that pose a larger threat,” Hodrcroft told the Guardian. “To truly keep these viruses on the radar globally, we need to keep demanding more equitable training, funding and equipment distribution.”

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  • Roberta Heale 1 ,
  • Alison Twycross 2
  • 1 School of Nursing , Laurentian University , Sudbury , Ontario , Canada
  • 2 School of Health and Social Care , London South Bank University , London , UK
  • Correspondence to Dr Roberta Heale, School of Nursing, Laurentian University, Sudbury, ON P3E2C6, Canada; rheale{at}laurentian.ca

http://dx.doi.org/10.1136/eb-2017-102845

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What is it?

Case study is a research methodology, typically seen in social and life sciences. There is no one definition of case study research. 1 However, very simply… ‘a case study can be defined as an intensive study about a person, a group of people or a unit, which is aimed to generalize over several units’. 1 A case study has also been described as an intensive, systematic investigation of a single individual, group, community or some other unit in which the researcher examines in-depth data relating to several variables. 2

Often there are several similar cases to consider such as educational or social service programmes that are delivered from a number of locations. Although similar, they are complex and have unique features. In these circumstances, the evaluation of several, similar cases will provide a better answer to a research question than if only one case is examined, hence the multiple-case study. Stake asserts that the cases are grouped and viewed as one entity, called the quintain . 6  ‘We study what is similar and different about the cases to understand the quintain better’. 6

The steps when using case study methodology are the same as for other types of research. 6 The first step is defining the single case or identifying a group of similar cases that can then be incorporated into a multiple-case study. A search to determine what is known about the case(s) is typically conducted. This may include a review of the literature, grey literature, media, reports and more, which serves to establish a basic understanding of the cases and informs the development of research questions. Data in case studies are often, but not exclusively, qualitative in nature. In multiple-case studies, analysis within cases and across cases is conducted. Themes arise from the analyses and assertions about the cases as a whole, or the quintain, emerge. 6

Benefits and limitations of case studies

If a researcher wants to study a specific phenomenon arising from a particular entity, then a single-case study is warranted and will allow for a in-depth understanding of the single phenomenon and, as discussed above, would involve collecting several different types of data. This is illustrated in example 1 below.

Using a multiple-case research study allows for a more in-depth understanding of the cases as a unit, through comparison of similarities and differences of the individual cases embedded within the quintain. Evidence arising from multiple-case studies is often stronger and more reliable than from single-case research. Multiple-case studies allow for more comprehensive exploration of research questions and theory development. 6

Despite the advantages of case studies, there are limitations. The sheer volume of data is difficult to organise and data analysis and integration strategies need to be carefully thought through. There is also sometimes a temptation to veer away from the research focus. 2 Reporting of findings from multiple-case research studies is also challenging at times, 1 particularly in relation to the word limits for some journal papers.

Examples of case studies

Example 1: nurses’ paediatric pain management practices.

One of the authors of this paper (AT) has used a case study approach to explore nurses’ paediatric pain management practices. This involved collecting several datasets:

Observational data to gain a picture about actual pain management practices.

Questionnaire data about nurses’ knowledge about paediatric pain management practices and how well they felt they managed pain in children.

Questionnaire data about how critical nurses perceived pain management tasks to be.

These datasets were analysed separately and then compared 7–9 and demonstrated that nurses’ level of theoretical did not impact on the quality of their pain management practices. 7 Nor did individual nurse’s perceptions of how critical a task was effect the likelihood of them carrying out this task in practice. 8 There was also a difference in self-reported and observed practices 9 ; actual (observed) practices did not confirm to best practice guidelines, whereas self-reported practices tended to.

Example 2: quality of care for complex patients at Nurse Practitioner-Led Clinics (NPLCs)

The other author of this paper (RH) has conducted a multiple-case study to determine the quality of care for patients with complex clinical presentations in NPLCs in Ontario, Canada. 10 Five NPLCs served as individual cases that, together, represented the quatrain. Three types of data were collected including:

Review of documentation related to the NPLC model (media, annual reports, research articles, grey literature and regulatory legislation).

Interviews with nurse practitioners (NPs) practising at the five NPLCs to determine their perceptions of the impact of the NPLC model on the quality of care provided to patients with multimorbidity.

Chart audits conducted at the five NPLCs to determine the extent to which evidence-based guidelines were followed for patients with diabetes and at least one other chronic condition.

The three sources of data collected from the five NPLCs were analysed and themes arose related to the quality of care for complex patients at NPLCs. The multiple-case study confirmed that nurse practitioners are the primary care providers at the NPLCs, and this positively impacts the quality of care for patients with multimorbidity. Healthcare policy, such as lack of an increase in salary for NPs for 10 years, has resulted in issues in recruitment and retention of NPs at NPLCs. This, along with insufficient resources in the communities where NPLCs are located and high patient vulnerability at NPLCs, have a negative impact on the quality of care. 10

These examples illustrate how collecting data about a single case or multiple cases helps us to better understand the phenomenon in question. Case study methodology serves to provide a framework for evaluation and analysis of complex issues. It shines a light on the holistic nature of nursing practice and offers a perspective that informs improved patient care.

  • Gustafsson J
  • Calanzaro M
  • Sandelowski M

Competing interests None declared.

Provenance and peer review Commissioned; internally peer reviewed.

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Wilson P, Mathie E, Keenan J, et al. ReseArch with Patient and Public invOlvement: a RealisT evaluation – the RAPPORT study. Southampton (UK): NIHR Journals Library; 2015 Sep. (Health Services and Delivery Research, No. 3.38.)

Cover of ReseArch with Patient and Public invOlvement: a RealisT evaluation – the RAPPORT study

ReseArch with Patient and Public invOlvement: a RealisT evaluation – the RAPPORT study.

Chapter 6 findings from the case studies.

In this chapter we present the findings from the 22 case studies. We provide a rationale for why NPT was found to be the most comprehensive and predictive programme theory for PPI and present the 16 NPT informed mechanisms that were tested within the case studies. We then summarise the key findings and list the contexts that enabled mechanisms. CMO tables are provided, illustrating salient actions within the case studies, potential contexts, plausible mechanisms and potential outcomes. Organised under the major case study actions, data are presented to illustrate how the CMO tables were arrived at. We draw on specific case studies, including their NPT radar plots, to provide illustrative exemplars. The chapter concludes with evidence of PPI impact and outcomes.

  • Normalisation Process Theory as the candidate programme theory being tested

Our testing within case studies was framed by the 16 NPT mechanisms grouped under the four headings (see Chapter 3 ) and presented in Table 11 . When applied to the 22 case studies, NPT 121 , 134 had sufficient explanatory power to predict which case studies had PPI embedded as normal practice; therefore, it predicted both policy outcomes and the processes and infrastructure required for effective PPI that had positive outcomes both methodologically and morally. Using NPT as a MRT developed out of health service research, we directly interpreted PPI as the complex intervention, which then shaped our data collection tools and analytical framework (see Chapter 3 ).

TABLE 11

Mechanisms to embed PPI

Summary of key findings

This is one of the first studies to contribute significantly to our understanding of PPI as a concept, through the analysis of a large number of case studies, selected to capture varying levels of PPI embeddedness, in order to understand how it may change over time during the research process.

In testing whether or not topic area had an influence on the embedding of PPI, we found similarity between the nature of the clinician–patient relationship and the way PPI was enacted. This was further influenced by the topic area’s history of PPI and the tacit models that had evolved. For example, we found PPI in IDD studies to be framed by an empowerment model and resonant of the long history of partnership working between practitioners and service users. Well-established PPI structures in some topic areas such as dementia provided a pragmatic source for the lay perspective, but we found unintended outcomes for this model, including the outsourcing of PPI to external parties with little researcher engagement. It also exemplified a ‘one-off’ model whereby PPI was limited to a single task.

Researcher perceptions of what lay representatives could be expected to understand or be interested in, coupled with a lack of effort to communicate in an accessible way, sometimes led to limiting lay involvement in parts of the research process, potentially limiting impact. However, we also found in areas such as basic science and tissue banks, where PPI has traditionally been seen as having a limited role, that research teams were enabling PPI, leading to improved relevance of research priorities and questions.

While still challenging for a number of studies and funders, recruiting a diverse range of lay people was enhanced when the study setting interfaced with a diverse population. Particular PPI structures helped, including an outreach model with either a specific lay person or a co-ordinator acting as a bridge to a broader community. The quality of such connections was important to create the context for involvement. The resulting impact was culturally sensitive, participant-focused research designs.

In contrast, researchers’ descriptions of ‘usual suspects’ as lay representatives reflected a perception of concerns about the professionalisation of PPI. However, our findings suggested this was at odds with reality and with the advantages of the experienced lay representative being able to develop a number of skills that helped their role, and enabling a career trajectory for the lay person within PPI.

An important finding in both the survey and the case studies was the dual role, whereby the lay advisor was also a study participant. Although this had the benefit of real-time feedback about the impact of the research design and enhanced a sense of ownership of the study for lay respondents, there was also evidence of conflicts of interest and a blurring of roles. In some case studies the dual role was a deliberate PPI design; however, in others it clearly demonstrated that involvement was not understood as being different from participation, and highlighted the level of PPI drift away from INVOLVE definitions. It was also indicative of a lack of training or experience in PPI, particularly in novice researchers. Training or on-the-job experience not only helped researchers to differentiate between involvement and participation, but also enhanced an understanding of what both parties bought to the table. Development of positive relationships underpinned by trust was the minimal requirement for any form of PPI; this led to improved self-worth for lay people, and increased researchers’ confidence in their work. Breakdown in this relationship had a profound effect on levels of PPI embeddedness over time.

It was clear from the case studies that PPI was most likely to be embedded when hosted in well-resourced research centres with a dedicated budget and PPI co-ordinator. PPI groups and panels had continued engagement with the research host organisation, were reimbursed equitably and had social interaction with the research teams; these are crucial to the sustaining of positive relationships. Resourcing PPI in such a way also enabled a fully entwined model of PPI, in which lay people and researchers worked seamlessly together, with research priorities and research questions created by the lay people involved. This generated some research programmes that would not have been run without lay involvement. However, embedding PPI to this level required not only resources but also time to develop.

We found that funder requirements played a key role in influencing levels of reimbursement. In addition, how PPI was operationalised in individual studies could be traced back to the funder’s ethos of PPI. Within funding organisations there was a growing interest in evaluating processes and outcomes of PPI within studies. However, even with funder expectations, only a limited number of case studies were reflecting on and evaluating PPI in an ongoing way to improve the quality of PPI processes and outcomes.

Enabling contexts

The findings suggested there were eight enabling contexts for the mechanisms ( Box 5 ). Five of these (funder, topic area and design, resources, organisation of PPI and research host) were expected, based on the literature, and shaped our sampling framework to ensure a range of case studies as a test-bed. The other three (training, positive relationships and positive experience) became visible during data collection and analysis.

Enabling contexts C1 Funder requirements for PPI in research.

Context–mechanism–outcome configurations

As described in Chapter 3 , through an iterative process we tested candidate CMO configurations within each case study and discussed our findings with case study respondents in the tracking interviews, with our reference groups and finally at the four regional events. We identified six CMO configurations that explained salient case study actions, potential contexts, plausible mechanisms and potential outcomes, both intended and unintended. CMO configurations focus on immediate outcomes within a study. It was not possible to include longer-term outcomes of a study, as these evolve over a longer period of time. Tables of each CMO are presented and then illustrated by data and case study exemplars. Within exemplars, NPT radar plots will be shown, and any change in PPI embeddedness over time will be illustrated through tracking radar plots.

  • Purpose, structure and role of patient and public involvement

Table 12 illustrates the CMO configuration for this action. Funder requirements were a significant enabling context, and had resulted in a more structured approach to PPI. It was also facilitated by host organisations with an established PPI infrastructure, such as an established group or panel, and access to training. At the time of data collection, this enabling context was provided by some topic areas (dementia and diabetes mellitus) with network support for PPI. Having adequate resources to maintain this group in terms of administration and reimbursement was vital for sustained engagement with PPI in research.

TABLE 12

Context, mechanism and outcome configuration: purpose, role and structure for PPI

For some case studies, the purpose, structure and role for PPI were an inherent part of the research design. For example, CS03 (see Box 10 ) and CS23 (see Box 21 ) were funded to coproduce an intervention (self-management website and mobile phone applications for young people with diabetes mellitus). Other case studies sometimes had to craft a PPI structure from new because of the funder’s requirements.

Case study 03: diabetes mellitus Experts by experience, different levels:

Case study 23: diabetes mellitus Four YPD as advisory group.

Funder requirements

Researchers were particularly aware that when applying for specific grants there were even stronger imperatives to have PPI as a funding requirement. PPI was recognised as a part of the contemporary research landscape, and some reflected that having formalised PPI as a requirement was beneficial, as experience of good PPI usually leads to more in the future:

more researchers are willing to engage, whether that’s because they want to or whether because they have to because of the grant application, I think there’s a bit of both there, but then again, that’s fine because those that . . . engage because they have to kind of start to begin to see the worth of it anyway. CS07Res01-01

Overall, the funder respondents clearly asserted that PPI both in research and at funder and system level had developed significantly over the previous 5 years, describing a journey along a continuum of learning and understanding of PPI, despite noting that there was still some way to go until it was fully embedded as normal practice:

I think organisationally that’s been a sea-change . . . Externally with researchers I sense there has broadly been a change but there’s still a lot to do, but certainly the quality of the PPI anecdotally that we’re getting in our applications is on the up, possibly to do with . . . everything being reviewed by a public contributor. Funder01

Structures and processes for PPI within funder organisations themselves inevitably varied and strongly reflected the influence of their core funding source, mission, scale and length of service. PPI structures had developed either quite systematically or more recently and organically as part of the overall PPI movement.

Working closely with INVOLVE, two overarching programme management organisations and two research programmes that are funded by central government had, over a number of years, developed similar, embedded structures for PPI within their organisations. However, the sheer volume of applications to process could potentially result in the PPI representatives having to work with a conveyor belt approach. The industrial scale of PPI as metaphor was also picked up by one of the lay representatives:

I think, having started from a low base, it’s [PPI] now in danger I think of almost becoming an industry; that is that everybody concerned with health care has to have some public involvement, and that goes for GP practices, hospitals, and very much in research, all areas of research . . . It sometimes strikes me that it’s a kind of bandwagon. Don’t get me wrong, I think it’s one of the most useful things in the health economy, but it seems to have made jobs for an awful lot of people, let’s put it that way. Funder07(lay rep.)

The other funding bodies taking part in the RAPPORT study had only recently started to implement PPI strategies in their organisations. A government-funded research council had endorsed its PPI strategy only a year before and there was now a strategic vision around PPI. The structure of this funding organisation was less complex and was led by a member of staff responsible for both public involvement and engagement. This organisation had a PPI panel of around 20 members who were offered the opportunity to be involved in particular funded projects; alternatively, the organisation would ask specific medical charities to nominate lay representatives for particular condition-specific projects. Another large national funder, financed through endowments, had a different stance on PPI, focusing more on public engagement:

patient and public involvement doesn’t just have to be people in a focus group or a patient representative on a steering committee, it can, you can use kind of more engagement approaches that can still inform and can kind of be part of the research process . . . sometimes when I talk to people in the patient and public involvement sphere there’s quite a narrow definition of how they see patient and public involvement, and so yeah, I can see it a bit wider than that. Funder08

Public engagement was seen as a key policy driver within this organisation, and strategically it focused on facilitating research teams to improve its public engagement, with PPI being seen as operationalised at research team level.

We also interviewed two representatives from condition-specific medical research charities. Their PPI strategies had gradually developed over recent years:

we’re currently looking at expanding it, so it is something that’s definitely on the radar of people within the charity, it’s just the technicalities. I think, you know, everyone’s definitely willing to do it and I know that our Medical Director is very keen on PPI, and I think it is almost evolving organically . . . Funder01(CharityA)

A major finding from the interviews with funder representatives was that their stances or values (and thus PPI structures and processes) were actively shaped by the origin of their funding and their histories. The funding organisations that received government public funding as part of a national research agenda clearly articulated the reasons for PPI in methodological terms:

It [PPI], you know, is likely to improve recruitment. It makes sure that it meets patient needs so that when it gets out the other end if you like into the implementation phase that it can actually have a possibility of having impact on an individual with a said condition. Funder04

In contrast, the medical charities reliant on fundraising spoke of PPI in terms of an ethical rationale:

we get our money from the public, from people with the condition, so it’s really important that we include viewpoints of people with the condition in our decision. Funder02(CharityB)

Hence, funders influenced PPI in subtly different ways depending on their organisational values. Case studies funded by NIHR funding streams were required to have PPI as a different way of working within the actual research process because of the emphasis on the methodological importance of PPI. In contrast, those funded by charities tended to have less focus on a requirement for PPI in the actual research process, with structures in their organisation concentrated more on ensuring PPI in funding decisions.

Structures for patient and public involvement

Host organisations, and in particular CLAHRCs, were instrumental in providing a PPI infrastructure. This often involved having a designated lead for PPI. Six of the case studies had a dedicated PPI co-ordinator who was separate from the research team, and a further case study had a research team member who took on the role of the PPI co-ordinator as part of their duties. Case study 21 ( Box 6 ) had a colocated co-ordinator who, as a non-researcher, was seen to bridge the gap between researchers and the public:

Case study 21: IDDs The research centre hosts a large PPI group made up of parents.

she’s become a great interface between us and the families because she helps, she’s . . . she knows enough about research to be able to explain what we do, but equally doesn’t know enough that she can challenge me or others in the team to explain more clearly what we’re asking of families. And I think that’s probably the greatest reason for our success has been the sort of creation of that role and the development of it. CS21Res01-01

Case study 21 exemplified fully embedded PPI which was enabled by all eight identified contexts. It also demonstrated an ‘entwined’ model of PPI in which research and PPI were wrapped together much like a double helix. It was hosted within a research centre primarily funded by a charity (C1) with a topic area (children with severe cognitive disabilities) (C3) where active involvement of parents was seen as a prerequisite of meaningful research. The study design (systematic review) (C3), compared with the ongoing qualitative research being undertaken in the programme of work, required more effort from the research team to ensure that parents were involved and the review was rigorous. The research centre (C7) had an established PPI system (C6) including a funded co-ordinator who supported parents and undertook extensive outreach work. The centre was also part of a CLAHRC with a vibrant PPI community and resources for PPI (C4), and parents were reimbursed for their time and received training (C2) for their role. Resources also included the time researchers needed to work with parents on the systematic review. This level of resources was necessary for an entwined model of PPI (see Chapter 7 ). There was a strong focus on positive relationships (C5) that were developed over time and enhanced by social activities. This led to a positive experience of PPI (C8) for all involved and the sustaining of a virtuous cycle whereby PPI became increasingly embedded. At the start of data collection PPI was already embedded in CS21, so there was no change in the tracking radar plots over time.

The need for time to develop a PPI infrastructure that could support embedded PPI was also clear in CS22 ( Box 7 ). The topic area of CF had little history of established PPI structures, and the study designs are more commonly towards basic science. This case study captured the early days of study set-up and developing PPI, so radar plots were less full. After a year and despite focused work by a PPI champion, the radar plots remained unchanged, suggesting that embedding PPI requires a significant amount of time: at least 5 years. The limited impact of PPI may reflect the very early stages of a research study; however, as other case studies show significant impact in the early stages of the research cycle, it may also be indicative of a neophyte PPI structure which is not enabling a fuller impact.

Case study 22: CF Parents of children with CF (one member of charity). Experience of committees.

Outsourcing patient and public involvement

For case studies not hosted by organisations with existing PPI structures, an alternative was to recruit an ad hoc, project-specific group of people or individuals to support the study as PPI. However, another possibility was for research teams to access external PPI groups or panels. Topic area (C3) was an enabling factor and respondents from two national networks covering dementia and diabetes mellitus both held a list of names of interested PPI representatives. One network had a formal registration process on its website (which was updated annually and had around 3000 names) and the other spoke of a more informal, dynamic list based on personal relationships. Both networks had ready access to around 150–250 regularly involved and engaged PPI representatives; had been approached by researchers (in this topic area and beyond) for PPI in protocol development, funding before the application stage, help with PPI budgets and recruitment; and often organised local focus groups to gather PPI views.

Panels were preferred by some because they were more focused on a specific question and were hoped to consult with a wider population:

I think that the PPI, you get from a reference panel is potentially more focused on specific important questions . . . for example a Trial Steering Committee which might only meet twice a year or, and if the layperson can’t attend. ResearchNetwork02

Panels were felt to be a very effective way of using PPI time and skills, and easy access to existing groups made PPI feasible within the time line of a project. However, although convenient, recruiting solely through local PPI networks with trained and prepared members of the public was seen as not always appropriate for effective PPI. Researchers within some of our case studies expressed concern about the difficulty of recruiting more than just the ‘usual suspects’:

one of the problems is ensuring that you actually are getting real and representative user involvement and not just the people who happen to be around who always get signed up to these user involvement things . . . actually it’s quite easy I think to get the usual suspects. CS23Res04-01

There was also evidence that relying on an external group had led to a ‘one-off’ model of PPI in which researchers had requested help for just one task and there was an absence of PPI throughout the rest of the research process. This limited the potential impact of PPI and was characterised by a more ambivalent view towards the value or impact of PPI. In a few case studies, the CI appeared unconvinced of the value of PPI:

but where’s the evidence that it [PPI] does work, maybe there’s scientific management for a programme that should just be done by scientists, internal, external and managers and maybe there are other elements that really need a PPI input, I don’t think that’s terribly well worked out at the moment. CS01Res02-01

Case study 01 ( Box 8 ) provides an example of this model.

Case study 01: dementia Panel: an established local research network panel with a paid co-ordinator, who has worked with CI before. Panel asked for views on access to patient notes.

The evidence suggested that training around PPI for researchers was likely to be an enabling context, but there were mixed and even polarised views on training for lay representatives. Nevertheless, even in case studies with embedded PPI, researchers had not received formal training on PPI. Rather, they had learned through experience within an environment supportive of PPI.

Understanding PPI as different from study participation was a prerequisite for the development of appropriate structures, purposes and roles for PPI. Most researchers could articulate the difference; however, it was significant that many junior researchers could not. This lack of understanding was attributed by some to a lack of formal training:

there was no formal training, I just, you know, from what my colleagues and supervisors have just briefly mentioned but nothing formal on it and I think it would be an important part early on for trainees interested in research. CS14Res02-01

Of those lay respondents in the case studies who had received training, the majority had been provided by CLAHRCs, public involvement groups or research networks. However, the need for training for lay representatives did not emerge so strongly from the data as for early-career researchers. Indeed, various arguments were put forward against training, such as potentially compromising the lay perspective, or skills already existing because of extensive PPI experience or transferable skills from work life:

I don’t think there was any necessity for training at all. There’s certainly obviously one or two people have got good committee experience who are sitting round the table, on the lay side, so no, I don’t think there was any necessity at all. CS13PPI05-01

In stark contrast a minority of lay representatives suggested it was impossible to contribute meaningfully without some understanding of research:

I don’t think that you can just so easily shove inexperienced patients in to a PPI role without them being, having some training and having some support because there’s no question that, you know, the whole research agenda is incredibly complicated and they talk in a language which is, you know, if you’re not a researcher you sometimes have no idea what they are talking about when they’re talking about face validity and constructs and confidence intervals and so on and so on. CS14PPI02-01

However, the above quote suggests that this lay representative felt it was essential for the PPI representative to be able to cope with the research world, rather than the research community needing to make the effort to include the lay world in an accessible way. Making the effort also included working towards recruiting lay representatives who reflected the diversity of a study population.

  • Recruiting lay representatives reflecting the diversity of a study population

Table 13 illustrates the CMO configuration for this action. Formal training for researchers played a part in helping them to identify the need for this action, but experience on the job of recruiting diverse lay representatives was a more common enabling factor. It was easier to achieve this action when the research setting interfaced with and had access to a diverse population. Particular topic areas such as IDD had developed links with less-heard groups, and in a number of case studies these links were provided by a PPI co-ordinator or a lay person within an outreach model. In a few case studies, recruiting lay members as representative of the study population was actually operationalised through recruiting study participants to also have advisory input: a dual role.

TABLE 13

Context, mechanism and outcome configuration: diversity

Strategies for recruiting lay representatives

Being able to understand the research through the viewpoint of a target population was seen as key:

I was sat on a table with speech and language therapist, physiotherapists, paediatricians, and a handful of parents, all as equals, you know? . . . and I was just thinking ‘What does that mean to me as a parent’, thinking of my child’s capabilities and all the other children that I knew. CS21PPI01-01

However, finding lay representatives who they felt could present the viewpoint of the research study’s target population was often challenging for research teams. This was more frequently cited for BME groups. We attempted to include case studies that were likely to have a target population from the BME community. One case study specifically focused on the experiences of a particular ethnic group living with arthritis (CS18). One of the study sites was located in an area with a high percentage of people from this ethnic background, and the lay representative was recruited through that site:

I was going to the clinic, attending the clinic and the nurse actually asked me if it’s okay because I speak different, three or four different languages. CS18PPI02-01

This opportunistic recruitment meant that CS18 benefited from the input of a lay representative who demonstrably understood the enablers of recruitment in far more depth than the research team:

what we had was an audio CD because a lot of people do not read the script, [specific language], so some of our interviewees did not speak English so we got the information sheet translated and put onto CD and she [PPI01] listened to that and gave feedback on that because there are different dialects of [specific language], apparently some are deemed posher than others and there’s all sorts of things that I was not aware of initially. CS18Res01-01

While there was trust in this lay representative’s expertise demonstrated by the peak in the collective action segment of the radar plot (bold outline) ( Box 9 ), the construct as a whole was affected by one major challenge: that the CI (who was effectively the PPI lead within this study) and the PPI representative were located at a significant distance from each other.

Case study 18: arthritis Patient and public involvement representatives normally recruited to each study via an established PPI group based at the university. Only one took part in CS18. Expert by experience (has condition). This PPI representative was (more...)

We also included four case studies focused on type 2 diabetes mellitus with the expectation that these would include a relatively high percentage of research participants from BME groups susceptible to this condition. One of these case studies (CS03) ( Box 10 ) had used strategies (advertising and interviewing applicants) to recruit a diverse range of lay representatives:

Strategies used when recruiting individual PPI representatives reflected researchers’ attempts to involve people who could bring both specific and broader perspectives. Recruitment of individual lay representatives was from five main groups: general public; expert by experience; carer/parent; patient representative; study participant. Individuals could take on multiple roles and represent their views at different levels. However, relying on just one or two individuals also raised the issue of representativeness:

it’s impossible, you can’t expect one person to speak on behalf of everyone so I guess the question would be what would be useful, or truly influential patient involvement? Is it enough to have just one person or two people who will be very, very good and who will be enthusiastic, but the question is, how representative are their opinions into their input? CS03Res02-01

Nevertheless, one model of using a single lay representative as a conduit to a broader constituency appeared to work well. The outreach model, as exemplified by CS02 ( Box 11 ), involved one representative from a charity who then linked with 20 members of the support group in an iterative way to inform the study design and recruitment materials. An unforeseen impact from this PPI was to raise concerns over the safety of the study, resulting in extra study visits and a questionnaire (see Impact and outcomes of patient and public involvement ).

Case study 02: diabetes mellitus Steering committee: national representative. One PPI representative (senior position in charity) sits on trial steering committee. PPI representative then consults the (20) panel members, invites feedback, collates answers (more...)

Some case studies also bought together project-specific panels. Case study 12 ( Box 12 ) was particularly enabled by being located in a teaching hospital with relatively good resources for research (C4), which were sufficient for PPI honoraria.

Case study 12: diabetes mellitus Newly formed panel: experts by experience, participants on the trial, mentors on the trial. Less PPI at the early stages of the research, became involved with study documents. One lay representative had already worked (more...)

Challenges in ensuring diversity

Researchers acknowledged there was much work to be done to ensure diversity in PPI. The fact that only a very few of our PPI respondents were not from a white British background exemplifies the common problem as described by one of the funders:

we have as much of a problem as anyone about, you know, diversity and all those issues are still issues which we need to explore further. I think often public, people who get involved with PPI are a self-selecting group and it’s really difficult to bring in groups wider and that’s a usual excuse and I hate it, and I hate it when researchers say it. But I, it, you know, for example if somebody couldn’t read and write how would we include them in this process? If someone wasn’t, we do manage to include people who are not computer literate but then these days how are they going to even find out about us if they don’t have a computer? How are they going to know who to ring? Funder01

Difficulties in accessing ‘representative’ PPI were particularly marked for public health studies when the focus was on healthy or ‘at-risk’ populations with particular lifestyles. The difficulties for public health studies was also linked to the setting (e.g. broad communities) in which they took place. Those studies taking place in settings with ready access to patients obviously had greater potential for recruiting both participants and PPI representatives onto their studies:

the problem at the university is that those researchers that aren’t clinical or don’t have good links into the clinical setting, it becomes very difficult to identify service users to sit on a panel like that so we’re in quite a privileged position because we’re right next to the outpatients clinic and that makes our life a lot easier for maintaining that model. CS18Res01-01

The dual role

Clinicians who were also researchers had the added advantage of having ready access to patients as potential PPI representatives. For example, one case study (CS14) (see Box 26 ) hosted by a district general hospital with few embedded PPI structures was able to involve patients through an active condition-specific support group facilitated by clinical department staff. However, the distinction between being involved and being a research participant was often blurred in this case study, with PPI being understood by many of the respondents as a dual role. This dual role was overt in another arthritis-related study (CS08) ( Box 13 ), where the PPI respondent was also a study participant. While there are potential ethical conflicts here, this lay representative actively recruited participants through her own network and had a strong sense of purpose. This action-orientated approach to PPI resulted in a fuller quadrant in the radar plot denoting a positive appraisal of the PPI within CS08 (see bold outline in box figure).

Case study 14: arthritis Hybrid: national representative, local service user group and expert by experience. However, these components did not come together and hence there was no cross-fertilisation. The national representative has advised nationally (more...)

Case study 08: arthritis Dual role: PPI representative already known to CI through being on funding committee but also has joint issues so is participating in the research as well as acting as an advisor.

Although respondents in CS08 were comfortable with this dual role, it was operationalised in an ad hoc manner that was unlikely to lead to any embedding of PPI. In contrast, this dual role was carefully constructed and managed in a longitudinal cohort study (CS13, see Box 16 ). A rolling PPI panel was drawn from study participants and the role was clearly defined and separated. The impact of this role included both increased public engagement with the study and improved participant retention. This model of PPI was enabled by topic area (public health with healthy participants) and the longitudinal design, which allowed relationships to be developed and sustained over time. This was a well-resourced study with dedicated PPI staff and good organisation, and was run from community hospitals at the heart of local populations. For the public undertaking this dual role, there was a sense of ownership of the study, with subsequent sustained engagement. Two tissue bank studies also had lay representatives who advised but also had donated samples. In CS17 (see Box 23 ), engagement was sustained, but for the other (CS16, see Box 20 ) the sense of ownership became a cause of conflict, which is presented in Enablers and barriers to trust .

Case study 13: public health ‘Consultation’ panel hybrid model, built upon earlier, less formalised (mass consultation, participant feedback) PPI panel drawn from large cohort study (now mostly retirement age). Panel meet quarterly with (more...)

Case study 17: diabetes mellitus Established panel for over 10 years; about 30 on panel and two attend each monthly meeting (usually invite four). Meeting and reviewing papers. PPI mixture of research-naive and ‘professional lay people’. (more...)

Case study 16: diabetes mellitus National expert network: charity. Dual role (participants and representatives).

If this dual role was to have a positive impact, then the purpose, structure and clear role boundaries needed to be defined.

  • Whole research team is engaged with patient and public involvement

A distinct action of case studies where PPI was embedded was engagement of the whole team with PPI, and having the skill set to do this. Funder requirements (C1) for plain English summaries were bringing into sharp focus the need to be able to explain technical aspects of the research in an accessible way, and the most effective way of doing this was to work in partnership with lay representatives (C5). This needed time to achieve (C4) and could also be helped through specific training (C2). It was particularly evident as an action in the IDD topic area (C3). The CMO configuration for this action is shown in Table 14 .

TABLE 14

Context, mechanism and outcome configuration: whole research team engagement

Relying on one person to lead patient and public involvement

As described in Purpose, structure and role of patient and public involvement , having someone to lead and co-ordinate was important in embedding PPI. If there was not a designated co-ordinator, this role was often carried out in addition to a junior researcher role and was not part of the original job description. Different levels of commitment to this role were found and PPI representatives spoke of often not having one ‘designated person’. Continuity of personnel with responsibility for PPI was an issue. For example, one PPI representative reported seeing someone different at each meeting (CS05) ( Box 14 ) and another said the enthusiastic support ‘gradually dwindled’ (CS14). If the whole team was not engaged with PPI, the loss of the PPI champion had a detrimental impact.

Case study 05: arthritis Steering committee: one expert by experience, recruited through national arthritis body, who was a patient of the CI. Was asked to change consultants. Nursing background and interested in research. Understands some of the medical (more...)

Patient and public involvement as a collective action

Case studies demonstrating agreement of all individuals in the team that PPI should be part of their work were particularly strong within the IDD topic area, where there is an acknowledged history and strong investment in PPI. The CI from CS11 ( Box 15 ) clearly articulated this:

Case study 11: IDD Two PPI representatives are new to PPI in research (one voluntary worker, one carer) and one more experienced (expert patient). Preference for PPI recruitment from established condition-specific networks (built on previous relationships (more...)

in order to understand and develop theory effectively, you need to really have a conversation with service users and probably somebody who has the problem with the condition, and that is how psychological theory develops. You know, it is that, ‘Are you doing something to people or are you doing it with people?’ and doing it to people, you know, there’s such a power imbalance, and given the backdrop and the history associated with people with disabilities internationally, that’s not politically palatable to me personally and to, you know, society, I suppose. CS11Res01

Although the NIHR funding (C1) was used to pay out-of-pocket expenses, this case study was hosted by a medical school, with the CI reporting limited engagement with PPI. However, it is the topic area (C3) that is the strongest enabling feature, suggesting a culture where ‘nothing about me without me’ shaped research practice. This CI also framed the challenge to explain technicalities more clearly to lay audiences positively, as good practice for communicating ideas to the public:

saying things like, ‘Oh, this is a stepped wedge design,’ and ‘We’re randomising,’ . . . you can use that language, but people aren’t going to understand it. So, you’re going to spend all your time explaining what you mean, so you might as well just use simpler language to start with, and perhaps really as a researcher or scientist, that’s a good thing because it helps improve your communication skills with lay people and the general public. CS11Res01-01

This whole team engagement was not unique to IDD as a topic area. For example, in CS13 (public health) ( Box 16 ) although a project-specific PPI panel was facilitated by a lead person, all senior researchers took it in turns to attend panel meetings. The embedding of PPI in this study was enabled through access to resources from grant monies (C4) and a longitudinal design (C3) that enabled relationships to be sustained (C5).

  • Mutual understanding and trust

While formal training (C2) had a part to play in helping both researchers and the public to understand each other’s roles in research, positive relationships (C5) sustained over time led to PPI as a positive experience (C8) and the development of trust, which was key for this action. Reimbursement of out-of-pocket expenses and time contributed to maintaining trust. If clearly articulated, funders’ expectations (C1) of reimbursement were an enabling context, as was the topic area (C3) if reimbursement was normal practice. Host organisations (C7) had a key role in providing resources (C4) for reimbursement and ensuring payment was smooth. The CMO configuration for this action is shown in Table 15 .

TABLE 15

Context, mechanism and outcome configuration: mutual understanding and trust

Coherence in understanding the contribution of patient and public involvement

As the bedrock for trust, lay representatives and researchers needed to have a shared understanding of the purpose of PPI. Novice researchers were more likely to be unable to fully distinguish PPI as separate from research participation. For example, a registrar in CS14 defined PPI as:

patients contributing to research and enrolling into research studies, whether they had portfolio status or not. CS14Res02-01

While this impeded an understanding of what PPI could offer to the research process, other researchers and PPI representatives provided a variety of reasons for carrying out PPI including gaining insight into the lived experience of a particular health condition, and to provide reassurance for researchers that their research question resonates with the patient community. This was exemplified in CS07 ( Box 17 ).

Case study 07: diabetes mellitus Experts by experience panel (≥ 10 patients who have lived with diabetes mellitus for over 5 years). Recruited from diabetes research network panel. Members of the CS07 panel are on their own Diabetes UK (more...)

Case study 07 was enabled through an established diabetes (C3) network group (C6) housed in the host organisation (C7). The study focus on processes of care (C3) also enabled coherence. PPI members met regularly and were involved in a number of projects which helped promote sustained engagement (C5). However, lay representatives were not reimbursed for their time because of bureaucratic difficulties; rather, they were taken out for a social meal.

Whereas the experience of established panels was seen by many researchers as a bonus, others spoke of the tension between wanting someone who was ‘outside’ the research environment and wanting someone who was also able to engage with research studies (possessing some research skills) and thus perceived as being able to perform the necessary PPI tasks. This notion of wanting the right person with a short distance between direct experience and its interpretation but who also can feel comfortable in a research environment is maybe a contradiction in itself. There was evidence of an ongoing debate about whether or not the experience of a condition (direct or indirect) was seen as less legitimate because of that person’s professional background, experience or training in research or health care:

we’re all patients . . . yeah, and some of us have PhDs and some of us don’t, so it’s quite difficult to kind of define what is a lay representative . . . they’re really just people who, actually, through their qualifications, they should be research assistants but don’t happen to have a job in research but are on a lay panel. And I kind of think ‘what . . . are you really a lay person? You’re just an unpaid researcher’, but I’m not entirely sure whether that’s right . . . CS17Res01-01

Our findings suggested that defining PPI as a discrete and commonly understood component of research was difficult but the range of PPI representatives can be summarised through a fourfold typology based on an insider/outsider perspective (on one axis) and a range of research skills (on the other) ( Figure 8 ). Research studies can be placed along these axes; however, within one research study there may be a mixture of individuals with varying skills and perspectives.

Insider/outsider perspective.

While the insider/outsider debate was articulated in a number of case studies, those that had embedded PPI were likely to have sustained engagement with the same group of PPI representatives over a long time.

Building relationships over time

We found that the relationship between the researchers and PPI representatives was a key factor for successful PPI. Relationships took time to establish, which was particularly difficult at the beginning of research (or even before the proposal is written). One finding from the case studies was that the majority of PPI representatives had a previous working relationship with the research team. Of the 51 PPI representatives, 33 (64.7%) had some prior working relationship with either the CI or members of the research team (three were patients of the CI and also members of a service user group, so had worked together before), nine (17.6%) had a more distant acquaintance (but described themselves as being within the same loose network) and nine (17.6%) PPI representatives were completely new to the research team (recruited from outside existing structures). The obvious advantage of having a previous relationship meant that PPI could start as soon as possible within the research project, whereas more time was needed to establish relationships through informal small meetings if the lay representatives and researchers had not previously met.

Research teams spoke of initial meetings where everyone got to know each other and having these times of informality before starting on the ‘academic’ business. The benefits of PPI representatives having the opportunity to get to know each other also provided support later in the project. Social elements were important in encouraging and maintaining continual engagement in the research study and should not be underestimated by researchers. Some of the case studies also ran social events outside the research, which again helped to build and maintain relationships:

We do these family fun days as well, which we get together once a year, just to get together at the zoo or something. [PPI co-ordinator] works phenomenally hard to build relationships with the families that . . . So, it’s a partnership really. CS21Res01-01

In more formal advisory or steering committee meetings, PPI representatives spoke of being specifically welcomed into the meeting (sometimes being met beforehand). Most importantly, during the meeting, successful PPI was being ‘genuinely’ listened to and their comments taken on board. The relationship between the researchers and the PPI representatives was key to fully embedding PPI within the research study. The researchers needed certain social skills, which included being approachable, good listening skills and group work skills:

initially facilitating and always presented a positive, welcoming, friendly, supportive space to you. CS17PPI01-02

Patient and public involvement representatives reported that meetings needed to have a ‘flat structure’ where PPI representatives felt free and at ease to speak.

Relationships could change over time, either through loss of trust or as trust developed, as illustrated in CS19 ( Box 18 ). Although only subtly different, the radar plots show a change in all quadrants but particularly in collective action (bold box), where M10 (trust in each other’s PPI work and expertise is maintained) is included as a mechanism. This reflects clarification of roles and the improving relationship and trust in the PPI work:

Case study 19: public health Committees: two representatives (one a coapplicant) on trial steering committee (meet twice a year). Two PPI representatives on trial management group (meet once/twice a year).

I don’t know what they want me to prepare for, I don’t know what they want me to do, and I don’t know if the confusion is because of my professional role [. . .] and I don’t know if they’re waiting for me to take the lead, and I’m waiting for them to treat me as a patient. . . . I’m a little bit disappointed. It feels almost tokenistic. CS19PPI02-01
Conflict between roles resolved . . . CS19PPI02 feels happier now that they are no longer post-surgery, less vulnerable. They had a long chat with a rheumatology person in department who had done a lot of PPI work who reassured CS19PPI02 that one PPI voice is better than none, more confidence to feel you don’t have to represent all patients, can just give your own experience. Different way of looking at the value of their contribution. CS19PPI02, notes of tracking interview 6 months later

Trust as the foundation for patient and public involvement

A relationship framed by trust was the minimum requirement for PPI to have a positive impact. Although PPI was not embedded within CS14 (see Box 26 ), the relationship between lay representatives and the clinician was based on trust built up from a clinician–patient relationship with continuity over time:

there’s a trust there, I trust them that they wouldn’t ask me to do something that wouldn’t be, you know, it would be difficult or wouldn’t necessarily be appropriate or whatever. CS14PPI01-01

Some researchers also trusted their lay representatives to undertake the work in a way that was workable for the researcher:

It’s always good, you know, on research it’s you need good people you can work with and that’s what I would be looking for, to set up some relationship of trust and mutual respect . . . Without thinking of them as a hindrance. CS15Res03-01

Case study 15 ( Box 19 ) exemplified how, even when resources were minimal for PPI, the very existence of mutual trust resulted in positive PPI impact. This study was housed in an organisation with no PPI infrastructure and with minimal resources for PPI despite the study being funded by the NIHR. The research setting [intensive care unit (ICU)] provided particular challenges: consent and recruitment difficulties in a high-stress environment; difficulty in recruiting lay representatives, as they were often traumatised by their time in ICU; and lack of resources, as there was no large charitable funder. The lay representative in CS15 had an impact on recruitment processes for the study and provided a valid argument to present to the ethics committee for this approach:

Case study 15: dementia One national representative. PPI role confined to trial steering group.

we put a thing here saying in the consent ‘to continue information now you’ve regained consciousness, we would like your permission to continue in the research’, now [PPI01 has] written ‘I realise this might not be possible but in my own experience of delirium I was regarded as having capacity long before I was in my right mind or capable of rational decision making. I appreciate this may be beyond the scope of the study but if there were any way to change the emphasis for the patient remaining in the study unless they chose to opt out, I think that would be much better’. CS15Res03-01

It can be clearly seen how M10 appears as a peak in the collective action section of the radar plot (bold square).

Enablers and barriers to trust

Sustained feedback to PPI representatives was a clear enabler of trust and continued engagement:

and they’re always thanking us for our participation. All the time. Always saying, you know, I get it in e-mail messages, we get it at the meetings and they always say how valuable our input is, you know, they make us feel worthwhile and that is good. CS13PPI03-04

This feedback was recognised by many researchers as being important:

I think it’s important, what I’ve learnt is that if you are going to ask them things you need to feed back to them so that it’s terrible to actually ask their opinion and they never hear again, so I’m quite good now, it’s an agenda item that you know, I feed back what I’ve heard from different people, because they’re left wondering . . . CS07Res01-01

The forum in which researchers and lay representatives came together was also an important enabling context for trust. The majority of our case studies had PPI representatives as members of steering committees (one or more lay representatives per study) which met every 3 or 6 months to advise the research team but did not necessarily have a ‘hands-on’ role with the research. However, different research teams made different uses of their steering committee members, with some members making comments only during the meeting and others who were asked to comment on documents throughout the study. As shown in CS04 (see Box 22 ), there was a varying sense of equality within the committee:

Case study 04: diabetes mellitus Experts by experience.

it wasn’t run by the Professor from the top down in sort of military fashion, it was a round table discussion where anybody could contribute . . . whilst it could have been intimidating actually it was very welcoming, and the person who chaired the meeting was very sensitive to that. CS04PPI02-01

However, the formal term ‘steering committee’ put some PPI representatives off: ‘if they said someone to be on the Steering Group I mean I would never, I would have just thought well that wouldn’t be . . . that sounds too high powered for me’ (CS04PPI01-01).

Despite it often being seen as good practice, there was little evidence that this relational integration was being formalised through job descriptions or contracts for the PPI representatives. However, at the start of the study researchers often clarified expected commitments to attending meetings; other PPI input was often less formalised. Those case studies which had high levels of PPI activity could achieve this through flexibility and allowing PPI representatives to ‘dip in and out’ as their other commitments also varied:

parents will stick with the programme because they know that they can step in and out if needs be, and the team also think about how they can include people that might not be able to travel, so whether it’s joining in a meeting by phoning in to it and participating over the phone or sending responses or comments and feedback in an e-mail, so it’s made it available and it’s made accessible. CS21PPI02-01

However, trust in CS16 ( Box 20 ) was lost because of a lack of formal agreements about access and ownership of a database. This issue appeared midway through data collection and the impact can be quite clearly seen on the radar plots tracked over time. The impact can also be seen in the way the PPI was appraised (hatched box); because of this experience the charity would get legal documents drawn up before working with researchers again.

Virtual patient and public involvement

There has been a recent move towards the increasing use of technology and teleconferences being used as a means to include lay representatives who might otherwise not be able to attend meetings. However, this move towards ‘virtual’ contact as opposed to ‘face to face’ has implications for the establishment of relationships. One lay representative said that they always wanted an initial face-to-face meeting to make any following (virtual) meetings easier. As presented in Strategies for recruiting lay representatives , being unable to meet in person also caused problems in CS18, where the CI and lay representative were in different regions. The challenges of building and sustaining relationships through virtual contact were also raised by a funder. Maintaining arm’s length relationships was acknowledged to be difficult for the army of remote lay reviewers, and they found it difficult to sustain any more active involvement. Case study 23 ( Box 21 ) provided an example of virtual PPI with young adults, and also demonstrated how this medium provided an outreach model (see Discussion ).

The benefit of this virtual form of PPI was obvious:

I’ve got a main informant on Twitter . . . asked her if she could work with me on developing a paper and she’s a young person . . . and so she basically threw some question out to Twitter to her one and a half thousand followers . . . and we sort of put some questions to them and we’d written a paper within 3 weeks. CS23Res04-01

Case study 23 also had an advisory PPI group made up of four young people with the condition. At their request, this group was hosted separately from the research team meetings and deliberately had an ‘informal feel’. These separate meetings were envisaged to be a series of evening, face-to-face meetings with monies allocated to cover travel expenses. However, in reality, as a result of competing demands placed on the attention of this age group, the group did PPI ‘virtually’. Co-ordinating such involvement was a significant workload, which was difficult to predict and cost for. However, as this was adapted to over time, the tracking radar plot became fuller.

Reimbursement

Reimbursing lay representatives for their time is intuitively an enabler of trust and seen as normal good practice, yet payment for time was surprisingly rare in the case studies, although all were paid for out-of-pocket expenses. This was not only because of financial restraints but also reflected a continuing debate from a minority of respondents on how payment fitted with the notion of volunteerism. For example, in CS08 (see Box 13 ) PPI was felt to be more of a voluntary role, which payment would then ‘professionalise’:

No, I think it should be voluntary . . . because you’ll be paying for services for like, I guess, advice or public feedback, if you’re paying them then it’s, I don’t think, it’s more official, I guess . . . CS08Res02-01

This was rejected by many lay representatives:

It is and part of the problem is that people just kind of make an assumption, oh they’re patients, we won’t need to pay them. And you know our time in our life is just as . . . important as a researcher’s or a doctor’s. CS14PPI02-01

Among the five case studies reimbursing for time, the amounts ranged from £25 per meeting to £75. This was often enabled by the host organisation, such as a CLAHRC or research centre. However, even within well-funded host organisations such as HEIs, researchers related institutional barriers to paying lay representatives within institutional systems reliant upon inappropriate standardised status classifications (such as lay people having to be classed as visiting lecturers), electronic forms and difficulties dealing with cash refunds, as well as payments affecting lay volunteers’ benefit payments and tax arrangements. Hence, the host organisations that managed reimbursement and arrangements seamlessly made lay representatives feel a collegial partner with the organisation.

National charity representatives reported that they were being asked to be involved with an increasing number of research studies, which is not necessarily the main part of their work. One PPI representative called for there to be some recognition of cost to the organisation and the consequences:

there must be other charities like me in other therapeutic areas who are getting the same issues . . . So I would have thought that we should be looking at this at a national level to say if patients are going to be involved in research in a way that they have not been previously then they need support to do that and it should not, all of the cost of doing that, should not fall solely on the third sector. We should be getting some kind of NHS/government DH [Department of Health] support for this. CS14PPI02-01

One paid charity representative said her workload was such that she did PPI work in her own time. Perhaps in acknowledgement of this, another charity representative in a PPI role was contracted (part time) by the research project – yet further blurring the lines between PPI and researcher. It could also be argued that paid employment also introduces different obligations and commitments to involvement, although it has the potential to clarify an otherwise open-ended commitment.

  • Opportunities for patient and public involvement throughout the research process

A characteristic of studies with fully embedded PPI was that opportunities for PPI in all parts of the research process were fully exploited. The CMO configuration for this action is shown in Table 16 . As an enabling context for embeddedness, it was not necessarily how the PPI was organised but how much PPI representatives were encouraged to be involved and were exposed to different areas of the study throughout its stages where they could have an impact. There were reservations from some researchers on the potential for PPI in the early work of basic science designs (C3). However, we found that, with appropriate training (C2) and experience, lay representatives were effectively contributing to funding decisions for basic science studies, and prioritisation for tissue bank studies. This was further enabled by having a pool of lay representatives (C6) with sufficient interest and expertise to contribute effectively at all stages of the research.

TABLE 16

Context, mechanism and outcome configuration: opportunities for patient and public involvement throughout the research process

Patient and public involvement and the research cycle

Performing the necessary tasks for PPI appeared limited to certain stages of the research cycle. Some researchers recognised the importance of having PPI before studies were funded but acknowledged the difficulty of finding appropriate PPI representatives in a short time frame. Many researchers felt comfortable involving PPI representatives in the general review of study documents but not so certain about involvement in other parts of the research process. In most case studies there was significant PPI during study set-up, but this often decreased as the research progressed, for example when patient recruitment or data collection started. Researchers often reported that the pressure to recruit research participants (during data collection) resulted in less capacity to enable involvement of PPI representatives. This impacted most on relational aspects, with changes evident in this sector of the NPT radar plots.

The distinctive characteristic of case studies that enabled involvement at all stages of the research process was the presence of a dedicated individual facilitating PPI (e.g. CS21, see Box 6 ). A complementary or alternative approach was having a lay coapplicant who was fully involved from the inception of the design, and sometimes undertook an outreach role, or worked as an integral part of the research team. Case study 04 ( Box 22 ) had one experienced lay member as coapplicant; this was enabled by the research topic being focused on a patient evaluation tool, and by having an established PPI group with experienced lay members.

Patient and public involvement in different research designs

Funders and some researchers espoused stereotypical assumptions about the limitations of PPI in certain research designs, such as basic science, which has traditionally been an area with little PPI. A PPI co-ordinator working in a medical setting and talking about CTIMP (clinical trial of an investigational medicinal product) research observed that, because some researchers believed patients have difficulty in understanding the science and bench side of research, they find it hard to engage and have meaningful PPI. Similarly, one funder suggested PPI was more compatible with applied science:

I think it comes down to the complexity of science and the type of research that you’re talking about, some studies: when it’s very kind of lab based and it’s very molecular, doesn’t really lend itself to being able to involve the public or patient, you know, at a very kind of technical level. But there are a lot of opportunities in medical research where it is viable and it is possible to do it. Funder03

Other researchers also felt that involving PPI representatives in ‘technical’ discussions about certain research designs was tokenistic, as they were able to contribute very little:

I mean we’re doing a review of reviews . . . so it’s methodologically very challenging, it’s conceptually quite challenging, half the academics feel out of their depth, intellectually and conceptually. The PPI feel . . . that’s not to denigrate them or to put them down in any way at all, it’s not what PPI is about, . . . No, they come to the steering group and then they feel a bit left out and I think it’s a shame, I think it’s, you know I think it’s disrespectful in a way that not having, I mean I think, for that project it would be more respectful not to have PPI, does that make sense? CS03Res04-01

There was also some evidence that researchers felt concerned that some PPI representatives who lacked scientific understanding could jeopardise a study at the design stage. However, another funder challenged assumptions about the ability of experienced PPI to review less applied, more basic science applications:

when we set up these committees, there was a fear or a worry that they would have trouble reviewing basic science applications and therefore they would be more drawn towards the clinical ones, but actually what happens is, it’s quite funny really, it’s almost the other way round. I think they can see the pipedream or the hope at the end, and almost they’re more critical about clinical studies, I think maybe because it’s closer to the patient benefit. Funder01

Indeed CS17 ( Box 23 ) successfully involved PPI in approving bench research proposals in genetic epidemiology through a panel model whereby the PPI representatives are presented with lay protocols written specifically for the panel.

  • Levels of involvement

Beyond stages of research, respondents identified themselves as working at different ‘levels’ or degrees of consultation and collaboration. Rather than being polarised, these approaches could be used interchangeably throughout the project:

I mean research is knocking a billiard ball gently down a table to the other end and the role of the public bit is to just have to influence and push it to the left, push it to the right, give the researchers, oh it’s difficult to describe, isn’t it? Because it’s not, I understand entirely it’s not complete consultation and on some occasions it’s taken seriously. I think, put it this way, to keep the researchers in touch. CS03PPI02-01
To me, I mean, I think there are different levels at which you can involve people through the standard three levels. I mean, to me, we like to work with people as collaboratively as possible. I realise there is a role for consultative involvement in research but, for me, it’s being able to work in partnership really with members of the public to help design and to have ideas for research really. CS21Res02-01

Although none of our case studies was user-led, as described in the previous section some did have lay representatives as coapplicants or co-researchers (CS04, CS19, CS21 and CS23), although levels of involvement also varied. Although CS17 (see previous section) did involve lay representatives at all stages, researchers also raised as an issue the move towards lay representatives as coapplicants. There were concerns that this was becoming the ‘gold-standard’ of PPI and people questioned if all study designs are suited to having PPI representatives as coapplicants:

it is difficult to have coapplicants on the kind of research we do, because of the nature of it, you know, if a member of the public came up and said I think you should compare the level of HbA 1C [glycated haemoglobin] compared to glucose, they wouldn’t be a member of the public, they would be a scientist, to even know what the question was . . . because I think there is the idea that being coapplicants, and making videos is a measure of doing good PPI. CS17Res01-04

Nevertheless, some felt that funding was more likely with a PPI representative as coapplicant; but this was not confirmed by any of our funder respondents. However, there was clearly a lack of reflection on whether or not having lay coapplicants made any particular impact on the research process and outcomes.

  • Reflection, appraisal and evaluation

Only two of the case studies provided any evidence of systematically appraising the PPI contribution to their study. However, funders’ requirements (C1) for an evaluation of PPI in the final report were beginning to have an influence, but any evaluative work was less commonly a collaborative endeavour for a research team. In contrast, host organisations (C7) that had embedded PPI infrastructures were more likely to evaluate and fine-tune PPI processes in a collaborative way. Having developed over time, embedded PPI infrastructures also enabled positive relationships (C5) in which researchers and lay members could reflect honestly on what and what had not worked well. Table 17 illustrates the CMO configuration for this action.

TABLE 17

Context, mechanism and outcome configuration: reflection, appraisal and evaluation

Systematic appraisal of patient and public involvement

Of the two case studies with systematic appraisal, CS13 (see Box 16 ) had an annual evaluation, with a review of the PPI contribution and model at the panel annual general meeting. The researcher co-ordinating PPI ‘measures’ the extent of PPI against published best practice guides to assess if PPI can be of use in further phases of the research:

The NIHR, five or six points in the research cycle in which people should be involved, I’ve always bought into that notion, so we try and use that as a template for judging how we’re doing internally. CS13Res05-01

Case study 21 provided the RAPPORT study with numerous documents which recorded PPI activities and impact but currently did not formally evaluate PPI. However, the case study site was actively involved in piloting an evaluative framework for PPI with clear intentions to change its PPI practices in future to include systematic appraisal.

However, researchers often did not have the time or resources to record PPI activities and reflect on PPI input, and some did not see it as something they should be doing. Respondents from CS06 ( Box 24 ) saw PPI as an implicit part of the research process and hence not requiring discrete evaluation:

Case study 06: public health Hybrid model consisting of one-off events for less experienced PPI, and an advisory group including a more experienced PPI with more commitment/ongoing responsibility required. Member of the general public. Three development (more...)

I wouldn’t say it has added value, I think it’s actually fundamental to, to the research inquiry . . . it’s not just added value, it’s intrinsic to the inquiry. CS06PPI01-01

However, as the NPT radar plots illustrate (bold box), although there was no systematic evaluation of PPI, respondents did individually appraise PPI as worthwhile in the study.

Other researchers struggled to evaluate PPI because there was little guidance or knowledge on how to carry out this task and recognised: ‘it’s quite hard to evaluate I would have thought’ (CS08Res01-02). Despite the lack of systematic evaluation, some research projects did record PPI activities, providing a baseline to document PPI input.

For some researchers a lack of robust evidence on the value of PPI was a problem. In CS10 ( Box 25 ) it was explicitly recognised that what was seen as ‘worthwhile’ by the general public might not be seen in the same way by researchers:

Case study 10: public health Experts by experience, using a ‘consultation’ approach.

especially not to researchers. To people outside the world of research, I can reason very happily [on the value of PPI]. But researchers want evidence and that’s the holy grail, and I haven’t seen it yet. CS10Res04-01

The rather mixed view on the value of PPI within CS10 can be seen in the radar plot in the case study summary. Within the tracking radar plot, the impact of questioning the value of the PPI in this study is marked.

Enabling contexts for evaluating patient and public involvement

Funders’ requirements (C1) were a strong enabling context for evaluation. For example, the requirement to report on PPI when NIHR-funded projects were completed was a major incentive for researchers to review processes and benefits of PPI in the project. Indeed, some case studies agreed to be part of the RAPPORT study as an aid to meet this requirement. However, approaches to evaluating the outcomes and impact of PPI were shaped by the funding organisation’s stance towards PPI. The data from the programme management organisations strongly resonated with the methodological argument for PPI; hence, the organisations were actively seeking ways of evaluating the impact of PPI on research outcomes. Approaches cited, however systematic, seemed descriptive and biased towards ‘good news’: the collection of illustrative case studies and the specific identification of PPI in the final research report, as described below.

I ask that all the monitoring programme managers, if they spot something really interesting or good or unusual or positive, that they just let me know. And then I keep a spreadsheet of all of those for posterity, for, you know, when I start doing, we’re doing a lot of work on impact here . . . we’ll have more ability to really get in and look at good examples of PPI. Funder04

There was evidence that this focus on evaluation, although not fully assessing and comparing impact, was resulting in some modification to the funder’s PPI work, for example developing advice to support lay representatives on trial steering committees.

For the funding organisations framing PPI more in the engagement paradigm, evaluation was focused on the impact of public engagement activities, and a web-based tool was used for researchers to record their public engagement activities and outcomes. For the condition-specific medical charities, again perhaps shaped by their moral stance on PPI, there was anecdotal evidence of where PPI has had an observable impact: ‘I think that they [grant applicants] have an increased awareness of the fact that they have to write a good lay summary’ (Funder01). However, there was no systematic appraisal of this.

For lay representatives, a positive appraisal of PPI was shaped not only by a positive experience (C8), but also by personal outcomes. Described further later, these outcomes included increased understanding of their health condition:

I read some of the interviews from other patients . . . it really helped me because personally . . . reading about how people are suffering from it and I’m not the only one, other people are also going through the same sort of problems, yeah. So some people do get better, people still live a happy life. CS18PPI02-01

For others it was a sense of giving something back to the health-care system:

I then felt well if I can do anything, you know for the greater good, I was happy to do it and so I get out of it the feeling I’m making a contribution towards the research and the further development of treatment for patients with rheumatoid. CS14PPI01-01

A number of researchers also felt PPI was worthwhile to them personally beyond impact just on the research process and outcomes. Researchers spoke of PPI bringing them closer to patients or service users, and reminding the researcher about the real aim of the research:

remind you a bit why you’re doing it because sitting in front of a load of numbers you sort of think, you know you’re doing it for those people. Because that’s the population you’re working with. CS13Res01-01

A positive experience of PPI was often the start of the process to establish PPI as normal practice:

she’s really been the one that’s been my epiphany for understanding patient involvement more than anyone. CS08Res01-01

Equally, a negative experience of PPI could hold up this process for some time:

I did an informal questionnaire amongst patients who we saw in the secondary care clinic, research patients, asking them to identify, you know, suitable research topics. However, I didn’t find it was very useful, patients mainly said that research should be concentrating on identifying a cure for diabetes, and that’s not completely helpful as that’s like a very long-term goal in research . . . then that sort of coloured my views of PPI for a little while afterwards thinking, hmm, I’m not sure really what patients want to get out of it or whether they have enough knowledge about the research process and personnel involved to be able to contribute effectively. CS02Res02-01

Modifying future work

The majority of the case studies reflected on their PPI approaches only informally towards the end of the study, so there was minimal evidence of any changes within actual case studies. However, in a longitudinal cohort study (CS14) there was also evidence that being a case study within the RAPPORT study provided the opportunity for participants to reflect on PPI and plan things differently for the future:

you’re making me think [interviewer], maybe I should do a little leaflet to send out to show them all what we are doing with their information. So as I’ve been talking to you that’s something I will be doing differently and I’ll bring it up at the meeting that we should be sending them an update or feedback. CS14Res03-03

This case study ( Box 26 ) was supported by minimal PPI infrastructure but the impact of reflection can be seen in the tracking radar plots (bold box).

For the majority of case studies, either modifications to PPI approaches would be operationalised in future studies, or the influence of that particular case study was affecting PPI approaches within other studies:

What is great now, lots and lots of studies are coming through . . . other departments who weren’t doing any PPI or patients, it is forcing them, I have access to a group of volunteers, pre-screened; you need to do PPI to get them! . . . we are getting sport scientists, oncologist, all sorts of people; the meetings are becoming more and more interesting . . . now the meeting [panel] has such a wide diversity of studies that are being discussed. CS17Res01-03

Hence, while the CS17 (see Box 23 ) tracking radar plot showed minimal change in the reflexive monitoring segment, if expanded to the research environment in which it was hosted then a far more significant change could be noted.

Nevertheless, extensive future changes to PPI approaches could be inhibited by a lack of understanding of what is possible, as exemplified by CS09 ( Box 27 ):

Case study 09: IDD Two national representatives of two different support groups. Both PPI representatives sit on project advisory group; one of them carries out much of the qualitative analysis.

I don’t know how you go about involving patient and public in planning research, that maybe sounds a bit silly; in my mind I have a big question mark about how it works: before you recruit anyone to the study you need ethical approval, and to me asking patients potentially what they want research to entail, is in a way recruiting them to a mini study before the main study. CS09Res02-01

While the radar plots indicate a comparatively embedded level of PPI, future potential impact of PPI is constrained by researchers’ beliefs. This reinforces findings presented earlier where potential PPI impact was inhibited by boundaries set by the research team.

  • Impact and outcomes of patient and public involvement

As presented in each CMO configuration, case study actions led to a number of methodological and moral impacts and outcomes. This section draws on the interview and documentary data to provide evidence of the methodological impacts and outcomes of PPI within the case studies. Here we define impact as the immediate effects of PPI, which may be intended as part of the objective for PPI within each study, or unintended. Outcomes are longer-term effects of PPI in relation to the overall goal for PPI in each study. 160 Eight of the 22 case studies concluded during the RAPPORT data collection period, so participants could provide summative assessments of the impact and also possible longer-term outcomes of PPI. However, it should be recognised that there are likely to be longer-term outcomes of studies that were not possible to capture within the time scale of the RAPPORT study.

Impact and/or outcomes were described within 13 stages of the research cycle/process and there were a range of topic areas with evidence of impact and outcomes ( Table 18 ). The following section provides evidence of PPI methodological impact and outcomes with specific examples from the 22 case studies. Impact and outcomes are applicable only to certain research designs and, of course, are a function of the original PPI objectives and overall goal.

TABLE 18

Methodological impact of PPI by topic area

Research priority and question setting

Five of the case studies reported that PPI representatives had been involved in research priority setting. For example, the panel in CS17 had input into deciding which research should be funded, although we received no documentary evidence to show the impact on decision-making. We were provided evidence of PPI impact in identifying research questions. For example, the research centre hosting CS21 has a large PPI group who are encouraged to put forward research questions, and this particular case study originated from one of the parents. The structure of the research centre and the priority that this organisation gives to PPI ensure that the ideas relevant to service users are carried out:

Because the very idea of the whole thing came from a parent, it’s been a very natural process to have families involved in it all of the time, and I think that’s the beauty of getting the idea from the family. You don’t have to then try and shoehorn PPI in, it’s already there. So, it’s just been from the word go. CS21Res01-01

Linking to the wider community

Four case studies utilised PPI to provide links to the wider community. Case study 02 exemplified this approach, with the single lay representative on the steering committee consulting with wider range of people from the study target population. A newsletter to this group provides evidence of the impact of this approach ( Box 28 ).

Documentary evidence: case study 02 [Patient organisation] members recommended changes to the draft proposal and these were incorporated into the final version and into the current protocol. The suggestions included:

In CS23, this PPI bridging role to the wider population (in this case younger people) was done via social media and was an effective way of getting one-off input from an often less-heard group. This input was used as a basis for a practice-focused article and also informed the development of the study ( Box 29 ).

Documentary evidence: case study 23 . . . what apps and websites are YPD [young people with diabetes] using? In order to review the use of apps and other online resources by YPDs, one of the authors (PPI rep.) discussed the use of apps (more...)

Lay representatives were also used as a link to recruit study participants. Examples included writing articles for newsletters to encourage participants to take part, being filmed as part of the recruitment video, using social media or approaching people directly through their networks (support groups).

Such connections with other groups of members of the public or service users proved to be valuable in recruitment, and in harnessing a wider range of (less accessible) PPI representatives/experiences, reassuring researchers who were concerned about the PPI representatives not being a ‘typical’ lay person.

Marketing the study

Two of the studies had PPI input regarding study logos, and in the first study the logo was changed ( Box 30 ).

Documentary evidence: case study 06 There was a lot of discussion about the photographs used. They preferred the picture of the couple walking in the wood, as this looked active and upbeat. However, they felt that there was also value in the older woman (more...)

However, in CS19 PPI advice was not taken on board, as the logo had been already commissioned and developed by the team (and PPI coapplicant), but it was later criticised as being potentially insensitive by steering group PPI representatives:

it was about their logo [. . .] I just hated it on sight, and their response to that was, ‘But we paid someone to do it and . . . maybe . . . [other] people wouldn’t feel like that.’ CS19PPI02

Design of study

Patient and public involvement representatives made comments on the protocol and design of the study in 13 of the case studies, particularly regarding lay summaries, data collection instruments and study information ( Box 31 ). In other case studies PPI representatives were consulted over study design; for example, they were asked whether a RCT or partial randomised control design should be used, and PPI representatives’ suggestion of a RCT design (CS07) was accepted. In another case study the PPI representatives were asked if they approved of particular methods of accessing patients’ notes (CS01). Data collection tools such as questionnaires were ‘softened’ by PPI representatives in terms of language and sensitivity (CS09, CS21).

Documentary evidence: case study 13 It was suggested at the last meeting that the third health-check webpage is too heavy on text and if the big paragraphs could be reduced with the option to expand if someone is interested in reading more information. (more...)

Safety of study

Involving patients’ groups in the governance of a study had evidence of potentially improving patient safety. In the original proposal of CS02, the researcher conceded that the research study was presented in a very clinical fashion and, because it was asking people to reduce the amount of a particular drug that they were taking, the safety element (from the patient’s point of view) had not been considered. PPI views (through a national charity panel) changed the application to include a safety questionnaire:

when I put together the original application, it didn’t really have much in terms of the safety element because I had taken it for granted that people are already on [x drug], reducing the dose wouldn’t make a big difference and I would have seen it in a clinical fashion, but as soon as we got the patients on board and had their comments coming through, one of the things that seemed to be coming through was a concern, or a potential concern from the patients that would it make them feel unwell or would it do anything to them? So therefore we then added an extra element asking patients about how they felt, safety questionnaires. CS02Res01-01

The outcome of PPI here was reassurance for patients in terms of safety and also improved recruitment rates, and a 3-month visit (for reassurance) was added to the study design for participants.

Design of intervention

In those studies which contained an intervention as part of their study design, PPI representatives helped to design or make suggestions to existing interventions to make them more acceptable/feasible. In CS03 one PPI representative suggested there should be more content on pre-pregnancy and diabetes mellitus, and the documentation confirmed that more was added into the resource intervention ( Box 32 ).

Documentary evidence: case study 03 I fully understand that you don’t want to go into the complexities of pregnancy with diabetes but I feel more is needed to inform women of the importance of pre-pregnancy planning and quick action once they (more...)

When the intervention was a questionnaire (CS04, CS07) the questionnaire was altered to include items not previously considered by the researcher:

I’m sort of embarrassed to admit it, but I went to that meeting thinking, ‘I know everything that should go in this questionnaire’, but I so didn’t, and loads of stuff came out in that meeting that I just never would have thought of. CS04Res01-01

In another case study (CS07) PPI representatives were involved in the validation of 260 pre- and post-questionnaires (which were used as part of the intervention). The PPI representatives took the questionnaire back to their local user groups and asked them to complete the questionnaire as a pilot. However, there was also evidence that researchers perceived an unintended outcome of PPI. In CS23 the CI (who was also a clinician) felt that the PPI representatives had steered the project off course, and that the interventions developed were neither innovative nor adequately focused on the research question.

Research ethics submission

Two of the case studies felt that having PPI helped their ethics submission by saying that materials had been viewed and approved by PPI representatives:

they [research ethics committee] take note it, of course the committees have their own lay people and I mean the one thing about lay people is they’re individuals like all of us, it’s a bit like a peer review and you might get lay members of the panel who don’t really agree but they take note of it and I think it carries quite a bit of weight, doesn’t always carry the day though. CS01Res02-01

Recruitment

One of the most frequently stated outcomes for PPI in our case studies was a perceived increase in recruitment rates to the research study (18 of the 22 case studies). Researchers commonly attributed recruitment success to the PPI input to materials (suggestions on layout, size, language, colour, length, readability, clarity and design; evidenced by tracked changes/before and after versions of documents) used for recruitment (PIS, invitation letters, consent forms). Suggested changes were made either directly by the PPI representatives themselves or by taking materials back to wider reference groups for further comments; for example parents showing the PIS to their children. PPI representatives made changes to language such as taking out the word ‘mortality’ or explaining technical words such as ‘lung function’. They introduced a summary section at the start of the PIS and produced information in a small, credit card-sized, format for people to carry in their wallets. Changes also included images of actual people wearing equipment or lying on scanners, and extra information about the length of procedure and the weight and size of any equipment was added (CS13 PIS).

One researcher felt able to quantify the increase in recruitment because of such PPI changes. A number of different versions of the PIS and invitation letter had been submitted to ethics committees:

we changed a few things but we did [a] stage [at a] time so we could see what had an impact, and that certainly did increase recruitment by, only you know, 1 or 2%, but 1 or 2% when you’re sending out thousands a month . . . CS12Res02-01

Outcome measures

Research teams advocated the use of PPI for outcome measures that were relevant to patients; this was particularly relevant to one arthritis study:

it was appreciated that there were certain things that we were measuring that we thought were really important, these patients actually weren’t interested in at all and didn’t deem relevant, whereas other issues we didn’t think were . . . well, we thought they were important, obviously, otherwise we wouldn’t measure them, but we didn’t realise how important they were to patients. CS14Res01-01

There was qualifying evidence here that the outcome measures had been changed or added to in the research design. Respondents also reported that this change of emphasis was fed into clinical guidelines, which may have an impact on patient experience.

Data analysis and collection

Two studies had PPI representatives involved directly in data collection. The PPI representative in CS18 was involved in data analysis; she was asked because of her cultural knowledge and to reassure the researchers that the analysis resonated with her experience of the ethnic ‘community’:

I want to check with the community that I’m not sort of completely going way off track here so I guess in some ways that was her main role, more than in this situation the experience of living with the illness really, it was actually her cultural knowledge that was most helpful. CS18Res01-01

In one case study where this PPI role could have been applicable but was not utilised (CS21), this was a deliberate restriction because of ethical considerations; many of the study participants would have been known to the PPI representatives.

Patient and public involvement representatives also made a contribution to data analysis ( Box 33 ).

Documentary evidence: case study 09 As you say, the difference in preference is interesting. What I could really do with – if you ever have five minutes – is for you just to talk me through one or two of the tables as I am rubbish at interpreting (more...)

The impact of this was clearly described by the researcher:

When I initially did a straight comparison women’s views versus health professional’s views, [PPI02] suggested I break down the women, into those that had experience with [xxx] or [xxxx], compared them to women who haven’t had any problem [xxxx] and we found quite big differences between the two groups. CS09Res01-02

Dissemination

Two of the case studies (CS17 and CS21) mentioned that the PPI representatives had presented the study findings at conferences, and six examples of academic papers with PPI representatives as coauthors were submitted to the RAPPORT study. One of the PPI representatives, who was working as an academic researcher 3 days a week on the project, was first author of a paper (and her organisation was the charity mentioned in the paper). Other representatives were mentioned in the acknowledgements at the end of the paper. Some case studies in the RAPPORT study had not yet reached dissemination phases; however, our tracking interviews suggested that, in a number of cases where it had been planned that PPI representatives would be involved in dissemination, this had not happened.

Moral impact and outcomes

In addition to the outcomes which were identified in terms of the research project, the researchers and PPI representatives also identified personal outcomes associated with their PPI role. The personal benefits of PPI have been well documented, and those reported here echo previous studies. These included increased self-confidence and mental challenge. The PPI role helped people to keep mentally active in retirement or unemployment and provided the possibility of leading to other roles or responsibilities:

. . . enriches our research but also enriches their lives. CS21Res01
. . . it just opens up a world of opportunities. CS21PPI01

Interestingly, some PPI representatives spoke of the benefits of their involvement to the wider society: ‘maybe it’ll change the world a little bit’ (CS11PPI02-01). In CS03, the PPI representatives felt that they could pass back information to their wider network and again be ‘boundary spanners’ (which Williams 161 describes as ‘individuals who have a dedicated job role or responsibility to work in collaborative environments’) between the academic world and the patient community:

I have met since my diagnosis other people who’ve had [condition] for many many years who haven’t necessarily had access to much information or they haven’t, or they have had access to information and services but it’s been a bit sporadic and I always wanted to kind of pass that information along or back to people that I’d met, so . . . I’ve kind of been a lay tutor. CS03PPI04-01

Longer-term outcomes

The RAPPORT study was designed to include studies that concluded during our data collection period, with the expectation that outcomes of PPI could be summatively assessed. Among the eight that were completed, we found no evidence of any immediate outcomes of PPI for the research findings. However, out of these eight studies, five had demonstrated clear embedding of PPI and interestingly it was these studies that clearly identified the outcome as developing further grant applications, as more research was required. These five case studies were continuing to work with their lay representatives to generate further research questions. Out of the remaining three, one was in follow-up, we could find no evidence from the other two case studies of any particular outcome, and from a dissemination perspective there was nothing publicly accessible providing results or outcomes of the studies. It is clear that, as in all evaluation of research impact, longer-term outcomes influenced by PPI need an extensive time to detect.

Collective understanding about the purpose and role of PPI was an important mechanism leading to positive outcomes, and was enabled by training and certain topics and study designs. Values quite clearly shaped this understanding, and there was some questioning of whether or not PPI was appropriate in all study designs. Three main models of PPI were identified: a bounded, one-off model, an outreach model and a fully intertwined model. Even in research settings with minimal PPI infrastructure, there was clear evidence that establishing and maintaining relationships was crucial and required time. PPI as a dynamic process was significantly compromised when relationships broke down. It was also clear that a dual role (participant/involvee) was relatively common, and that an unintended consequence of the evolving national and regional PPI structure was an outsourcing of PPI, with associated researcher disengagement. These key areas will now be explored further in the discussion.

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  • Cite this Page Wilson P, Mathie E, Keenan J, et al. ReseArch with Patient and Public invOlvement: a RealisT evaluation – the RAPPORT study. Southampton (UK): NIHR Journals Library; 2015 Sep. (Health Services and Delivery Research, No. 3.38.) Chapter 6, Findings from the case studies.
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Chapter 11 Case Research

Case research, also called case study, is a method of intensively studying a phenomenon over time within its natural setting in one or a few sites. Multiple methods of data collection, such as interviews, observations, prerecorded documents, and secondary data, may be employed and inferences about the phenomenon of interest tend to be rich, detailed, and contextualized. Case research can be employed in a positivist manner for the purpose of theory testing or in an interpretive manner for theory building. This method is more popular in business research than in other social science disciplines.

Case research has several unique strengths over competing research methods such as experiments and survey research. First, case research can be used for either theory building or theory testing, while positivist methods can be used for theory testing only. In interpretive case research, the constructs of interest need not be known in advance, but may emerge from the data as the research progresses. Second, the research questions can be modified during the research process if the original questions are found to be less relevant or salient. This is not possible in any positivist method after the data is collected. Third, case research can help derive richer, more contextualized, and more authentic interpretation of the phenomenon of interest than most other research methods by virtue of its ability to capture a rich array of contextual data. Fourth, the phenomenon of interest can be studied from the perspectives of multiple participants and using multiple levels of analysis (e.g., individual and organizational).

At the same time, case research also has some inherent weaknesses. Because it involves no experimental control, internal validity of inferences remain weak. Of course, this is a common problem for all research methods except experiments. However, as described later, the problem of controls may be addressed in case research using “natural controls”. Second, the quality of inferences derived from case research depends heavily on the integrative powers of the researcher. An experienced researcher may see concepts and patterns in case data that a novice researcher may miss. Hence, the findings are sometimes criticized as being subjective. Finally, because the inferences are heavily contextualized, it may be difficult to generalize inferences from case research to other contexts or other organizations.

It is important to recognize that case research is different from case descriptions such as Harvard case studies discussed in business classes. While case descriptions typically describe an organizational problem in rich detail with the goal of stimulating classroom discussion and critical thinking among students, or analyzing how well an organization handled a specific problem, case research is a formal research technique that involves a scientific method to derive explanations of organizational phenomena.

Case research is a difficult research method that requires advanced research skills on the part of the researcher, and is therefore, often prone to error. Benbasat et al. (1987) [8] describe five problems frequently encountered in case research studies. First, many case research studies start without specific research questions, and therefore end up without having any specific answers or insightful inferences. Second, case sites are often chosen based on access and convenience, rather than based on the fit with the research questions, and are therefore cannot adequately address the research questions of interest. Third, researchers often do not validate or triangulate data collected using multiple means, which may lead to biased interpretation based on responses from biased interviewees. Fourth, many studies provide very little details on how data was collected (e.g., what interview questions were used, which documents were examined, what are the organizational positions of each interviewee, etc.) or analyzed, which may raise doubts about the reliability of the inferences. Finally, despite its strength as a longitudinal research method, many case research studies do not follow through a phenomenon in a longitudinal manner, and hence present only a cross-sectional and limited view of organizational processes and phenomena that are temporal in nature.

Key Decisions in Case Research

Several key decisions must be made by a researcher when considering a case research method. First, is this the right method for the research questions being studied? The case research method is particularly appropriate for exploratory studies for discovering relevant constructs in areas where theory building at the formative stages, for studies where the experiences of participants and context of actions are critical, and for studies aimed at understanding complex, temporal processes (why and how of a phenomenon) rather than factors or causes (what). This method is well-suited for studying complex organizational processes that involve multiple participants and interacting sequences of events, such as organizational change and large-scale technology implementation projects.

Second, what is the appropriate unit of analysis for a case research study? Since case research can simultaneously examine multiple units of analyses, the researcher must decide whether she wishes to study a phenomenon at the individual, group, and organizational level or at multiple levels. For instance, a study of group decision making or group work may combine individual-level constructs such as individual participation in group activities with group-level constructs, such as group cohesion and group leadership, to derive richer understanding than that can be achieved from a single level of analysis.

Third, should the researcher employ a single-case or multiple-case design? The single case design is more appropriate at the outset of theory generation, if the situation is unique or extreme, if it is revelatory (i.e., the situation was previously inaccessible for scientific investigation), or if it represents a critical or contrary case for testing a well-formulated theory. The multiple case design is more appropriate for theory testing, for establishing generalizability of inferences, and for developing richer and more nuanced interpretations of a phenomenon. Yin (1984) [9] recommends the use of multiple case sites with replication logic, viewing each case site as similar to one experimental study, and following rules of scientific rigor similar to that used in positivist research.

Fourth, what sites should be chosen for case research? Given the contextualized nature of inferences derived from case research, site selection is a particularly critical issue because selecting the wrong site may lead to the wrong inferences. If the goal of the research is to test theories or examine generalizability of inferences, then dissimilar case sites should be selected to increase variance in observations. For instance, if the goal of the research is to understand the process of technology implementation in firms, a mix of large, mid-sized, and small firms should be selected to examine whether the technology implementation process differs with firm size. Site selection should not be opportunistic or based on convenience, but rather based on the fit with research questions through a process called “theoretical sampling.”

Fifth, what techniques of data collection should be used in case research? Although interview (either open-ended/unstructured or focused/structured) is by far the most popular data collection technique for case research, interview data can be supplemented or corroborated with other techniques such as direct observation (e.g., attending executive meetings, briefings, and planning sessions), documentation (e.g., internal reports, presentations, and memoranda, as well as external accounts such as newspaper reports), archival records (e.g., organization charts, financial records, etc.), and physical artifacts (e.g., devices, outputs, tools). Furthermore, the researcher should triangulate or validate observed data by comparing responses between interviewees.

Conducting Case Research

Most case research studies tend to be interpretive in nature. Interpretive case research is an inductive technique where evidence collected from one or more case sites is systematically analyzed and synthesized to allow concepts and patterns to emerge for the purpose of building new theories or expanding existing ones. Eisenhardt (1989) [10] propose a “roadmap” for building theories from case research, a slightly modified version of which is described below. For positivist case research, some of the following stages may need to be rearranged or modified; however sampling, data collection, and data analytic techniques should generally remain the same.

Define research questions. Like any other scientific research, case research must also start with defining research questions that are theoretically and practically interesting, and identifying some intuitive expectations about possible answers to those research questions or preliminary constructs to guide initial case design. In positivist case research, the preliminary constructs are based on theory, while no such theory or hypotheses should be considered ex ante in interpretive research. These research questions and constructs may be changed in interpretive case research later on, if needed, but not in positivist case research.

Select case sites. The researcher should use a process of “theoretical sampling” (not random sampling) to identify case sites. In this approach, case sites are chosen based on theoretical, rather than statistical, considerations, for instance, to replicate previous cases, to extend preliminary theories, or to fill theoretical categories or polar types. Care should be taken to ensure that the selected sites fit the nature of research questions, minimize extraneous variance or noise due to firm size, industry effects, and so forth, and maximize variance in the dependent variables of interest. For instance, if the goal of the research is to examine how some firms innovate better than others, the researcher should select firms of similar size within the same industry to reduce industry or size effects, and select some more innovative and some less innovative firms to increase variation in firm innovation. Instead of cold-calling or writing to a potential site, it is better to contact someone at executive level inside each firm who has the authority to approve the project or someone who can identify a person of authority. During initial conversations, the researcher should describe the nature and purpose of the project, any potential benefits to the case site, how the collected data will be used, the people involved in data collection (other researchers, research assistants, etc.), desired interviewees, and the amount of time, effort, and expense required of the sponsoring organization. The researcher must also assure confidentiality, privacy, and anonymity of both the firm and the individual respondents.

Create instruments and protocols. Since the primary mode of data collection in case research is interviews, an interview protocol should be designed to guide the interview process. This is essentially a list of questions to be asked. Questions may be open-ended (unstructured) or closed-ended (structured) or a combination of both. The interview protocol must be strictly followed, and the interviewer must not change the order of questions or skip any question during the interview process, although some deviations are allowed to probe further into respondent’s comments that are ambiguous or interesting. The interviewer must maintain a neutral tone, not lead respondents in any specific direction, say by agreeing or disagreeing with any response. More detailed interviewing techniques are discussed in the chapter on surveys. In addition, additional sources of data, such as internal documents and memorandums, annual reports, financial statements, newspaper articles, and direct observations should be sought to supplement and validate interview data.

Select respondents. Select interview respondents at different organizational levels, departments, and positions to obtain divergent perspectives on the phenomenon of interest. A random sampling of interviewees is most preferable; however a snowball sample is acceptable, as long as a diversity of perspectives is represented in the sample. Interviewees must be selected based on their personal involvement with the phenomenon under investigation and their ability and willingness to answer the researcher’s questions accurately and adequately, and not based on convenience or access.

Start data collection . It is usually a good idea to electronically record interviews for future reference. However, such recording must only be done with the interviewee’s consent. Even when interviews are being recorded, the interviewer should take notes to capture important comments or critical observations, behavioral responses (e.g., respondent’s body language), and the researcher’s personal impressions about the respondent and his/her comments. After each interview is completed, the entire interview should be transcribed verbatim into a text document for analysis.

Conduct within-case data analysis. Data analysis may follow or overlap with data collection. Overlapping data collection and analysis has the advantage of adjusting the data collection process based on themes emerging from data analysis, or to further probe into these themes. Data analysis is done in two stages. In the first stage (within-case analysis), the researcher should examine emergent concepts separately at each case site and patterns between these concepts to generate an initial theory of the problem of interest. The researcher can interview data subjectively to “make sense” of the research problem in conjunction with using her personal observations or experience at the case site. Alternatively, a coding strategy such as Glasser and Strauss’ (1967) grounded theory approach, using techniques such as open coding, axial coding, and selective coding, may be used to derive a chain of evidence and inferences. These techniques are discussed in detail in a later chapter. Homegrown techniques, such as graphical representation of data (e.g., network diagram) or sequence analysis (for longitudinal data) may also be used. Note that there is no predefined way of analyzing the various types of case data, and the data analytic techniques can be modified to fit the nature of the research project.

Conduct cross-case analysis. Multi-site case research requires cross-case analysis as the second stage of data analysis. In such analysis, the researcher should look for similar concepts and patterns between different case sites, ignoring contextual differences that may lead to idiosyncratic conclusions. Such patterns may be used for validating the initial theory, or for refining it (by adding or dropping concepts and relationships) to develop a more inclusive and generalizable theory. This analysis may take several forms. For instance, the researcher may select categories (e.g., firm size, industry, etc.) and look for within-group similarities and between-group differences (e.g., high versus low performers, innovators versus laggards). Alternatively, she can compare firms in a pair-wise manner listing similarities and differences across pairs of firms.

Build and test hypotheses. Based on emergent concepts and themes that are generalizable across case sites, tentative hypotheses are constructed. These hypotheses should be compared iteratively with observed evidence to see if they fit the observed data, and if not, the constructs or relationships should be refined. Also the researcher should compare the emergent constructs and hypotheses with those reported in the prior literature to make a case for their internal validity and generalizability. Conflicting findings must not be rejected, but rather reconciled using creative thinking to generate greater insight into the emergent theory. When further iterations between theory and data yield no new insights or changes in the existing theory, “theoretical saturation” is reached and the theory building process is complete.

Write case research report. In writing the report, the researcher should describe very clearly the detailed process used for sampling, data collection, data analysis, and hypotheses development, so that readers can independently assess the reasonableness, strength, and consistency of the reported inferences. A high level of clarity in research methods is needed to ensure that the findings are not biased by the researcher’s preconceptions.

Interpretive Case Research Exemplar

Perhaps the best way to learn about interpretive case research is to examine an illustrative example. One such example is Eisenhardt’s (1989) [11] study of how executives make decisions in high-velocity environments (HVE). Readers are advised to read the original paper published in Academy of Management Journal before reading the synopsis in this chapter. In this study, Eisenhardt examined how executive teams in some HVE firms make fast decisions, while those in other firms cannot, and whether faster decisions improve or worsen firm performance in such environments. HVE was defined as one where demand, competition, and technology changes so rapidly and discontinuously that the information available is often inaccurate, unavailable or obsolete. The implicit assumptions were that (1) it is hard to make fast decisions with inadequate information in HVE, and (2) fast decisions may not be efficient and may result in poor firm performance.

Reviewing the prior literature on executive decision -making, Eisenhardt found several patterns, although none of these patterns were specific to high-velocity environments. The literature suggested that in the interest of expediency, firms that make faster decisions obtain input from fewer sources, consider fewer alternatives, make limited analysis, restrict user participation in decision-making, centralize decision-making authority, and has limited internal conflicts. However, Eisenhardt contended that these views may not necessarily explain how decision makers make decisions in high-velocity environments, where decisions must be made quickly and with incomplete information, while maintaining high decision quality.

To examine this phenomenon, Eisenhardt conducted an inductive study of eight firms in the personal computing industry. The personal computing industry was undergoing dramatic changes in technology with the introduction of the UNIX operating system, RISC architecture, and 64KB random access memory in the 1980’s, increased competition with the entry of IBM into the personal computing business, and growing customer demand with double-digit demand growth, and therefore fit the profile of the high-velocity environment. This was a multiple case design with replication logic, where each case was expected to confirm or disconfirm inferences from other cases. Case sites were selected based on their access and proximity to the researcher; however, all of these firms operated in the high-velocity personal computing industry in California’s Silicon Valley area. The collocation of firms in the same industry and the same area ruled out any “noise” or variance in dependent variables (decision speed or performance) attributable to industry or geographic differences.

The study employed an embedded design with multiple levels of analysis: decision (comparing multiple strategic decisions within each firm), executive teams (comparing different teams responsible for strategic decisions), and the firm (overall firm performance). Data was collected from five sources:

  • Initial interviews with Chief Executive Officers: CEOs were asked questions about their firm’s competitive strategy, distinctive competencies, major competitors, performance, and recent/ongoing major strategic decisions. Based on these interviews, several strategic decisions were selected in each firm for further investigation. Four criteria were used to select decisions: (1) the decisions involved the firm’s strategic positioning,

(2) the decisions had high stakes, (3) the decisions involved multiple functions, and (4) the decisions were representative of strategic decision-making process in that firm.

  • Interviews with divisional heads: Each divisional head was asked sixteen open-ended questions, ranging from their firm’s competitive strategy, functional strategy, top management team members, frequency and nature of interaction with team, typical decision making processes, how each of the previously identified decision was made, and how long it took them to make those decisions. Interviews lasted between 1.5 and 2 hours, and sometimes extended to 4 hours. To focus on facts and actual events rather than respondents’ perceptions or interpretations, a “courtroom” style questioning was employed, such as when did this happen, what did you do, etc. Interviews were conducted by two people, and the data was validated by cross-checking facts and impressions made by the interviewer and note-taker. All interview data was recorded, however notes were also taken during each interview, which ended with the interviewer’s overall impressions. Using a “24-hour rule”, detailed field notes were completed within 24 hours of the interview, so that some data or impressions were not lost to recall.
  • Questionnaires: Executive team members at each firm were completed a survey questionnaire that captured quantitative data on the extent of conflict and power distribution in their firm.
  • Secondary data: Industry reports and internal documents such as demographics of the executive teams (responsible for strategic decisions), financial performance of firms, and so forth, were examined.
  • Personal observation: Lastly, the researcher attended a 1-day strategy session and a weekly executive meeting at two firms in her sample.

Data analysis involved a combination of quantitative and qualitative techniques. Quantitative data on conflict and power were analyzed for patterns across firms/decisions. Qualitative interview data was combined into decision climate profiles, using profile traits (e.g., impatience) mentioned by more than one executive. For within-case analysis, decision stories were created for each strategic decision by combining executive accounts of the key decision events into a timeline. For cross-case analysis, pairs of firms were compared for similarities and differences, categorized along variables of interest such as decision speed and firm performance. Based on these analyses, tentative constructs and propositions were derived inductively from each decision story within firm categories. Each decision case was revisited to confirm the proposed relationships. The inferred propositions were compared with findings from the existing literature to reconcile examine differences with the extant literature and to generate new insights from the case findings. Finally, the validated propositions were synthesized into an inductive theory of strategic decision-making by firms in high-velocity environments.

Inferences derived from this multiple case research contradicted several decision-making patterns expected from the existing literature. First, fast decision makers in high-velocity environments used more information, and not less information as suggested by the previous literature. However, these decision makers used more real-time information (an insight not available from prior research), which helped them identify and respond to problems, opportunities, and changing circumstances faster. Second, fast decision makers examined more (not fewer) alternatives. However, they considered these multiple alternatives in a simultaneous manner, while slower decision makers examined fewer alternatives in a sequential manner. Third, fast decision makers did not centralize decision making or restrict inputs from others, as the literature suggested. Rather, these firms used a two-tiered decision process in which experienced counselors were asked for inputs in the first stage, following by a rapid comparison and decision selection in the second stage. Fourth, fast decision makers did not have less conflict, as expected from the literature, but employed better conflict resolution techniques to reduce conflict and improve decision-making speed. Finally, fast decision makers exhibited superior firm performance by virtue of their built-in cognitive, emotional, and political processes that led to rapid closure of major decisions.

Positivist Case Research Exemplar

Case research can also be used in a positivist manner to test theories or hypotheses. Such studies are rare, but Markus (1983) [12] provides an exemplary illustration in her study of technology implementation at the Golden Triangle Company (a pseudonym). The goal of this study was to understand why a newly implemented financial information system (FIS), intended to improve the productivity and performance of accountants at GTC was supported by accountants at GTC’s corporate headquarters but resisted by divisional accountants at GTC branches. Given the uniqueness of the phenomenon of interest, this was a single-case research study.

To explore the reasons behind user resistance of FIS, Markus posited three alternative explanations: (1) system-determined theory: resistance was caused by factors related to an inadequate system, such as its technical deficiencies, poor ergonomic design, or lack of user friendliness, (2) people-determined theory: resistance was caused by factors internal to users, such as the accountants’ cognitive styles or personality traits that were incompatible with using the system, and (3) interaction theory: resistance was not caused not by factors intrinsic to the system or the people, but by the interaction between the two set of factors. Specifically, interaction theory suggested that the FIS engendered a redistribution of intra-organizational power, and accountants who lost organizational status, relevance, or power as a result of FIS implementation resisted the system while those gaining power favored it.

In order to test the three theories, Markus predicted alternative outcomes expected from each theoretical explanation and analyzed the extent to which those predictions matched with her observations at GTC. For instance, the system-determined theory suggested that since user resistance was caused by an inadequate system, fixing the technical problems of the system would eliminate resistance. The computer running the FIS system was subsequently upgraded with a more powerful operating system, online processing (from initial batch processing, which delayed immediate processing of accounting information), and a simplified software for new account creation by managers. One year after these changes were made, the resistant users were still resisting the system and felt that it should be replaced. Hence, the system-determined theory was rejected.

The people-determined theory predicted that replacing individual resistors or co-opting them with less resistant users would reduce their resistance toward the FIS. Subsequently, GTC started a job rotation and mobility policy, moving accountants in and out of the resistant divisions, but resistance not only persisted, but in some cases increased! In one specific instance, one accountant, who was one of the system’s designers and advocates when he worked for corporate accounting, started resisting the system after he was moved to the divisional controller’s office. Failure to realize the predictions of the people-determined theory led to the rejection of this theory.

Finally, the interaction theory predicted that neither changing the system or the people (i.e., user education or job rotation policies) will reduce resistance as long as the power imbalance and redistribution from the pre-implementation phase were not addressed. Before FIS implementation, divisional accountants at GTC felt that they owned all accounting data related to their divisional operations. They maintained this data in thick, manual ledger books, controlled others’ access to the data, and could reconcile unusual accounting events before releasing those reports. Corporate accountants relied heavily on divisional accountants for access to the divisional data for corporate reporting and consolidation. Because the FIS system automatically collected all data at source and consolidated them into a single corporate database, it obviated the need for divisional accountants, loosened their control and autonomy over their division’s accounting data, and making their job somewhat irrelevant. Corporate accountants could now query the database and access divisional data directly without going through the divisional accountants, analyze and compare the performance of individual divisions, and report unusual patterns and activities to the executive committee, resulting in further erosion of the divisions’ power. Though Markus did not empirically test this theory, her observations about the redistribution of organizational power, coupled with the rejection of the two alternative theories, led to the justification of interaction theory.

Comparisons with Traditional Research

Positivist case research, aimed at hypotheses testing, is often criticized by natural science researchers as lacking in controlled observations, controlled deductions, replicability, and generalizability of findings – the traditional principles of positivist research. However, these criticisms can be overcome through appropriate case research designs. For instance, the problem of controlled observations refers to the difficulty of obtaining experimental or statistical control in case research. However, case researchers can compensate for such lack of controls by employing “natural controls.” This natural control in Markus’ (1983) study was the corporate accountant who was one of the system advocates initially, but started resisting it once he moved to controlling division. In this instance, the change in his behavior may be attributed to his new divisional position. However, such natural controls cannot be anticipated in advance, and case researchers may overlook then unless they are proactively looking for such controls. Incidentally, natural controls are also used in natural science disciplines such as astronomy, geology, and human biology, such as wait for comets to pass close enough to the earth in order to make inferences about comets and their composition.

The problem of controlled deduction refers to the lack of adequate quantitative evidence to support inferences, given the mostly qualitative nature of case research data. Despite the lack of quantitative data for hypotheses testing (e.g., t-tests), controlled deductions can still be obtained in case research by generating behavioral predictions based on theoretical considerations and testing those predictions over time. Markus employed this strategy in her study by generating three alternative theoretical hypotheses for user resistance, and rejecting two of those predictions when they did not match with actual observed behavior. In this case, the hypotheses were tested using logical propositions rather than using mathematical tests, which are just as valid as statistical inferences since mathematics is a subset of logic.

Third, the problem of replicability refers to the difficulty of observing the same phenomenon given the uniqueness and idiosyncrasy of a given case site. However, using Markus’ three theories as an illustration, a different researcher can test the same theories at a different case site, where three different predictions may emerge based on the idiosyncratic nature of the new case site, and the three resulting predictions may be tested accordingly. In other words, it is possible to replicate the inferences of case research, even if the case research site or context may not be replicable.

Fourth, case research tends to examine unique and non-replicable phenomena that may not be generalized to other settings. Generalizability in natural sciences is established through additional studies. Likewise, additional case studies conducted in different contexts with different predictions can establish generalizability of findings if such findings are observed to be consistent across studies.

Lastly, British philosopher Karl Popper described four requirements of scientific theories: (1) theories should be falsifiable, (2) they should be logically consistent, (3) they should have adequate predictive ability, and (4) they should provide better explanation than rival theories. In case research, the first three requirements can be increased by increasing the degrees of freedom of observed findings, such as by increasing the number of case sites, the number of alternative predictions, and the number of levels of analysis examined. This was accomplished in Markus’ study by examining the behavior of multiple groups (divisional accountants and corporate accountants) and providing multiple (three) rival explanations.

Popper’s fourth condition was accomplished in this study when one hypothesis was found to match observed evidence better than the two rival hypotheses.

[8] Benbasat, I., Goldstein, D. K., and Mead, M. (1987). “The Case Research Strategy in Studies of Information Systems,” MIS Quarterly (11:3), 369-386.

[9] Yin, R. K. (2002), Case Study Research: Design and Methods . Thousand Oaks, CA: Sage Publications.

[10] Eisenhardt, K. M. (1989). “Building Theories from Case Research,” Academy of Management Review

(14:4), 532-550.

[11] Eisenhardt, K. M. (1989). “Making Fast Strategic Decisions in High-Velocity Environments,” Academy of Management Journal (32:3), 543-576.

[12] Markus, M. L. (1983). “Power, Politics, and MIS Implementation,” Communications of the ACM (26:6), 430-444.

  • Social Science Research: Principles, Methods, and Practices. Authored by : Anol Bhattacherjee. Provided by : University of South Florida. Located at : http://scholarcommons.usf.edu/oa_textbooks/3/ . License : CC BY-NC-SA: Attribution-NonCommercial-ShareAlike

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Management Research News

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Article publication date: 1 January 2002

Draws heavily on previous established research in an attempt to distil the key aspects of case study research in such a way as to encourage new researchers to grapple with and apply these. Explains when case study can be used, research design, data collection and data analysis, offering suggestions for drawing on the evidence in writing a report or dissertation. Briefly reviews alternative perspectives on the subject.

  • Case studies
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Rowley, J. (2002), "Using case studies in research", Management Research News , Vol. 25 No. 1, pp. 16-27. https://doi.org/10.1108/01409170210782990

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Case Study Research Writing Guidelines

case study research

Do you need to do a case study and write an essay based on your findings? Writing the academic paper is not as difficult as you think. Doing the case study research is the part you need to worry about, to be honest. Truth be told, doing case study research can take you days, if not weeks. Of course, the amount of time you spend researching greatly depends on the topic of your study.

Fortunately for high school and college students, we are here to shed some light on the case study assignment and on the research methodology. You will also find a quick guide towards the end of the blog post. It will help you write a case study research paper faster. Get a top grade on your next research case study with our help!

But What Is Case Study Research?

So, what is case study research? Case study research is exactly what its name suggests: the research you need to do to conduct the study. What is a case study, you ask? The case study is a research method in which the student analyzes a subject (it can be a person, a phenomenon, a trend, or even an animal) in real-life context. Simply put, the aim of your case study should be to analyze the subject as thoroughly as possible and then draw the appropriate conclusions.

Before you learn how to do case study research, you need to understand the differences between the various types of research. There are several methods you can use to gather data, each with its own applications. Let’s talk about the case study definition in research.

Main Types Of Case Study Research

The case study research methodology is important. It can make or break your study. Keep in mind that if you employ the wrong methods, the data you will gather will not be reliable. And don’t think that your professor won’t notice it. Teachers look at every case study research method you use to gather the evidence presented in your paper. Using the wrong method will get you a penalty – guaranteed. Here are the main types of case study research:

Explanatory case studies – this studies are primarily concerned with answering the “How” and “Why” questions. The researcher usually doesn’t have control over the subject or event. Your job is just to find out why and how something happened. Exploratory case studies – these case studies will answer the “What” and “Who” questions. The exploratory case study research methods include things like experiments, interviews, and even questionnaires in some cases. Descriptive case studies – these cases studies describe a sequence of events. Their main goal is to unearth the key phenomena at the heart of the issue being discussed. For example: “KFC Indonesia case study: the effects of multiculturalism on the marketing strategies.”

As you’ve probably heard, case study qualitative research is the best method for studying complex phenomena. It can even be used in health sciences to develop various theories and then develop the appropriate interventions. You won’t be using such complex methods in your high school or college case studies though.

Finding The Best Case Study Research Questions

Overall, the case study research design and methods are similar to methods used to write research papers or a custom thesis . First, you will need to figure out the perfect case study research design. After you have a rough idea of what your case study aims to achieve and you have a clear plan of action, it’s time to think about the questions. The truth is that nobody can give you a universal list of case study research questions. Why? Because the questions need to be tailored according to the goal of the study.

When creating the questions, you need to think how the answers will help you and your readers understand the phenomenon. In other words, you will word the questions according to the answers you need to write the paper. If you don’t know how to create excellent questions, you may need to get some case study research questions examples. These need to be custom-written for your study, of course.

In our opinion, the best way to get excellent questions is to get in touch with an academic writing company. Professional writers know exactly how to construct appropriate questions for any study you may think of. They have plenty of experience doing this, so you can expect to have an entire list of great questions in a matter of hours. You can even get an example of case study research that will be 100% original, written just for you.

Easy Way To Learn How To Do Case Study Research

Now that you know what is a case study research, it’s time to take a look at the simple steps you need to take in order to complete the study as fast as possible. Here is what you need to do, in order:

  • Find the topic of your case study. This is the phenomenon you wish to analyze. Again, it can be anything, including a person or an event.
  • You then need to define case study research methods. How will you analyze the phenomenon? Why is it relevant? What do you aim to learn?
  • Conduct the research and analyze the case thoroughly. Depending on the topic, you may need to conduct interviews or administer surveys. Gather all the data and organize it.
  • Start writing the case study. You will start with an introduction that presents the topic and your angle. Don’t forget to provide some background information about the topic so that your readers understand all the concepts.
  • Write the literature review section. You need to mention other studies that discuss the same topic, if any. Show your readers why they are incomplete or why there is a need to reinterpret their findings.
  • Write the methodology section. In this section, you will show your readers exactly which methods you used and why.
  • Write the discussion section. In this section, you will discuss the results of your research. It’s not enough to understand what is a case study in research. You also need to be able to analyze your findings and draw the most logical conclusions.
  • Write the conclusion section. This should be clear and concise and should summarize everything from the topic and methodology to the findings. Show your readers the significance of your research at the end of the conclusion paragraph.

On a final note, remember that the quality of your case study depends greatly on the value of the case study research. You need to make sure your research is spot-on; otherwise, you should consider getting some help from a professional writer.

Our writing service hires only the most top tier professionals to help out with any concerns and writing tasks you might have. They are knowledgeable and trustworthy, and can assist with anything, starting from proofreading, to doing data analysis for dissertation . Do not think twice about contacting us, as we are available 24/7 and to anyone in the world. Get in touch with our customer support team to get more details.

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Varieties of Qualitative Research Methods pp 67–72 Cite as

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The historical origin and strategy of case study research dates back many years in applied and natural sciences. Its roots are traceable to life sciences such as criminology, medicine, and psychology. In this regard, the case study method is recognized and widely used in social science, especially in political and cultural studies and sociology, and educational research.

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Baxter, P., & Jack, S. (2008). Qualitative case study methodology: Study design and implementation for novice researchers. The Qualitative Report, 13 (4), 544–559. http://www.nova.edu/ssss/QR/QR13-4/baxter.pdf

Bengtsson, L., & Larsson, R. (2012). Researching mergers and acquisitions with the case study method: Idiographic understanding of longitudinal integration processes. CSIR Electronic Working Paper Series , 4 . https://doi.org/10.4337/9781848449565.00015

Eisenhardt, K. M. (1989). Building theories from case study research. Academy of Management Review, 14 (14), 532–550. https://doi.org/10.1016/j.jbusres.2010.08.014

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Ndame, T. (2012). Whole school inclusion: A case study of two secondary schools in Cameroon . Graduate School of Education. College of Social Sciences and International Studies, University of Exeter, UK (EdD Thesis). http://hdl.handle.net/10036/3900

Ravenswood, K. (2011). Eisenhardt’s impact on theory in case study research. Journal of Business Research, 64 , 680–686.

Rozsahegyi, T. (2019). Case study. In M. Lambert (Ed.), Practical research method in education: An early researcher critical guide (pp. 124–131). Routledge.

Tsang, E. (2014). Case study and generalization in information systems research: A critical realist perspective. Journal of Strategic Information Systems, 23 , 174–186. https://doi.org/10.1016/j.jsis.2013.09.002

Yin, R. K. (2003). Case study research: Design and methods (3rd ed.) Sage.

Additional Readings

Creswell, J. W., & Creswell, J. D. (2018). Research design: Qualitative, quantitative and mixed methods approaches (5th ed.). Sage.

Harland, T. (2014). Learning about case study methodology to research higher education. Higher Education Research & Development, 33 (6), 1113–1122. https://doi.org/10.1080/07294360.2014.911253

Pan, S., & Tan, B. (2011). Demystifying case research: A structured-pragmatic-situational (SPS) approach to conducting case studies. Information and Organization, 21 , 161–176. https://doi.org/10.1016/j.infoandorg.2011.07.001

Tsang, E. (2013). Case study methodology: Causal explanation, contextualization and theorizing. Journal of International Management, 19 , 195–202. https://doi.org/10.1016/j.intman.2012.08.004

Yin, R. K. (2017). Case study research and applications: Designs and methods (6th ed.). Sage.

Zarnadze, S., Zarnadze, I., Baramidze, L., Sikharulidze, Z., Tabidze, D., & Bakradze, T. (2018). Problem based and case study methodology in medical education. European Scientific Journal, 120–128. https://doi.org/10.19044/esj.2018.c5p9

Online Resources

Case Study Research. https://www.youtube.com/watch?v=RPB3Q9cXmvs

Planning a Case Study. Part 2 of 3 on Case Studies. https://www.youtube.com/watch?v=o1JetXkFAr4

Qualitative analysis of interview data: A step-by-step guide for coding/indexing. https://www.youtube.com/watch?v=DRL4PF2u9XA

Qualitative Case Study. https://www.youtube.com/watch?v=QhvdC4vDjts

Replication or Single Cases. Part 3 of 3 on Case Studies. https://www.youtube.com/watch?v=b5CYZRyOlys

Types of Case Study. Part 1 of 3 on Case Studies. https://www.youtube.com/watch?v=gQfoq7c4UE4

What is case study and how to conduct case study research. https://www.youtube.com/watch?v=kynoEFQNEq8

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Trump asks appeals court to lift gag order imposed on him in 2020 election interference case

FILE - This undated photo provided by the Administrative Office of the U.S. Courts, shows U.S. District Judge Tanya Chutkan. Chutkan, the federal judge overseeing the 2020 election interference case against former President Donald Trump says those involved in the case must not disclose possible jurors' names as she set rules around conducting research into potential members of the jury.(Administrative Office of the U.S. Courts via AP, File)

FILE - This undated photo provided by the Administrative Office of the U.S. Courts, shows U.S. District Judge Tanya Chutkan. Chutkan, the federal judge overseeing the 2020 election interference case against former President Donald Trump says those involved in the case must not disclose possible jurors’ names as she set rules around conducting research into potential members of the jury.(Administrative Office of the U.S. Courts via AP, File)

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Former President Donald Trump asked a federal appeals court on Thursday to lift a gag order restricting his speech about potential witnesses, prosecutors and court staff in the case that accuses him of scheming to overturn his 2020 election loss.

Trump’s attorneys urged the U.S. Court of Appeals for the D.C. Circuit to block the gag order ruling from U.S. District Judge Tanya Chutkan while the Republican former president pursues his appeals.

Trump’s lawyers say they will seek relief from the U.S. Supreme Court if the appeals court denies his request, arguing that the gag order violates Trump’s First Amendment rights and those of “over 100 million Americans who listen to him.”

“The prosecution’s request for a Gag Order bristles with hostility to President Trump’s viewpoint and his relentless criticism of the government — including of the prosecution itself,” Trump’s lawyers wrote in court papers. “The Gag Order embodies this unconstitutional hostility to President Trump’s viewpoint.”

Republican presidential candidate Florida Gov. Ron DeSantis speaks during a meet and greet, Friday, Nov. 3, 2023, in Denison, Iowa. (AP Photo/Charlie Neibergall)

Chutkan, an appointee of former President Barack Obama, reimposed the gag order on Sunday after denying Trump’s request to let him speak freely while he challenges the restrictions in higher courts.

The order bars Trump from making public statements targeting special counsel Jack Smith and his team, court employees and possible witnesses. It does not prohibit Trump from airing general complaints, even incendiary ones, about the case against him. The judge has explicitly said Trump is still allowed to assert his claims of innocence and his claims that the case is politically motivated.

Trump has made verbal attacks on those involved in the criminal cases against him a central part of his bid to reclaim the White House in 2024. Trump has denied any wrongdoing in the case, and cast himself as the victim of a politically motivated justice system working to deny him another term.

In pushing to reinstate the gag order , prosecutors pointed to Trump’s recent social media comments about his former chief of staff Mark Meadows, which they said represented an attempt to influence and intimidate a likely witness in the case.

Trump’s lawyers say the gag order unfairly prevents him from responding to broadsides from potential witnesses. who themselves are public figures.

“The ‘witnesses’ who supposedly might be ‘intimidated’ by President Trump’s speech are former officials from the highest echelons of government who have repeatedly attacked President Trump and his fitness for the Presidency in public statements, national media interviews, and books,” Trump’s attorneys wrote.

Also on Thursday, the judge set rules around conducting research on possible jurors, who will be brought to the courthouse in Washington on Feb. 9 to fill out a questionnaire that will help the sides narrow down the jury pool before the trial. The trial is scheduled to begin on March 4.

Prosecutors had raised concerns about what Trump might do with research on possible jurors, citing the former president’s “continued use of social media as a weapon of intimidation in court proceedings.”

Trump’s lawyers have said the former president “has no intention of publicizing the names or other contact information of jurors.”

Chutkan said in her order on Thursday that while prosecutors and the defense can do open-source research into potential jurors, they cannot use non-public databases or have direct contact with them.

She ordered the sides not to reveal potential jurors’ names or any other identifying information. And she said that juror information can not be given to other entities not involved in the case — like Trump’s 2024 presidential campaign.

Richer reported from Boston.

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Trump asks appeals court to lift gag order imposed on him in 2020 election interference case

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Former President Donald Trump asked a federal appeals court on Thursday to lift a gag order restricting his speech about potential witnesses, prosecutors and court staff in the case that accuses him of scheming to overturn his 2020 election loss.

Trump’s attorneys urged the U.S. Court of Appeals for the D.C. Circuit to block the gag order ruling from U.S. District Judge Tanya Chutkan while the Republican former president pursues his appeals.

Trump's lawyers say they will seek relief from the U.S. Supreme Court if the appeals court denies his request, arguing that the gag order violates Trump's First Amendment rights and those of “over 100 million Americans who listen to him.”

“The prosecution’s request for a Gag Order bristles with hostility to President Trump’s viewpoint and his relentless criticism of the government — including of the prosecution itself," Trump's lawyers wrote in court papers. "The Gag Order embodies this unconstitutional hostility to President Trump’s viewpoint."

Chutkan, an appointee of former President Barack Obama, reimposed the gag order on Sunday after denying Trump’s request to let him speak freely while he challenges the restrictions in higher courts.

The order bars Trump from making public statements targeting special counsel Jack Smith and his team, court employees and possible witnesses. It does not prohibit Trump from airing general complaints, even incendiary ones, about the case against him. The judge has explicitly said Trump is still allowed to assert his claims of innocence and his claims that the case is politically motivated.

Trump has made verbal attacks on those involved in the criminal cases against him a central part of his bid to reclaim the White House in 2024. Trump has denied any wrongdoing in the case, and cast himself as the victim of a politically motivated justice system working to deny him another term.

In pushing to reinstate the gag order , prosecutors pointed to Trump’s recent social media comments about his former chief of staff Mark Meadows, which they said represented an attempt to influence and intimidate a likely witness in the case.

Trump's lawyers say the gag order unfairly prevents him from responding to broadsides from potential witnesses. who themselves are public figures.

“The 'witnesses' who supposedly might be ‘intimidated’ by President Trump’s speech are former officials from the highest echelons of government who have repeatedly attacked President Trump and his fitness for the Presidency in public statements, national media interviews, and books,” Trump's attorneys wrote.

Also on Thursday, the judge set rules around conducting research on possible jurors, who will be brought to the courthouse in Washington on Feb. 9 to fill out a questionnaire that will help the sides narrow down the jury pool before the trial. The trial is scheduled to begin on March 4.

Prosecutors had raised concerns about what Trump might do with research on possible jurors, citing the former president’s “continued use of social media as a weapon of intimidation in court proceedings.”

Trump’s lawyers have said the former president “has no intention of publicizing the names or other contact information of jurors.”

Chutkan said in her order on Thursday that while prosecutors and the defense can do open-source research into potential jurors, they cannot use non-public databases or have direct contact with them.

She ordered the sides not to reveal potential jurors’ names or any other identifying information. And she said that juror information can not be given to other entities not involved in the case — like Trump’s 2024 presidential campaign.

Richer reported from Boston.

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  1. How to do case study in Research

    in this case research

  2. How to do a Case Study

    in this case research

  3. Case Study Research

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  4. How to Create a Case Study + 14 Case Study Templates

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  5. Case Study Research Example / Example Of Case Study Methodology Pdf

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  6. Case Study

    in this case research

VIDEO

  1. 01.03a

  2. An Introduction to Single-Case Research Methods for Intervention Research

  3. American Cuckolds

  4. Examining DNA for Unknown Parentage

  5. What's the Best Telescope for My Camping Trip?

  6. Case Study Part 3: Developing or Selecting the Case

COMMENTS

  1. What Is a Case Study?

    Step 1: Select a case 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

  2. How to Use Case Studies in Research: Guide and Examples

    1. Select a case. Once you identify the problem at hand and come up with questions, identify the case you will focus on. The study can provide insights into the subject at hand, challenge existing assumptions, propose a course of action, and/or open up new areas for further research. 2.

  3. Writing a Case Study

    A case study research paper examines a person, place, event, condition, phenomenon, or other type of subject of analysis in order to extrapolate key themes and results that help predict future trends, illuminate previously hidden issues that can be applied to practice, and/or provide a means for understanding an important research problem with g...

  4. Exploring the Power of Cases studies & Research Insights

    What is a case study? Whereas quantitative methods look at phenomena at scale, case study research looks at a concept or phenomenon in considerable detail. While analyzing a single case can help understand one perspective regarding the object of research inquiry, analyzing multiple cases can help obtain a more holistic sense of the topic or issue.

  5. Case Study

    Defnition: 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.

  6. Case Study Method: A Step-by-Step Guide for Business Researchers

    Case study method is the most widely used method in academia for researchers interested in qualitative research ( Baskarada, 2014 ). Research students select the case study as a method without understanding array of factors that can affect the outcome of their research.

  7. Doing Case Study Research: A Practical Guide for Begining Researchers

    The study utilized a case study research design (Hancock et al., 2021): an intensive analysis and description of school systems' use of technology to address inequities during the COVID-19 ...

  8. Case Study Research: How to Apply It in Different Domains ...

    Case study research is a qualitative and quantitative research methodology that involves in-depth analysis of a specific phenomenon, event, or situation in its real-world context. Case...

  9. Understanding and Identifying 'Themes' in Qualitative Case Study Research

    The next research case by Kristina Ryabova, Victoria Fomina and Anjan Ghosh do a process study using the analysis process of Gioia . The study explored the possible link between product creativity and business model and suggested that a creative enterprise can address both competition and environmental shocks through the process consisting of ...

  10. What the Case Study Method Really Teaches

    December 21, 2021 Klaus Vedfelt/Getty Images Summary. It's been 100 years since Harvard Business School began using the case study method. Beyond teaching specific subject matter, the case...

  11. Trump asks appeals court to lift gag order imposed on him in 2020

    Former President Donald Trump has asked a federal appeals court to lift a gag order restricting his speech about potential witnesses, prosecutors and court staff in the case that accuses him of ...

  12. (PDF) Case Study Research

    This chapter addresses the peculiarities, characteristics, and major fallacies of single case research designs. A single case study research design is a collective term for an in-depth analysis of ...

  13. Investigators are being sent to US research base on Antarctica to look

    Investigators are being sent to US research base on Antarctica to look into sexual violence concerns. The watchdog office overseeing the National Science Foundation is sending investigators to ...

  14. Mpox circulated for five years before global explosion in 2022

    Mpox was first discovered in the 1950s when outbreaks of the disease struck monkeys held in laboratories for research. The first human case was recorded in 1970 in the Democratic Republic of the ...

  15. Case Study in Psychology

    A case study meaning in psychology is a qualitative research method that seeks to understand a phenomenon in a real-life setting. A researcher will use a case study if they want to answer the how ...

  16. The case study approach

    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.

  17. What is a case study?

    There is no one definition of case study research. 1 However, very simply… 'a case study can be defined as an intensive study about a person, a group of people or a unit, which is aimed to generalize over several units'. 1 A case study has also been described as an intensive, systematic investigation of a single individual, group, community or s...

  18. Case Study Methodology of Qualitative Research: Key Attributes and

    1. Case study is a research strategy, and not just a method/technique/process of data collection. 2. A case study involves a detailed study of the concerned unit of analysis within its natural setting. A de-contextualised study has no relevance in a case study research.

  19. Findings from the case studies

    In this chapter we present the findings from the 22 case studies. We provide a rationale for why NPT was found to be the most comprehensive and predictive programme theory for PPI and present the 16 NPT informed mechanisms that were tested within the case studies. We then summarise the key findings and list the contexts that enabled mechanisms. CMO tables are provided, illustrating salient ...

  20. Chapter 11 Case Research

    The case research method is particularly appropriate for exploratory studies for discovering relevant constructs in areas where theory building at the formative stages, for studies where the experiences of participants and context of actions are critical, and for studies aimed at understanding complex, temporal processes (why and how of a phenom...

  21. Using case studies in research

    Abstract. Draws heavily on previous established research in an attempt to distil the key aspects of case study research in such a way as to encourage new researchers to grapple with and apply these. Explains when case study can be used, research design, data collection and data analysis, offering suggestions for drawing on the evidence in ...

  22. How To Do Case Study Research? Step-By-Step Manual

    Conduct the research and analyze the case thoroughly. Depending on the topic, you may need to conduct interviews or administer surveys. Gather all the data and organize it. Start writing the case study. You will start with an introduction that presents the topic and your angle.

  23. Case Study

    According to Rozsahegyi ( 2019, p. 124), a case study is a research design that is particularly suitable for developing, extending, and deepening understanding and knowledge about aspects of the real-life world. Yin ( 2003) outlines that a case study is used when: (a) the focus of the study is to answer "how" and "why" questions; (b) it ...

  24. Trump asks appeals court to lift gag order imposed on him in 2020

    FILE - This undated photo provided by the Administrative Office of the U.S. Courts, shows U.S. District Judge Tanya Chutkan. Chutkan, the federal judge overseeing the 2020 election interference case against former President Donald Trump says those involved in the case must not disclose possible jurors' names as she set rules around conducting research into potential members of the jury ...

  25. Using Research for Investigative Decision-Making

    In general, research is systematic inquiry. It starts with a question and uses a process to find answers. This search for answers is expanded through the scientific method, which ensures the testability of initial questions and the generalizable and predictive quality of findings.. Behavioral and investigative research can be actively sought out by research-savvy decision makers to address a ...

  26. Case Study Research

    Case study research in information systems. Graeme Shanks, Nargiza Bekmamedova, in Research Methods (Second Edition), 2018. Conclusion. Case study research is one of the most widely used research approaches within information systems and is also an important method in library and information studies/science. It is a highly flexible research approach that may be used within different ...

  27. Case Research

    Case Studies. Long a staple of political science research, case studies have the advantage of examining politics holistically. Sometimes this comes at the expense of the ability to generalize findings by placing them in a rigorous theoretical context. That such is not an inherent limitation of the case study method can be seen in two very ...

  28. Trump asks appeals court to lift gag order imposed on him in 2020

    Former President Donald Trump asked a federal appeals court on Thursday to lift a gag order restricting his speech about potential witnesses, prosecutors and court staff in the case that accuses him of scheming to overturn his 2020 election loss. Trump's attorneys urged the U.S. Court of Appeals for the D.C. Circuit to block the gag order ruling from U.S. District Judge Tanya Chutkan while ...

  29. Get help finding research and creative endeavors opportunities

    The Undergraduate Research Office has scheduled several "All About Finding Research and Creative Endeavors" information sessions in the next few weeks. These 50-minute sessions provide students with the basic information for finding research on and around the Case Western Reserve University campus. These sessions will focus on projects offered during the academic year, but some guidance ...

  30. FDA eye drop recall: Don't use these CVS, Rite Aid, Walmart and Target

    This new eye drop recall follows recalls earlier this year. The over-the-counter lubricating drops are sold by CVS, Rite Aid, Target, Walmart, Leader, Rugby and Velocity Pharma. The complete list of recalled eye drops is available here. The FDA recalled the products after its investigators found unsanitary conditions in the manufacturing ...