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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 .

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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McCombes, S. (2023, June 22). What Is a Case Study? | Definition, Examples & Methods. Scribbr. Retrieved August 28, 2023, from https://www.scribbr.com/methodology/case-study/

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Home » Case Study – Methods, Examples and Guide

Case Study – Methods, Examples and Guide

Table of Contents

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.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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Case Study | Definition, Examples & Methods

Case Study | Definition, Examples & Methods

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

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

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

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

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

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

Prevent plagiarism, run a free check.

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

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

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

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

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

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

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

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

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

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

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

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

Cite this Scribbr article

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

McCombes, S. (2023, January 30). Case Study | Definition, Examples & Methods. Scribbr. Retrieved 28 August 2023, from https://www.scribbr.co.uk/research-methods/case-studies/

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Shona McCombes

Other students also liked, correlational research | guide, design & examples, a quick guide to experimental design | 5 steps & examples, descriptive research design | definition, methods & examples.

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What the Case Study Method Really Teaches

Nitin Nohria

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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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.

Analyze case study research

Dovetail streamlines case study research to help you uncover and share actionable insights

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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What Is a Case Study?

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Benefits and Limitations

Types of case studies, how to write a case study.

A case study is an in-depth study of one person, group, or event. In a case study, nearly every aspect of the subject's life and history is analyzed to seek patterns and causes of behavior. Case studies can be used in various fields, including psychology, medicine, education, anthropology, political science, and social work.

The purpose of a case study is to learn as much as possible about an individual or group so that the information can be generalized to many others. Unfortunately, case studies tend to be highly subjective, and it is sometimes difficult to generalize results to a larger population.

While case studies focus on a single individual or group, they follow a format similar to other types of psychology writing. If you are writing a case study, it is important to follow the rules of APA format .

A case study can have both strengths and weaknesses. Researchers must consider these pros and cons before deciding if this type of study is appropriate for their needs.

One of the greatest advantages of a case study is that it allows researchers to investigate things that are often difficult to impossible to replicate in a lab. Some other benefits of a case study:

Allows researchers to collect a great deal of information
Give researchers the chance to collect information on rare or unusual cases
Permits researchers to develop hypotheses that can be explored in experimental research

On the negative side, a case study:

Cannot necessarily be generalized to the larger population
Cannot demonstrate cause and effect
May not be scientifically rigorous
Can lead to bias

Researchers may choose to perform a case study if they are interested in exploring a unique or recently discovered phenomenon. The insights gained from such research can help the researchers develop additional ideas and study questions that might be explored in future studies.

However, it is important to remember that the insights gained from case studies cannot be used to determine cause and effect relationships between variables. However, case studies may be used to develop hypotheses that can then be addressed in experimental research.

Case Study Examples

There have been a number of notable case studies in the history of psychology. Much of Freud's work and theories were developed through the use of individual case studies. Some great examples of case studies in psychology include:

Anna O : Anna O. was a pseudonym of a woman named Bertha Pappenheim, a patient of a physician named Josef Breuer. While she was never a patient of Freud's, Freud and Breuer discussed her case extensively. The woman was experiencing symptoms of a condition that was then known as hysteria and found that talking about her problems helped relieve her symptoms. Her case played an important part in the development of talk therapy as an approach to mental health treatment.
Phineas Gage : Phineas Gage was a railroad employee who experienced a terrible accident in which an explosion sent a metal rod through his skull, damaging important portions of his brain. Gage recovered from his accident but was left with serious changes in both personality and behavior.
Genie : Genie was a young girl subjected to horrific abuse and isolation. The case study of Genie allowed researchers to study whether language could be taught even after critical periods for language development had been missed. Her case also served as an example of how scientific research may interfere with treatment and lead to further abuse of vulnerable individuals.

Such cases demonstrate how case research can be used to study things that researchers could not replicate in experimental settings. In Genie's case, her horrific abuse had denied her the opportunity to learn language at critical points in her development.

This is clearly not something that researchers could ethically replicate, but conducting a case study on Genie allowed researchers the chance to study phenomena that are otherwise impossible to reproduce.

There are a few different types of case studies that psychologists and other researchers might utilize:

Collective case studies : These involve studying a group of individuals. Researchers might study a group of people in a certain setting or look at an entire community. For example, psychologists might explore how access to resources in a community has affected the collective mental well-being of those living there.
Descriptive case studies : These involve starting with a descriptive theory. The subjects are then observed, and the information gathered is compared to the pre-existing theory.
Explanatory case studies : These are often used to do causal investigations. In other words, researchers are interested in looking at factors that may have caused certain things to occur.
Exploratory case studies : These are sometimes used as a prelude to further, more in-depth research. This allows researchers to gather more information before developing their research questions and hypotheses .
Instrumental case studies : These occur when the individual or group allows researchers to understand more than what is initially obvious to observers.
Intrinsic case studies : This type of case study is when the researcher has a personal interest in the case. Jean Piaget's observations of his own children are good examples of how an intrinsic cast study can contribute to the development of a psychological theory.

The three main case study types often used are intrinsic, instrumental, and collective. Intrinsic case studies are useful for learning about unique cases. Instrumental case studies help look at an individual to learn more about a broader issue. A collective case study can be useful for looking at several cases simultaneously.

The type of case study that psychology researchers utilize depends on the unique characteristics of the situation as well as the case itself.

There are also different methods that can be used to conduct a case study, including prospective and retrospective case study methods.

Prospective case study methods are those in which an individual or group of people is observed in order to determine outcomes. For example, a group of individuals might be watched over an extended period of time to observe the progression of a particular disease.

Retrospective case study methods involve looking at historical information. For example, researchers might start with an outcome, such as a disease, and then work their way backward to look at information about the individual's life to determine risk factors that may have contributed to the onset of the illness.

Where to Find Data

There are a number of different sources and methods that researchers can use to gather information about an individual or group. Six major sources that have been identified by researchers are:

Archival records : Census records, survey records, and name lists are examples of archival records.
Direct observation : This strategy involves observing the subject, often in a natural setting . While an individual observer is sometimes used, it is more common to utilize a group of observers.
Documents : Letters, newspaper articles, administrative records, etc., are the types of documents often used as sources.
Interviews : Interviews are one of the most important methods for gathering information in case studies. An interview can involve structured survey questions or more open-ended questions.
Participant observation : When the researcher serves as a participant in events and observes the actions and outcomes, it is called participant observation.
Physical artifacts : Tools, objects, instruments, and other artifacts are often observed during a direct observation of the subject.

Section 1: A Case History

This section will have the following structure and content:

Background information : The first section of your paper will present your client's background. Include factors such as age, gender, work, health status, family mental health history, family and social relationships, drug and alcohol history, life difficulties, goals, and coping skills and weaknesses.

Description of the presenting problem : In the next section of your case study, you will describe the problem or symptoms that the client presented with.

Describe any physical, emotional, or sensory symptoms reported by the client. Thoughts, feelings, and perceptions related to the symptoms should also be noted. Any screening or diagnostic assessments that are used should also be described in detail and all scores reported.

Your diagnosis : Provide your diagnosis and give the appropriate Diagnostic and Statistical Manual code. Explain how you reached your diagnosis, how the client's symptoms fit the diagnostic criteria for the disorder(s), or any possible difficulties in reaching a diagnosis.

Section 2: Treatment Plan

This portion of the paper will address the chosen treatment for the condition. This might also include the theoretical basis for the chosen treatment or any other evidence that might exist to support why this approach was chosen.

Cognitive behavioral approach : Explain how a cognitive behavioral therapist would approach treatment. Offer background information on cognitive behavioral therapy and describe the treatment sessions, client response, and outcome of this type of treatment. Make note of any difficulties or successes encountered by your client during treatment.
Humanistic approach : Describe a humanistic approach that could be used to treat your client, such as client-centered therapy . Provide information on the type of treatment you chose, the client's reaction to the treatment, and the end result of this approach. Explain why the treatment was successful or unsuccessful.
Psychoanalytic approach : Describe how a psychoanalytic therapist would view the client's problem. Provide some background on the psychoanalytic approach and cite relevant references. Explain how psychoanalytic therapy would be used to treat the client, how the client would respond to therapy, and the effectiveness of this treatment approach.
Pharmacological approach : If treatment primarily involves the use of medications, explain which medications were used and why. Provide background on the effectiveness of these medications and how monotherapy may compare with an approach that combines medications with therapy or other treatments.

This section of a case study should also include information about the treatment goals, process, and outcomes.

When you are writing a case study, you should also include a section where you discuss the case study itself, including the strengths and limitiations of the study. You should note how the findings of your case study might support previous research.

In your discussion section, you should also describe some of the implications of your case study. What ideas or findings might require further exploration? How might researchers go about exploring some of these questions in additional studies?

Here are a few additional pointers to keep in mind when formatting your case study:

Never refer to the subject of your case study as "the client." Instead, their name or a pseudonym.
Read examples of case studies to gain an idea about the style and format.
Remember to use APA format when citing references .

A Word From Verywell

Case studies can be a useful research tool, but they need to be used wisely. In many cases, they are best utilized in situations where conducting an experiment would be difficult or impossible. They are helpful for looking at unique situations and allow researchers to gather a great deal of information about a specific individual or group of people.

If you have been directed to write a case study for a psychology course, be sure to check with your instructor for any specific guidelines that you are required to follow. If you are writing your case study for professional publication, be sure to check with the publisher for their specific guidelines for submitting a case study.

Simply Psychology. Case Study Method .

Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach . BMC Med Res Methodol . 2011 Jun 27;11:100. doi:10.1186/1471-2288-11-100

Gagnon, Yves-Chantal. The Case Study as Research Method: A Practical Handbook . Canada, Chicago Review Press Incorporated DBA Independent Pub Group, 2010.

Yin, Robert K. Case Study Research and Applications: Design and Methods . United States, SAGE Publications, 2017.

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

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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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The case study approach

Sarah crowe.

1 Division of Primary Care, The University of Nottingham, Nottingham, UK

Kathrin Cresswell

2 Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK

Ann Robertson

3 School of Health in Social Science, The University of Edinburgh, Edinburgh, UK

Anthony Avery

Aziz sheikh.

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

Introduction

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

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

This paper is structured around the following main questions: What is a case study? What are case studies used for? How are case studies conducted? What are the potential pitfalls and how can these be avoided? We draw in particular on four of our own recently published examples of case studies (see Tables Tables1, 1 , ,2, 2 , ,3 3 and and4) 4 ) and those of others to illustrate our discussion[ 3 - 7 ].

Example of a case study investigating the reasons for differences in recruitment rates of minority ethnic people in asthma research[ 3 ]

Example of a case study investigating the process of planning and implementing a service in Primary Care Organisations[ 4 ]

Example of a case study investigating the introduction of the electronic health records[ 5 ]

Example of a case study investigating the formal and informal ways students learn about patient safety[ 6 ]

What is a case study?

A case study is a research approach that is used to generate an in-depth, multi-faceted understanding of a complex issue in its real-life context. It is an established research design that is used extensively in a wide variety of disciplines, particularly in the social sciences. A case study can be defined in a variety of ways (Table (Table5), 5 ), the central tenet being the need to explore an event or phenomenon in depth and in its natural context. It is for this reason sometimes referred to as a "naturalistic" design; this is in contrast to an "experimental" design (such as a randomised controlled trial) in which the investigator seeks to exert control over and manipulate the variable(s) of interest.

Definitions of a case study

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

These are however not necessarily mutually exclusive categories. In the first of our examples (Table (Table1), 1 ), we undertook an intrinsic case study to investigate the issue of recruitment of minority ethnic people into the specific context of asthma research studies, but it developed into a instrumental case study through seeking to understand the issue of recruitment of these marginalised populations more generally, generating a number of the findings that are potentially transferable to other disease contexts[ 3 ]. In contrast, the other three examples (see Tables Tables2, 2 , ,3 3 and and4) 4 ) employed collective case study designs to study the introduction of workforce reconfiguration in primary care, the implementation of electronic health records into hospitals, and to understand the ways in which healthcare students learn about patient safety considerations[ 4 - 6 ]. Although our study focusing on the introduction of General Practitioners with Specialist Interests (Table (Table2) 2 ) was explicitly collective in design (four contrasting primary care organisations were studied), is was also instrumental in that this particular professional group was studied as an exemplar of the more general phenomenon of workforce redesign[ 4 ].

What are case studies used for?

According to Yin, case studies can be used to explain, describe or explore events or phenomena in the everyday contexts in which they occur[ 1 ]. These can, for example, help to understand and explain causal links and pathways resulting from a new policy initiative or service development (see Tables Tables2 2 and and3, 3 , for example)[ 1 ]. In contrast to experimental designs, which seek to test a specific hypothesis through deliberately manipulating the environment (like, for example, in a randomised controlled trial giving a new drug to randomly selected individuals and then comparing outcomes with controls),[ 9 ] the case study approach lends itself well to capturing information on more explanatory ' how ', 'what' and ' why ' questions, such as ' how is the intervention being implemented and received on the ground?'. The case study approach can offer additional insights into what gaps exist in its delivery or why one implementation strategy might be chosen over another. This in turn can help develop or refine theory, as shown in our study of the teaching of patient safety in undergraduate curricula (Table (Table4 4 )[ 6 , 10 ]. Key questions to consider when selecting the most appropriate study design are whether it is desirable or indeed possible to undertake a formal experimental investigation in which individuals and/or organisations are allocated to an intervention or control arm? Or whether the wish is to obtain a more naturalistic understanding of an issue? The former is ideally studied using a controlled experimental design, whereas the latter is more appropriately studied using a case study design.

Case studies may be approached in different ways depending on the epistemological standpoint of the researcher, that is, whether they take a critical (questioning one's own and others' assumptions), interpretivist (trying to understand individual and shared social meanings) or positivist approach (orientating towards the criteria of natural sciences, such as focusing on generalisability considerations) (Table (Table6). 6 ). Whilst such a schema can be conceptually helpful, it may be appropriate to draw on more than one approach in any case study, particularly in the context of conducting health services research. Doolin has, for example, noted that in the context of undertaking interpretative case studies, researchers can usefully draw on a critical, reflective perspective which seeks to take into account the wider social and political environment that has shaped the case[ 11 ].

Example of epistemological approaches that may be used in case study research

How are case studies conducted?

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

Defining the case

Carefully formulated research question(s), informed by the existing literature and a prior appreciation of the theoretical issues and setting(s), are all important in appropriately and succinctly defining the case[ 8 , 12 ]. Crucially, each case should have a pre-defined boundary which clarifies the nature and time period covered by the case study (i.e. its scope, beginning and end), the relevant social group, organisation or geographical area of interest to the investigator, the types of evidence to be collected, and the priorities for data collection and analysis (see Table Table7 7 )[ 1 ]. A theory driven approach to defining the case may help generate knowledge that is potentially transferable to a range of clinical contexts and behaviours; using theory is also likely to result in a more informed appreciation of, for example, how and why interventions have succeeded or failed[ 13 ].

Example of a checklist for rating a case study proposal[ 8 ]

For example, in our evaluation of the introduction of electronic health records in English hospitals (Table (Table3), 3 ), we defined our cases as the NHS Trusts that were receiving the new technology[ 5 ]. Our focus was on how the technology was being implemented. However, if the primary research interest had been on the social and organisational dimensions of implementation, we might have defined our case differently as a grouping of healthcare professionals (e.g. doctors and/or nurses). The precise beginning and end of the case may however prove difficult to define. Pursuing this same example, when does the process of implementation and adoption of an electronic health record system really begin or end? Such judgements will inevitably be influenced by a range of factors, including the research question, theory of interest, the scope and richness of the gathered data and the resources available to the research team.

Selecting the case(s)

The decision on how to select the case(s) to study is a very important one that merits some reflection. In an intrinsic case study, the case is selected on its own merits[ 8 ]. The case is selected not because it is representative of other cases, but because of its uniqueness, which is of genuine interest to the researchers. This was, for example, the case in our study of the recruitment of minority ethnic participants into asthma research (Table (Table1) 1 ) as our earlier work had demonstrated the marginalisation of minority ethnic people with asthma, despite evidence of disproportionate asthma morbidity[ 14 , 15 ]. In another example of an intrinsic case study, Hellstrom et al.[ 16 ] studied an elderly married couple living with dementia to explore how dementia had impacted on their understanding of home, their everyday life and their relationships.

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

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

The selected case study site(s) should allow the research team access to the group of individuals, the organisation, the processes or whatever else constitutes the chosen unit of analysis for the study. Access is therefore a central consideration; the researcher needs to come to know the case study site(s) well and to work cooperatively with them. Selected cases need to be not only interesting but also hospitable to the inquiry [ 8 ] if they are to be informative and answer the research question(s). Case study sites may also be pre-selected for the researcher, with decisions being influenced by key stakeholders. For example, our selection of case study sites in the evaluation of the implementation and adoption of electronic health record systems (see Table Table3) 3 ) was heavily influenced by NHS Connecting for Health, the government agency that was responsible for overseeing the National Programme for Information Technology (NPfIT)[ 5 ]. This prominent stakeholder had already selected the NHS sites (through a competitive bidding process) to be early adopters of the electronic health record systems and had negotiated contracts that detailed the deployment timelines.

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

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

Collecting the data

In order to develop a thorough understanding of the case, the case study approach usually involves the collection of multiple sources of evidence, using a range of quantitative (e.g. questionnaires, audits and analysis of routinely collected healthcare data) and more commonly qualitative techniques (e.g. interviews, focus groups and observations). The use of multiple sources of data (data triangulation) has been advocated as a way of increasing the internal validity of a study (i.e. the extent to which the method is appropriate to answer the research question)[ 8 , 18 - 21 ]. An underlying assumption is that data collected in different ways should lead to similar conclusions, and approaching the same issue from different angles can help develop a holistic picture of the phenomenon (Table (Table2 2 )[ 4 ].

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

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

Analysing, interpreting and reporting case studies

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

The Framework approach is a practical approach, comprising of five stages (familiarisation; identifying a thematic framework; indexing; charting; mapping and interpretation) , to managing and analysing large datasets particularly if time is limited, as was the case in our study of recruitment of South Asians into asthma research (Table (Table1 1 )[ 3 , 24 ]. Theoretical frameworks may also play an important role in integrating different sources of data and examining emerging themes. For example, we drew on a socio-technical framework to help explain the connections between different elements - technology; people; and the organisational settings within which they worked - in our study of the introduction of electronic health record systems (Table (Table3 3 )[ 5 ]. Our study of patient safety in undergraduate curricula drew on an evaluation-based approach to design and analysis, which emphasised the importance of the academic, organisational and practice contexts through which students learn (Table (Table4 4 )[ 6 ].

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

When reporting findings, it is important to provide the reader with enough contextual information to understand the processes that were followed and how the conclusions were reached. In a collective case study, researchers may choose to present the findings from individual cases separately before amalgamating across cases. Care must be taken to ensure the anonymity of both case sites and individual participants (if agreed in advance) by allocating appropriate codes or withholding descriptors. In the example given in Table Table3, 3 , we decided against providing detailed information on the NHS sites and individual participants in order to avoid the risk of inadvertent disclosure of identities[ 5 , 25 ].

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

The case study approach is, as with all research, not without its limitations. When investigating the formal and informal ways undergraduate students learn about patient safety (Table (Table4), 4 ), for example, we rapidly accumulated a large quantity of data. The volume of data, together with the time restrictions in place, impacted on the depth of analysis that was possible within the available resources. This highlights a more general point of the importance of avoiding the temptation to collect as much data as possible; adequate time also needs to be set aside for data analysis and interpretation of what are often highly complex datasets.

Case study research has sometimes been criticised for lacking scientific rigour and providing little basis for generalisation (i.e. producing findings that may be transferable to other settings)[ 1 ]. There are several ways to address these concerns, including: the use of theoretical sampling (i.e. drawing on a particular conceptual framework); respondent validation (i.e. participants checking emerging findings and the researcher's interpretation, and providing an opinion as to whether they feel these are accurate); and transparency throughout the research process (see Table Table8 8 )[ 8 , 18 - 21 , 23 , 26 ]. Transparency can be achieved by describing in detail the steps involved in case selection, data collection, the reasons for the particular methods chosen, and the researcher's background and level of involvement (i.e. being explicit about how the researcher has influenced data collection and interpretation). Seeking potential, alternative explanations, and being explicit about how interpretations and conclusions were reached, help readers to judge the trustworthiness of the case study report. Stake provides a critique checklist for a case study report (Table (Table9 9 )[ 8 ].

Potential pitfalls and mitigating actions when undertaking case study research

Stake's checklist for assessing the quality of a case study report[ 8 ]

Conclusions

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

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

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

Pre-publication history

The pre-publication history for this paper can be accessed here:

http://www.biomedcentral.com/1471-2288/11/100/prepub

Acknowledgements

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

Yin RK. Case study research, design and method. 4. London: Sage Publications Ltd.; 2009. [ Google Scholar ]
Keen J, Packwood T. Qualitative research; case study evaluation. BMJ. 1995; 311 :444–446. [ PMC free article ] [ PubMed ] [ Google Scholar ]
Sheikh A, Halani L, Bhopal R, Netuveli G, Partridge M, Car J. et al. Facilitating the Recruitment of Minority Ethnic People into Research: Qualitative Case Study of South Asians and Asthma. PLoS Med. 2009; 6 (10):1–11. [ PMC free article ] [ PubMed ] [ Google Scholar ]
Pinnock H, Huby G, Powell A, Kielmann T, Price D, Williams S, The process of planning, development and implementation of a General Practitioner with a Special Interest service in Primary Care Organisations in England and Wales: a comparative prospective case study. Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R&D (NCCSDO) 2008. http://www.sdo.nihr.ac.uk/files/project/99-final-report.pdf
Robertson A, Cresswell K, Takian A, Petrakaki D, Crowe S, Cornford T. et al. Prospective evaluation of the implementation and adoption of NHS Connecting for Health's national electronic health record in secondary care in England: interim findings. BMJ. 2010; 41 :c4564. [ PMC free article ] [ PubMed ] [ Google Scholar ]
Pearson P, Steven A, Howe A, Sheikh A, Ashcroft D, Smith P. the Patient Safety Education Study Group. Learning about patient safety: organisational context and culture in the education of healthcare professionals. J Health Serv Res Policy. 2010; 15 :4–10. doi: 10.1258/jhsrp.2009.009052. [ PubMed ] [ CrossRef ] [ Google Scholar ]
van Harten WH, Casparie TF, Fisscher OA. The evaluation of the introduction of a quality management system: a process-oriented case study in a large rehabilitation hospital. Health Policy. 2002; 60 (1):17–37. doi: 10.1016/S0168-8510(01)00187-7. [ PubMed ] [ CrossRef ] [ Google Scholar ]
Stake RE. The art of case study research. London: Sage Publications Ltd.; 1995. [ Google Scholar ]
Sheikh A, Smeeth L, Ashcroft R. Randomised controlled trials in primary care: scope and application. Br J Gen Pract. 2002; 52 (482):746–51. [ PMC free article ] [ PubMed ] [ Google Scholar ]
King G, Keohane R, Verba S. Designing Social Inquiry. Princeton: Princeton University Press; 1996. [ Google Scholar ]
Doolin B. Information technology as disciplinary technology: being critical in interpretative research on information systems. Journal of Information Technology. 1998; 13 :301–311. doi: 10.1057/jit.1998.8. [ CrossRef ] [ Google Scholar ]
George AL, Bennett A. Case studies and theory development in the social sciences. Cambridge, MA: MIT Press; 2005. [ Google Scholar ]
Eccles M. the Improved Clinical Effectiveness through Behavioural Research Group (ICEBeRG) Designing theoretically-informed implementation interventions. Implementation Science. 2006; 1 :1–8. doi: 10.1186/1748-5908-1-1. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
Netuveli G, Hurwitz B, Levy M, Fletcher M, Barnes G, Durham SR, Sheikh A. Ethnic variations in UK asthma frequency, morbidity, and health-service use: a systematic review and meta-analysis. Lancet. 2005; 365 (9456):312–7. [ PubMed ] [ Google Scholar ]
Sheikh A, Panesar SS, Lasserson T, Netuveli G. Recruitment of ethnic minorities to asthma studies. Thorax. 2004; 59 (7):634. [ PMC free article ] [ PubMed ] [ Google Scholar ]
Hellström I, Nolan M, Lundh U. 'We do things together': A case study of 'couplehood' in dementia. Dementia. 2005; 4 :7–22. doi: 10.1177/1471301205049188. [ CrossRef ] [ Google Scholar ]
Som CV. Nothing seems to have changed, nothing seems to be changing and perhaps nothing will change in the NHS: doctors' response to clinical governance. International Journal of Public Sector Management. 2005; 18 :463–477. doi: 10.1108/09513550510608903. [ CrossRef ] [ Google Scholar ]
Lincoln Y, Guba E. Naturalistic inquiry. Newbury Park: Sage Publications; 1985. [ Google Scholar ]
Barbour RS. Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? BMJ. 2001; 322 :1115–1117. doi: 10.1136/bmj.322.7294.1115. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
Mays N, Pope C. Qualitative research in health care: Assessing quality in qualitative research. BMJ. 2000; 320 :50–52. doi: 10.1136/bmj.320.7226.50. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
Mason J. Qualitative researching. London: Sage; 2002. [ Google Scholar ]
Brazier A, Cooke K, Moravan V. Using Mixed Methods for Evaluating an Integrative Approach to Cancer Care: A Case Study. Integr Cancer Ther. 2008; 7 :5–17. doi: 10.1177/1534735407313395. [ PubMed ] [ CrossRef ] [ Google Scholar ]
Miles MB, Huberman M. Qualitative data analysis: an expanded sourcebook. 2. CA: Sage Publications Inc.; 1994. [ Google Scholar ]
Pope C, Ziebland S, Mays N. Analysing qualitative data. Qualitative research in health care. BMJ. 2000; 320 :114–116. doi: 10.1136/bmj.320.7227.114. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
Cresswell KM, Worth A, Sheikh A. Actor-Network Theory and its role in understanding the implementation of information technology developments in healthcare. BMC Med Inform Decis Mak. 2010; 10 (1):67. doi: 10.1186/1472-6947-10-67. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
Malterud K. Qualitative research: standards, challenges, and guidelines. Lancet. 2001; 358 :483–488. doi: 10.1016/S0140-6736(01)05627-6. [ PubMed ] [ CrossRef ] [ Google Scholar ]
Yin R. Case study research: design and methods. 2. Thousand Oaks, CA: Sage Publishing; 1994. [ Google Scholar ]
Yin R. Enhancing the quality of case studies in health services research. Health Serv Res. 1999; 34 :1209–1224. [ PMC free article ] [ PubMed ] [ Google Scholar ]
Green J, Thorogood N. Qualitative methods for health research. 2. Los Angeles: Sage; 2009. [ Google Scholar ]
Howcroft D, Trauth E. Handbook of Critical Information Systems Research, Theory and Application. Cheltenham, UK: Northampton, MA, USA: Edward Elgar; 2005. [ Google Scholar ]
Blakie N. Approaches to Social Enquiry. Cambridge: Polity Press; 1993. [ Google Scholar ]
Doolin B. Power and resistance in the implementation of a medical management information system. Info Systems J. 2004; 14 :343–362. doi: 10.1111/j.1365-2575.2004.00176.x. [ CrossRef ] [ Google Scholar ]
Bloomfield BP, Best A. Management consultants: systems development, power and the translation of problems. Sociological Review. 1992; 40 :533–560. [ Google Scholar ]
Shanks G, Parr A. Proceedings of the European Conference on Information Systems. Naples; 2003. Positivist, single case study research in information systems: A critical analysis. [ Google Scholar ]

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Case Study Research – Everything You Wanted to Know

Case study research remains a controversial data collection approach. However, it is recognized widely in different social studies. That’s because it enables researchers to provide in-depth explanations of different social behaviors.

What is case study research, methods used in case study research, types of case study research, example of case study research, how to do case study research.

Perhaps, you’re wondering, what is a case study research? Maybe you want to know what it involves. Well, this is a research method that utilizes reports from past studies. It allows researchers to explore and understand complex issues using those reports. This research method may be considered robust, especially when researchers require holistic, in-depth investigation.

Most social sciences recognize case study research design and methods and their roles have become more prominent. This approach is used to research and write about topics in education, sociology, and community-based issues like drug addiction, poverty, and unemployment.

In social studies, the case study is a research method in which a phenomenon is investigated in its real-life context. It’s an empirical inquiry and research strategy that is based on an in-depth investigation of a group, event, or individual to explore the underlying principles causes.

Essentially, this study can be defined as an exploratory and descriptive analysis of a case. But, what is a case study in research? Well, a case can be anything that a researcher wants to investigate. This can include a person, a group, an event, a decision, a policy, period, institution, or any other system that can be studied historically.

This type of research uses the same study methodology with other research types. But, the most common case study research method starts with the definition of a single case. It can also be a group comprising similar cases. These can be incorporated for a multiple-case study.

This is followed by a search to determine what is already known about the case or cases. This search can involve a review of grey literature, reports, and media content. This review plays a critical role in enabling the researchers to understand the case. It also informs researchers when it comes to developing case study research questions.

In most case studies, data is often qualitative, though not exclusively. Thus, researchers engage in case study qualitative research. When researchers use multiple cases, they analyze each case separately. Themes can arise from assertions or analysis about the entire case.

Case study research methodology can include: Personal interviews Archival records Psychometric tests Direct observation

Case studies are more in-depth when compared to observational research. That’s because they use several records or measures while focusing on a single subject. In some cases, a multiple-case design can be used. What’s more, a case study can be retrospective or prospective. A retrospective case study uses criteria to choose cases from historical records. Prospective case studies, on the other hand, uses established criteria while including extra cases as long as they meet the set criteria.

Because case studies use qualitative data like the one collected from interviews, they tend to be more liable. However, quantitative data and questionnaires can also be used. For instance, a case study can be used in clinical research to monitor and determine the effectiveness of treatment.

When you research case study, you explore causation to identify the underlying principles. But, they can’t be generalized to a larger population the way researchers do when conducting experimental research. They also can’t provide predictive power the same way correlational research can do. Rather, they provide extensive data that can be used to develop new hypotheses that can be used for further research. It can also be used to study rare conditions or events that are hard-to-study.

A case study research paper can fall into any of these categories:

Illustrative case study- This is a descriptive type of case study. It uses one or two instances to describe an event. The purpose of an illustrative case study is to make what is considered unfamiliar familiar. It also provides a common language for the readers about a subject.
Exploratory case study- This is also called a pilot case study. It comprises condensed case studies that are performed before a large-scale investigation. Its purpose is to help researchers identify research questions and select the measurement types before the main investigation. The major drawback of this study is that it can make initial findings convincing and lead to their premature release as conclusions.
Cumulative case study- This is a case study that entails the aggregation of information from different sources that were collected at varying times. The goal is to collect past studies to enhance generalization without spending more time or cost on new and probably repetitive studies.
Critical instance case study- This examines one or several sites to examine a situation of specific interest with no or little interest in generalizing them. It can also be used to challenge or question universal or highly generalized assertions. This method can be used to answer the cause and effect study questions.

People may define case study research differently based on these major types of this investigation. Nevertheless, it’s an intensive and systematic investigation of a group, community, individuals, or other units where the researchers examine in-depth data that relate to several variables.

Case study definition in research may vary. However, students should be keen to choose topics they are comfortable researching and writing about. Here are case study research question examples that be used for this kind of investigation.

How and why are employees abusing drugs at workplaces?
How is social media influencing modern businesses?
What are the most effective ways for small businesses to plan their advertising budget?
How can social media ads help in driving customers?
How can employees engage during tough times?
How can a business consider small customers to make bigger profits?
How good is care quality for complex patients at major Nurse Practitioner-Led Clinics?
How effective are pediatric pain management practices by nurses?

Different data collection methods can be used to assess and understand each case separately. This can lead to a better understanding of the phenomenon under investigation. The goal of the case study research design is to provide a framework that can be used to evaluate and analyze complex issues. For instance, in the last two examples above, a case study can be used to shed light on the nursing practice as a holistic approach. It can also provide a perspective that will inform the nurses to give improved care to their patients.

When writing a case study paper, follow these steps, suggested by our writing professionals :

Determine the case to study, data collection methods, and the information to gather.
Select the subjects or people to participate in the case study.
Prepare relevant materials like questionnaires to collect relevant information. This should also include your research problem.
Use the collected data to write your case.
Add the appendices and references
Proofread and edit your final case study paper

In a nutshell, a case study entails collecting data that leads to a better understanding of a phenomenon. The methodology of a case study provides a framework that is used to analyze and evaluate more complex issues.

Top 40 Most Popular Case Studies of 2021

Two cases about Hertz claimed top spots in 2021's Top 40 Most Popular Case Studies

Two cases on the uses of debt and equity at Hertz claimed top spots in the CRDT’s (Case Research and Development Team) 2021 top 40 review of cases.

Hertz (A) took the top spot. The case details the financial structure of the rental car company through the end of 2019. Hertz (B), which ranked third in CRDT’s list, describes the company’s struggles during the early part of the COVID pandemic and its eventual need to enter Chapter 11 bankruptcy.

The success of the Hertz cases was unprecedented for the top 40 list. Usually, cases take a number of years to gain popularity, but the Hertz cases claimed top spots in their first year of release. Hertz (A) also became the first ‘cooked’ case to top the annual review, as all of the other winners had been web-based ‘raw’ cases.

Besides introducing students to the complicated financing required to maintain an enormous fleet of cars, the Hertz cases also expanded the diversity of case protagonists. Kathyrn Marinello was the CEO of Hertz during this period and the CFO, Jamere Jackson is black.

Sandwiched between the two Hertz cases, Coffee 2016, a perennial best seller, finished second. “Glory, Glory, Man United!” a case about an English football team’s IPO made a surprise move to number four. Cases on search fund boards, the future of malls, Norway’s Sovereign Wealth fund, Prodigy Finance, the Mayo Clinic, and Cadbury rounded out the top ten.

Other year-end data for 2021 showed:

Online “raw” case usage remained steady as compared to 2020 with over 35K users from 170 countries and all 50 U.S. states interacting with 196 cases.
Fifty four percent of raw case users came from outside the U.S..
The Yale School of Management (SOM) case study directory pages received over 160K page views from 177 countries with approximately a third originating in India followed by the U.S. and the Philippines.
Twenty-six of the cases in the list are raw cases.
A third of the cases feature a woman protagonist.
Orders for Yale SOM case studies increased by almost 50% compared to 2020.
The top 40 cases were supervised by 19 different Yale SOM faculty members, several supervising multiple cases.

CRDT compiled the Top 40 list by combining data from its case store, Google Analytics, and other measures of interest and adoption.

All of this year’s Top 40 cases are available for purchase from the Yale Management Media store .

And the Top 40 cases studies of 2021 are:

1. Hertz Global Holdings (A): Uses of Debt and Equity

2. Coffee 2016

3. Hertz Global Holdings (B): Uses of Debt and Equity 2020

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Article Information

The dose odds ratio curve was generated using the conditional logistic regression model adjusting for Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), glucocorticoid use, and systemic lupus erythematosus (SLE) immunosuppressant use at the visit proceeding each 6-month period. The smoothed curve was fitted with restricted cubic splines with knots at 2.5 mg/kg per day, 5 mg/kg per day, and 6 mg/kg per day. The reference hydroxychloroquine dose was 5 mg/kg per day.

eFigure. Case-crossover Study Design

Association of Hydroxychloroquine Use With Retinopathy Original Investigation May 1, 2016 This case series study determines the degree of inner and outer retinal involvement in short- and long-term use of hydroxychloroquine before the development of retinopathy in patients treated at an academic medical center. Luis de Sisternes, PhD; Julia Hu, BA; Daniel L. Rubin, MD, MS; Michael F. Marmor, MD
Hydroxychloroquine Dose and Risk of Systemic Lupus Erythematosus Flares—Reply Comment & Response February 28, 2023 April M. Jorge, MD; Yuqing Zhang, ScD; Hyon K. Choi, MD
Hydroxychloroquine Dose and Risk of Systemic Lupus Erythematosus Flares Comment & Response February 28, 2023 Fernando Caravaca-Fontán, MD, PhD; Federico Yandian, MD; Fernando C. Fervenza, MD, PhD

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Jorge AM , Mancini C , Zhou B, et al. Hydroxychloroquine Dose per Ophthalmology Guidelines and the Risk of Systemic Lupus Erythematosus Flares. JAMA. 2022;328(14):1458–1460. doi:10.1001/jama.2022.13591

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Hydroxychloroquine Dose per Ophthalmology Guidelines and the Risk of Systemic Lupus Erythematosus Flares

1 Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
2 Division of Rheumatology, NYU Langone Health, New York
3 Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts
Original Investigation Association of Hydroxychloroquine Use With Retinopathy Luis de Sisternes, PhD; Julia Hu, BA; Daniel L. Rubin, MD, MS; Michael F. Marmor, MD
Comment & Response Hydroxychloroquine Dose and Risk of Systemic Lupus Erythematosus Flares—Reply April M. Jorge, MD; Yuqing Zhang, ScD; Hyon K. Choi, MD
Comment & Response Hydroxychloroquine Dose and Risk of Systemic Lupus Erythematosus Flares Fernando Caravaca-Fontán, MD, PhD; Federico Yandian, MD; Fernando C. Fervenza, MD, PhD

Hydroxychloroquine prevents systemic lupus erythematosus (SLE) flares and is recommended for all patients with SLE. 1 However, its long-term toxicity includes retinopathy, particularly at doses greater than 5 mg/kg per day. 2 This dose-dependent risk led to 2016 ophthalmology guidelines 3 and subsequent rheumatology recommendations 1 to avoid prescribing hydroxychloroquine doses greater than 5 mg/kg per day. We assessed the association of this dose threshold on lupus flares.

We identified patients with SLE from Massachusetts General Hospital who had 2 or more rheumatology visits and used hydroxychloroquine between January 1, 2016, and December 31, 2020, the 5-year period immediately following the 2016 hydroxychloroquine dosing guidelines. 3 This study was approved by the Mass General Brigham Institutional Review Board, which waived informed consent.

We conducted a case-crossover study for which each patient served as their own control. We defined case periods as the 6 months prior to a lupus flare. Control periods were defined as each 6-month period prior to a visit with no flare (eFigure in the Supplement ). Each patient could have multiple nonoverlapping case and control periods. On medical record review, we assessed the outcomes of all lupus flares documented at each rheumatology encounter. Flares were defined using the revised Safety of Estrogens in Lupus National Assessment (SELENA)–Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) flare index (rSFI), including grades mild, moderate, and severe. 4

The exposure of interest was the mean weight-based hydroxychloroquine dose assessed during each 6-month case or control period, categorized as either less than or equal to 5 mg/kg per day or greater than 5 mg/kg per day. 1 , 3

We used conditional logistic regression analysis, matched within a patient, to assess the association of hydroxychloroquine dose over the prior 6 months with the risk of lupus flares, adjusting for glucocorticoid use, immunosuppressant use, and disease activity (clinical SLEDAI score, 5 continuous scale, range 0-101; ≤4 considered low disease activity) prior to each period. We repeated the analysis limited to moderate or severe flares, with mild flares included as control periods. We conducted subgroup analyses by SLE duration, history of lupus nephritis, and baseline SLEDAI score. To characterize the dose-response trend for the risk of lupus flares, we used restricted cubic splines to generate a smoothed dose odds ratio (OR) curve. We used SAS version 9.4 (SAS Institute Inc). Statistical significance was set at a 2-sided P < .05.

Of 342 patients with SLE who used hydroxychloroquine during the study period, 168 (49%) had at least 1 lupus flare and were included in the case-crossover analysis; 80 (23%) had a moderate or severe flare. The mean age was 43 years (SD, 14.7); 148 (88%) were women. The mean baseline clinical SLEDAI score was 3.5 (SD, 3.4); 25 (21%) had lupus nephritis, 72 (43%) used glucocorticoids, and 80 (48%) used oral immunosuppressants.

There were 308 case periods (mean, 1.8 period per patient), including 141 moderate or severe flare periods, and 420 control periods. The adjusted OR (AOR) for any lupus flare associated with taking hydroxychloroquine doses of 5 mg/kg per day or less vs more than 5 mg/kg per day was 1.98 (95% CI, 1.03-3.79) and for moderate or severe lupus flares the AOR was 6.04 (95% CI, 1.71-21.30) ( Table ). The corresponding AORs were similar across subgroups but only reached significance for patients with baseline SLEDAI scores of 4 or less (AOR, 2.41 [95% CI, 1.17-4.96]). The smoothed dose OR curve indicated an apparent threshold near 5 mg/kg per day of hydroxychloroquine for an increased risk of flares ( Figure ).

In this case-crossover study within a contemporary SLE cohort, hydroxychloroquine dosing of 5 mg/kg per day or less, in accordance with current ophthalmology and rheumatology guidelines, was associated with a higher risk of lupus flares, including moderate or severe flares. Furthermore, the dose trend analysis also suggested an apparent threshold near 5 mg/kg per day. A recent study demonstrated that a higher risk of lupus flares was associated with any dose reduction, irrespective of the specific dose. 6 Together, these findings suggest reduced efficacy of lower hydroxychloroquine dosing for lupus disease activity, particularly around doses of 5 mg/kg per day or less.

Study limitations include the retrospective study design and the lack of information on medication adherence within each period. Additionally, this study used an academic medical center cohort, and future studies should replicate these findings in diverse settings.

This study highlights the need to consider individualized risks and benefits in choosing the optimal dose of hydroxychloroquine, an important medication in lupus care.

Accepted for Publication: July 20, 2022.

Published Online: September 16, 2022. doi: 10.1001/jama.2022.13591

Corresponding Author: April M. Jorge, MD, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge St, Ste 1600, Boston, MA 02114 ( [email protected] ).

Author Contributions: Dr Jorge had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Jorge.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Zhou and Zhang.

Administrative, technical, or material support: Jorge, Mancini, Zhou, Ho, Zhang, Choi.

Supervision: Jorge, Zhang, Costenbader, Choi.

Conflict of Interest Disclosures: Dr Jorge is supported by grant K23-AR-079-040 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Dr Costenbader is supported by grant K24-AR-066109 from NIAMS. Dr Choi is supported by grant P50-AR-060772 from NIAMS.

Funding/Support: Dr Jorge is supported by the Rheumatology Research Foundation Scientist Development Award.

Role of the Funder/Sponsor: The Rheumatology Research Foundation had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank Michael Wu, MPH (Lurie Center, Massachusetts General Hospital), for assistance with data collection and Xiaoqing Fu, MS (Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital), for assistance with data management. Mr Wu and Ms Fu did not receive compensation for this study.

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Open Access
Published: 25 August 2023

Application of case-based learning in psychology teaching: a meta-analysis

Fanghui Wu 1 ,
Tao Wang 1 ,
Danxu Yin 1 ,
Xiaoxiao Xu 1 ,
Cancan Jin 1 ,
Nan Mu 1 &
Qingrong Tan 1

BMC Medical Education volume 23 , Article number: 609 ( 2023 ) Cite this article

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Case-based learning (CBL) has been found to be effective for many subjects, but there is currently a lack of evidence regarding its utility in psychology education. The present study investigated whether CBL pedagogy can improve students’ academic performance in psychology courses compared to the traditional teaching methods.

A systematic review and meta-analysis were conducted to investigate the effectiveness of CBL in psychology teaching. Databases including PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI) , the VIP database , and Wanfang data were searched to find eligible randomized controlled trials. Pooled effect estimates were calculated using Hedges’ g under the random effects model, and a subgroup analysis was carried to investigate the heterogeneity among studies.

Fifteen studies with 2172 participants, 1086 in the CBL group and 1086 in the traditional lecture-based teaching group, were included in the meta-analysis. Students in the CBL group scored significantly higher on exams than those in the lecture-based group [Hedges’ g = 0.68, 95%CI (0.49, 0.88), p < 0.00]. Relatively high heterogeneity was noted among the included studies. Publication bias was examined by the funnel plot and Egger’s test, but did not significantly influence the stability of the results. A subsequent evaluation using the trim-and-fill method confirmed that no single study was skewing the overall results. A qualitative review of the included studies suggested that most students in the CBL group were satisfied with the CBL teaching mode.

Conclusions

This meta-analysis indicated that the CBL pedagogy could be effective in psychology education, and might help increase students’ academic scores, while encouraging a more engaging and cooperative learning environment. At present, the application of CBL in psychology education is in its initial stage. Problems related to the curriculum itself, research methodology, and challenges faced by both teachers and learners have confined its practice. Fully tapping into the strengths of CBL in psychology teaching will require additional work and advancing research.

Peer Review reports

Case-based learning (CBL), also known as case-based teaching or case-based instruction, is a student-centered pedagogy that requires students’ active participation in analyzing and discussing cases provided by the teacher. Although no standardized definition has been acknowledged, the teaching method is thought to have been systematically introduced by the Harvard Law School in the early twentieth century, and is a signature teaching format in the Harvard Business School. Their website claims that under the CBL method curriculum, students need to “put themselves in the shoes of actual decision-makers” to solve the problem by using what they have learned in advance [ 1 ]. The successful application of CBL in the fields of law and business has promoted its application in other types of professional education, such as medicine, dentistry, and science education, as an active and important pedagogy.

Compared with traditional lecture-based strategies, CBL has some special advantages and characteristics. The CBL approach has previously been described in terms of its aim(s), content, and processes. In brief, the primary aim of CBL is to prepare students for professional practice [ 2 ]. That is, the use of cases empowers students to apply theoretical knowledge to contextual situations, and thus facilitates knowledge transfer, as well as problem-solving and critical thinking skills [ 2 , 3 ]. Authentic and effective teaching cases are the key content of CBL. The achievement of CBL objectives largely depends on the case construction and facilitation. Kim et al. [ 4 ] proposed a conceptual framework wherein cases must be relevant, realistic, engaging, challenging, and instructional to be effective. Moreover, cases are often situation-based, and can be delivered in multiple ways such as the text (the most common way), the computer or web assisted format, and the real-life simulation. Some have stressed on the combined use of case-based method and the situation-based learning in diverse forms such as role play [ 5 ], while we believe that case analyses shall be the core in the teaching process. Inquiry-based learning is regarded as the best instruction process for this type of case-based learning [ 2 ], but this may be done in different ways. In general, group discussion is the most common application. It has been pointed out [ 6 , 7 ] that case discussion is the most important part as the process, because engaging and debriefing in case discussions can help students obtain new knowledge, connect new knowledge to experience, and build their knowledge structure [ 2 ]. Therefore, CBL excels in linking theory to practice since students are exposed to and then asked to solve the real or simulated cases deliberately composed by the teaching team. Another method of inquiry-based education, problem-based learning (PBL), is often compared with CBL. What distinguish CBL are that CBL format requires students’ prior knowledge to solve specific problems in the profession, the process of which is under the guidance of the trained teachers. By comparison, when using PBL, learning occurs during solving the problem with little previous knowledge or the teacher’s control of the whole class, and thus there would be more “unfocused tangents” [ 8 ]. In this perspective, CBL is more structured, effective, and accepted by students and the teaching faculty especially at the undergraduate education. Moreover, case-based instruction benefits both students and teachers in that it stimulates the students’ learning motivation and enthusiasm, and it urges teachers to constantly refresh their professional knowledge and boost innovation [ 9 ]. In this regard, applying CBL in teaching brings challenges and higher expectations to both teachers and students.

Psychology is an applied discipline, which includes educational psychology, clinical psychology, organizational psychology, and others. As an important component of medicine and health systems, psychology is essential for both psychology majors and future clinicians. Graduates are expected to use psychological knowledge to deal with the relationship between doctors and patients, provide health care suggestions and prescribe psychotherapies if necessary. At the same time, the subject features strong theoretical bases that are intricate to understand. However, traditional lecture-based teaching is somewhat an indoctrination of theories, while CBL gives attention to both theory and application. In this case, a growing number of teaching teams have realized the advantages of using case-based instruction to teach psychology.

Since the 1990s, CBL has been increasingly implemented in psychology courses, including educational psychology, clinical psychology, introductory psychology and so on. Research on the application of CBL in teaching psychology has mainly focused on the content and processes related to using it, such as course planning, case construction and facilitation, and in endeavors to more efficiently implement CBL. From the teaching perspective, it is critical to ensure the optimal development and best use psychological cases. Based on the overall aims and requirements of the course syllabus, the instructor or teaching team may emphasize the construction of the content and structure of the case, utilizing mature cases or creating specific model cases to support and bridge the gap between theory and practice [ 10 , 11 , 12 , 13 ]. Meanwhile, the strategy, concrete methods and steps required to utilize cases in psychology courses is another vital topic, especially for prospective teachers in the training program and as teaching practice included in various professional courses [ 14 , 15 ].

With regard to the students’ learning, improvements in academic performance and the development of self-teaching, clinical reasoning, and satisfaction in learning are the core concerns [ 11 , 16 ]. Some positive and valuable feedback about the effectiveness of CBL in psychology teaching have been obtained in previous studies [ 11 , 16 ]. However, several challenges associated with applying CBL in psychology teaching also exist, such as the lack of viable cases, insufficient time for successful implementation, students’ lack of readiness to utilize the new information, and so on. Moreover, the effects of CBL on academic performance (as indicated by exam scores) are still being debated because the method is often unstructured and subjective compared to the traditional lecture-based teaching [ 10 ], some students appreciated the lecture-based method in helping them prepare for a written exam [ 17 ]. Although several studies have proved its effectiveness, some research showed that there were no significant differences in the final exam scores between students in a CBL group and a traditional lecture-based group [ 18 ], so additional work is needed on this topic. Therefore, this study applied a meta-analysis to determine the effectiveness of CBL in teaching psychology courses, and to identify the factors influencing the efficacy of the method, so as to have a more thorough understanding of the strategy and to better support subsequent studies of the use of CBL in psychology teaching.

Study design

The meta-analysis adhered to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA statements) [ 19 ].

Literature search

The research data were collected from open-access journals from both China and abroad. To be specific, the literature search was carried out in the PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI) , and VIP databases , and using Wanfang data from the earliest publication date (in December of 1976) to August 29th, 2022.

The key terms used in search were as follows: “case-based learning”, “case-based”, or “CBL” and “psychology”. Filters were used to seek out target randomized controlled trials.

Inclusion and exclusion criteria

The study adopted the following inclusion criteria: (1) randomized controlled trials with an experimental group involving the CBL pattern and a controlled group receiving traditional lectures in psychology-related courses; (2) participants were undergraduates or vocational school students; (3) students’ academic performance was quantified by the exam score that was reported with a mean and standard deviation. Studies were excluded when (1) different research methods (other than RCTs) were used; (2) the study was missing data; (3) the publication was a review or meta-analysis. For missing data, we meant that studies did not report the number of participants, the exam scores with a mean and standard deviation nor could these indices be calculated, or any other data that were essential for data synthesis.

For the quality evaluation of the included studies, all of them were first graded by 2 authors according to the standards of the Jadad scale [ 20 ] concerning randomization, double blinding, and withdrawals and dropouts, which is normally applied for clinical experimental research studies. Specifically, for randomization, if words such as randomly, random , or randomization were used, the study was given 1 point, and 1 additional point was given for specifying the method and it being used in an appropriate way. Double blinding also increased the total score by 2 points, 1 for mentioning the method, and an additional 1 point for the adequacy and specific description of the method. For withdrawals and dropouts, 1 point was given if there were no withdrawals/drop-outs, or if it was clearly stated that there were participants who withdrew or dropped out of the study. The highest possible full score was 5, so a total score of 1–2 indicated a low-quality article while a score of 3–5 refers to a high-quality article.

However, some scholars have put forward different opinions [ 21 , 22 ] about the use of randomized experiments in education research, and suggested that blinding both the teacher and the student could be impossible [ 23 ]. For this reason, the scores of the Jadad scale may not adequately indicate the quality of the studies included in the meta-analysis. To our knowledge, no evaluation tool has been developed specifically to assess the quality of these types of studies in the educational field.

Data extraction and literature screening

All the searched articles were managed with the EndnoteX9 software. Two researchers worked independently for record screening and data extraction under the guidance of the inclusion and exclusion criteria. If there were controversies during the screening process, the studies were discussed until the two researchers reached a consensus. For the qualified papers, information concerning the author, publication year, sample size, majors of participants, teaching methods used, courses taught, and outcome data were collected. The outcome data comprised quantitative statistics of the students’ academic scores, as well as their satisfaction and evaluation of CBL if this information was available.

Statistical analysis

Statistical analyses were conducted using the STATA 16.0 software. Continuous variables were demonstrated as the standardized mean difference (SMD), and the results were based on the 95% confidence interval (CI). First, the effects of CBL on the participants’ academic performance was examined by pooling the extracted data together using the effect size of Hedges’ g. The heterogeneity of the data was investigated using the I 2 value. If I 2 < 50% and p > 0.1, a fixed effects model would be used, otherwise a random effects model would be chosen for the meta-analysis. In addition to heterogeneity testing, subgroup analyses were performed and a Galbraith plot was generated. Lastly, publication bias was evaluated by conducting the Egger’s test and using a funnel plot. If publication bias was detected, a trim and fill method would be applied to see whether the bias related to a specific publication would influence the results.

Study characteristics

The systematic search of the literature identified 763 relevant articles from online databases (Fig. 1 ). Specifically, 143 records were obtained from CNKI , 191 records from Wanfang Data , 105 records from VIP databases , 152 records from PubMed , 134 records from Embase , 36 records from the Web of Science , and 2 additional records were obtained from other sources. The EndNoteX9 tool helped remove 169 duplicate records automatically, and 47 additional duplicates were excluded manually. After screening the titles and abstracts to exclude irrelevant studies, 50 records were kept for further review. Of the 50 articles, 35 studies were removed after the full-text was read for various reasons: 27 studies did not follow the design of randomized controlled trials, five studies reported insufficient data and data mismatch, two studies were reviews, and the full text version of one study could not be retrieved.

Finally, 15 studies [ 11 , 16 , 18 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ] in total were included in the meta-analysis and further discussions, and the characteristics of each study are shown in Table 1 . The 15 studies comprised 2172 participants, 1086 in CBL groups and 1086 in control groups. Among them, five studies compared the effects of CBL with traditional lectures in medical psychology courses, five studies involved trials in teaching nursing psychology, and the other five studies were carried out in teaching management psychology, the instruction for a clinical internship, experimental psychology, introductory psychology, and the psychology of adjustment. Although these courses are fundamental in psychology education, each type of curriculum follows a different pattern. We predict that there would be a certain level of heterogeneity due to the variety of courses, and subgroup analyses were done based on the different course types.

The risk of bias for the included randomized controlled trials was assessed according to the Jadad score [ 20 ], and the results are presented in Table 2 . In terms of randomization, nine studies complying with a randomization process without explaining the specific methods used received a score of one, and one study [ 32 ] using lot drawing was scored two. No study applied double-blinding methodology in the design. No withdrawals or dropouts were seen in any of the trials, so all were given a score of one. Thus, one study scored three points, nine scored two points, and the other five scored one point in the quality assessment.

Regarding outcome variables, besides academic performance (indicated by means and standard deviations), seven studies also investigated CBL’s effects through questionnaires such as teaching evaluations, self-assessments of learning abilities, psychological scales, and so on. Generally, students expressed positive attitudes towards the case-based approach and provided positive feedback. More details can be seen in Table 1 .

The PRISMA flow chart for the selection of studies included in the meta-analysis

Quantitative analysis of pooled effects

A statistically significant pooled effect size (Hedges’ g) was observed when comparing students’ academic scores based on whether they had CBL or traditional lecture-based teaching. As shown in the forest plot (Fig. 2 ), the total effect of CBL yielded better results than lecture-based learning [Hedges’ g = 0.68, 95%CI (0.49, 0.88), p < 0.00]. The heterogeneity was relatively high ( I 2 = 78.90%, p < 0.00), suggesting that a random effects model should be applied.

Forest plot showing the impact of CBL on students’ academic performance compared with conventional LBL under the random effects model

Investigation of heterogeneity

Due to a high heterogeneity across the meta-analysis, a subgroup analysis was conducted to explore the source of the heterogeneity. We considered that the characteristics of the different courses may have resulted in high heterogeneity. Thus, we divided the 15 studies into two categories based on the different course types: basic theory courses (n = 2) [ 11 , 35 ] and applied courses (n = 13) [ 16 , 18 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. The results presented in Fig. 3 suggest that in basic theory courses, the students in the CBL group had significantly higher exam scores than did those in the control group [Hedges’ g = 0.61, 95%CI (0.33, 0.89), p < 0.00]. Likewise, in the applied psychological courses, the exam scores in the CBL group were obviously higher than those in the traditional lecture group [Hedges’ g = 0.69, 95%CI (0.47, 0.92), p < 0.00]. Hence, the results of the subgroup analysis suggested that CBL led to significant improvements in scores related to teaching both types of psychology courses. After this sub-grouping, the heterogeneity in the basic theory group became non-significant ( I 2 = 0.00%, p = 0.64), while it remained high in the applied course group ( I 2 = 81.80%, p = 0.00), suggesting that the different course types may not be the source of heterogeneity. This finding led us to further investigate the studies using a Galbraith plot (Fig. 4 ).

Forest plot for the subgroup analysis based on different course types

Galbraith plot of the 15 studies

As shown in Fig. 4 , four studies [ 18 , 26 , 32 , 33 ] outside the parallel lines were considered to be the potential sources of heterogeneity. After removing them, no obvious heterogeneity was found across studies ( I 2 = 21.50%, p = 0.24). However, even after removing these four studies, a forest plot (Fig. 5 ) indicated that the total examination scores of students in the CBL group were still significantly higher than those in the control group [Hedges’ g = 0.65, 95% CI (0.54, 0.76), p < 0.00].

Forest plot after removing four studies [ 18 , 26 , 32 , 33 ]

Sensitivity analysis

A sensitivity analysis was performed by omitting studies one-by-one to see whether any single study could affect the statistical significance of the results in the meta-analysis. Figure 6 shows that the point estimate of pooled effects after removing each study always stayed within the confidence interval, suggesting that the results were stable.

Sensitivity analysis of the pooled studies

Publication bias

To further assess the data, a funnel plot was generated. The funnel plot (Fig. 7 ) appears to be somewhat asymmetrical. Egger’s test was also performed as a reference, and the findings suggested that there was slight publication bias in the meta-analysis ( t = 2.21; p = 0.046).

Funnel plot of the studies included in the meta-analysis

Due to the publication bias indicated by Egger’s test, a trim-and-fill method was applied to test whether the bias could affect the results. Figure 8 indicated that after hypothetically filling five missing studies, the funnel plot would become visually symmetrical, wherein no publication bias would exist. Notably, the new pooled effect under the random effects model was still significant [Hedges’ g = 1.69, 95%CI (1.41, 2.04), p < 0.00], indicating that the existence of publication bias did not significantly influence the robustness of the meta-analysis.

Results of trim-and-fill method

Qualitative evaluation of the effectiveness of CBL

Eleven studies reported results from questionnaires and open-ended surveys that investigated the students’ evaluation of and attitudes towards CBL after experiencing the whole teaching process. Table 1 displays these descriptions in detail. All eleven studies reported that CBL was beneficial for students, and its beneficial effects included: (1) aroused learning interests [ 16 , 24 , 28 , 30 , 33 ]; (2) enhanced self-study abilities [ 16 , 18 ]; (3) improved communication and cooperation [ 16 , 28 , 34 ]; and (4) improved problem-solving capabilities [ 30 , 33 ].

Students studying psychology often find themselves in a dilemma since they are expected to apply what they have learned in their future career or in real life to settle problems and make decisions, while the abstract theories they have learned are divorced from reality. It is difficult to provide these skills via only traditional lectures. CBL has been proposed as a method to fix this gap. Based on a literature search, we found that most of the published studies were qualitative, and there have been only a few quantitative studies designed to examine the strengths of CBL in psychology education, and there have been even fewer studies with high-quality experimental designs. Among the limited RCT studies, the CBL teaching mode was more often implemented in applied courses, especially in medical psychology and nursing psychology. The two courses are interdisciplinary that applies psychological theories and techniques into clinical and health-care practice. Thus, CBL is more often practiced in teaching these applied psychological courses. Evidences of CBL’s effectiveness in other psychology courses are fewer. That is to say, the application of cases-based method in teaching psychology is still in its early stages. Thus, we aim to gather data from the existing literature to investigate whether CBL could be useful in psychology education by meta-analysis. To our knowledge, this is the first meta-analysis conducted to investigate the effectiveness of CBL in psychology education. Our results support the idea that CBL could be beneficial in teaching psychology and may be superior to traditional lecture-based learning. Students in the CBL group acquired higher scores in examinations and improved their problem-solving and critical thinking, which is in agreement with other studies in clinical medicine education [ 36 ] and dental education [ 37 ].

Several factors may affect the efficacy of CBL in psychology teaching. For instance, the way the teaching team organize the cases, the quality of the teaching staff, the duration of case analysis, and many others may affect the successful implementation of CBL. Importantly, the quality of the case is critical for eliciting the students’ interest [ 10 ], thus promoting substantive case discussions [ 13 ]. The cases from the included studies were from clinical practice or fictional, but few provided this information, so the importance of whether the case was ‘real’ and many other details about the case could not be analyzed. While we believe fictional cases can be as effective as true clinical cases for CBL, it is necessary to ensure that the fictional cases are believable and indistinguishable from real cases.

The strategy that the instructor uses in facilitating and debriefing class discussions is also important [ 10 ]. The comparative research reported by Engle and Faux [ 13 ] suggests that a higher percentage of contribution to case discussions was observed in the classes where more authority was offered to the student by the instructor, while more structured instruction could facilitate the stronger use of psychological theory. It is difficult to determine which strategy is superior, since each instructor has his or her own style and customs, and student learning styles also vary. However, regardless of the teaching style, it is important that instructors receive training in CBL teaching before its implementation to ensure their professionalism and to increase efficacy of the case instruction. Students’ responses also affect the instructor’s implementation of CBL. One study on students’ stress levels found that the students’ stress escalated when they changed to a CBL environment from traditional teaching [ 38 ]. A study by Baeten et al. [ 39 ] suggested that gradually introducing students to CBL is important for their autonomous motivation and academic achievement. Thus, it is suggested that instructors should keep an eye on students’ feelings and obtain timely feedback during the implementation of case instruction.

The meta-analysis showed relatively high heterogeneity among the studies. The subgroup analysis showed that different course types did not appear to account for this heterogeneity. However, we believe that this result could offer some implications. Psychology curriculum is broad and extensive that courses vary from each other. Just as the saying goes, one man’s meat maybe another man’s poison, we wondered whether CBL could still be statistically more effective than traditional LBL in different types of psychology courses especially in those theory-oriented courses. The results supported that CBL could be more effective than LBL on improving students’ academic scores whenever teaching the courses of the basic theories or the application content. Nevertheless, the basic theory courses group only comprised two courses, indicating that CBL is more often practiced in those application-oriented courses. It suggests that we could make the effort to use case-based method in theory-oriented psychology courses in the future.

To further investigate the source of heterogeneity and whether it will influence the stability and reliability of the result, a Galbraith plot was drawn. It helped identify four studies [ 18 , 26 , 32 , 33 ] that may have contributed most to the heterogeneity. The heterogeneity may be related to differences in the research design, the implementation of the intervention as discussed above, as well as the characteristics of participants. For instance, Song et al. [ 33 ] applied CBL to teach the mental outpatient internship that students learnt from hands-on cases by observing the process of psychotherapy at the scene, and after the observation, students would hold a discussion and try to simulate the scene under the guidance of the instructor. This first-hand experience of cases differs from the in-class discussion that not only students’ previous knowledge would be recalled, but also their emotions and feelings would be elicited. It is in line with the Constructivist views of learning that it is essentially social in nature [ 10 ]. This diverse type of case-based teaching mode might cause heterogeneity statistically, but we think it is worth trying in other applied psychology courses teaching in the future. It is difficult to analyze all of these elements using the limited information offered by each article, but we tried to elaborate on the methodology of the included RCTs. Specifically, the participants in the study of Su et al. [ 32 ] all knew the information about the trial which may cause biases since the students in the CBL group might feel that they were paid special attention. Likewise, Song [ 26 ] used non-probability sampling which might cause heterogeneity. There are different views regarding the use of controlled experiments when performing education research. Some have stressed the importance of diversity in educational research methods, believing that double-blinding is hard to follow even in the simpler experiments performed outside the educational setting [ 21 ]. Moreover, randomization may also be difficult to achieve because the student participants had been streamed beforehand based on different programs. It is recommended that in the education field, evaluators should rely more on ethnographic methods with more descriptive information [ 22 ], such as that obtained by observing or videotaping. Nevertheless, an RCT may still be possible in the education field. However, it is necessary to design more effective trials or experiments to balance the internal and external validity with regard to the unique characteristics of education research.

The qualitative evidence drawn from questionnaires and surveys of the 11 studies suggests that a large percentage of students were more strongly motivated to learn when CBL was applied. Overall, the students’ subjective evaluations suggested that CBL helped their learning reach a deeper level, which means that they had a better and more extensive understanding of the theoretical knowledge being taught in the course. Additionally, because CBL is a team effort, the students’ communication and cooperation skills would noticeably be strengthened during the class, based on both interactions between teacher and student and interactions between and among students.

Nevertheless, some limitations exist in this study. First, few studies were included in the meta-analysis, resulting in a relatively small sample size. We adopted the inclusion criteria used for randomized-controlled trials, leading to the exclusion of qualitative studies and any study with another design. In addition, education research may be inevitably subject to biases caused by the implementation of blinding and randomization [ 22 ]. It is suggested that the type of educational intervention, control environment and the instructors’ training experiences, which are not assessed as part of the Jadad score, should be investigated when evaluating the reliability of education research [ 22 ]. Educational research is currently very diverse, which is why we wished to collect and synthesize more evidence to provide more reliable results using a meta-analysis. Second, the effectiveness of CBL was mainly quantified based on the academic score, which is simple to use, but shows only short-term results, which may be relatively subjective. The efficacy of CBL should also be evaluated using other educational indicators, such as motivation and interest, and it should be tracked in the long-term. Third, the study only compared the effects of CBL with LBL. In the future, CBL should be compared with other new teaching methods to further investigate its strengths and weaknesses.

In general, the present meta-analysis indicates that CBL is more effective than LBL in improving students’ academic scores in psychology, and was a method welcomed and appreciated by the students. CBL features the combination of theories and practice, makes the classroom more engaging and encourages more cooperation and communication among students and teachers. In this way, the students’ learning interest would be stimulated, and their problem-solving and critical thinking skills could be better practiced. However, the application of CBL in psychology education is still in its initial stage, and there are no systematic standards or acknowledged rules to follow. Quantitative research on this area is still limited, with a lack of appropriate methods to control for probable biases to reach better decisions about the effectiveness of CBL in teaching psychology. Hence, the application of CBL in psychology teaching must be the subject of further research and exploration.

Data Availability

The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

Case-based learning

Lecture-based learning

Team-based learning

Problem-based learning

Harvard Business School. : What is the Case Method?. https://www.hbs.edu/case-method-project/about/Pages/case-method-teaching.aspx (2022). Accessed 13 Nov 2022.

Thistlethwaite JE, Davies D, Ekeocha S, Kidd JM, Macdougall C, Matthews P, et al. The effectiveness of case-based learning in health professional education. A beme systematic review: beme guide no. 23. Med Teach. 2012;34(6):e421–44.

Article Google Scholar

Kassirer JP. Teaching clinical reasoning: case-based and coached. Acad Med, 2010(7).

Kim S, Phillips WR, Pinsky L, et al. A conceptual framework for developing teaching cases: a review and synthesis of the literature across disciplines[J]. Med Educ. 2010;40(9):867–76.

Xie XZ. The advancement of case-based learning: the combination of CBL and situation-based simulation. Acad Degrees Graduate Educ. 2017;290(01):32–6. https://doi.org/10.16750/j.adge.2017.01.008 .

Merseth KE. The early history of case-based instruction: insight for teacher education today. J Teacher Educ. 1991;42(4):243–9.

Shulman LS. Toward a pedagogy of cases. In: Shulman JH, editor. Case Methods in Teacher Education. New York: Teachers College Press; 1992. pp. 1–30.

Google Scholar

Srinivasan M, Wilkes M, Stevenson F, Nguyen T, Slavin S. Comparing problem- based learning with case-based learning: effects of a major curricular shift at two institutions. Acad Med. 2007;82(1):74–82.

Xia WY, Gu B, Huang PJ, Jiang Y, Wang F, Zhao C, et al. Application of case-based teaching in China’s medical education. Northwest Med Educ. 2011;19(5):923–5.

Sudzina MR. Case study as a constructivist pedagogy for teaching educational psychology[J]. Educational Psychol Rev, 1997: 199–218.

Mayo JA. Case-based instruction: a technique for increasing conceptual application in introductory psychology. J Constructivist Psychol. 2002;15(1):65–74.

Block KK. The “case” method in modern educational psychology texts[J]. Teach Teacher Educ. 1996;12(5):483–500.

Engle RA, Faux RB. Towards productive disciplinary Engagement of prospective teachers in Educational psychology: comparing two methods of case-based Instruction[J]. Teach Educational Psychol. 2006;1(2):n2.

Patricia Pia W, Brigitte L, Tamara S et al. Case-based blended eLearning scenarios-adequate for competence development or more?[J]. Neuropsychiatrie : Klinik, Diagnostik, Therapie und Rehabilitation : Organ der Gesellschaft Osterreichischer Nervenarzte und Psychiater, 33(4):207–11.

Mayo JA. Observational diary: the merits of journal writing as case-based instruction in introductory psychology[J]. J Constructivist Psychol. 2003;16(3):233–47.

He Y. An experimental study of CBL in the teaching of medical psychology. J Nanjing Med Univ (social sciences). 2014;03:246–50.

Kassebaum D, Averbach R, Fryer G. Student preference for a case-based vs. lecture instructional format. J Dent Educ. 1991;55(12):781–4.

Hou XY, Jing HQ. Application of CBL in teaching nursing psychology. J Med Inform. 2014;32:3–4.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71 .

Jadad A. Assessing the quality of reports of randomized clinical trials: is blinding necessary? [J]. Control Clin Trials. 1996;17:1–12.

Thomas G. After the gold rush: questioning the “gold standard” and reappraising the status of experiment and randomized controlled trials in education[J]. Harv Educational Rev. 2016;86(3):390–411.

Tolsgaard MG, Ku C, Woods NN, et al. Quality of randomised controlled trials in medical education reported between 2012 and 2013: a systematic review protocol[J]. BMJ open. 2014;4(7):e005155.

Parks T. Randomized controlled trials in medical education[J]. J R Soc Med. 2009;102(6):214–4.

Mayo JA. Using case-based instruction to bridge the gap between theory and practice in psychology of adjustment. J Constructivist Psychol. 2004;17(2):137–46.

Li SQ, Rao HP, Yao SH, Lan CL, Qiu HP, Cheng X. Application of CBL in nursing psychology education. Health Vocat Educ.2010;(13):55–6.

Song RL. Application of CBL and simulated learning in the teaching of nursing psychology. Chin J Practical Nerv Dis 2010;(14):10–1.

Xie LY, Li YL. Application of CBL in teaching nursing psychology. Guangdong Vocat Tech Educ Res.2013;(02):57–9.

Kong GZ, Zhou JR. An experimental study of CBL in the teaching of managerial psychology. J Chifeng Univ (natural Sci edition). 2014;04:271–3. https://doi.org/10.13398/j.cnki.issn1673-260x.2014.04.112 .

Zhang Q, Rui DS, Li YC. Evaluation of the effectiveness of CBL in teaching medical psychology. J Nongken Med 2014;(01):90–1.

Luo SQ. Application of case teaching method in medical psychology teaching. World Latest Medicine Information 2017(98):286doi: https://doi.org/10.19613/j.cnki.1671-3141.2017.98.254 .

Pei TJ, Zhang YY, Wu M. Application of case method teaching and simulated learning in nursing psychology teaching. Psychol Doctor. 2017;23(030):321–2.

Su JP, He YJ, Zhang HL, Miao YR, You B, Nie Y. Evaluation of the application value of CBL in the teaching of medical psychology. China Health Care & Nutrition. 2019;029(005):383.

Song XH, Li JM, Wu KW, Zhang YT, Xu QR. Application effect of case teaching method in clinical practice teaching of applied psychology undergraduates. China Continuing Medical Education. 2019;(04):3–5.

Nie GH, Hou QH, Nong QQ. Application of the teaching method of team-based learning combined with case-based learning in the teaching of medical psychology. China Continuing Medical Education. 2021;13(2):5.

Xiao YL. Exploring innovative teaching methods of experimental psychology. The Guide of Science and Education. 2021;(16):129–31.

Cen XY, Hua Y, Niu S, Yu T. Application of case-based learning in medical student education: a meta-analysis. Eur Rev Med Pharmacol Sci. 2021;25(8):3173–81.

Dong H, Guo C, Zhou L, Zhao J, Wu X, Zhang X, Zhang X. Effectiveness of case-based learning in chinese dental education: a systematic review and meta-analysis. BMJ open. 2022;12(2):e048497.

Ahmad FA, Karimi AA, Alboloushi NA, Al-Omari QD, AlSairafi FJ, Qudeimat MA. Stress level of dental and medical students: comparison of effects of a subject-based curriculum versus a case‐based integrated curriculum. J Dent Educ. 2017;81(5):534–44.

Baeten M, Dochy F, Struyven K. The effects of different learning environments on students’ motivation for learning and their achievement. Br J Educ Psychol. 2013;83(3):484–501.

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This study was supported by a grant from the Chongqing Higher Education Teaching Reform Research Program (No.212167) and the supporting plan of Army Medical University (No.410301060177).

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T.W., F.W., N.M. and X.X. contributed to the conception of the study. F.W. and D.Y. collected and analyzed the data. F.W. drafted the manuscript. T.W., C.J. and Q.T. contributed to the revision of the manuscript with constructive suggestions. All authors have reviewed and approved the manuscript.

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Wu, F., Wang, T., Yin, D. et al. Application of case-based learning in psychology teaching: a meta-analysis. BMC Med Educ 23 , 609 (2023). https://doi.org/10.1186/s12909-023-04525-5

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Rapid advancement of emerging technologies—combined with the increasing demands from customers and ongoing disruptive market forces—are driving organizations to prioritize digital transformation more than ever. According to a recent survey conducted by the IBM Institute for Business Value in cooperation with Oxford Economics, 67% percent of executive respondents say their organizations need to transform quickly to keep up with the competition, while 57% report current market disruptions are placing unprecedented pressure on their IT. 1

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Water Reuse Case Study: The Alaska Water and Sewer Challenge

EPA and partners have created a series of case studies that highlight the different water reuse approaches communities have taken to meet their water quality and water quantity needs. Each case study contains information about the technical, financial, institutional, and policy aspects of these water reuse systems and the communities they are located in.

Potential Benefits

Policy, institutional, and regulatory environment, financial and contractual agreements, lessons learned and conclusions, background documents.

Location: Rural Alaska

Project Goals: Solicit designs for household reuse systems for homes in rural Alaska, each producing about 400 gallons (1,500 liters) of non-potable water per week

Financial Concept: Produce an onsite water reuse solution, with monthly operating costs of less than $135 per household

Project Phases: 1) form teams, 2) fund teams, 3) pilot testing, 4) field testing, and 5) deploy systems

Selected Project Information:

Team: University of Alaska Anchorage (UAA) team comprised of academic staff, engineering consultants, health professionals, and rural community partners

Status: Phase 4, field system development and testing (as of January 2023)

Source of Water: Greywater

Reuse Application: Non-potable uses (i.e. laundry, shower, sink)

Potential Benefits: Better access to non-potable water, improved health of residents, reduced time and costs hauling potable water for supply and greywater for disposal, less odor from dry toilets, reduced transportation-related greenhouse gas emissions

Thousands of residents in rural Alaska lack access to running water or flush toilets due to their remote locations and the local climate. To address this issue, the Alaska Department of Environmental Conservation (DEC) funded the Alaska Water and Sewer Challenge - a research and technology development competition intended to identify a suitable decentralized water reuse solution for use in rural Alaska homes. The DEC solicited designs that could safely and affordably supply homes with clean water but were also acceptable for the end users and feasible for implementation in rural Alaska. The winning design consisted of an onsite greywater recycling system coupled with urine-diverting dry toilets, which could significantly reduce the reliance on imported water for non-potable uses. Since the system avoided the use of water for flushing toilets, it limited the need to export sewage for treatment and disposal. As of this publication in June 2023, the selected design was progressing toward the implementation stage.

Over 3,300 Alaska homes do not have access to indoor potable water or flush toilets. Many of these homes are in rural villages and can only be accessed in the summer by plane or boat. Conventional wastewater treatment plants and conveyance systems are not reasonable options in these communities for many reasons, including the distances between homes and community centers and frozen subsurface conditions in many areas (i.e., permafrost). In the past, various agencies funded expensive community-wide water supply and sanitation efforts, typically focused on truck-haul water programs, to meet the needs of the communities amid the challenging conditions. Households in parts of rural Alaska import an average of 420 gallons (1,590 liters) of potable water per week from truck-haul access points in their communities. This approach provides safe drinking water to citizens by giving them access to potable water in a central location. Similarly, community-wide centers provide a location for rural Alaskans to safely dispose of waste from dry toilets (i.e., honey buckets, plastic lined buckets that are widely used to dispose of urine and feces). However, both practices are associated with high operational costs for communities and burden residents with the need to haul large loads of water and waste to and from central access points. The high cost of potable water and waste disposal means some families may choose to purchase less water than they need, capture and utilize untreated rainwater, reuse water without adequate treatment, and potentially dispose wastes directly to the environment. Additionally, the lack of affordable in-home water and sewage disposal is linked to many health challenges for rural Alaskans. Generally, people who do not have enough water for basic hygiene are at higher risk of gastrointestinal infections, such as those caused by norovirus, E. coli , or Cryptosporidium parvum .

The Alaska Department of Environmental Conservation (DEC), in coordination with tribal, state, and federal agencies, initiated a research and development competition in 2013, to find more efficient and affordable ways to deliver drinking water and sewage disposal services to residents in rural Alaska. This competition, called the Alaska Water and Sewer Challenge, solicited innovative and cost-effective designs to meet the water supply needs of rural Alaska households. The Alaska Water and Sewer Challenge received applications from close to 20 teams.

Schematic showing the different project phases

Figure 1: Alaska Water and Sewer Challenge program schedule.

Alaska Water and Sewer Challenge representatives identified the following performance targets to evaluate the submitted designs:

Constructability and durability.
Capital cost.
Water use for health benefits (minimum capacity of 15 gallons, or 57 liters, per day per person).
Operation and maintenance cost (monthly cost less than $135 per household).
Freeze and thaw recovery capability.
Modularity of household system.
Feasibility (extreme temperatures, permafrost, remote accessibility, operability, regulatory).
Compliance with plumbing code.
Parts availability.
Acceptance and use by end users.

During prototype development stage of the challenge (Phases 2), all teams were guided by a steering committee made up of tribal, state, and federal agencies with knowledge relevant to the technical aspects of the projects. The group met regularly to review the status of work, make decisions about the progression of each team, and evaluate team proposals and prototypes. During the development stage and later stages of the challenge, focus groups engaged the public (including potential users) on the feasibility and usability of possible designs.

Three teams were selected as semi-finalists to move onto Phase 3 - Prototype Development and Pilot Testing, which involved monitoring pilot-scale versions of each team’s design over nine months. Because many rural Alaska households lack flush toilets, all three teams incorporated reuse into their design by treating greywater separately for non-potable reuse.

Selected Design: Onsite Reuse in Rural Alaska

In 2022, one of the three semi-finalist designs was selected as the winning design and moved into the field system development and testing phase (Phase 4). This team, made up of academics from University of Alaska Anchorage (UAA), engineering consultants, and health professionals, partnered with two rural communities (Kipnuk and Koyukuk) to gather feedback and inform their team’s design.

Figure 2 shows a schematic of the prototype design developed by the UAA team. The wash water system collects greywater from the kitchen and bathroom sinks, shower, and laundry and treats the water to a level suitable for human contact, but not for drinking. The reused water is pumped to fulfill the same non-potable demands (kitchen sink, bathroom sink, shower, and laundry). A separate drinking water source (typically from a truck-haul supplier) is used to supply individual taps in the kitchen and bathroom dedicated to potable uses. The greywater recycling system generates a small volume of concentrated greywater which must be disposed of on a weekly basis. Also, the use of urine-diverting dry toilets reduces odors, as compared to conventional dry toilets in which urine and feces are combined (i.e., honey buckets). However, waste from the urine-diverting toilet must be transported from the home by the residents to a disposal facility.

This figure shows how water moves through the protype system. Importantly it shows that toilets are separate from the rest of the system and waste will not be treated.

Figure 2: Prototype system schematic showing separate systems for various water uses for the household. Blue lines (long dash) represent potable water sourced from centralized community washeterias, orange lines represent potable or non-potable water (e.g., rainwater) selected by the user to supplement the greywater recycling system, green lines represent non-potable onsite recycled water, and grey lines (short dash) represent greywater, which is treated onsite. Black lines represent waste residuals hauled offsite. Source: University of Alaska Anchorage.

By using the greywater recycling system, the user can generate 406 gallons (1,537 liters) of wash water from an initial input of only 35 gallons (132 liters) of water weekly. This input is represented by the orange line in Figure 2 and can consist of non-potable sources, such as rain, river, or lake water, depending on availability to the user. This water source supplies the wash water system and will be used only for non-potable demands. Because the greywater recycling system uses a reverse osmosis filter as part of its treatment process, it generates a concentrated greywater waste stream which must be collected and removed from the treatment system periodically. The UAA team estimates that 35 gallons (132 liters) of concentrated greywater and nine gallons (34 liters) of urine will be removed from the home weekly—44 gallons (166 liters) total. On a weekly basis, it is estimated that the households will need 14 gallons (53 liters) of potable water to be hauled in for potable uses.

Image showing the inside of a building with tubes and pipes

Figure 3: Interior of the prototype system. Source: University of Alaska Anchorage.

The proposed treatment system is housed in a 10-foot (3-meter) shipping container to allow for affordable and modular construction and deployment. The treatment process includes the following steps:

Air-assisted soap removal.
Nanofiltration and reverse osmosis filtration.
UV disinfection.
Ozone disinfection.

UAA demonstrated that the treatment system can achieve over 7 log 10 removal of both bacteria and viruses (i.e., 99.99999% removal), lower turbidity to less than 0.1 nephelometric turbidity units (NTU), reduce total organic carbon to concentrations less than 0.5 milligrams per liter, and maintain a pH between 6 and 8. The system is self-contained and energy requirements are met with a 12-volt battery, as connection to the electrical grid is challenging for many of these communities.

Onsite greywater reuse will significantly reduce the amount of hauled water needed for households and communities. For example, if the design selected from the Alaska Water and Sewer Challenge is scaled past the research phase and implemented in communities, each household with an onsite non-potable greywater reuse system would save the cost and labor of hauling about 400 gallons (roughly 1,500 liters) of potable water per week. There will still be a need to import some potable drinking water from the community’s truck-haul access point, but the volume will be significantly reduced, from the current average of 420 gallons (1,590 liters) per week per household to 14 gallons (53 liters) per week per household. Because the greywater recycling system is separate from the toilets, the design would also drastically reduce the volume of wastewater needed to be hauled offsite for disposal when compared to conventional residential systems that combine wastewater from flush toilets with greywater. Incorporating a urine-diverting toilet also reduces odor issues compared to conventional dry toilets that combine urine and feces (i.e., honey buckets).

Given the location of these communities and the harsh environmental conditions, all-terrain vehicles are needed to transport water and wastewater. The fuel for these vehicles must also be flown in. The combined cost of the vehicles and fuel is prohibitively high for many families, requiring many to ration their water or try to reuse it in unsanitary ways; the latter likely contributes to an increased disease burden in these communities. Reducing the frequency of hauling potable water from access points back to communities can save on fuel costs and free up time for other pursuits. UAA’s model provides a cost-effective way for rural Alaskans to meet their daily water needs which is imperative to the health and vitality of these communities.

The Alaska Water and Sewer Challenge was developed by the Alaska Department of Environmental Conservation in coordination with tribal, state, and federal agencies. There has been significant collaboration with other entities, including the National Blue Ribbon Commission for Onsite Non-Potable Water Systems, the WateReuse Association, U.S. EPA, the Indian Health Service, the U.S. Arctic Research Commission, the Centers for Disease Control and Prevention, and the U.S. Department of Agriculture Rural Development Program.

The current focus of the Alaska Water and Sewer Challenge is to develop decentralized non-potable reuse designs that produce water that is safe for human contact. EPA’s Human Subjects Research Review Office provided approval before the beginning of Phase 4 testing at a residential unit on University of Alaska’s campus. Currently, Alaska does not have a water reuse program and does not regulate water reuse at the state level, including for onsite reuse.

When the Alaska Water and Sewer Challenge was initially launched, the state legislature funded Phases 1–3 with $4 million in state and federal funding (75 percent state and 25 percent EPA). Phase 4 is currently funded with $1.3 million (again, 75 percent state and 25 percent EPA). Phase 5, including deployment of the system to houses, will require more funding, but it is unclear what sources will support this final stage.

Research and technology development competitions, such as the Alaska Water and Sewer Challenge, take time to identify and test realistic solutions and develop and deploy prototypes. This competition encountered and overcame various issues since its inception, including staff changes across the involved partner organizations and delays due to COVID-19. The Alaska Department of Environmental Conservation and the selected team from the University of Alaska Anchorage have had to persevere while working toward a feasible design. Despite these challenges, the final stages (Phase 5) of the Alaska Water and Sewer Challenge are still being implemented due to the great need for safe, cost-effective water supply and disposal in rural Alaska communities.

There are many hurdles still to come to implement the selected onsite reuse system designed for the Alaska Water and Sewer Challenge, including identifying funding mechanisms, technical challenges associated with deployment in remote areas, operation and maintenance of the system, and user acceptance of water reuse.

Alaska Department of Environmental Conservation. 2013. Request for proposals (statements of qualifications) .

Alaska Department of Environmental Conservation. 2022. Alaska Water and Sewer Challenge.

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Open Access
Published: 27 June 2011

The case study approach

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

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

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Introduction

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

What is a case study?

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

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

What are case studies used for?

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

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

How are case studies conducted?

Defining the case

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

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

Selecting the case(s)

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

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

Collecting the data

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

Analysing, interpreting and reporting case studies

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

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

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

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

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

Conclusions

Yin RK: Case study research, design and method. 2009, London: Sage Publications Ltd., 4

Google Scholar

Keen J, Packwood T: Qualitative research; case study evaluation. BMJ. 1995, 311: 444-446.

Article CAS PubMed PubMed Central Google Scholar

Sheikh A, Halani L, Bhopal R, Netuveli G, Partridge M, Car J, et al: Facilitating the Recruitment of Minority Ethnic People into Research: Qualitative Case Study of South Asians and Asthma. PLoS Med. 2009, 6 (10): 1-11.

Article Google Scholar

Pinnock H, Huby G, Powell A, Kielmann T, Price D, Williams S, et al: The process of planning, development and implementation of a General Practitioner with a Special Interest service in Primary Care Organisations in England and Wales: a comparative prospective case study. Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R&D (NCCSDO). 2008, [ http://www.sdo.nihr.ac.uk/files/project/99-final-report.pdf ]

Robertson A, Cresswell K, Takian A, Petrakaki D, Crowe S, Cornford T, et al: Prospective evaluation of the implementation and adoption of NHS Connecting for Health's national electronic health record in secondary care in England: interim findings. BMJ. 2010, 41: c4564-

Pearson P, Steven A, Howe A, Sheikh A, Ashcroft D, Smith P, the Patient Safety Education Study Group: Learning about patient safety: organisational context and culture in the education of healthcare professionals. J Health Serv Res Policy. 2010, 15: 4-10. 10.1258/jhsrp.2009.009052.

Article PubMed Google Scholar

van Harten WH, Casparie TF, Fisscher OA: The evaluation of the introduction of a quality management system: a process-oriented case study in a large rehabilitation hospital. Health Policy. 2002, 60 (1): 17-37. 10.1016/S0168-8510(01)00187-7.

Stake RE: The art of case study research. 1995, London: Sage Publications Ltd.

Sheikh A, Smeeth L, Ashcroft R: Randomised controlled trials in primary care: scope and application. Br J Gen Pract. 2002, 52 (482): 746-51.

PubMed PubMed Central Google Scholar

King G, Keohane R, Verba S: Designing Social Inquiry. 1996, Princeton: Princeton University Press

Doolin B: Information technology as disciplinary technology: being critical in interpretative research on information systems. Journal of Information Technology. 1998, 13: 301-311. 10.1057/jit.1998.8.

George AL, Bennett A: Case studies and theory development in the social sciences. 2005, Cambridge, MA: MIT Press

Eccles M, the Improved Clinical Effectiveness through Behavioural Research Group (ICEBeRG): Designing theoretically-informed implementation interventions. Implementation Science. 2006, 1: 1-8. 10.1186/1748-5908-1-1.

Article PubMed Central Google Scholar

Netuveli G, Hurwitz B, Levy M, Fletcher M, Barnes G, Durham SR, Sheikh A: Ethnic variations in UK asthma frequency, morbidity, and health-service use: a systematic review and meta-analysis. Lancet. 2005, 365 (9456): 312-7.

Sheikh A, Panesar SS, Lasserson T, Netuveli G: Recruitment of ethnic minorities to asthma studies. Thorax. 2004, 59 (7): 634-

CAS PubMed PubMed Central Google Scholar

Hellström I, Nolan M, Lundh U: 'We do things together': A case study of 'couplehood' in dementia. Dementia. 2005, 4: 7-22. 10.1177/1471301205049188.

Som CV: Nothing seems to have changed, nothing seems to be changing and perhaps nothing will change in the NHS: doctors' response to clinical governance. International Journal of Public Sector Management. 2005, 18: 463-477. 10.1108/09513550510608903.

Lincoln Y, Guba E: Naturalistic inquiry. 1985, Newbury Park: Sage Publications

Barbour RS: Checklists for improving rigour in qualitative research: a case of the tail wagging the dog?. BMJ. 2001, 322: 1115-1117. 10.1136/bmj.322.7294.1115.

Mays N, Pope C: Qualitative research in health care: Assessing quality in qualitative research. BMJ. 2000, 320: 50-52. 10.1136/bmj.320.7226.50.

Mason J: Qualitative researching. 2002, London: Sage

Brazier A, Cooke K, Moravan V: Using Mixed Methods for Evaluating an Integrative Approach to Cancer Care: A Case Study. Integr Cancer Ther. 2008, 7: 5-17. 10.1177/1534735407313395.

Miles MB, Huberman M: Qualitative data analysis: an expanded sourcebook. 1994, CA: Sage Publications Inc., 2

Pope C, Ziebland S, Mays N: Analysing qualitative data. Qualitative research in health care. BMJ. 2000, 320: 114-116. 10.1136/bmj.320.7227.114.

Cresswell KM, Worth A, Sheikh A: Actor-Network Theory and its role in understanding the implementation of information technology developments in healthcare. BMC Med Inform Decis Mak. 2010, 10 (1): 67-10.1186/1472-6947-10-67.

Article PubMed PubMed Central Google Scholar

Malterud K: Qualitative research: standards, challenges, and guidelines. Lancet. 2001, 358: 483-488. 10.1016/S0140-6736(01)05627-6.

Article CAS PubMed Google Scholar

Yin R: Case study research: design and methods. 1994, Thousand Oaks, CA: Sage Publishing, 2

Yin R: Enhancing the quality of case studies in health services research. Health Serv Res. 1999, 34: 1209-1224.

Green J, Thorogood N: Qualitative methods for health research. 2009, Los Angeles: Sage, 2

Howcroft D, Trauth E: Handbook of Critical Information Systems Research, Theory and Application. 2005, Cheltenham, UK: Northampton, MA, USA: Edward Elgar

Book Google Scholar

Blakie N: Approaches to Social Enquiry. 1993, Cambridge: Polity Press

Doolin B: Power and resistance in the implementation of a medical management information system. Info Systems J. 2004, 14: 343-362. 10.1111/j.1365-2575.2004.00176.x.

Bloomfield BP, Best A: Management consultants: systems development, power and the translation of problems. Sociological Review. 1992, 40: 533-560.

Shanks G, Parr A: Positivist, single case study research in information systems: A critical analysis. Proceedings of the European Conference on Information Systems. 2003, Naples

Pre-publication history

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Division of Primary Care, The University of Nottingham, Nottingham, UK

Sarah Crowe & Anthony Avery

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Kathrin Cresswell, Ann Robertson & Aziz Sheikh

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

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Received : 29 November 2010

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Published : 27 June 2011

DOI : https://doi.org/10.1186/1471-2288-11-100

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Case Study – Methods, Examples and Guide

Types of Case Study

Single-Case Study

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