multiple case study creswell

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When considering the category of community, the goal is to work as closely as possible with the community.  Since the ultimate goal of CBR is "social change for social justice" (Stoecker, 2002a, p. 9), the closer the researcher is to the members of the community who are dealing with the problem (Stoecker, 2003), the greater the potential to empower.  The community continuum includes grassroots organizations on one end and organizations which do not represent the community or use practices that "disempower the community" (Strand et al., 2003a. p. 73) on the other (see Figure 1).  In between are organizations that are a level removed from grassroots organizations but still seek to represent the community democratically, what Strand et al. (2003a) call "midlevel organizations" (p. 74).  Conducting CBR projects with midlevel organizations is what Strand et al. (2003a) label " doing CBR in the middle " (p. 73). 

Within this analytic framework, I conceptualize collaboration as shared decision making.  The goal is that the community should have equal power with the researcher and that decision making should be a shared process throughout (Strand et al., 2003a).  When considering this concept within the continuum, shared decision making is at one end of the continuum and at the other end the decisions are made primarily by the researcher (see Figure 1).  A companion to collaboration is the concept of participation in knowledge creation.  The primary goal in relation to this aspect of the framework is that the community assists in the creation of all knowledge that is generated during the CBR process, thus leading to community empowerment.  This point of the framework is based on the principle that the knowledge of community members is valid (Strand et al., 2003a) and integral to creating strong results.  At one end of the continuum, the community is involved in all aspects of knowledge creation, at the other end, the researcher controls the creation of knowledge (see Figure 1). 

The final point of the analytic framework is change (see Figure 1).  If you consider CBR within the radical framework described by Stoecker (2003), the goal for change is "massive structural changes in the distribution of power and resources through far-reaching changes in governmental policy, economic practices, or cultural norms" (p. 36).  This goal can be difficult to achieve.  More often, CBR work leads to programmatic changes within an organization or other more limited changes (Strand et al., 2003a).  However, each change within a community can have a cumulative effect that can lead to broader change.  Community-based research that does not involve the community in close collaboration and knowledge creation is less likely to create change that benefits the community.

Analysis of Contrasting Cases

Since this study utilizes contrasting cases, data analysis occurs at two levels: within-case and across cases (Merriam, 1998).  Merriam (1998) describes this process:            

For the within-case analysis , each case is first treated as a comprehensive case in and of itself.  Data are gathered so the researcher can learn as much about the contextual variables as possible that might have a bearing on the case...Once the analysis of each case is completed, cross-case analysis begins.  A qualitative, inductive, multicase study seeks to build abstractions across cases (pp. 194-195).

For each case, I analyzed observations, interviews, and documents to develop a description of the case. This description depicts the setting and participants as well as a general chronology of events and provides the reader with an understanding of the particulars of the case (Creswell, 1998).  This allows the reader to develop an understanding of the case within the larger context (Creswell, 2002).  Then using the analytic framework I developed, I did some within-case analysis and organized the categories that emerged during each study around the four constructs of my analytic framework.  This within-case analysis focused on answering the primary research question: What is the process of collaborating with a community partner on a community-based research project?  Thus each case analysis consists of  "both description and thematic development" (Creswell, 2002, p. 486).           

After completing the within-case analysis, I focused on the cross-case analysis to address three of the sub-questions of the study: What kinds of issues arise when collaborating on a community-based research project? What facilitates or hinders the process of collaboration? and, What does the researcher gain through this collaborative process, and what are the benefits for the community?  In the cross-case analysis, I used data from both case studies to address these questions.  I explored the categories that had emerged throughout each case study and then compared to see if these categories were supported in both cases.  I used the categories and themes that emerged during the within-case analysis and the cross-case analysis to determine "naturalistic generalizations" (Creswell, 1998, p. 154) concerning the field of community-based research.  Creswell (1998) defines naturalistic generalizations as "generalizations that people can learn from the case either for themselves or for applying it to a population of cases" (p. 154).  These naturalistic generalizations address the final question of the study: What can we learn from these experiences to inform the field of CBR?

In order to lend credibility to the findings of my study, I incorporated a variety of validity procedures.  The first validity procedure I employed was prolonged engagement in the field (Creswell & Miller, 2000) or what Merriam (1998) calls "long-term observation" (p. 204).  I worked on my case study with the Coalition for a period of nine months, and I worked with John and Maria for a period of eight months.  During each of these case studies, I had consistent contact with my community partners.  Collaborating with my community partners for this length of time allowed me to develop tentative categories in my findings and then follow up on these preliminary findings through observations or interviews (Creswell & Miller, 2000).  Therefore, the length of each case study and the consistent contact I had with my community partners lends credibility to my perceptions of this experience.

In addition to prolonged engagement in the field, another important validity procedure I employed, which is integral to case study design, was triangulation (Creswell, 1998).  Merriam (1998) defines triangulation as "using multiple investigators, multiple sources of data, or multiple methods to confirm the emerging findings" (p. 204).  I employed methodological triangulation (Creswell & Miller, 2000) since I collected three forms of data: observations, interviews, and documents.  I also employed multiple sources of data since interviews were conducted with several participants (Creswell & Miller, 2000).  I used the process of triangulation to seek convergence in the data and to confirm or disconfirm emerging categories and themes (Creswell & Miller, 2000).  As part of this process, I employed another validity strategy, disconfirming evidence (Creswell &  Miller, 2000).  Categories or themes that emerged in the within-case analysis were compared across cases.  If a category did not hold true across cases, it was generally deemed to be unreliable.  However, I did utilize what Creswell (1998) calls direct interpretation.  In direct interpretation, "the case study researcher looks at a single instance and draws meaning from it without looking for multiple instances" (p. 154).  I did recognize that there were single incidents specific to only one case that were significant to the study as well. 

Since this case study focused on the study of process, my perceptions were an integral component of the research.  However, since I did write interpretations of what I considered to be the perceptions of others, I used member checking to ensure accurate portrayal (Creswell & Miller, 2000).  I conducted member checking toward the end of the study so that it would not potentially disrupt the collaborative process.  I shared an outline of findings with Lisa Brown with the Coalition and also John Brewer and Maria Swenson in my small town and allowed them the opportunity to provide feedback.  Lisa Brown responded to the findings through email and said, "Thanks for sharing [these findings].  I feel it is accurate, and that it was a learning experience for all of us."  Maria Swenson also responded to the findings that I shared with she and John.  She said, "I looked at [the findings] and it sounds good.  I agree with all said."  John also said that he thought that the findings looked good. 

Finally, I used the validity procedure of thick description when writing about the study in order to give the reader a sense of being there and to capture the essence of the experience (Creswell & Miller, 2000).  This is an important feature in case study design that is presented to the reader through the case description.  The case description for each contrasting case is included in chapters four and five.  

            Subjectivity

Another method of creditability I used continuously throughout the research process was researcher reflexivity (Creswell & Miller, 2000).  I incorporated researcher reflexivity by constantly questioning my assumptions about what I thought was happening.  I sought to maintain a heightened sense of awareness of the biases that I brought to the study and maintained this awareness when adding contextual data to field notes, observations transcriptions, and interview transcriptions, and also when writing journal entries. 

Since my perceptions of the research process played a major part in the findings of the study, it was important that I attend to the idea of subjectivity.  Peshkin (1988), defines subjectivity as "the quality of the investigator that affects the results of observational investigation" (p. 17).  Peshkin (1988) points out that an individual's subjectivity is not something that can be removed, and it is therefore something researchers need to be aware of throughout the research process.  Peshkin (1988) identified the various facets of his subjectivities through a series of I's, for example, the "justice-seeking I" (p. 18) and "the community-maintenance I" (p. 18).  Though Peshkin does not view subjectivity as necessarily negative, he does feel it is something that researchers need to realize and acknowledge.  It was important to examine my own subjectivities throughout the research process so that I was aware of how these subjectivities could influence my interpretations and portrayal of events.  As Strand (2000) points out, "the researcher's values, experiences, and personal points of view are as much a part of the research process as those of the people studied, and they should be discussed and acknowledged" (p. 91). 

Since the two CBR projects I worked on were in different settings and related to different types of work, I dealt with different subjectivities within each case study.  In my work with the Coalition for Schools many of the subjectivities that I brought to that collaboration arose from my past experience as a classroom teacher.  I hold the perception that people who do not have experience in a K-12 classroom do not generally understand the issues that classroom teachers have to address.  I can be defensive and overly sensitive to criticism that I feel puts the blame on teachers.  There were many times during my partnership with the Coalition that I realized this subjectivity was influencing my reactions to statements made by Lisa Brown or Marge Bowline.  I also think that this perception at times clouded my view of the knowledge that Lisa brought to the equation.  Though I felt that she was very knowledgeable in certain areas, I questioned her understanding of what was actually happening in the schools that are part of the Coalition.  I tried to be aware of my bias in this area, though I do not believe I was always successful in controlling how this bias influenced my work with Lisa. 

Another bias that I brought to my work with the Coalition was the idea that a successful partnership should not have conflict.  I tend to avoid conflict in my personal life.  I have difficulty at times recognizing the benefits that conflict can bring.  Because of this, I did not communicate as effectively with Lisa as I could have.  If had been more willing to risk conflict, we may have been able to develop a more productive working relationship.  When I began my work with John Brewer and Maria Swenson, I determined that I would not avoid conflict in this collaboration.  When a situation did arise where John and I disagreed, I engaged him, and we talked through the matter.  The outcome was that we both were able to see the value of the other's viewpoint. 

Though I was able to address the issue of conflict avoidance in my work in John Brewer and Maria Swenson, there were other subjectivities and biases of which I had to be aware.  I am liable to have the perception that small towns tend to discriminate against minorities.  Since all of the projects that I completed with John and Maria involved the immigrant population in town, I felt at times that I was waiting for someone to say something that would demonstrate their prejudice.  At times, I would jump to the conclusion that a particular statement was pejorative.  When looking back again at the statement in the context of the full conversation, I realized at times that I may have misinterpreted particular statements.  I had to make a concerted effort not to single out statements just because they supported my bias.  Nevertheless, this subjectivity did influence whom I chose to partner with during this case study.  I had originally planned to include Maria's supervisor, Jennifer Payton, in our collaboration.  However, after meeting with Jennifer in October 2003, I decided not to collaborate with her since she made several comments during the meeting that I perceived to be pejorative.  If I had decided to work with Jennifer, I may have found that these comments did not represent discrimination but rather a lack of understanding of the impact of language choices. 

Two other subjectivities that I brought into my work on both projects related to my experience with previous CBR projects.  As I was involved in another community-based research project before working on my dissertation, I already had an initial perception of how the process works.  One concern that arose during my previous experience was the issue of communicating with my community partner.  I had difficulty developing a research question because the conversations that I shared with my community partner seemed circuitous.  We talked around questions during several meetings before I was finally able to gain a sense of what she was hoping to achieve from the research.  Though these past experiences with community-based research helped me to anticipate some of the issues that arose, I tried to make sure that the anticipation of issues did not create issues. 

When entering into CBR projects, it is important to me that I am doing work that I view as meaningful.  Work that is meaningful to me would be research that allows me to consistently interact with members of the community on a personal level.  However, I tried to maintain the awareness that the research that I wished to pursue was not necessarily the research that the people I was collaborating with wished to pursue.  I continued to remind myself that these discrepancies should not interfere with the development of a research design that was beneficial to my community partner and had the potential to bring about effective change.  Since change is the goal of community-based research, I needed to be sure that the change I was assisting to create was the change that the community partner was seeking to make rather than the change that I would have liked to pursue. 

Finally, when a researcher carries out a qualitative study, it is also important to attend to the subjectivities that the researcher brings based on gender, age, ethnicity, and socioeconomic status.  I feel at times that I lack self-awareness of how these orientations impact the way that I view the world.  Though I tried to be conscious of these factors while doing my research, I am not sure that I was successful in completely exploring how these subjectivities may have influenced my research.  I do feel, however, that my status was an issue in the work that I conducted with the Coalition for Schools.  My status in relation to my age (under 40) and my position as a graduate student influenced how my community partners at the Coalition viewed my role, and my socioeconomic background impacted the level of confidence that I felt when working with members of the Coalition.  I come from a working class background while my community partners at the Coalition come from backgrounds of higher status both in relation to levels of education and socioeconomic status.  At times, I did feel out of place moving through the world of the Coalition in that I often felt that I was from a lower class than many of the people with which I came into contact.  I felt most comfortable when interacting with teachers or parents. 

In order to minimize the impact of my subjectivities, I closely monitored my feelings as I carried out my research.  I looked for situations where I felt uncomfortable or that I wanted to avoid as well as situations where I felt comfortable and that I wanted to continue.  When these feelings arose, I realized that I was usually being influenced by subjectivity (Glesne, 1999; Peshkin, 1988).  I analyzed my feelings and considered how they related to my subjectivities, then took note of these occurrences in my journal (Peshkin, 1988).  Throughout the research process, I was mindful of previously identified subjectivities.  I also tried to be aware of newly emerging subjectivities that I may not have considered (Peshkin, 1988) that would potentially influence my research. 

Limitations of This Study

This study seeks to compare two cases of conducting community-based research.  However, there are differences between the two experiences that may have impacted the findings of the study.  In my work with the Coalition, I was a paid employee.  Though I was hired with the understanding that I would be a collaborative researcher, I believe my position as an employee impacted how Marge Bowline and Lisa Brown viewed my role, and it also impacted my reactions to various situations.  The fact that I was an employee in the first case study when collaborating with the Coalition but in the second case study I was independent, may have created some of the differences that were apparent in the two cases. 

Another limitation of this study is that it primarily focuses on the researcher's experience of this process.  Though I did interview my community partners, the number of interviews in the first case study was more limited.  If I had conducted additional interviews throughout the first case study, I might have additional information to support or contradict some of my observations.  However, the purpose of this study is to provide insight into this process for practitioners in the field of community-based research, thus it is beneficial to explore the researcher's perspective of these two experiences. 

The final limitation of this study relates to the timeline of the completion of the study.  Since I only recently finalized data collection in relation to my work with John Brewer and Maria Swenson, I am not really able to make an assessment at this point as to whether any of the work we completed will affect change.  My work with the Coalition was completed almost a year ago so it easier to assess the impact of that work.  However, even with the first case study, there is a possibility that some of the work that I completed could eventually lead to change.  If I were to conduct a long-term case study in relation to either of these collaborations, it would be more feasible to assess the impact of our work. 

This chapter provided an overview to the case study methods that were used to conduct this study.  I detailed a rationale for choosing this method, then described data collection, analysis, and procedures in relation to validity.  Since this is a process study of the methodology of CBR, I also described the foundations of this methodology.  The next three chapters will present the findings of this study.  Chapters four and five provide a synopsis of the within-case analysis of each of the contrasting cases.  I begin each chapter with a chronological overview of the major events of the case and then present within-case analysis organized around the four concepts of my analytic framework.  In chapter six, I present the findings from the cross-case analysis that address the sub-questions of the study and identify the "naturalistic generalizations" (Creswell, 1998, p. 154) that emerged from the study with recommendations for further research. 

Methodology: Multiple-Case Qualitative Study

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This longitudinal multiple-case study is qualitative in nature, with data collection lasting for more than a year. As this study set out to understand the experiences, feelings, emotions, conceptions, and understanding of students about their experiences, a qualitative research approach was adopted to “identify issues from the perspective of” the participants, and to study them in a natural setting (Hennink et al., 2011, p. 9).

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Research Guides

Case Studies

Dee Degner; Amani Gashan; and Natalia Ramirez Casalvolone

Description

Creswell and Poth (2018) define case study as a strategy that involves the study of an issue explored through one or more cases within a bounded system (i.e., a setting or a context), a methodology, a type of design in qualitative research, or an object of study, as well as a product of the inquiry.

Flyvbjerg (2011) defines case study as an intensive analysis of an individual unit (as a person or community) stressing developmental factors in relation to the environment. Case study methodology aims to describe one or more cases in depth. It examines how something may be occurring in a given case or cases and typically uses multiple data sources to gather information. Creswell and Poth also argue that the use of different sources of information is to provide depth to the case description. Case study methodology aims to describe one or more cases in depth. It examines how something may be occurring in a given case or cases and typically uses multiple data sources to gather the information. This is the first step of data analysis in a qualitative case study. Following this, researchers must decide whether there is a case study to analyze, determine the boundaries of their case study and its context, decide whether they wish to use single or multiple case studies, and explore approaches to analyzing themes and articulating findings. Creswell and Poth (2018) are an ideal resource for defining case study, learning about its parts, and executing case study methodology.

Creswell, J. W., & Poth, C. N. (2018). Qualitative inquiry & research: choosing among five approaches (4th ed.) . Thousand Oaks, CA: Sage.

Flyvbjerg, B. (2011). Case study. In N. K. Denzin, & Y.S. Lincoln (Eds.), The Sage handbook of qualitative research (pp. 301-316 ). Thousand Oaks, CA: Sage.

Key Research Books and Articles on Case Study Methodology

Ashley, L. D. (2017). Case study research. In R. Coe, M. Waring, L. Hedges & J. Arthur (Eds), Research methods & methodologies in education (2nd ed., pp. 114-121). Thousand Oaks, CA: Sage.

This edited text discusses several research methods in education. Dr. Laura Day Ashley, a professor at the University of Birmingham in the United Kingdom, contributes a chapter on case study research. Using research on how private and public schools impact education in developing countries, she describes case studies and gives an example.

Baxter, P., & Jack, S. (2008). Qualitative case study methodology: Study design and implementation for novice researchers. Qualitative Report, 13 (4), 544-559.  http://nsuworks.nova.edu/cgi/viewcontent.cgi?article=1573&context=tqr

The authors of this study presented an account of the qualitative case study methodology that can provide beneficial tools for researchers to explore any phenomenon under study within its context. The aim of this study was to guide novice researchers in understanding the required information for the design and implementation of any qualitative case study research project. This paper offers an account of the types of case study designs along with practical recommendations to determine the case under study, write the research questions, develop propositions, and bind the case. It also includes a discussion of data resources and the triangulation procedure in case study research.

Creswell, J. W. & Poth, C. N. (2018). Qualitative inquiry & research: choosing among five approaches (4th ed.) . Los Angeles, CA: SAGE.

The authors are both recognized academics in the field of qualitative research; Dr. Creswell has authored many articles and 26 books on topics such as mixed-methods research, qualitative research, and research design, and Dr. Poth has written more than 30 peer reviewed journal articles and was a guest co-editor at the International Journal of Qualitative Methods. The book thoroughly reviews and compares five qualitative and inquiry designs, including research, phenomenological research, grounded theory research, ethnographic research, and case study research. Chapter 4, which is titled Five Qualitative Approaches, gives a thorough description and explanation of what a case study research contemplates. It discusses its definition and origins, its features, the types of case study procedures to follow when doing a case study, and the challenges faced during case study development. In the appendix, on page 119, the authors offer an example of a case study and a question that can be used for discussion. The entire book has pertinent information for both novice and experienced researchers in qualitative research. It covers all parts of the research process, from posing a framework to data collection, data analysis, and writing up.

Yin, R. K. (2016). Qualitative research from start to finish . New York, NY: The Guilford Press.

Yin is the CEO of an applied research firm. He has authored numerous articles in many fields, including education. He also authored Case Study Research, which is now in its Sixth Edition. This book uses three approaches (practical, inductive, and adaptive) to highlight many important aspects of Qualitative Research. He provides a definition of case study and references how case study differs from other types of research.

Recent Dissertations Using Case Study Methodology

Clapp, F. N. (2017). Teachers’ and researchers’ beliefs of learning and the use of learning progressions (Doctoral dissertation). Retrieved from ProQuest Dissertations & Theses Global. (Order Number 10261732)

This study from Colorado State University was designed to identify the beliefs and discourse that both the Learning Progressions (LP) developers and the intended LP implementers held around student learning, teaching, and learning progressions. The study’s research questions were examined through the use of an instrumental case study. The researchers were deliberate in applying theory and study phenomena in their context, as it investigated teachers’ practices in the context of their respective classrooms.

Applying theory to the study phenomena, this study provided insight into the relationship between LP models and teachers’ perceptions about how students learn content in a particular context. The data was collected using interviews with teachers who participated in a year-long teacher-in-residence program. Researchers and content experts who conceptualized the LP were also interviewed to study the impact that it had on participants’ perceptions of the LP and any teacher reported changes in their respective classrooms. The findings of this study inform literature on both science teacher professional development and LP’s theory to practice.

Ruiz, A. M. (2011). Teachers and English language learners experiencing the secondary mainstream classroom: A case study (Doctoral Dissertation). Retrieved from ProQuest Dissertations & Theses Global. (Order Number 3471646)

This study from Georgia State University answered the following questions: 1) How does a secondary mainstream teacher experience the phenomenon of the inclusion of ELLs in a mainstream content area classroom? 2) How do ELLs experience the phenomenon of inclusion within the secondary mainstream content area classrooms? 3) How do the points of interaction between the secondary mainstream teacher, the English language learners, the content and the context shape the experiences of the inclusive classroom?

To comprehend the socio-constructivist learning theory which guided the design of this study, one must begin with understanding the epistemological stance of constructionism. Constructionism is seated within an interpretivist paradigm which asserts that reality does exist outside the realm of human interpretation; rather, it is human interpretation which makes meaning of this reality. The researcher applied Denzin and Lincoln’s (2004) bricoleur approach to this study, as it offered them the opportunity “to piece together a set of representations that is fitted to the specifics of this complex situation in an overlapping series of events” (p. 4). The researcher stated that his worldview shaped his research questions which called for a single case study research design.

Smith, P. H. (2000). Community as resource for minority language learning: A case study of Spanish-English dual-language schooling (Doctoral dissertation). Retrieved from ProQuest Dissertations & Theses Global. (Order Number 304578045)

The author studied a school where a dual language (Spanish- English) program was being developed. He focused on the role of the community and the students’ acquisition of Spanish. Through a case study design, his theoretical framework was contemplated under the fields of language planning, language revitalization, and funds of knowledge. The author believed that minority language (Spanish) acquisition could be supported by incorporating local language resources, and in this way undermine the strong influence of the English language. To analyze his data, he went through a triangulation process of participant observation in classrooms, literacy instruction, teacher, parent and community interviews, and document and archival analysis. Findings showed that minority language resources are less often incorporated in the curriculum than those of the language majority. Thus the study suggested that these types of programs should include the funds of knowledge and available resources of the language minority communities.

Internet Resources

Graham R Gibbs. (2012, October 24). Types of Case Study. Parts 1-3 on Case Studies .

This series of videos by Graham R. Gibbs at the University of Huddersfield effectively explains case studies. Some of Gibbs’ books on qualitative research include Qualitative Data Analysis: Explorations with NVivo (2002) and Analyzing Qualitative Data (2018).

Graham R Gibbs. (2012, October 24). Types of Case Study. Part 1 on Case Studies . Retrieved from https://youtu.be/gQfoq7c4UE4

The first part of this series is an attempt to define case studies. Dr. Gibbs argued that it is a contemporary study of one person, one event, or one company. This contemporary phenomenon cab be studied in its social life context by using multiple sources of evidence.

When completing a case study, we either examine what affects our case and what effect it has on others, or we study the relationship between “the case” and between the other factors. In a typical case study approach,  you choose one site to do your work and then you collect information by talking to people, using observations, interviews, or focus groups at that location. Case study is typically descriptive, meaning “you write what you see”, but it could also be exploratory or explanatory.

Types of Case Study:

• Individual case study: One single person
• Set of individual case studies: Looking at three single practices
• Community studies: Many people in one community
• Social group studies: The case representing social phenomenon “how something is defined in a social position”
• Studies of organizations and institutions: The study of “election, ford, or fielding”
• Studies of events, roles, and relationships: Family relationships

Graham R Gibbs. (2012, October 24). Planning a case study. Part 2 on Case Studies . Retrieved from https://youtu.be/o1JEtXkFAr4

The second part of this series explains how to plan a case study. Dr. Gibbs argues that when planning to conduct a case study, we should think about the conceptual framework, research questions, research design, sampling/replication strategy, methods and instruments, and analysis of data.

For any type of research, a good source of inspiration could be either from personal experiences or from talking with people about a certain topic that we can adopt.

The Conceptual Framework: Displays the important features of a case study; shows the relationships between the features; makes assumptions explicit; is selective, iterative, and based on theory; takes account of previous research; includes personal orientations, and includes overlap and inconsistency.

Research questions should:

• Be consistent with your conceptual framework.
• Cover conceptual framework.
• Be structured and focused.
• Be answerable.
• Form a basis for data collection.

Graham R Gibbs. (2012, October 24). Replication or Single Cases. Part 3 of 3 on Case Studies . https://youtu.be/b5CYZRyOlys

In the final part of the three videos of case study, Dr. Gibbs examines case study designs and variations that are possible. He also discusses replication strategies which help give the studies reliability and test to see if they can be generalized. Dr. Gibbs highlights the methods and instruments used, how to analyze the data, and concludes with problems of validity you may encounter and common pitfalls of case study research. In summary, case studies can involve gathering a lot of data and you can start analyzing the data while collecting and going through it.

shirlanne84. (2014). Different types of case study </. Retrieved from https://youtu.be/tWsnvYs9Brs

In this short video (1.49 min.), three kinds of case studies (exploratory, descriptive, and explanatory) are described, as well as rationales for using them. These rationales are as follows:

• Exploratory: If you know nothing about the case.
• Descriptive: When you write what you see, you are describing the situation.
• Explanatory: When you try to understand why things are happening, then you explain them.

Shuttleworth, M. (2008, Apr. 1). Case study research design [website]. Retrieved Feb 20, 2018 from https://explorable.com/case-study-research-design

This is a useful website that provides a guide to almost all of the research methods. It offers a clear explanation about what a case study is, the argument for and against the case study research design, how to design and conduct a case study, and how to analyze the results. This source provides a journey from the introduction of case study until the analysis of your data.

Case Studies Copyright © 2019 by Dee Degner; Amani Gashan; and Natalia Ramirez Casalvolone is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License , except where otherwise noted.

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

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

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

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

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

Definitions of qualitative case study research

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

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

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

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

Current methodological issues in qualitative case study research

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

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

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

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

Assessment of rigour

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

Framework for assessing quality in qualitative case study research.

Adapted from Stake ( 1995 , p. 131).

Study design

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

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

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

Search strategy

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

Outcomes of search of qualitative methods journals.

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

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

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

Case study methodology or method

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

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

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

Case study of something particular and case selection

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

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

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

Contextually bound case study

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

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

Article synopsis of case study research using Stake's tradition

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

Article synopsis of case study research using Yin's tradition

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

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

Researcher and case interactions and triangulation

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

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

Study design inconsistent with methodology

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

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

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

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

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

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

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

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

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

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

Limitations of the review

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

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

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

Conflict of interest and funding

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

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What are you looking for?

A case study is a research approach that explores and investigates a particular phenomenon within its natural context in an in-depth and detailed manner, through one or more cases, and utilises multiple sources of data (Creswell, 2007; Crowe, Cresswell and Robertson et al., 2011; Yin, 1994). The multiplicity of sources in case studies may come from multiple data collection methods or from multiple accounts collected using a single method from people with different perspectives on the phenomena being observed (Lewis, 2003).  It is an in-depth and multifaceted study of a particular case (or cases) within a bounded context (Green and Thorogood, 2009; Miles and Huberman, 1994; Yin, 1994). It is both a methodology and research design as well as an object and outcome of inquiry (Stake, 1995; Yin, 2009).

Case studies are employed throughout various fields of study and are especially common in the social sciences. Case studies often involve qualitative methods, but they may also apply quantitative and mixed methods. They are an excellent method of inquiry to describe, compare, evaluate, and understand the various aspects of a phenomenon. Data sources used in case studies could be interviews, questionnaires, observation, audio recordings, video recordings, documents, reports or visual materials or artefacts (drawings, photographs etc.)

There are three main types of case studies (Stake, 1995):

Intrinsic Case Study - focuses on studying a unique phenomenon. Researchers must describe the uniqueness of the phenomenon which sets it apart.

Instrumental Case Study - uses a specific case to gain a broader and deeper understanding of a phenomenon.

Collective Case Study - uses multiple cases to gain an even broader and deeper understanding of a phenomenon.

These categories are not mutually exclusive and can overlap. An intrinsic study can also be instrumental or collective, for example. An instrumental study may also be a collective one. For instance, these two categories are sometimes referred to as ‘single instrumental case study’ and ‘multiple instrumental case study’.

Crowe, Cresswell and Robertson et al. (2011) suggest that it is useful to think through following stages of the case study when planning a case study:

Defining the Case

Selecting the Case

Collecting the Data

Analysing the Data

Interpreting Data

Reporting the Findings 

Link to Evaluating a Case Study

Crowe, Cresswell and Robertson et al. (2011) have indicated following pros and cons of the case study:

In-depth, multifaceted understanding of phenomenon in real-life context

Excellent method for explaining, describing, and exploring complex issues.

Works well in capturing information towards answering the ‘how’, ‘what’, and ‘why’ questions.

Can help develop or refine theory.

Widely used and established research design

Selecting/conceptualising the wrong case(s) resulting in lack of theoretical generalisations.

Collecting large volumes of data that are not relevant to the case or too little to be of any value.

Defining/bounding the case.

Lack of rigour.

Ethical issues.

Integration with theoretical framework.

chevron-down Examples

Brikše et al., 2014

Viberg et al., 2020

Yantaç et al., 2014

chevron-down References

Brikše, I., Freibergs, V., & Spurava, G. (2014). Children’s Internet Competence vs. Self-confidence and Self-comfort: Case Study of Latvia BT - Information Literacy. Lifelong Learning and Digital Citizenship in the 21st Century. In S. Kurbanoğlu, S. Špiranec, E. Grassian, D. Mizrachi, & R. Catts (Eds.), European Conference on Information Literacy: Information Literacy. Lifelong Learning and Digital Citizenship in the 21st Century (pp. 233–242). Springer International Publishing.

Creswell, J. (2007). Qualitative Inquiry & Research Design: Choosing Among Five Approaches. 2. ed. SAGE.

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

Green, J., & Thorogood, N. (2009). Qualitative Methods for Health Research. (2nd edition). Sage.

Lewis, J. (2003). In Ritchie, J., & Lewis, J. (Eds). Qualitative Research Practice: A Guide for Social Science Students and Researchers. Sage Publications.

Miles, M. B., & Huberman, A. M. (1994). Qualitative Data Analysis : An Expanded Sourcebook (2.ed.). Sage.

Stake, R. (1995). The Art of Case Study Research. SAGE.

Viberg, O., Grönlund, Å., & Andersson, A. (2020). Integrating digital technology in mathematics education: a Swedish case study. Interactive Learning Environments . https://doi.org/10.1080/10494820.2020.1770801

Yantaç, A. E., Esin Orhun, S., & Ünlüer Çimen, A. (2014). A Challenging Design Case Study for Interactive Media Design Education: Interactive Media for Individuals with Autism. Lecture Notes in Computer Science (Including Subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics) , 8520 LNCS (PART 4), 185–196. https://doi.org/10.1007/978-3-319-07638-6_19

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Yin, R. K. (2009). Case Study Research : Design and Methods  (4th ed.). SAGE Publications.

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• Artificial intelligence in healthcare

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AI Chatbots Provide Inconsistent Musculoskeletal Health Information

Multiple studies indicate that chatgpt, google bard, and bingai demonstrate limited accuracy when presenting information about orthopedic procedures..

• Shania Kennedy, Assistant Editor

Artificial intelligence (AI) chatbots like ChatGPT, Google Bard, and BingAI provide information about musculoskeletal health with inconsistent accuracy, according to recent studies presented at the 2024 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

As large language model (LLM) chatbots become more popular, researchers have raised concerns about how these tools should be used in medicine. AI chatbots have shown promise in tasks like data processing and supporting patient education, but they also carry significant ethical and legal risks.

Many have emphasized that AI tools have the potential to supplement the expertise of medical professionals to improve care, but the extent to which the tools can do so is still being investigated across medical specialties.

The three studies presented at the AAOS meeting sought to explore the validity and accuracy of musculoskeletal health information conveyed by popular AI chatbots. Overall, the researchers found that chatbots can generate concise summaries of information about orthopedic conditions and procedures, but each was limited in one or more information categories.

The first study, “Potential misinformation and dangers associated with clinical use of LLM chatbots,” presented by a team from Weill Cornell Medicine, investigated how well ChatGPT-4, Google Bard, and BingAI can explain orthopedic concepts, address patient queries, and integrate clinical information into responses.

The chatbots were tasked with answering 45 questions across "Bone Physiology," "Referring Physician," and "Patient Query" categories. Each chatbot’s response was then assessed for accuracy on a zero to four scale by two independent, blinded reviewers.

Analysis of the chatbots’ responses revealed that each tool provided answers that included the most critical salient points at least some of the time: ChatGPT in 76.6 percent of cases, Google Bard in 33 percent of cases, and BingAI in 16.7 percent of cases.

Every chatbot was also severely limited in its ability to provide clinical management suggestions, often omitting workup steps and deviating from the standard of care.

ChatGPT and Google Bard could provide mostly accurate responses to less complex patient queries, but failed to request key medical information required to provide a complete response.

The second study, “Is ChatGPT ready for prime time? Assessing the accuracy of AI in answering common arthroplasty patient questions,” presented by researchers from Connecticut Orthopaedics, evaluated the chatbot’s ability to respond to 80 questions about hip and knee replacements.

Each query was presented to ChatGPT twice: first, asking the question as written, and then requesting that the chatbot respond as an orthopedic surgeon. Members of the research team then scored the accuracy of each response from one to four.

Approximately 26 percent of the chatbot’s responses were rated an average of three on the scale – indicating that the answer was partially accurate, but incomplete – when asked without a prompt. Eight percent of responses had an average rating of less than three when asked with a prompt.

The tool performed significantly better when prompted to respond as a surgeon, reaching 92 percent accuracy. However, ChatGPT’s limitations led the research team to conclude that it is not an appropriate resource for patients and that an orthopedic-focused chatbot should be developed.

The third study, “Can ChatGPT 4.0 be used to answer patient questions concerning the Latarjet procedure for anterior shoulder instability?” presented by the Hospital for Special Surgery, sought to explore the tool’s potential as an adjunct for clinicians.

The research team conducted a Google search for "Latarjet" to determine the top ten frequently asked questions and sources pulled by the search engine in relation to the procedure. The researchers then asked ChatGPT to perform the same search to identify questions and sources.

Google provided a small percentage of academic sources related to Latarjet procedures, pulling most of its information from larger medical practices and surgeons’ personal websites. In contrast, ChatGPT provided a range of clinically relevant information, all of which was taken from academic sources.

The teams behind each study underscored that their findings are key to helping understand the efficacy and potential future applications of AI chatbots in orthopedics.

ChatGPT has been shown to effectively answer patient questions , highlighting its promise for patient education, but the integration of AI in healthcare presents a host of challenges for patients and providers.

Patient trust is a major hurdle that healthcare organizations must tackle before the widespread adoption of these tools. Recent reports indicate that roughly 50 percent of patients don’t trust chatbot-provided medical advice, instead preferring to defer to their providers.

However, trust could be bolstered by ensuring that AI tools take a “human in the loop” approach and by informing patients that these technologies are guided by medical professionals.

But as AI continues to shape patient engagement , health systems will be forced to navigate the data privacy and HIPAA compliance concerns around chatbots .

• ChatGPT, Provider Responses Almost Indistinguishable to Patients
• ChatGPT Achieves High Accuracy in Clinical Decision-Making Tasks
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Judge orders hearing to consider tossing key evidence in Trump classified docs case

The federal judge overseeing Donald Trump 's classified documents case on Thursday ordered an additional hearing to determine whether prosecutors improperly used evidence protected by attorney-client privilege to secure their indictment against the former president.

The video is from a previous report.

In an 11-page ruling issued, Judge Aileen Cannon wrote that an additional hearing was necessary to resolve "pertinent factual disputes" related to key evidence in the case.

As previously reported by ABC News, prosecutors have relied on the notes of Trump's former lead attorney Evan Corcoran to support their allegations that the former president obstructed justice by hiding classified documents from investigators.

After a federal judge in Washington D.C. determined last year that the notes were not protected by attorney-client privilege because Trump used his attorney in furtherance of a crime, defense attorneys asked Cannon to reconsider whether the evidence should be tossed out.

WATCH THE PRESIDENTIAL DEBATE | 1st Biden-Trump presidential debate: What time is it and how to watch

Judge Cannon wrote in Thursday's order that she would set a date for the hearing in a separate order.

She heard arguments on the defense motion to suppress the evidence during a sealed hearing on Tuesday morning.

Trump pleaded not guilty last year to 40 criminal counts related to his handling of classified materials after leaving the White House, after prosecutors said he repeatedly refused to return hundreds of documents and took steps to thwart the government's efforts to get the documents back.

Trump has denied all charges and denounced the probe as a political witch hunt.

This is a developing story. Please check back for updates.

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Global South health care practices contribute to spread of antimicrobial resistance across the world, study suggests

by University of Helsinki

Many bacteria resistant to multiple antibiotics originate in Pakistan and other parts of the Indian subcontinent. Infections caused by these bacteria are challenging to treat; longer treatment with broad-spectrum antibiotics is required and despite this, mortality is increased in those infected with multiresistant bacteria.

A study published in Nature Communications sheds light on the prevalence of antimicrobial resistance in the Pakistani population. The multidisciplinary study conducted between the University of Helsinki and the Cambridge-based Wellcome Sanger Institute also investigated the short-term effects of antibiotic use on the occurrence of resistant bacteria in individual patients.

"Travelers returning from the Indian subcontinent face the highest risk of carrying multi-resistant bacteria. To understand the global emergence of resistance, it is essential to explore the resistant strains spreading in these high-risk regions," says Anu Kantele, Professor of Infectious Diseases at the University of Helsinki and Senior Medical Officer at Helsinki University Hospital.

Genes in the entire bacterial culture were identified

Researchers took rectal swab samples from roughly a thousand patients who had an appointment at a small hospital in the Lahore metropolitan area. Approximately half the patients provided control samples after a one-month monitoring period.

The researchers used the samples to explore the impact of antibiotic use on Escherichia coli bacteria carried by people. Samples were also collected from healthy volunteers across the Punjab, Pakistan's most populated province.

Infectious diseases physician Tamim Khawaja spent four months in Pakistan collecting samples from locals. These were cultivated on-site at a local laboratory, and the bacterial cultures were frozen and delivered to Finland.

The DNA of the cultures was sequenced using a new deep sequencing method in cooperation with the Wellcome Sanger Institute. The analysis was conducted using new methods developed by Tommi Mäklin, Postdoctoral Researcher at the University of Helsinki, with which all information contained by DNA could be used accurately. As a result, the research consortium was able to identify diversity in E. coli bacteria, both in individuals and at the level of the population.

"Thanks to the better scalability of the latest sequencing technology and the methods developed by my team, we have opened a different perspective on research on the evolutionary dynamics of bacteria and resistance. I believe that this approach will help us achieve several breakthroughs in the next few years," says Professor Jukka Corander.

The study showed that the prevalence of the E. coli bacterial strains found in Pakistan displayed significant variation, even in samples collected from a single individual. The researchers also observed that many bacterial strains common in Europe could not compete with local strains in Pakistan, even though many can be found on both continents.

"For example, ST58, an E. coli strain common in Pakistan, has caused serious infections in countries with a high standard of living. In western countries, asymptomatic carriers of this strain are rare, but in Pakistan, ST58 was the third most common type of E. coli colonizing people. Then again, certain E. coli strains that cause urinary tract infections and are carried asymptomatically by healthy people in western countries were rare in Pakistan, possibly due to the high antibiotic selective pressure," Mäklin says.

No antibiotics just in case

Some of the E. coli bacteria found in Pakistan were genetically close to strains sequenced previously in Norway.

"This is highly representative of how bacteria travel from one continent to the next as quickly as people," says Kantele.

"Reducing unnecessary antibiotic use in Western countries isn't enough; it's in everyone's best interest to help poorer countries use antibiotics more wisely. During our research, we realized that physicians often have less than a minute per patient, leading to the frequent prescription of broad-spectrum antibiotics just in case. In our health care crisis, we often forget that the crisis is far greater in poorer countries and its impact reaches us," says Khawaja.

The study is part of his doctoral dissertation.

Journal information: Nature Communications

Provided by University of Helsinki

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