In order to develop a thorough understanding of the case, the case study approach usually involves the collection of multiple sources of evidence, using a range of quantitative e. The use of multiple sources of data data triangulation has been advocated as a way of increasing the internal validity of a study i. Brazier and colleagues used a mixed-methods case study approach to investigate the impact of a cancer care programme[ 22 ].
Here, quantitative measures were collected with questionnaires before, and five months after, the start of the intervention which did not yield any statistically significant results. Qualitative interviews with patients however helped provide an insight into potentially beneficial process-related aspects of the programme, such as greater, perceived patient involvement in care.
The authors reported how this case study approach provided a number of contextual factors likely to influence the effectiveness of the intervention and which were not likely to have been obtained from quantitative methods alone. In collective or multiple case studies, data collection needs to be flexible enough to allow a detailed description of each individual case to be developed e. It is important that data sources from different cases are, where possible, broadly comparable for this purpose even though they may vary in nature and depth. Making sense and offering a coherent interpretation of the typically disparate sources of data whether qualitative alone or together with quantitative is far from straightforward.
Repeated reviewing and sorting of the voluminous and detail-rich data are integral to the process of analysis. In collective case studies, it is helpful to analyse data relating to the individual component cases first, before making comparisons across cases. Attention needs to be paid to variations within each case and, where relevant, the relationship between different causes, effects and outcomes[ 23 ]. Data will need to be organised and coded to allow the key issues, both derived from the literature and emerging from the dataset, to be easily retrieved at a later stage.
An initial coding frame can help capture these issues and can be applied systematically to the whole dataset with the aid of a qualitative data analysis software package. Theoretical frameworks may also play an important role in integrating different sources of data and examining emerging themes.
Case study findings can have implications both for theory development and theory testing. They may establish, strengthen or weaken historical explanations of a case and, in certain circumstances, allow theoretical as opposed to statistical generalisation beyond the particular cases studied[ 12 ]. These theoretical lenses should not, however, constitute a strait-jacket and the cases should not be "forced to fit" the particular theoretical framework that is being employed.
When reporting findings, it is important to provide the reader with enough contextual information to understand the processes that were followed and how the conclusions were reached. In a collective case study, researchers may choose to present the findings from individual cases separately before amalgamating across cases. Care must be taken to ensure the anonymity of both case sites and individual participants if agreed in advance by allocating appropriate codes or withholding descriptors. The case study approach is, as with all research, not without its limitations.
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The volume of data, together with the time restrictions in place, impacted on the depth of analysis that was possible within the available resources. This highlights a more general point of the importance of avoiding the temptation to collect as much data as possible; adequate time also needs to be set aside for data analysis and interpretation of what are often highly complex datasets.
Research Methods – Introduction to Community Psychology
Case study research has sometimes been criticised for lacking scientific rigour and providing little basis for generalisation i. There are several ways to address these concerns, including: the use of theoretical sampling i. Transparency can be achieved by describing in detail the steps involved in case selection, data collection, the reasons for the particular methods chosen, and the researcher's background and level of involvement i. Seeking potential, alternative explanations, and being explicit about how interpretations and conclusions were reached, help readers to judge the trustworthiness of the case study report.
Stake's checklist for assessing the quality of a case study report[ 8 ]. The case study approach allows, amongst other things, critical events, interventions, policy developments and programme-based service reforms to be studied in detail in a real-life context. It should therefore be considered when an experimental design is either inappropriate to answer the research questions posed or impossible to undertake. Considering the frequency with which implementations of innovations are now taking place in healthcare settings and how well the case study approach lends itself to in-depth, complex health service research, we believe this approach should be more widely considered by researchers.
Though inherently challenging, the research case study can, if carefully conceptualised and thoughtfully undertaken and reported, yield powerful insights into many important aspects of health and healthcare delivery.
Case Study Method
AS conceived this article. SC and AS are guarantors. We are grateful to the participants and colleagues who contributed to the individual case studies that we have drawn on. We would also like to thank the expert reviewers for their insightful and constructive feedback. Our thanks are also due to Dr. Allison Worth who commented on an earlier draft of this manuscript. National Center for Biotechnology Information , U.
Published online Jun Author information Article notes Copyright and License information Disclaimer. Corresponding author. Sarah Crowe: ku.
Received Nov 29; Accepted Jun This article has been cited by other articles in PMC. Abstract The case study approach allows in-depth, multi-faceted explorations of complex issues in their real-life settings.
Introduction The case study approach is particularly useful to employ when there is a need to obtain an in-depth appreciation of an issue, event or phenomenon of interest, in its natural real-life context. Table 1 Example of a case study investigating the reasons for differences in recruitment rates of minority ethnic people in asthma research[ 3 ]. Context: Minority ethnic people experience considerably greater morbidity from asthma than the White majority population. Research has shown however that these minority ethnic populations are likely to be under-represented in research undertaken in the UK; there is comparatively less marginalisation in the US.
Study design: Single intrinsic case study The case: Centred on the issue of recruitment of South Asian people with asthma. A supplementary questionnaire was also provided to researchers.
Analysis: Framework approach. The attitudes of the researchers' towards inclusion: The majority of UK researchers interviewed were generally supportive of the idea of recruiting ethnically diverse participants but expressed major concerns about the practicalities of achieving this; in contrast, the US researchers appeared much more committed to the policy of inclusion. Stereotypes and prejudices: We found that some of the UK researchers' perceptions of ethnic minorities may have influenced their decisions on whether to approach individuals from particular ethnic groups.
These stereotypes centred on issues to do with, amongst others, language barriers and lack of altruism.
Demographic, political and socioeconomic contexts of the two countries: Researchers suggested that the demographic profile of ethnic minorities, their political engagement and the different configuration of the health services in the UK and the US may have contributed to differential rates. Open in a separate window. Table 2 Example of a case study investigating the process of planning and implementing a service in Primary Care Organisations[ 4 ].
Context: Health work forces globally are needing to reorganise and reconfigure in order to meet the challenges posed by the increased numbers of people living with long-term conditions in an efficient and sustainable manner. Through studying the introduction of General Practitioners with a Special Interest in respiratory disorders, this study aimed to provide insights into this important issue by focusing on community respiratory service development. Objective: To understand and compare the process of workforce change in respiratory services and the impact on patient experience specifically in relation to the role of general practitioners with special interests in a theoretically selected sample of Primary Care Organisations PCOs , in order to derive models of good practice in planning and the implementation of a broad range of workforce issues.
Study design: Multiple-case design of respiratory services in health regions in England and Wales. The cases: Four PCOs. Data collection: Face-to-face and telephone interviews, e-mail discussions, local documents, patient diaries, news items identified from local and national websites, national workshop.
Analysis: Reading, coding and comparison progressed iteratively. In the screening phase of this study which involved semi-structured telephone interviews with the person responsible for driving the reconfiguration of respiratory services in 30 PCOs , the barriers of financial deficit, organisational uncertainty, disengaged clinicians and contradictory policies proved insurmountable for many PCOs to developing sustainable services. A key rationale for PCO re-organisation in was to strengthen their commissioning function and those of clinicians through Practice-Based Commissioning.
However, the turbulence, which surrounded reorganisation was found to have the opposite desired effect. Implementing workforce reconfiguration was strongly influenced by the negotiation and contest among local clinicians and managers about "ownership" of work and income.
Despite the intention to make the commissioning system more transparent, personal relationships based on common professional interests, past work history, friendships and collegiality, remained as key drivers for sustainable innovation in service development.
This work was conducted in the early stages of a major NHS reorganisation in England and Wales and thus, events are likely to have continued to evolve beyond the study period; we therefore cannot claim to have seen any of the stories through to their conclusion. Table 3 Example of a case study investigating the introduction of the electronic health records[ 5 ].