methodology case study research

• Privacy Policy

Home » Case Study – Methods, Examples and Guide

Case Study – Methods, Examples and Guide

Table of Contents

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

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

Types of Case Study

Types and Methods of Case Study are as follows:

Single-Case Study

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

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

Multiple-Case Study

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

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

Exploratory Case Study

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

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

Descriptive Case Study

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

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

Instrumental Case Study

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

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

Case Study Data Collection Methods

Here are some common data collection methods for case studies:

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

Observations

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

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

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

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

How to conduct Case Study Research

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

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

Examples of Case Study

Here are some examples of case study research:

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

Application of Case Study

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

Business and Management

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

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

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

Social Sciences

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

Law and Ethics

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

Purpose of Case Study

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

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

Case studies can also serve other purposes, including:

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

Advantages of Case Study Research

There are several advantages of case study research, including:

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

Limitations of Case Study Research

There are several limitations of case study research, including:

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

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

You may also like

Survey Research – Types, Methods, Examples

Applied Research – Types, Methods and Examples

Quantitative Research – Methods, Types and...

Ethnographic Research -Types, Methods and Guide

Textual Analysis – Types, Examples and Guide

Focus Groups – Steps, Examples and Guide

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

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

Research question

• Conceptual framework
• Conceptual vs. theoretical framework

Data collection

• Qualitative research methods
• Focus groups
• Observational research

What is a case study?

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

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

Case studies

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

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

Definition of a case study

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

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

Characteristics of case studies

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

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

The role of case studies in research

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

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

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

What is the purpose of a case study?

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

Why use case studies in qualitative research?

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

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

The explanatory, exploratory, and descriptive roles of case studies

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

The impact of case studies on knowledge development

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

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

Types of case studies

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

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

Exploratory case studies

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

Descriptive case studies

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

Explanatory case studies

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

Intrinsic, instrumental, and collective case studies

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

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

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

Critical information systems research

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

Health research

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

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

Asthma research studies

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

Other fields

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

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

Whatever field you're in, ATLAS.ti puts your data to work for you

Download a free trial of ATLAS.ti to turn your data into insights.

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

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

Propositions

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

Units of analysis

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

Argumentation

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

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

Ready to jumpstart your research with ATLAS.ti?

Conceptualize your research project with our intuitive data analysis interface. Download a free trial today.

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

Defining the research question

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

Selecting and defining the case

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

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

Developing a detailed case study protocol

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

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

Collecting data

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

Analyzing and interpreting data

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

Writing the case study report

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

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

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

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

Observations

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

Documents and artifacts

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

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

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

Ensuring the quality of data collection

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

Data analysis

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

Organizing the data

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

Categorizing and coding the data

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

Identifying patterns and themes

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

Interpreting the data

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

Verification of the data

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

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

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

Benefits include the following:

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

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

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

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

Ready to analyze your data with ATLAS.ti?

See how our intuitive software can draw key insights from your data with a free trial today.

Have a language expert improve your writing

Run a free plagiarism check in 10 minutes, automatically generate references for free.

• Knowledge Base
• Methodology
• Case Study | Definition, Examples & Methods

Case Study | Definition, Examples & Methods

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

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

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

Table of contents

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

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

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

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

Prevent plagiarism, run a free check.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cite this Scribbr article

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

McCombes, S. (2023, January 30). Case Study | Definition, Examples & Methods. Scribbr. Retrieved 7 June 2024, from https://www.scribbr.co.uk/research-methods/case-studies/

Is this article helpful?

Shona McCombes

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

The Case Study as Research Method: A Practical Handbook

Qualitative Research in Accounting & Management

ISSN : 1176-6093

Article publication date: 21 June 2011

Scapens, R.W. (2011), "The Case Study as Research Method: A Practical Handbook", Qualitative Research in Accounting & Management , Vol. 8 No. 2, pp. 201-204. https://doi.org/10.1108/11766091111137582

Emerald Group Publishing Limited

Copyright © 2011, Emerald Group Publishing Limited

This book aims to provide case‐study researchers with a step‐by‐step practical guide to “help them conduct the study with the required degree of rigour” (p. xi).

It seeks to “demonstrate that the case study is indeed a scientific method” (p. 104) and to show “the usefulness of the case method as one tool in the researcher's methodological arsenal” (p. 105). The individual chapters cover the various stages in conducting case‐study research, and each chapter sets out a number of practical steps which have to be taken by the researcher. The following are the eight stages/chapters and, in brackets, the number of steps in each stages:

Assessing appropriateness and usefulness (4).

Ensuring accuracy of results (21).

Preparation (6).

Selecting cases (4).

Collecting data (7).

Analyzing data (4).

Interpreting data (3).

Reporting results (4).

It is particularly noticeable that ensuring accuracy of results has by far the largest number of number of steps – 21 steps compared to seven or fewer steps in the other stages. This reflects Gagnon's concern to demonstrate the scientific rigour of case‐study research. In the forward, he explains that the book draws on his experience in conducting his own PhD research, which was closely supervised by three professors, one of whom was inclined towards quantitative research. Consequently, his research was underpinned by the principles and philosophy of quantitative research. This is clearly reflected in the approach taken in this book, which seeks to show that case‐study research is just as rigorous and scientific as quantitative research, and it can produce an objective and accurate representation of the observed reality.

There is no discussion of the methodological issues relating to the use of case‐study research methods. This is acknowledged in the forward, although Gagnon refers to them as philosophical or epistemological issues (p. xii), as he tends to use the terms methodology and method interchangeably – as is common in quantitative research. Although he starts (step 1.1) by trying to distance case and other qualitative research from the work of positivists, arguing that society is socially constructed, he nevertheless sees social reality as objective and independent of the researcher. So for Gagnon, the aim of case research is to accurately reflect that reality. At various points in the book the notion of interpretation is used – evidence is interpreted and the (objective) case findings have to be interpreted.

So although there is a distancing from positivist research (p. 1), the approach taken in this book retains an objective view of the social reality which is being researched; a view which is rather different to the subjective view of reality taken by many interpretive case researchers. This distinction between an objective and a subjective view of the social reality being researched – and especially its use in contrasting positivist and interpretive research – has its origins the taxonomy of Burrell and Morgan (1979) . Although there have been various developments in the so‐called “objective‐subjective debate”, and recently some discussion in relation to management accounting research ( Kakkuri‐Knuuttila et al. , 2008 ; Ahrens, 2008 ), this debate is not mentioned in the book. Nevertheless, it is clear that Gagnon is firmly in the objective camp. In a recent paper, Johnson et al. (2006, p. 138) provide a more contemporary classification of the different types of qualitative research. In their terms, the approach taken in this book could be described as neo‐empiricist – an approach which they characterise as “qualitative positivists”.

The approach taken in this handbook leaves case studies open to the criticisms that they are a small sample, and consequently difficult to generalise, and to arguments that case studies are most appropriate for exploratory research which can subsequently be generalised though quantitative research. Gagnon explains that this was the approach he used after completing his thesis (p. xi). The handbook only seems to recognise two types of case studies, namely exploratory and raw empirical case studies – the latter being used where “the researcher is interested in a subject without having formed any preconceived ideas about it” (p. 15) – which has echoes of Glaser and Strauss (1967) . However, limiting case studies to these two types ignores other potential types; in particular, explanatory case studies which are where interpretive case‐study research can make important contributions ( Ryan et al. , 2002 ).

This limited approach to case studies comes through in the practical steps which are recommended in the handbook, and especially in the discussion of reliability and validity. The suggested steps seem to be designed to keep very close to the notions of reliability and validity used in quantitative research. There is no mention of the recent discussion of “validity” in interpretive accounting research, which emphasises the importance of authenticity and credibility and their implications for writing up qualitative and case‐study research ( Lukka and Modell, 2010 ). Although the final stage of Gagnon's handbook makes some very general comments about reporting the results, it does not mention, for example, Baxter and Chua's (2008) paper in QRAM which discusses the importance of demonstrating authenticity, credibility and transferability in writing qualitative research.

Despite Gagnon's emphasis on traditional notions of reliability and validity the handbook provides some useful practical advice for all case‐study researchers. For example, case‐study research needs a very good research design; case‐study researchers must work hard to gain access to and acceptance in the research settings; a clear strategy is needed for data collection; the case researcher should create field notes (in a field notebook, or otherwise) to record all the thoughts, ideas, observations, etc. that would not otherwise be collected; and the vast amount of data that case‐study research can generate needs to be carefully managed. Furthermore, because of what Gagnon calls the “risk of mortality” (p. 54) (i.e. the risk that access to a research site may be lost – for instance, if the organisation goes bankrupt) it is crucial for some additional site(s) to be selected at the outset to ensure that the planned research can be completed. This is what I call “insurance cases” when talking to my own PhD students. Interestingly, Gagnon recognises the ethical issues involved in doing case studies – something which is not always mentioned by the more objectivist type of case‐study researchers. He emphasises that it is crucial to honour confidentiality agreements, to ensure data are stored securely and that commitments are met and promises kept.

There is an interesting discussion of the advantages and disadvantages of using computer methods in analysing data (in stage 6). However, the discussion of coding appears to be heavily influenced by grounded theory, and is clearly concerned with producing an accurate reflection of an objective reality. In addition, Gagnon's depiction of case analysis is overly focussed on content analysis – possibly because it is a quantitative type of technique. There is no reference to the other approaches available to qualitative researchers. For example, there is no mention of the various visualisation techniques set out in Miles and Huberman (1994) .

To summarise, Gagnon's book is particularly useful for case‐study researchers who see the reality they are researching as objective and researcher independent. However, this is a sub‐set of case‐study researchers. Although some of the practical guidance offered is relevant for other types of case‐study researchers, those who see multiple realities in the social actors and/or recognise the subjectivity of the research process might have difficulty with some of the steps in this handbook. Gagnon's aim to show that the case study is a scientific method, gives the handbook a focus on traditional (quantitatively inspired) notions rigour and validity, and a tendency to ignore (or at least marginalise) other types of case study research. For example, the focus on exploratory cases, which need to be supplemented by broad based quantitative research, overlooks the real potential of case study research which lies in explanatory cases. Furthermore, Gagnon is rather worried about participant research, as the researcher may play a role which is “not consistent with scientific method” (p. 42), and which may introduce researcher bias and thereby damage “the impartiality of the study” (p. 53). Leaving aside the philosophical question about whether any social science research, including quantitative research, can be impartial, this stance could severely limit the potential of case‐study research and it would rule out both the early work on the sociology of mass production and the recent calls for interventionist research. Clearly, there could be a problem where a researcher is trying to sell consulting services, but there is a long tradition of social researchers working within organisations that they are studying. Furthermore, if interpretive research is to be relevant for practice, researchers may have to work with organisations to introduce new ideas and new ways of analysing problems. Gagnon would seem to want to avoid all such research – as it would not be “impartial”.

Consequently, although there is some good practical advice for case study researchers in this handbook, some of the recommendations have to be treated cautiously, as it is a book which sees case‐study research in a very specific way. As mentioned earlier, in the Forward Gagnon explicitly recognises that the book does not take a position on the methodological debates surrounding the use of case studies as a research method, and he says that “The reader should therefore use and judge this handbook with these considerations in mind” (p. xii). This is very good advice – caveat emptor .

Ahrens , T. ( 2008 ), “ A comment on Marja‐Liisa Kakkuri‐Knuuttila ”, Accounting, Organizations and Society , Vol. 33 Nos 2/3 , pp. 291 ‐ 7 , Kari Lukka and Jaakko Kuorikoski.

Baxter , J. and Chua , W.F. ( 2008 ), “ The field researcher as author‐writer ”, Qualitative Research in Accounting & Management , Vol. 5 No. 2 , pp. 101 ‐ 21 .

Burrell , G. and Morgan , G. ( 1979 ), Sociological Paradigms and Organizational Analysis , Heinneman , London .

Glaser , B.G. and Strauss , A.L. ( 1967 ), The Discovery of Grounded Theory: Strategies for Qualitative Research , Aldine , New York, NY .

Johnson , P. , Buehring , A. , Cassell , C. and Symon , G. ( 2006 ), “ Evaluating qualitative management research: towards a contingent critieriology ”, International Journal of Management Reviews , Vol. 8 No. 3 , pp. 131 ‐ 56 .

Kakkuri‐Knuuttila , M.‐L. , Lukka , K. and Kuorikoski , J. ( 2008 ), “ Straddling between paradigms: a naturalistic philosophical case study on interpretive research in management accounting ”, Accounting, Organizations and Society , Vol. 33 Nos 2/3 , pp. 267 ‐ 91 .

Lukka , K. and Modell , S. ( 2010 ), “ Validation in interpretive management accounting research ”, Accounting, Organizations and Society , Vol. 35 , pp. 462 ‐ 77 .

Miles , M.B. and Huberman , A.M. ( 1994 ), Qualitative Data Analysis: A Source Book of New Methods , 2nd ed. , Sage , London .

Ryan , R.J. , Scapens , R.W. and Theobald , M. ( 2002 ), Research Methods and Methodology in Finance and Accounting , 2nd ed. , Thomson Learning , London .

Related articles

We’re listening — tell us what you think, something didn’t work….

Report bugs here

All feedback is valuable

Please share your general feedback

Join us on our journey

Platform update page.

Visit emeraldpublishing.com/platformupdate to discover the latest news and updates

Questions & More Information

Answers to the most commonly asked questions here

• Open access
• Published: 27 June 2011

The case study approach

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

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

784k Accesses

1048 Citations

37 Altmetric

Metrics details

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

Peer Review reports

Introduction

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

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

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

What is a case study?

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

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

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

What are case studies used for?

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

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

How are case studies conducted?

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

Defining the case

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

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

Selecting the case(s)

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

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

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

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

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

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

Collecting the data

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

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

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

Analysing, interpreting and reporting case studies

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

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

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

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

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

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

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

Conclusions

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

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

Google Scholar  

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

Article   CAS   PubMed   PubMed Central   Google Scholar  

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

Article   Google Scholar  

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

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

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

Article   PubMed   Google Scholar  

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

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

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

PubMed   PubMed Central   Google Scholar  

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

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

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

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

Article   PubMed Central   Google Scholar  

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

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

CAS   PubMed   PubMed Central   Google Scholar  

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

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

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

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

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

Mason J: Qualitative researching. 2002, London: Sage

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

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

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

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

Article   PubMed   PubMed Central   Google Scholar  

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

Article   CAS   PubMed   Google Scholar  

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

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

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

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

Book   Google Scholar  

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

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

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

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

Pre-publication history

The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-2288/11/100/prepub

Download references

Acknowledgements

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

Author information

Authors and affiliations.

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

Sarah Crowe & Anthony Avery

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

Kathrin Cresswell, Ann Robertson & Aziz Sheikh

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

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Sarah Crowe .

Additional information

Competing interests.

The authors declare that they have no competing interests.

Authors' contributions

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

Rights and permissions

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Reprints and permissions

About this article

Cite this article.

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

Download citation

Received : 29 November 2010

Accepted : 27 June 2011

Published : 27 June 2011

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

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Case Study Approach
• Electronic Health Record System
• Case Study Design
• Case Study Site
• Case Study Report

BMC Medical Research Methodology

ISSN: 1471-2288

• General enquiries: [email protected]

• Search Menu
• Sign in through your institution
• Browse content in Arts and Humanities
• Browse content in Archaeology
• Anglo-Saxon and Medieval Archaeology
• Archaeological Methodology and Techniques
• Archaeology by Region
• Archaeology of Religion
• Archaeology of Trade and Exchange
• Biblical Archaeology
• Contemporary and Public Archaeology
• Environmental Archaeology
• Historical Archaeology
• History and Theory of Archaeology
• Industrial Archaeology
• Landscape Archaeology
• Mortuary Archaeology
• Prehistoric Archaeology
• Underwater Archaeology
• Zooarchaeology
• Browse content in Architecture
• Architectural Structure and Design
• History of Architecture
• Residential and Domestic Buildings
• Theory of Architecture
• Browse content in Art
• Art Subjects and Themes
• History of Art
• Industrial and Commercial Art
• Theory of Art
• Biographical Studies
• Byzantine Studies
• Browse content in Classical Studies
• Classical History
• Classical Philosophy
• Classical Mythology
• Classical Literature
• Classical Reception
• Classical Art and Architecture
• Classical Oratory and Rhetoric
• Greek and Roman Epigraphy
• Greek and Roman Law
• Greek and Roman Archaeology
• Greek and Roman Papyrology
• Late Antiquity
• Religion in the Ancient World
• Digital Humanities
• Browse content in History
• Colonialism and Imperialism
• Diplomatic History
• Environmental History
• Genealogy, Heraldry, Names, and Honours
• Genocide and Ethnic Cleansing
• Historical Geography
• History by Period
• History of Agriculture
• History of Education
• History of Emotions
• History of Gender and Sexuality
• Industrial History
• Intellectual History
• International History
• Labour History
• Legal and Constitutional History
• Local and Family History
• Maritime History
• Military History
• National Liberation and Post-Colonialism
• Oral History
• Political History
• Public History
• Regional and National History
• Revolutions and Rebellions
• Slavery and Abolition of Slavery
• Social and Cultural History
• Theory, Methods, and Historiography
• Urban History
• World History
• Browse content in Language Teaching and Learning
• Language Learning (Specific Skills)
• Language Teaching Theory and Methods
• Browse content in Linguistics
• Applied Linguistics
• Cognitive Linguistics
• Computational Linguistics
• Forensic Linguistics
• Grammar, Syntax and Morphology
• Historical and Diachronic Linguistics
• History of English
• Language Acquisition
• Language Variation
• Language Families
• Language Evolution
• Language Reference
• Lexicography
• Linguistic Theories
• Linguistic Typology
• Linguistic Anthropology
• Phonetics and Phonology
• Psycholinguistics
• Sociolinguistics
• Translation and Interpretation
• Writing Systems
• Browse content in Literature
• Bibliography
• Children's Literature Studies
• Literary Studies (Asian)
• Literary Studies (European)
• Literary Studies (Eco-criticism)
• Literary Studies (Modernism)
• Literary Studies (Romanticism)
• Literary Studies (American)
• Literary Studies - World
• Literary Studies (1500 to 1800)
• Literary Studies (19th Century)
• Literary Studies (20th Century onwards)
• Literary Studies (African American Literature)
• Literary Studies (British and Irish)
• Literary Studies (Early and Medieval)
• Literary Studies (Fiction, Novelists, and Prose Writers)
• Literary Studies (Gender Studies)
• Literary Studies (Graphic Novels)
• Literary Studies (History of the Book)
• Literary Studies (Plays and Playwrights)
• Literary Studies (Poetry and Poets)
• Literary Studies (Postcolonial Literature)
• Literary Studies (Queer Studies)
• Literary Studies (Science Fiction)
• Literary Studies (Travel Literature)
• Literary Studies (War Literature)
• Literary Studies (Women's Writing)
• Literary Theory and Cultural Studies
• Mythology and Folklore
• Shakespeare Studies and Criticism
• Browse content in Media Studies
• Browse content in Music
• Applied Music
• Dance and Music
• Ethics in Music
• Ethnomusicology
• Gender and Sexuality in Music
• Medicine and Music
• Music Cultures
• Music and Religion
• Music and Culture
• Music and Media
• Music Education and Pedagogy
• Music Theory and Analysis
• Musical Scores, Lyrics, and Libretti
• Musical Structures, Styles, and Techniques
• Musicology and Music History
• Performance Practice and Studies
• Race and Ethnicity in Music
• Sound Studies
• Browse content in Performing Arts
• Browse content in Philosophy
• Aesthetics and Philosophy of Art
• Epistemology
• Feminist Philosophy
• History of Western Philosophy
• Metaphysics
• Moral Philosophy
• Non-Western Philosophy
• Philosophy of Science
• Philosophy of Action
• Philosophy of Law
• Philosophy of Religion
• Philosophy of Language
• Philosophy of Mind
• Philosophy of Perception
• Philosophy of Mathematics and Logic
• Practical Ethics
• Social and Political Philosophy
• Browse content in Religion
• Biblical Studies
• Christianity
• East Asian Religions
• History of Religion
• Judaism and Jewish Studies
• Qumran Studies
• Religion and Education
• Religion and Health
• Religion and Politics
• Religion and Science
• Religion and Law
• Religion and Art, Literature, and Music
• Religious Studies
• Browse content in Society and Culture
• Cookery, Food, and Drink
• Cultural Studies
• Customs and Traditions
• Ethical Issues and Debates
• Hobbies, Games, Arts and Crafts
• Natural world, Country Life, and Pets
• Popular Beliefs and Controversial Knowledge
• Sports and Outdoor Recreation
• Technology and Society
• Travel and Holiday
• Visual Culture
• Browse content in Law
• Arbitration
• Browse content in Company and Commercial Law
• Commercial Law
• Company Law
• Browse content in Comparative Law
• Systems of Law
• Competition Law
• Browse content in Constitutional and Administrative Law
• Government Powers
• Judicial Review
• Local Government Law
• Military and Defence Law
• Parliamentary and Legislative Practice
• Construction Law
• Contract Law
• Browse content in Criminal Law
• Criminal Procedure
• Criminal Evidence Law
• Sentencing and Punishment
• Employment and Labour Law
• Environment and Energy Law
• Browse content in Financial Law
• Banking Law
• Insolvency Law
• History of Law
• Human Rights and Immigration
• Intellectual Property Law
• Browse content in International Law
• Private International Law and Conflict of Laws
• Public International Law
• IT and Communications Law
• Jurisprudence and Philosophy of Law
• Law and Politics
• Law and Society
• Browse content in Legal System and Practice
• Courts and Procedure
• Legal Skills and Practice
• Primary Sources of Law
• Regulation of Legal Profession
• Medical and Healthcare Law
• Browse content in Policing
• Criminal Investigation and Detection
• Police and Security Services
• Police Procedure and Law
• Police Regional Planning
• Browse content in Property Law
• Personal Property Law
• Study and Revision
• Terrorism and National Security Law
• Browse content in Trusts Law
• Wills and Probate or Succession
• Browse content in Medicine and Health
• Browse content in Allied Health Professions
• Arts Therapies
• Clinical Science
• Dietetics and Nutrition
• Occupational Therapy
• Operating Department Practice
• Physiotherapy
• Radiography
• Speech and Language Therapy
• Browse content in Anaesthetics
• General Anaesthesia
• Neuroanaesthesia
• Browse content in Clinical Medicine
• Acute Medicine
• Cardiovascular Medicine
• Clinical Genetics
• Clinical Pharmacology and Therapeutics
• Dermatology
• Endocrinology and Diabetes
• Gastroenterology
• Genito-urinary Medicine
• Geriatric Medicine
• Infectious Diseases
• Medical Oncology
• Medical Toxicology
• Pain Medicine
• Palliative Medicine
• Rehabilitation Medicine
• Respiratory Medicine and Pulmonology
• Rheumatology
• Sleep Medicine
• Sports and Exercise Medicine
• Clinical Neuroscience
• Community Medical Services
• Critical Care
• Emergency Medicine
• Forensic Medicine
• Haematology
• History of Medicine
• Browse content in Medical Dentistry
• Oral and Maxillofacial Surgery
• Paediatric Dentistry
• Restorative Dentistry and Orthodontics
• Surgical Dentistry
• Medical Ethics
• Browse content in Medical Skills
• Clinical Skills
• Communication Skills
• Nursing Skills
• Surgical Skills
• Medical Statistics and Methodology
• Browse content in Neurology
• Clinical Neurophysiology
• Neuropathology
• Nursing Studies
• Browse content in Obstetrics and Gynaecology
• Gynaecology
• Occupational Medicine
• Ophthalmology
• Otolaryngology (ENT)
• Browse content in Paediatrics
• Neonatology
• Browse content in Pathology
• Chemical Pathology
• Clinical Cytogenetics and Molecular Genetics
• Histopathology
• Medical Microbiology and Virology
• Patient Education and Information
• Browse content in Pharmacology
• Psychopharmacology
• Browse content in Popular Health
• Caring for Others
• Complementary and Alternative Medicine
• Self-help and Personal Development
• Browse content in Preclinical Medicine
• Cell Biology
• Molecular Biology and Genetics
• Reproduction, Growth and Development
• Primary Care
• Professional Development in Medicine
• Browse content in Psychiatry
• Addiction Medicine
• Child and Adolescent Psychiatry
• Forensic Psychiatry
• Learning Disabilities
• Old Age Psychiatry
• Psychotherapy
• Browse content in Public Health and Epidemiology
• Epidemiology
• Public Health
• Browse content in Radiology
• Clinical Radiology
• Interventional Radiology
• Nuclear Medicine
• Radiation Oncology
• Reproductive Medicine
• Browse content in Surgery
• Cardiothoracic Surgery
• Gastro-intestinal and Colorectal Surgery
• General Surgery
• Neurosurgery
• Paediatric Surgery
• Peri-operative Care
• Plastic and Reconstructive Surgery
• Surgical Oncology
• Transplant Surgery
• Trauma and Orthopaedic Surgery
• Vascular Surgery
• Browse content in Science and Mathematics
• Browse content in Biological Sciences
• Aquatic Biology
• Biochemistry
• Bioinformatics and Computational Biology
• Developmental Biology
• Ecology and Conservation
• Evolutionary Biology
• Genetics and Genomics
• Microbiology
• Molecular and Cell Biology
• Natural History
• Plant Sciences and Forestry
• Research Methods in Life Sciences
• Structural Biology
• Systems Biology
• Zoology and Animal Sciences
• Browse content in Chemistry
• Analytical Chemistry
• Computational Chemistry
• Crystallography
• Environmental Chemistry
• Industrial Chemistry
• Inorganic Chemistry
• Materials Chemistry
• Medicinal Chemistry
• Mineralogy and Gems
• Organic Chemistry
• Physical Chemistry
• Polymer Chemistry
• Study and Communication Skills in Chemistry
• Theoretical Chemistry
• Browse content in Computer Science
• Artificial Intelligence
• Computer Architecture and Logic Design
• Game Studies
• Human-Computer Interaction
• Mathematical Theory of Computation
• Programming Languages
• Software Engineering
• Systems Analysis and Design
• Virtual Reality
• Browse content in Computing
• Business Applications
• Computer Security
• Computer Games
• Computer Networking and Communications
• Digital Lifestyle
• Graphical and Digital Media Applications
• Operating Systems
• Browse content in Earth Sciences and Geography
• Atmospheric Sciences
• Environmental Geography
• Geology and the Lithosphere
• Maps and Map-making
• Meteorology and Climatology
• Oceanography and Hydrology
• Palaeontology
• Physical Geography and Topography
• Regional Geography
• Soil Science
• Urban Geography
• Browse content in Engineering and Technology
• Agriculture and Farming
• Biological Engineering
• Civil Engineering, Surveying, and Building
• Electronics and Communications Engineering
• Energy Technology
• Engineering (General)
• Environmental Science, Engineering, and Technology
• History of Engineering and Technology
• Mechanical Engineering and Materials
• Technology of Industrial Chemistry
• Transport Technology and Trades
• Browse content in Environmental Science
• Applied Ecology (Environmental Science)
• Conservation of the Environment (Environmental Science)
• Environmental Sustainability
• Environmentalist Thought and Ideology (Environmental Science)
• Management of Land and Natural Resources (Environmental Science)
• Natural Disasters (Environmental Science)
• Nuclear Issues (Environmental Science)
• Pollution and Threats to the Environment (Environmental Science)
• Social Impact of Environmental Issues (Environmental Science)
• History of Science and Technology
• Browse content in Materials Science
• Ceramics and Glasses
• Composite Materials
• Metals, Alloying, and Corrosion
• Nanotechnology
• Browse content in Mathematics
• Applied Mathematics
• Biomathematics and Statistics
• History of Mathematics
• Mathematical Education
• Mathematical Finance
• Mathematical Analysis
• Numerical and Computational Mathematics
• Probability and Statistics
• Pure Mathematics
• Browse content in Neuroscience
• Cognition and Behavioural Neuroscience
• Development of the Nervous System
• Disorders of the Nervous System
• History of Neuroscience
• Invertebrate Neurobiology
• Molecular and Cellular Systems
• Neuroendocrinology and Autonomic Nervous System
• Neuroscientific Techniques
• Sensory and Motor Systems
• Browse content in Physics
• Astronomy and Astrophysics
• Atomic, Molecular, and Optical Physics
• Biological and Medical Physics
• Classical Mechanics
• Computational Physics
• Condensed Matter Physics
• Electromagnetism, Optics, and Acoustics
• History of Physics
• Mathematical and Statistical Physics
• Measurement Science
• Nuclear Physics
• Particles and Fields
• Plasma Physics
• Quantum Physics
• Relativity and Gravitation
• Semiconductor and Mesoscopic Physics
• Browse content in Psychology
• Affective Sciences
• Clinical Psychology
• Cognitive Neuroscience
• Cognitive Psychology
• Criminal and Forensic Psychology
• Developmental Psychology
• Educational Psychology
• Evolutionary Psychology
• Health Psychology
• History and Systems in Psychology
• Music Psychology
• Neuropsychology
• Organizational Psychology
• Psychological Assessment and Testing
• Psychology of Human-Technology Interaction
• Psychology Professional Development and Training
• Research Methods in Psychology
• Social Psychology
• Browse content in Social Sciences
• Browse content in Anthropology
• Anthropology of Religion
• Human Evolution
• Medical Anthropology
• Physical Anthropology
• Regional Anthropology
• Social and Cultural Anthropology
• Theory and Practice of Anthropology
• Browse content in Business and Management
• Business Strategy
• Business History
• Business Ethics
• Business and Government
• Business and Technology
• Business and the Environment
• Comparative Management
• Corporate Governance
• Corporate Social Responsibility
• Entrepreneurship
• Health Management
• Human Resource Management
• Industrial and Employment Relations
• Industry Studies
• Information and Communication Technologies
• International Business
• Knowledge Management
• Management and Management Techniques
• Operations Management
• Organizational Theory and Behaviour
• Pensions and Pension Management
• Public and Nonprofit Management
• Strategic Management
• Supply Chain Management
• Browse content in Criminology and Criminal Justice
• Criminal Justice
• Criminology
• Forms of Crime
• International and Comparative Criminology
• Youth Violence and Juvenile Justice
• Development Studies
• Browse content in Economics
• Agricultural, Environmental, and Natural Resource Economics
• Asian Economics
• Behavioural Finance
• Behavioural Economics and Neuroeconomics
• Econometrics and Mathematical Economics
• Economic Systems
• Economic Methodology
• Economic History
• Economic Development and Growth
• Financial Markets
• Financial Institutions and Services
• General Economics and Teaching
• Health, Education, and Welfare
• History of Economic Thought
• International Economics
• Labour and Demographic Economics
• Law and Economics
• Macroeconomics and Monetary Economics
• Microeconomics
• Public Economics
• Urban, Rural, and Regional Economics
• Welfare Economics
• Browse content in Education
• Adult Education and Continuous Learning
• Care and Counselling of Students
• Early Childhood and Elementary Education
• Educational Equipment and Technology
• Educational Strategies and Policy
• Higher and Further Education
• Organization and Management of Education
• Philosophy and Theory of Education
• Schools Studies
• Secondary Education
• Teaching of a Specific Subject
• Teaching of Specific Groups and Special Educational Needs
• Teaching Skills and Techniques
• Browse content in Environment
• Applied Ecology (Social Science)
• Climate Change
• Conservation of the Environment (Social Science)
• Environmentalist Thought and Ideology (Social Science)
• Natural Disasters (Environment)
• Social Impact of Environmental Issues (Social Science)
• Browse content in Human Geography
• Cultural Geography
• Economic Geography
• Political Geography
• Browse content in Interdisciplinary Studies
• Communication Studies
• Museums, Libraries, and Information Sciences
• Browse content in Politics
• African Politics
• Asian Politics
• Chinese Politics
• Comparative Politics
• Conflict Politics
• Elections and Electoral Studies
• Environmental Politics
• Ethnic Politics
• European Union
• Foreign Policy
• Gender and Politics
• Human Rights and Politics
• Indian Politics
• International Relations
• International Organization (Politics)
• International Political Economy
• Irish Politics
• Latin American Politics
• Middle Eastern Politics
• Political Methodology
• Political Communication
• Political Philosophy
• Political Sociology
• Political Theory
• Political Behaviour
• Political Economy
• Political Institutions
• Politics and Law
• Politics of Development
• Public Administration
• Public Policy
• Quantitative Political Methodology
• Regional Political Studies
• Russian Politics
• Security Studies
• State and Local Government
• UK Politics
• US Politics
• Browse content in Regional and Area Studies
• African Studies
• Asian Studies
• East Asian Studies
• Japanese Studies
• Latin American Studies
• Middle Eastern Studies
• Native American Studies
• Scottish Studies
• Browse content in Research and Information
• Research Methods
• Browse content in Social Work
• Addictions and Substance Misuse
• Adoption and Fostering
• Care of the Elderly
• Child and Adolescent Social Work
• Couple and Family Social Work
• Direct Practice and Clinical Social Work
• Emergency Services
• Human Behaviour and the Social Environment
• International and Global Issues in Social Work
• Mental and Behavioural Health
• Social Justice and Human Rights
• Social Policy and Advocacy
• Social Work and Crime and Justice
• Social Work Macro Practice
• Social Work Practice Settings
• Social Work Research and Evidence-based Practice
• Welfare and Benefit Systems
• Browse content in Sociology
• Childhood Studies
• Community Development
• Comparative and Historical Sociology
• Economic Sociology
• Gender and Sexuality
• Gerontology and Ageing
• Health, Illness, and Medicine
• Marriage and the Family
• Migration Studies
• Occupations, Professions, and Work
• Organizations
• Population and Demography
• Race and Ethnicity
• Social Theory
• Social Movements and Social Change
• Social Research and Statistics
• Social Stratification, Inequality, and Mobility
• Sociology of Religion
• Sociology of Education
• Sport and Leisure
• Urban and Rural Studies
• Browse content in Warfare and Defence
• Defence Strategy, Planning, and Research
• Land Forces and Warfare
• Military Administration
• Military Life and Institutions
• Naval Forces and Warfare
• Other Warfare and Defence Issues
• Peace Studies and Conflict Resolution
• Weapons and Equipment

A newer edition of this book is available.

• < Previous chapter
• Next chapter >

22 Case Study Research: In-Depth Understanding in Context

Helen Simons, School of Education, University of Southampton

• Published: 01 July 2014
• Cite Icon Cite
• Permissions Icon Permissions

This chapter explores case study as a major approach to research and evaluation. After first noting various contexts in which case studies are commonly used, the chapter focuses on case study research directly Strengths and potential problematic issues are outlined and then key phases of the process. The chapter emphasizes how important it is to design the case, to collect and interpret data in ways that highlight the qualitative, to have an ethical practice that values multiple perspectives and political interests, and to report creatively to facilitate use in policy making and practice. Finally, it explores how to generalize from the single case. Concluding questions center on the need to think more imaginatively about design and the range of methods and forms of reporting requiredto persuade audiences to value qualitative ways of knowing in case study research.

Introduction

This chapter explores case study as a major approach to research and evaluation using primarily qualitative methods, as well as documentary sources, contemporaneous or historical. However, this is not the only way in which case study can be conceived. No one has a monopoly on the term. While sharing a focus on the singular in a particular context, case study has a wide variety of uses, not all associated with research. A case study, in common parlance, documents a particular situation or event in detail in a specific sociopolitical context. The particular can be a person, a classroom, an institution, a program, or a policy. Below I identify different ways in which case study is used before focusing on qualitative case study research in particular. However, first I wish to indicate how I came to advocate and practice this form of research. Origins, context, and opportunity often shape the research processes we endorse. It is helpful for the reader, I think, to know how I came to the perspective I hold.

The Beginnings

I first came to appreciate and enjoy the virtues of case study research when I entered the field of curriculum evaluation and research in the 1970s. The dominant research paradigm for educational research at that time was experimental or quasi- experimental, cost-benefit, or systems analysis, and the dominant curriculum model was aims and objectives ( House, 1993 ). The field was dominated, in effect, by a psychometric view of research in which quantitative methods were preeminent. But the innovative projects we were asked to evaluate (predominantly, but not exclusively, in the humanities) were not amenable to such methodologies. The projects were challenging to the status quo of institutions, involved people interpreting the policy and programs, were implemented differently in different contexts and regions, and had many unexpected effects.

We had no choice but to seek other ways to evaluate these complex programs, and case study was the methodology we found ourselves exploring, in order to understand how the projects were being implemented, why they had positive effects in some regions of the country and not others, and what the outcomes meant in different sociopolitical and cultural contexts. What better way to do this than to talk with people to see how they interpreted the “new” curriculum; to watch how teachers and students put it into practice; to document transactions, outcomes, and unexpected consequences; and to interpret all in the specific context of the case ( Simons, 1971 , 1987 , pp. 55–89). From this point on and in further studies, case study in educational research and evaluation came to be a major methodology for understanding complex educational and social programs. It also extended to other practice professions, such as nursing, health, and social care ( Zucker, 2001 ; Greenhalgh & Worrall, 1997 ; Shaw & Gould, 2001 ). For further details of the evolution of the case study approach and qualitative methodologies in evaluation, see House, 1993 , pp. 2–3; Greene, 2000 ; Simons, 2009 , pp. 14–18; Simons & McCormack, 2007 , pp. 292–311).

This was not exactly the beginning of case study, of course. It has a long history in many disciplines ( Simons, 1980; Ragin, 1992; Gomm, Hammersley, & Foster, 2004 ; Platt, 2007 ), many aspects of which form part of case study practice to this day. But its evolution in the context just described was a major move in the contemporary evolution of the logic of evaluative inquiry ( House, 1980 ). It also coincided with movement toward the qualitative in other disciplines, such as sociology and psychology. This was all part of what Denzin & Lincoln (1994) termed “a quiet methodological revolution” (p. ix) in qualitative inquiry that had been evolving over the course of forty years.

There is a further reason why I continue to advocate and practice case study research and evaluation to this day and that is my personal predilection for trying to understand and represent complexity, for puzzling through the ambiguities that exist in many contexts and programs and for presenting and negotiating different values and interests in fair and just ways.

Put more simply, I like interacting with people, listening to their stories, trials and tribulations—giving them a voice in understanding the contexts and projects with which they are involved, and finding ways to share these with a range of audiences. In other words, the move toward case study methodology described here suited my preference for how I learn.

Concepts and Purposes of Case Study

Before exploring case study as it has come to be established in educational research and evaluation over the past forty years, I wish to acknowledge other uses of case study. More often than not, these relate to purpose, and appropriately so in their different contexts, but many do not have a research intention. For a study to count as research, it would need to be a systematic investigation generating evidence that leads to “new” knowledge that is made public and open to scrutiny. There are many ways to conduct research stemming from different traditions and disciplines, but they all, in different ways, involve these characteristics.

Everyday Usage: Stories We Tell

The most common of these uses of case study is the everyday reference to a person, an anecdote or story illustrative of a particular incident, event, or experience of that person. It is often a short, reported account commonly seen in journalism but also in books exploring a phenomenon, such as recovery from serious accidents or tragedies, where the author chooses to illustrate the story or argument with a “lived” example. This is sometimes written by the author and sometimes by the person whose tale it is. “Let me share with you a story,” is a phrase frequently heard

The spirit behind this common usage and its power to connect can be seen in a report by Tim Adams of the London Olympics opening ceremony’s dramatization by Danny Boyle.

It was the point when we suddenly collectively wised up to the idea that what we are about to receive over the next two weeks was not only about “legacy collateral” and “targeted deliverables,” not about G4S failings and traffic lanes and branding opportunities, but about the second-by-second possibilities of human endeavour and spirit and communality, enacted in multiple places and all at the same time. Stories in other words. ( Adams, 2012 )

This was a collective story, of course, not an individual one, but it does convey some of the major characteristics of case study—that richness of detail, time, place, multiple happenings and experiences—that are also manifest in case study research, although carefully evidenced in the latter instance. We can see from this common usage how people have come to associate case study with story. I return to this thread in the reporting section.

Professions Individual Cases

In professional settings, in health and social care, case studies, often called case histories , are used to accurately record a person’s health or social care history and his or her current symptoms, experience, and treatment. These case histories include facts but also judgments and observations about the person’s reaction to situations or medication. Usually these are confidential. Not dissimilar is the detailed documentation of a case in law, often termed a case precedent when referred to in a court case to support an argument being made. However in law there is a difference in that such case precedents are publicly documented.

Case Studies in Teaching

Exemplars of practice.

In education, but also in health and social care training contexts, case studies have long been used as exemplars of practice. These are brief descriptions with some detail of a person or project’s experience in an area of practice. Though frequently reported accounts, they are based on a person’s experience and sometimes on previous research.

Case scenarios

Management studies are a further context in which case studies are often used. Here, the case is more like a scenario outlining a particular problem situation for the management student to resolve. These scenarios may be based on research but frequently are hypothetical situations used to raise issues for discussion and resolution. What distinguishes these case scenarios and the case exemplars in education from case study research is the intention to use them for teaching purposes.

Country Case Studies

Then there are case studies of programs, projects, and even countries, as in international development, where a whole-country study might be termed a case study or, in the context of the Organization for Economic Co-operation and Development (OECD), where an exploration is conducted of the state of the art of a subject, such as education or environmental science in one or several countries. This may be a contemporaneous study and/or what transpired in a program over a period of time. Such studies often do have a research base but frequently are reported accounts that do not detail the design, methodology, and analysis of the case, as a research case study would do, or report in ways that give readers a vicarious experience of what it was like to be there. Such case studies tend to be more knowledge and information-focused than experiential.

Case Study as History

Closer to a research context is case study as history—what transpired at a certain time in a certain place. This is likely to be supported by documentary evidence but not primary data gathering unless it is an oral history. In education, in the late 1970s, Stenhouse (1978) experimented with a case study archive. Using contemporaneous data gathering, primarily through interviewing, he envisaged this database, which he termed a “case record,” forming an archive from which different individuals,, at some later date, could write a “case study.” This approach uses case study as a documentary source to begin to generate a history of education, as the subtitle of Stenhouse’s 1978 paper indicates “Towards a contemporary history of education.”

Case Study Research

From here on, my focus is on case study research per se, adopting for this purpose the following definition:

Case study is an in-depth exploration from multiple perspectives of the complexity and uniqueness of a particular project, policy, institution or system in a “real-life” context. It is research based, inclusive of different methods and is evidence-led. ( Simons, 2009 , p. 21).

For further related definitions of case study, see Stake (1995) , Merriam (1998), and Chadderton & Torrance (2011) . And for definitions from a slightly different perspective, see Yin (2004) and Thomas (2011a) .

Not Defined by Method or Perspective

The inclusion of different methods in the definition quoted above definition signals that case study research is not defined by methodology or method. What defines case study is its singularity and the concept and boundary of the case. It is theoretically possible to conduct a case study using primarily quantitative data if this is the best way of providing evidence to inform the issues the case is exploring. It is equally possible to conduct case study that is mainly qualitative, to engage people with the experience of the case or to provide a rich portrayal of an event, project, or program.

Or one can design the case using mixed methods. This increases the options for learning from different ways of knowing and is sometimes preferred by stakeholders who believe it provides a firmer basis for informing policy. This is not necessarily the case but is beyond the scope of this chapter to explore. For further discussion of the complexities of mixing methods and the virtue of using qualitative methods and case study in a mixed method design, see Greene (2007) .

Case study research may also be conducted from different standpoints—realist, interpretivist, or constructivist, for example. My perspective falls within a constructivist, interpretivist framework. What interests me is how I and those in the case perceive and interpret what we find and how we construct or co-construct understandings of the case. This not only suits my predilection for how I see the world, but also my preferred phenomenological approach to interviewing and curiosity about people and how they act in social and professional life.

Qualitative Case Study Research

Qualitative case study research shares many characteristics with other forms of qualitative research, such as narrative, oral history, life history, ethnography, in-depth interview, and observational studies that utilize qualitative methods. However, its focus, purpose, and origins, in educational research at least, are a little different.

The focus is clearly the study of the singular. The purpose is to portray an in-depth view of the quality and complexity of social/educational programs or policies as they are implemented in specific sociopolitical contexts. What makes it qualitative is its emphasis on subjective ways of knowing, particularly the experiential, practical, and presentational rather than the propositional ( Heron, 1992 , 1999 ) to comprehend and communicate what transpired in the case.

Characteristic Features and Advantages

Case study research is not method dependent, as noted earlier, nor is it constrained by resources or time. Although it can be conducted over several years, which provides an opportunity to explore the process of change and explain how and why things happened, it can equally be carried out contemporaneously in a few days, weeks, or months. This flexibility is extremely useful in many contexts, particularly when a change in policy or unforeseen issues in the field require modifying the design.

Flexibility extends to reporting. The case can be written up in different lengths and forms to meet different audience needs and to maximize use (see the section on Reporting). Using the natural language of participants and familiar methods (like interview, observation, oral history) also enables participants to engage in the research process, thereby contributing significantly to the generation of knowledge of the case. As I have indicated elsewhere ( Simons, 2009 ), “This is both a political and epistemological point. It signals a potential shift in the power base of who controls knowledge and recognizes the importance of co-constructing perceived reality through the relationships and joint understandings we create in the field” (p. 23).

Possible Disadvantages

If one is an advocate, identifying advantages of a research approach is easier than pointing out its disadvantages, something detractors are quite keen to do anyway! But no approach is perfect, and here are some of the issues that often trouble people about case study research. The “sample of one” is an obvious issue that worries those convinced that only large samples can constitute valid research and especially if this is to inform policy. Understanding complexity in depth may not be a sufficient counterargument, and I suspect there is little point in trying to persuade otherwise For frequently, this perception is one of epistemological and methodological, if not ideological, preference.

However, there are some genuine concerns that many case researchers face: the difficulty of processing a mass of data; of “telling the truth” in contexts where people may be identifiable; personal involvement, when the researcher is the main instrument of data gathering; and writing reports that are data-based, yet readable in style and length. But one issue that concerns advocates and nonadvocates alike is how inferences are drawn from the single case.

Answers to some of these issues are covered in the sections that follow. Whether they convince may again be a question of preference. However, it is worth noting here that I do not think we should seek to justify these concerns in terms identified by other methodologies. Many of them are intrinsic to the nature and strength of qualitative case study research.

Subjectivity, for instance, both of participants and researcher is inevitable, as it is in many other qualitative methodologies. This is often the basis on which we act. Rather than see this as bias or something to counter, it is an intelligence that is essential to understanding and interpreting the experience of participants and stakeholders. Such subjectivity needs to be disciplined, of course, through procedures that examine both the validity of individuals’ representations of “their truth”, and demonstrate how the researcher took a reflexive approach to monitoring how his or her own values and predilections may have unduly influenced the data.

Types of Case Study

There are numerous types of case study, too many to categorize, I think, as there are overlaps between them. However, attempts have been made to do this and, for those who value typologies, I refer them to Bassey (1999) and, for a more extended typology, to Thomas (2011b) . A slightly different approach is taken by Gomm, Hammersley, and Foster (2004) in annotating the different emphases in major texts on case study. What I prefer to do here is to highlight a few familiar types to focus the discussion that follows on the practice of case study research.

Stake (1995) offers a threefold distinction that is helpful when it comes to practice, he says, because it influences the methods we choose to gather data (p. 4). He distinguishes between an intrinsic case study , one that is studied to learn about the particular case itself and an instrumental case study , in which we choose a case to gain insight into a particular issue (i.e., the case is instrumental to understanding something else; p. 3). The collective case study is what its name suggests: an extension of the instrumental to several cases.

Theory-led or theory-generated case study is similarly self-explanatory, the first starting from a specific theory that is tested through the case; the second constructing a theory through interpretation of data generated in the case. In other words, one ends rather than begins with a theory. In qualitative case study research, this is the more familiar route. The theory of the case becomes the argument or story you will tell.

Evaluation case study requires a slightly longer description as this is my context of practice, one which has influenced the way I conduct case study and what I choose to emphasize in this chapter. An evaluation case study has three essential features: to determine the value of the case, to include and balance different interests and values, and to report findings to a range of stakeholders in ways that they can use. The reasons for this may be found in the interlude that follows, which offers a brief characterization of the social and ethical practice of evaluation and why qualitative methods are so important in this practice.

Interlude: Social and Ethical Practice of Evaluation

Evaluation is a social practice that documents, portrays, and seeks to understand the value of a particular project, program, or policy. This can be determined by different evaluation methodologies, of course. But the value of qualitative case study is that it is possible to discern this value without decontextualizing the data. While the focus of the case is usually a project, program, policy, or some unit within, studies of key individuals, what I term case profiles , may be embedded within the overall case. In some instances, these profiles, or even shorter cameos of individuals, may be quite prominent. For it is through the perceptions, interpretations, and interactions of people that we learn how policies and programs are enacted ( Kushner, 2000 , p. 12). The program is still the main focus of analysis, but, in exploring how individuals play out their different roles in the program, we get closer to the actual experience and meaning of the program in practice.

Case study evaluation is often commissioned from an external source (government department or other agency) keen to know the worth of publicly funded programs and policies to inform future decision making. It needs to be responsive to issues or questions identified by stakeholders, who often have different values and interests in the expected outcomes and appreciate different perspectives of the program in action. The context also is often highly politicized, and interests can conflict. The task of the evaluator in such situations becomes one of including and balancing all interests and values in the program fairly and justly.

This is an inherently political process and requires an ethical practice that offers participants some protection over the personal data they give as part of the research and agreed audiences access to the findings, presented in ways they can understand. Negotiating what information becomes public can be quite difficult in singular settings where people are identifiable and intricate or problematic transactions have been documented. The consequences that ensue from making knowledge public that hitherto was private may be considerable for those in the case. It may also be difficult to portray some of the contextual detail that would enhance understanding for readers.

The ethical stance that underpins the case study research and evaluation I conduct stems from a theory of ethics that emphasizes the centrality of relationships in the specific context and the consequences for individuals, while remaining aware of the research imperative to publicly report. It is essentially an independent democratic process based on the concepts of fairness and justice, in which confidentiality, negotiation, and accessibility are key principles ( MacDonald, 1976 ; Simons, 2009 , pp. 96–111; and Simons 2010 ). The principles are translated into specific procedures to guide the collection, validation, and dissemination of data in the field. These include:

engaging participants and stakeholders in identifying issues to explore and sometimes also in interpreting the data;

documenting how different people interpret and value the program;

negotiating what data becomes public respecting both the individual’s “right to privacy” and the public’s “right to know”;

offering participants opportunities to check how their data are used in the context of reporting;

reporting in language and forms accessible to a wide range of audiences;

disseminating to audiences within and beyond the case.

For further discussion of the ethics of democratic case study evaluation and examples of their use in practice, see Simons (2000 , 2006 , 2009 , chapter 6, 2010 ).

Designing Case Study Research

Design issues in case study sometimes take second place to those of data gathering, the more exciting task perhaps in starting research. However, it is critical to consider the design at the outset, even if changes are required in practice due to the reality of what is encountered in the field. In this sense, the design of case study is emergent, rather than preordinate, shaped and reshaped as understanding of the significance of foreshadowed issues emerges and more are discovered.

Before entering the field, there are a myriad of planning issues to think about related to stakeholders, participants, and audiences. These include whose values matter, whether to engage them in data gathering and interpretation, the style of reporting appropriate for each, and the ethical guidelines that will underpin data collection and reporting. However, here I emphasize only three: the broad focus of the study, what the case is a case of, and framing questions/issues. These are steps often ignored in an enthusiasm to gather data, resulting in a case study that claims to be research but lacks the basic principles required for generation of valid, public knowledge.

Conceptualize the Topic

First, it is important that the topic of the research is conceptualized in a way that it can be researched (i.e., it is not too wide). This seems an obvious point to make, but failure to think through precisely what it is about your research topic you wish to investigate will have a knock-on effect on the framing of the case, data gathering, and interpretation and may lead, in some instances, to not gathering or analyzing data that actually informs the topic. Further conceptualization or reconceptualization may be necessary as the study proceeds, but it is critical to have a clear focus at the outset.

What Constitutes the Case

Second, I think it is important to decide what would constitute the case (i.e., what it is a case of) and where the boundaries of this lie. This often proves more difficult than first appears. And sometimes, partly because of the semifluid nature of the way the case evolves, it is only possible to finally establish what the case is a case of at the end. Nevertheless, it is useful to identify what the case and its boundaries are at the outset to help focus data collection while maintaining an awareness that these may shift. This is emergent design in action.

In deciding the boundary of the case, there are several factors to bear in mind. Is it bounded by an institution or a unit within an institution, by people within an institution, by region, or by project, program or policy,? If we take a school as an example, the case could be comprised of the principal, teachers, and students, or the boundary could be extended to the cleaners, the caretaker, the receptionist, people who often know a great deal about the subnorms and culture of the institution.

If the case is a policy or particular parameter of a policy, the considerations may be slightly different. People will still be paramount—those who generated the policy and those who implemented it—but there is likely also to be a political culture surrounding the policy that had an influence on the way the policy evolved. Would this be part of the case?

Whatever boundary is chosen, this may change in the course of conducting the study when issues arise that can only be understood by going to another level. What transpires in a classroom, for example, if this is the case, is often partly dependent on the support of the school leadership and culture of the institution and this, in turn, to some extent is dependent on what resources are allocated from the local education administration. Much like a series of Russian dolls, one context inside the other.

Unit of analysis

Thinking about what would constitute the unit of analysis— a classroom, an institution, a program, a region—may help in setting the boundaries of the case, and it will certainly help when it comes to analysis. But this is a slightly different issue from deciding what the case is a case of. Taking a health example, the case may be palliative care support, but the unit of analysis the palliative care ward or wards. If you took the palliative care ward as the unit of analysis this would be as much about how palliative care was exercised in this or that ward than issues about palliative care support in general. In other words, you would need to have specific information and context about how this ward was structured and managed to understand how palliative care was conducted in this particular ward. Here, as in the school example above, you would need to consider which of the many people who populate the ward form part of the case—nurses, interns, or doctors only, or does it extend to patients, cleaners, nurse aides, and medical students?

Framing Questions and Issues

The third most important consideration is how to frame the study, and you are likely to do this once you have selected the site or sites for study. There are at least four approaches. You could start with precise questions, foreshadowed issues ( Smith & Pohland, 1974 ), theories, or a program logic. To some extent, your choice will be dictated by the type of case you have chosen, but also by your personal preference for how to conduct it—in either a structured or open way.

Initial questions give structure; foreshadowed issues more freedom to explore. In qualitative case study, foreshadowed issues are more common, allowing scope for issues to change as the study evolves, guided by participants’ perspectives and events in the field. With this perspective, it is more likely that you will generate a theory of the case toward the end, through your interpretation and analysis.

If you are conducting an instrumental case study, staying close to the questions or foreshadowed issues is necessary to be sure you gain data that will illuminate the central focus of the study. This is critical if you are exploring issues across several cases, although it is possible to do a cross-case analysis from cases that have each followed a different route to discovering significant issues.

Opting to start with a theoretical framework provides a basis for formulating questions and issues, but it can also constrain the study to only those questions/issues that fit the framework. The same is true with using program logic to frame the case. This is an approach frequently adopted in evaluation case study where the evaluator, individually or with stakeholders, examines how the aims and objectives of the program relate to the activities designed to promote it and the outcomes and impacts expected. It provides direction, although it can lead to simply confirming what was anticipated, rather than documenting what transpired in the case.

Whichever approach you choose to frame the case, it is useful to think about the rationale or theory for each question and what methods would best enable you to gain an understanding of them. This will not only start a reflexive process of examining your choices—an important aspect of the process of data gathering and interpretation—it will also aid analysis and interpretation further down the track.

Methodology and Methods

Qualitative case study research, as already noted, appeals to subjective ways of knowing and to a primarily qualitative methodology, that captures experiential understanding ( Stake, 2010 , pp. 56–70). It follows that the main methods of data gathering to access this way of knowing will be qualitative. Interviewing, observation, and document analysis are the primary three, often supported by critical incidents, focus groups, cameos, vignettes, diaries/journals, and photographs. Before gathering any primary data, however, it is useful to search relevant existing sources (written or visual) to learn about the antecedents and context of a project, program, or policy as a backdrop to the case. This can sharpen framing questions, avoid unnecessary data gathering, and shorten the time needed in the field.

Given that there are excellent texts on qualitative methods (see, for example, Denzin & Lincoln, 1994 ; Seale, 1999 ; Silverman, 2000 , 2004 ), I will not discuss all potential relevant methods here, but simply focus on the qualities of the primary methods that are particularly appropriate for case study research.

Primary Qualitative Data Gathering Methods

Interviewing.

The most effective style of interviewing in qualitative case study research to gain in-depth data, document multiple perspectives and experiences and explore contested issues is the unstructured interview, active listening and open questioning are paramount, whatever prequestions or foreshadowed issues have been identified. This can include photographs—a useful starting point with certain cultural groups and the less articulate, to encourage them to tell their story through connecting or identifying with something in the image.

The flexibility of unstructured interviewing has three further advantages for understanding participants’ experiences. First, through questioning, probing, listening, and, above all, paying attention to the silences and what they mean, you can get closer to the meaning of participants’ experiences. It is not always what they say.

Second, unstructured interviewing is useful for engaging participants in the process of research. Instead of starting with questions and issues, invite participants to tell their stories or reflect on specific issues, to conduct their own self-evaluative interview, in fact. Not only will they contribute their particular perspective to the case, they will also learn about themselves, thereby making the process of research educative for them as well as for the audiences of the research.

Third, the open-endedness of this style of interviewing has the potential for creating a dialogue between participants and the researcher and between the researcher and the public, if enough of the dialogue is retained in the publication ( Bellah, Madsen, Sullivan, Swidler, & Tipton, 1985 ).

Observations

Observations in case study research are likely to be close-up descriptions of events, activities, and incidents that detail what happens in a particular context. They will record time, place, specific incidents, transactions, and dialogue, and note characteristics of the setting and of people in it without preconceived categories or judgment. No description is devoid of some judgment in selection, of course, but, on the whole, the intent is to describe the scene or event “as it is,” providing a rich, textured description to give readers a sense of what it was like to be there or provide a basis for later interpretation.

Take the following excerpt from a study of the West Bromwich Operatic Society. It is the first night of a new production, The Producers , by this amateur operatic society. This brief excerpt is from a much longer observation of the overture to the first evening’s performance, detailing exactly what the production is, where it is, and why there is such a tremendous sense of atmosphere and expectation surrounding the event. Space prevents including the whole observation, but I hope you can get a glimmer of the passion and excitement that precedes the performance:

Birmingham, late November, 2011, early evening.... Bars and restaurants spruce up for the evening’s trade. There is a chill in the air but the party season is just starting....

A few hundred yards away, past streaming traffic on Suffolk Street, Queensway, an audience is gathering at the New Alexandra Theatre. The foyer windows shine in the orange sodium night. Above each one is the rubric: WORLD CLASS THEATRE.

Inside the preparatory rituals are being observed; sweets chosen, interval drinks ordered and programmes bought. People swap news and titbits about the production.... The bubble of anticipation grows as the 5-minute warning sounds. People make their way to the auditorium. There have been so many nights like this in the past 110 years since a man named William Coutts invested £10,000 to build this palace of dreams.... So many fantasies have been played under this arch: melodramas and pantomimes, musicals and variety.... So many audiences, settling down in their tip-up seats, wanting to be transported away from work, from ordinariness and private troubles.... The dimming lights act like a mother’s hush. You could touch the silence. Boinnng! A spongy thump on a bass drum, and the horns pipe up that catchy, irrepressible, tasteless tune and already you’re singing under your breath, ‘Springtime for Hitler and Germany....’ The orchestra is out of sight in the pit. There’s just the velvet curtain to watch as your fingers tap along. What’s waiting behind? Then it starts it to move. Opening night.... It’s opening night! ( Matarasso, 2012 , pp. 1–2)

For another and different example—a narrative observation of an everyday but unique incident that details date, time, place, and experience—see Simons (2009 , p. 60).

Such naturalistic observations are also useful in contexts where we cannot understand what is going on through interviewing alone—in cultures with which we are less familiar or where key actors may not share our language or have difficulty expressing it. Careful description in these situations can help identify key issues, discover the norms and values that exist in the culture, and, if sufficiently detailed, allow others to cross corroborate what significance we draw from these observations. This last point is very important to avoid the danger in observation of ascribing motivations to people and meanings to transactions.

Finally, naturalistic observations are very important in highly politicized environments, often the case in commissioned evaluation case study, where individuals in interview may try to elude the “truth” or press on you that their view is the “right” view of the situation. In these contexts, naturalistic observations not only enable you to document interactions as you perceive them, but they also provide a cross-check on the veracity of information obtained in interviews.

Document analysis

Analysis of documents, as already intimated, is useful for establishing what historical antecedents might exist to provide a springboard for contemporaneous data gathering. In most cases, existing documents are also extremely pertinent for understanding the policy context.

In a national policy case study I conducted on a major curriculum change, the importance of preexisting documentation was brought home to me sharply when certain documentation initially proved elusive to obtain. It was difficult to believe that it did not exist, as the evolution of the innovation involved several parties who had not worked together before. There was bound, I thought, to be minuted meetings sharing progress and documentation of the “new” curriculum. In the absence of some crucial documents, I began to piece together the story through interviewing. Only there were gaps, and certain issues did not make sense.

It was only when I presented two versions of what I discerned had transpired in the development of this initiative in an interim report eighteen months into the study that things started to change. Subsequent to the meeting at which the report was presented, the “missing” documents started to appear. Suddenly found. What lay behind the “missing documents,” something I suspected from what certain individuals did and did not say in interview, was a major difference of view about how the innovation evolved, who was key in the process, and whose voice was more important in the context. Political differences, in other words, that some stakeholders were trying to keep from me. The emergence of the documents enabled me to finally produce an accurate and fair account.

This is an example of the importance of having access to all relevant documents relating to a program or policy in order to study it fairly. The other major way in which document analysis is useful in case study is for understanding the values, explicit and hidden, in policy and program documents and in the organization where the program or policy is implemented. Not to be ignored as documents are photographs, and these, too, can form the basis of a cultural and value analysis of an organization ( Prosser, 2000 ).

Creative artistic approaches

Increasingly, some case study researchers are employing creative approaches associated with the arts as a means of data gathering and analysis. Artistic approaches have often been used in representing findings, but less frequently in data gathering and interpretation ( Simons & McCormack, 2007 ). A major exception is the work of Richardson (1994) , who sees the very process of writing as an interpretative act, and of Cancienne and Snowber (2003) , who argue for movement as method.

The most familiar of these creative and artistic forms are written—narratives and short stories ( Clandinin & Connelly, 2000 ; Richardson, 1994 ; Sparkes, 2002 ), poems or poetic form ( Butler-Kisber, 2010 ; Duke, 2007 ; Richardson, 1997 ; Sparkes & Douglas, 2007 ), cameos of people, or vignettes of situations. These can be written by participants or by the researcher or developed in partnership. They can also be shared with participants to further interpret the data. But photographs also have a long history in qualitative research for presenting and constructing understanding ( Butler-Kisber, 2010 ; Collier, 1967 ; Prosser, 2000 ; Rugang, 2006 ; Walker, 1993 ).

Less common are other visual forms of gathering data, such as “draw and write” ( Sewell, 2011 ), artefacts, drawings, sketches, paintings, and collages, although all forms are now on the increase. For examples of the use of collage in data gathering, see Duke (2007) and Butler-Kisber (2010) , and for charcoal drawing, Elliott (2008) .

In qualitative inquiry broadly, these creative approaches are now quite common. And in the context of arts and health in particular (see, for example, Frank, 1997 ; Liamputtong & Rumbold, 2008 ; Spouse, 2000 ), we can see how artistic approaches illuminate in-depth understanding. However, in case study research to date, I think narrative forms have tended to be most prominent.

Finally, for capturing the quality and essence of peoples’ experience, nothing could be more revealing than a recording of their voices. Video diaries—self-evaluative portrayals by individuals of their perspectives, feelings, or experience of an event or situation—are a most potent way both of gaining understanding and communicating that to others. It is rather more difficult to gain access for observational videos, but they are useful for documentation and have the potential to engage participants and stakeholders in the interpretation.

Getting It All Together

Case study is so often associated with story or with a report of some event or program that it is easy to forget that much analysis and interpretation has gone on before we reach this point. In many case study reports, this process is hidden, leaving the reader with little evidence on which to assess the validity of the findings and having to trust the one who wrote the tale.

This section briefly outlines possibilities, first, for analyzing and interpreting data, and second, for how to communicate the findings to others. However it is useful to think of these together and indeed, at the start, because decisions about how you report may influence how you choose to make sense of the data. Your choice may also vary according to the context of the study—what is expected or acceptable—and your personal predilections, whether you prefer a more rational than intuitive mode of analysis, for example, or a formal or informal style of writing up that includes images, metaphor, narratives, or poetic forms.

Analyzing and Interpreting Data

When it comes to making sense of data, I make a distinction between analysis—a formal inductive process that seeks to explain—and interpretation, a more intuitive process that gains understanding and insight from a holistic grasp of data, although these may interact and overlap at different stages.

The process, whichever emphasis you choose, is one of reducing or transforming a large amount of data to themes that can encapsulate the overarching meaning in the data. This involves sorting, refining, and refocusing data until they make sense. It starts at the beginning with preliminary hunches, sometimes called “interpretative asides” or “working hypotheses,” later moving to themes, analytic propositions, or a theory of the case.

There are many ways to conduct this process. Two strategies often employed are concept mapping —a means of representing data visually to explore links between related concepts—and progressive focusing ( Parlett & Hamilton, 1976 ), the gradual reframing of initially identified issues into themes that are then further interpreted to generate findings. Each of these strategies tends to have three stages: initial sense making, identification of themes, and examination of patterns and relationships between them.

If taking a formal analytic approach to the task, the data would likely be broken down into segments or datasets (coded and categorized) and then reordered and explored for themes, patterns, and possible propositions. If adopting a more intuitive process, you might focus on identifying insights through metaphors and images, lateral thinking, or puzzling over paradoxes and ambiguities in the data, after first immersing yourself in the total dataset, reading and re-reading interview scripts, observations and field notes to get a sense of the whole. Trying out different forms of making sense through poetry, vignettes, cameos, narratives, collages, and drawing are further creative ways to interpret data, as are photographs taken in the case arranged to explain or tell the story of the case.

Reporting Case Study Research

Narrative structure and story.

As indicated in the introduction, telling a story is often associated with case study and some think this is what a case study is. In one sense, it is and, given that story is the natural way in which we learn ( Okri, 1997 ), it is a useful framework both for gathering data and for communicating case study findings. Not any story will do however. To count as research, it must be authentic, grounded in data, interpreted and analyzed to convey the meaning of the case.

There are several senses in which story is appropriate in qualitative case study: in capturing stories participants tell, in generating a narrative structure that makes sense of the case (i.e., the story you will tell), and in deciding how you communicate this narrative (i.e., in story form). If you choose a written story form (and advice here can be sought from Harrington (2003) and Caulley (2008) ), it needs to be clearly structured, well written, and contain only the detail that is necessary to give readers the vicarious experience of what it was like in the case. If the story is to be communicated in other ways, through, for example, audio or videotape, or computer or personal interaction, the same applies, substituting visual and interpersonal skill for written.

Matching forms of reporting to audience

The art of reporting is strongly connected to usability, so forms of reporting need to connect to the audiences we hope to inform: how they learn, what kind of evidence they value, and what kind of reporting maximizes the chances they will use the findings to promote policies and programs in the interests of beneficiaries. As Okri (1997) further reminds us, the writer only does half the work; the reader does the other (p. 41).

There may be other considerations as well: how open are commissioners to receiving stories of difficulties, as well as success stories? What might they need to hear beyond what is sought in the technical brief? And through what style of reporting would you try and persuade them? If conducting noncommissioned case study research, the scope for different forms of reporting is wider. In academia, for instance, many institutions these days accept creative and artistic forms of reporting when supported by supervisors and appreciated by examiners.

Styles of Reporting

The most obvious form of reporting is linear, often starting with a short executive summary and a brief description of focus and context, followed by methodology, the case study or thematic analysis, findings, and conclusions or implications. Conclusion-led reporting is similar in terms of its formality, but simply starts the other way around. From the conclusions drawn from the analyzed data, it works backward to tell the story through narrative, verbatim, and observational data of how these conclusions were reached. Both have a strong story line. The intent is analytic and explanatory.

Quite a different approach is to engage the reader in the experience and veracity of the case. Rather like constructing a portrait or editing a documentary film, this involves the sifting, constructing, re-ordering of frames, events and episodes to tell a coherent story primarily through interview excerpts, observations, vignettes, and critical incidents that depict what transpired in the case. Interpretation is indirect through the weaving of the data. The story can start at any point provided the underlying narrative structure is maintained to establish coherence ( House, 1980 , p. 116).

Different again, and from the other end of a continuum, is a highly interpretative account that may use similar ways of presenting data but weaves a story from the outset that is highly interpretative. Engaging metaphor, images, short stories, contradictions, paradoxes, and puzzles, it is invariably interesting to read and can be most persuasive. However, the evidence is less visible and therefore less open to alternative interpretations.

Even more persuasive is a case study that uses artistic forms to communicate the story of the case. Paintings, poetic form, drawings, photography, collage, and movement can all be adopted to report findings, whether the data was acquired using these forms or by other means. The arts-based inquiry movement ( Mullen & Finley, 2003 ) has contributed hugely to the validation and legitimation of artistic and creative ways of representing qualitative research findings. The journal Qualitative Inquiry contains many good examples, but see also Liamputtong & Rumbold (2008) . Such artistic forms of representation may not be for everyone or appropriate in some contexts, but they do have the power to engage an audience and the potential to facilitate use.

Generalization in Case Study Research

One of the potential limitations of case study often proposed is that it is impossible to generalize. This is not so. However, the way in which one generalizes from a case is different from that adopted in traditional forms of social science research that utilize large samples (randomly selected) and statistical procedures and which assume regularities in the social world that allow cause and effect to be determined. In this form of research inferences from data are stated as formal propositions that apply to all in the target population. See Donmoyer (1990) for an argument on the restricted nature of this form of generalization when considering single-case studies.

Making inferences from cases with a qualitative data set arises more from a process of interpretation in context, appealing to tacit and situated understanding for acceptance of their validity. Such inferences are possible where the context and experience of the case is richly described so the reader can recognize and connect with the events and experiences portrayed. There are two ways to examine how to reach these generalized understandings. One is to generalize from the case to other cases of a similar or dissimilar nature. The other is to see what we learn in-depth from the uniqueness of the single case itself.

Generalizing from the Single Case

A common approach to generalization and one most akin to a propositional form is cross-case generalization. In a collective or multi-site case study, each case is explored to see if issues that arise in one case also exist in other cases and what interconnecting themes there are between them. This kind of generalization has a degree of abstraction and potential for theorizing and is often welcomed by commissioners of research concerned that findings from the single case do not provide an adequate or “safe” basis for policy determination.

However, there are four additional ways to generalize from the single case, all of which draw more on tacit knowledge and recognition of context, although in different ways. In naturalistic generalization , first proposed by Stake (1978) , generalization is reached on the basis of recognition of similarities and differences to cases with which we are familiar. To enable such recognition, the case needs to feature rich description; people’s voices; and enough detail of time, place, and context to provide a vicarious experience to help readers discern what is similar and dissimilar to their own context ( Stake, 1978 ).

Situated generalization ( Simons, Kushner, Jones, & James, 2003 ) is close to the concept of naturalistic generalization in relying for its generality on retaining a connectedness with the context in which it first evolved. However, it has an extra dimension in a practice context. This notion of generalization was identified in an evaluation of a research project that engaged teachers in and with research. Here, in addition to the usual validity criteria to establish the warrant for the findings, the generalization was seen as dependable if trust existed between those who conducted the research (teachers, in this example) and those thinking about using it (other teachers). In other words, beyond the technical validity of the research, teachers considered using the findings in their own practice because they had confidence in those who generated them. This is a useful way to think about generalization if we wish research findings to improve professional practice.

The next two concepts of generalization— concept and process generalization —relate more to what you discover in making sense of the case. As you interpret and analyze, you begin to generate a theory of the case that makes sense of the whole. Concepts may be identified that make sense in the one case but have equal significance in other cases of a similar kind, even if the contexts are different.

It is the concept that generalizes, not the specific content or context. This may be similar to the process Donmoyer (2008) identifies of “intellectual generalization” (quoted by Butler-Kisber, 2010 , p. 15) to indicate the cognitive understanding one can gain from qualitative accounts even if settings are quite different.

The same is true for generalization of a process. It is possible to identify a significant process in one case (or several cases) that is transferable to other contexts, irrespective of the precise content and contexts of those other cases. An example here is the collaborative model for sustainable school self-evaluation I identified in researching school self-evaluation in a number of schools and countries ( Simons, 2002 ). Schools that successfully sustained school self-evaluation had an infrastructure that was collaborative at all stages of the evaluation process from design to conduct of the study, to analyzing the results and to reporting the findings. This ensured that the whole school was involved and that results were discussed and built into the ongoing development of school policies and practice. In other cases, different processes may be discovered that have applicability in a range of contexts. As with concept generalization, it is the process that generalizes not the substantive content or specific context.

Particularization

The forms of generalization discussed above are useful when we have to justify case study in a research or policy context. But the overarching justification for how we learn from case study is particularization —a rich portrayal of insights and understandings interpreted in the particular context. Several authors have made this point ( Stake, 1995 ; Flyvberg, 2006 ; Simons 2009 ). Stake puts it most sharply when he observes that “The real business of case study is particularization, not generalization” (p. 8), referring here to the main reason for studying the singular, which is to understand the uniqueness of the case itself.

My perspective (explored further in Simons, 1996 ; Simons, 2009 , p. 239; Simons & McCormack, 2007 ) is similar in that I believe the “real” strength of case study lies in the insights we gain from in-depth study of the particular. But I also argue for the universality of such insights—if we get it “right.” By which I mean that if we are able to capture and report the uniqueness, the essence, of the case in all its particularity and present this in a way we can all recognize, we will discover something of universal significance. This is something of a paradox. The more you learn in depth about the particularity of one person, situation, or context, the more likely you are to discover something universal. This process of reaching understanding has support both from the way in which many discoveries are made in science and in how we learn from artists, poets, and novelists, who reach us by communicating a recognizable truth about individuals, human relationships, and/or social contexts.

This concept of particularization is far from new, as the quotation from a preface to a book written in 1908 attests. Stephen Reynolds, the author of A Poor Man’s House , notes that the substance of the book was first recorded in a journal, kept for purposes of fiction, and in letters to one of his friends, but fiction proved an inappropriate medium. He felt that the life and the people were so much better than anything he could invent. The book therefore consists of the journal and letters drawn together to present a picture of a typical poor man’s house and life, much as we might draw together a range of data to present a case study. It is not the substance of the book that concerns us here but the methodological relevance to case study research. Reynolds notes that the conclusions expressed are tentative and possibly go beyond this man’s life, so he thought some explanation of the way he arrived at them was needed:

Educated people usually deal with the poor man’s life deductively; they reason from the general to the particular; and, starting with a theory, religious, philanthropic, political, or what not, they seek, and too easily find, among the millions of poor, specimens—very frequently abnormal—to illustrate their theories. With anything but human beings, that is an excellent method. Human beings, unfortunately, have individualities. They do what, theoretically, they ought not to do, and leave undone those things they ought to do. They are even said to possess souls—untrustworthy things beyond the reach of sociologists. The inductive method—reasoning from the particular to the general... should at least help to counterbalance the psychological superficiality of the deductive method. ( Reynolds, 1908 : preface) 1

Slightly overstated perhaps, but the point is well made. In our search for general laws, we not only lose sight of the uniqueness and humanity of individuals, but reduce them in the process, failing to present their experience in any “real” sense. What is astonishing about the quotation is that it was written over a century ago and yet many still argue today that you cannot generalize from the particular.

Going even further back, in 1798, Blake proclaimed that “To Generalize is to be an Idiot. To Particularize is the Alone Distinction of Merit.” In research, we may not wish to make such a strong distinction: these processes both have their uses in different kinds of research. But there is a major point here for the study of the particular that Wilson (2008) notes in commenting on Blake’s perception when he says: “Favouring the abstract over the concrete, one ‘sees all things only thro’ the narrow chinks of his cavern”’ (referring here to Blake’s The Marriage of Heaven and Hell [1793]; in Wilson, 2008 , p. 62). The danger Wilson is pointing to here is that abstraction relies heavily on what we know from our past understanding of things, and this may prevent us experiencing a concrete event directly or “apprehend[ing] a particular moment” ( Wilson, 2008 , p. 63).

Blake had a different mission, of course, than case researchers, and he was not himself free from abstractions, as Wilson points out, although he fought hard “to break through mental barriers to something unique and living” ( Wilson, 2008 , p. 65). It is this search for the “unique and living” and experiencing the “isness” of the particular that we should take from the Blake example to remind ourselves of the possibility of discovering something “new,” beyond our current understanding of the way things are.

Focusing on particularization does not diminish the usefulness of case study research for policy makers or practitioners. Grounded in recognizable experience, the potential is there to reach a range of audiences and to facilitate use of the findings. It may be more difficult for those who seek formal generalizations that seem to offer a safe basis for policy making to accept case study reports. However, particular stories often hold the key to why policies have or have not worked well in the past. It is not necessary to present long cases—a criticism frequently levelled—to demonstrate the story of the case. Such case stories can be most insightful for policy makers who, like many of us in everyday life, often draw inferences from a single instance or case, whatever the formal evidence presented. “I am reminded of the story of....”

The case for studying the particular to inform practice in professional contexts needs less persuasion because practitioners can recognize the content and context quite readily and make the inference to their own particular context ( Simons et al., 2003 ). In both sets of circumstances—policy and practice—it is more a question of whether the readers of our case research accept the validity of findings determined in this way, how they choose to learn, and our skill in telling the case study story.

Conclusion and Future Directions

In this chapter, I have presented an argument for case study research, making the case, in particular, for using qualitative methods to highlight what it is that qualitative case study research can bring to the study of social and educational programs. I outlined the various ways in which case study is commonly used before focusing directly on case study as a major mode of research inquiry, noting characteristics it shares with other qualitative methodologies, as well as itsdifference and the difficulties it is sometimes perceived to have. The chapter emphasizes the importance of thinking through what the case is, to be sure that the issues explored and the data generated do illuminate this case and not any other.

But there is still more to be done. In particular, I think we need to be more adventurous in how we craft and report the case. I suspect we may have been too cautious in the past in how we justified case study research, borrowing concepts from other disciplines and forms of educational research. More than 40 years on, it is time to take a greater risk—in demonstrating the intrinsic nature of case study and what it can offer to our understanding of human and social situations.

I have already drawn attention to the need to design the case, although this could be developed further to accentuate the uniqueness of the particular case. One way to do this is to feature individuals more in the design itself, not only to explore programs and policies through perspectives of key actors or groups and transactions between them, which to some extent happens already, but also to get them to characterize what makes the context unique. This is the reversal of many a design framework that starts with the logic of a program and takes forward the argument for personal evaluation ( Kushner, 2000 ), noted in the interlude on evaluation. Apart from this attention to design, there are three other issues I think we need to explore further: the warrant for creative methods in case study, more imaginative reporting; and how we learn from a study of the singular.

Warrant for More Creative Methods in Case Study Research

The promise that creative methods have for eliciting in-depth understanding and capturing the unusual, the idiosyncratic, the uniqueness of the case, was mentioned in the methods section. Yet, in case study research, particularly in program and policy contexts, we have few good examples of the use of artistic approaches for eliciting and interpreting data, although more, as acknowledged later, for presenting it. This may be because case study research is often conducted in academic or policy environments, where propositional ways of knowing are more valued.

Using creative and artistic forms in generating and interpreting case study data offers a form of evidence that acknowledges experiential understanding in illuminating the uniqueness of the case. The question is how to establish the warrant for this way of knowing and persuade others of its virtue. The answer is simple. By demonstrating the use of these methods in action, by arguing for a different form of validity that matches the intrinsic nature of the method, and, above all, by good examples.

Representing Findings to Engage Audiences in Learning

In evaluative and research policy contexts, where case study is often the main mode of inquiry or part of a broader study, case study reports often take a formal structure or sometimes, where the context is receptive, a portrayal or interpretative form. But, too often, the qualitative is an add-on to a story told by other means or reduced to issues in which the people who gave rise to the data are no longer seen. However, there are many ways to put them center stage.

Tell good stories and tell them well. Or, let key actors tell their own stories. Explore the different ways technology can help. Make video clips that demonstrate events in context, illustrate interactions between people, give voice to participants—show the reality of the program, in other words. Use graphics to summarize key issues and interactive, cartoon technology, as seen on some TED presentations, to summarize and visually show the complexity of the case. Video diaries were mentioned in the methods section: seeing individuals tell their tales directly is a powerful way of communicating, unhindered by “our” sense making. Tell photo stories. Let the photos convey the narrative, but make sure the structure of the narrative is evident to ensure coherence. These are just the beginnings. Those skilled in information technology could no doubt stretch our imagination further.

One problem and a further question concerns our audiences. Will they accept these modes of communication? Maybe not, in some contexts. However, there are three points I wish to leave you with. First, do not presume that they won’t. If people are fully present in the story and the complexity is not diminished, those reading, watching, or hearing about the case will get the message. If you are worried about how commissioners might respond, remember that they are no different from any other stakeholder or participant when it comes to how they learn from human experience. Witness the reference to Okri (1997) earlier about how we learn.

Second, when you detect that the context requires a more formal presentation of findings, respond according to expectation but also include elements of other forms of presentation. Nudge a little in the direction of creativity. Third, simply take a chance, that risk I spoke about earlier. Challenge the status quo. Find situations and contexts where you can fully represent the qualitative nature of the experience in the cases you study with creative forms of interpretation and representation. And let the audience decide.

Learning from a Study of the Singular

Finally, to return to the issue of “generalization” in case study that worries some audiences. I pointed out in the generalization section several ways in which it is possible to generalize from case study research, not in a formal propositional sense or from a case to a population, but by retaining a connection with the context in which the generalization first arose—that is, to realize in-depth understanding in context in different circumstances and situations. However, I also emphasized that, in many instances, it is particularization from which we learn. That is the point of the singular case study, and it is an art to perceive and craft the case in ways that we can.

Acknowledgments

Parts of this chapter build on ideas first explored in Simons, 2009 .

I am grateful to Bob Williams for pointing out the relevance of this quotation from Reynolds to remind us that “there is nothing new under the sun” and that we sometimes continue to engage endlessly in debates that have been well rehearsed before.

Adams, T. ( 2012 ) ‘ Olympics 2012: Team GB falters but London shines bright on opening day ’, Observer, 29.07.12.

Google Scholar

Google Preview

Bassey, M. ( 1999 ). Case study research in educational settings . Buckingham: Open University Press.

Bellah, R. N. , Madsen, R. , Sullivan, W. M. , Swidler, A. , & Tipton, S. M. ( 1985 ). Habits of the heart . London: Harper and Row.

Blake, W. (1798– 1809 ). Annotations to Sir Joshua Reynolds’s Discourses , pp. xvii–xcviii (c. 1798–1809) repr. In Complete Writings , ed.   Geoffrey Keynes   (1957). ‘Discourse II,’ annotations to Sir Joshua Reynolds, Discourses (c. 1808) .

Butler-Kisber, L. ( 2010 ). Qualitative inquiry: Thematic, narrative and arts-informed perspectives . London: Sage.

Cancienne, M. B. , & Snowber, C. N. ( 2003 ). Writing rhythm: Movement as method.   Qualitative Inquiry , 9 (2), 237–253.

Caulley, D. N. ( 2008 ). Making qualitative research reports less boring: The techniques of writing creative nonfiction.   Qualitative Inquiry , 14 (3) pp. 424–449.

Chadderton, C. , & Torrance, H. ( 2011 ). Case study. In B. Somekh & C. Lewin (Eds.), Theory and methods in social research . (2nd ed. pp 53–60). London and Thousand Oaks, CA: Sage.

Clandinin, D. J. & Connelly, F. M. ( 2000 ) Narrative inquiry: Experience and story in qualitative research. Ist edn. SanFrancisco: Jossey Bass Publishers.

Collier, J., Jr. ( 1967 ). Visual anthropology: Photography as a research method . New York: Holt, Reinhart, & Winston.

Denzin, N. K. & Lincoln, Y. S. (Eds.) ( 1994 ) Handbook of Qualitative Research , London and Thousand Oaks, CA:Sage

Donmoyer, R. ( 1990 ). Generalization and the single case study. In E. W. Eisner & A. Peshkin (Eds.), Qualitative inquiry in education (pp. 175–200). New York: Teachers College Press.

Donmoyer, R. ( 2008 ). Generalizability. In L. M. Givens (Ed.), The Sage encyclopedia of qualitative inquiry (vol. 2, pp. 371–372). Thousand Oaks, CA: Sage.

Duke, S. (2007). A narrative case study evaluation of the role of the Nurse Consultant in palliative care. PhD thesis, University of Southampton, England.

Elliott, J. (2008). Dance mirrors: Embodying, actualizing and operationalizing a dance experience in a healthcare context. PhD thesis, University of Ulster, Belfast.

Frank. A. ( 1997 ). Enacting illness stories: When, what, why. In H. L. Nelson (Ed.), Stories and their limits (pp. 31–49). London: Routledge.

Flyvberg, B. ( 2006 ). Five misunderstandings about case-study research.   Qualitative Inquiry , 12 (2), 219–245.

Gomm, R. , Hammersley, M. , & Foster, P. (Eds.). ( 2004 ). Case study method: Key issues, key texts . [First published in 2000]. London and Thousand Oaks, CA: Sage.

Greene, J. C. ( 2000 ). Understanding social programs through evaluation. In N. K. Denzin and Y. S. Lincoln (Eds.), The handbook of qualitative research (2nd ed., pp. 981–999). Thousand Oaks, CA: Sage.

Greene, J. C. ( 2007 ). Mixing methods in social inquiry . San Francisco: Jossey Bass.

Greenhalgh, T. , & Worrall, J. G. ( 1997 ). From EBM to CSM: The evolution of context-sensitive medicine.   Journal of Evaluation in Clinical Practice , 3 (2), 105–108.

Harrington, W. ( 2003 ). What journalism can offer ethnography.   Qualitative Inquiry . 9 (1), 90–114.

Heron, J. ( 1992 ). Feeling and personhood . Sage: London.

Heron, J. ( 1999 ). The complete facilitator’s handbook . London: Kogan Page.

House, E. R. ( 1980 ). Evaluating with validity . London, Beverly Hills, CA: Sage.

House, E. R. ( 1993 ). Professional evaluation: Social impact and political consequences . Newbury Park and London: Sage

Kushner, S. ( 2000 ). Personalizing evaluation . London and Thousand Oaks, CA: Sage.

Liamputtong, P. , & Rumbold, J. (Eds.). ( 2008 ). Knowing differently: Arts-based and collaborative research methods . New York: Nova Science Publishers.

MacDonald, B. ( 1976 ). Evaluation and the control of education. In D. Tawney (Ed.), Curriculum evaluation today: Trends and implications . Schools Council Research Studies (pp. 125– 136). London: Macmillan.

Matarasso, F. ( 2012 ). West Bromwich Operatic Society: fine art of musical theatre . West Bromwich, UK: Multistory.

Merriam, S. B. ( 1988 ). Case study research in education: A qualitative Approach . San Francisco: Jossey Bass.

Mullen, C. A. , & Finley, S. (Eds.). ( 2003 ). Arts-based approaches to qualitative inquiry [Special Issue].   Qualitative Inquiry , 9 (2), 165–329.

Okri, B. ( 1997 ). A way of being free . London: Phoenix.

Parlett, M. , & Hamilton, D. ( 1976 ). Evaluation as illumination: A new approach to the study of innovatory programmes. In G. Glass (Ed.), Evaluation studies review annual, I (pp. 140–157). [First published in 1972 as Occasional Paper 9, Centre for Research in the Educational Sciences, University of Edinburgh.] Beverly Hills: CA: Sage.

Platt, J. ( 2007 ). Case study. In W. Outhwaite & S. P. Turner (Eds.), The Sage handbook of social science methodology (pp. 100–118). London: Sage.

Prosser, J. ( 2000 ). The moral maze of image ethics. In H. Simons & R. Usher (Eds.), Situated ethics in educational research (pp. 116–132). London and New York: Routledge/Falmer.

Ragin, C. C. ( 1992 ). Cases of “What is a case?” In C. C. Ragin & H. S. Becker (Eds.), What is a case?: Exploring the foundations of social inquiry (pp. 1–17). Cambridge: Cambridge University Press.

Reynolds, S. S. (1908). A Poor Man’s House . The Project Guttenberg eBook, July 25, 2008 [eBook#26126]. Accessed February 26, 2013, http.//www.gutenberg.org

Richardson, L. ( 1994 ). Writing as a form of inquiry. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of Qualitative Research (pp. 516–529). London: Sage.

Richardson, L. ( 1997 ). Fields of play (Constructing an academic life) . New Brunswick, NJ: Rutgers University Press.

Rugang, L. (2006). Chinese culture in globalisation: A multi-modal case study on visual discourse. PhD thesis, University of Southampton, England.

Seale, C. ( 1999 ). The quality of qualitative research . London and Thousand Oaks, CA: Sage.

Sewell, K. ( 2011 ). Researching sensitive issues: A critical appraisal of “draw and write” as a data collection technique in eliciting children’s perceptions.   International Journal of Research Methods in Education 34(2), pp.175–191.

Shaw, I. , & Gould, N. ( 2001 ). Qualitative research in social work: Context and method . London: Sage.

Silverman, D. ( 2000 ). Doing qualitative research: A practical handbook . London and Thousand Oaks. CA: Sage.

Silverman, D. (Ed.). ( 2004 ). Qualitative research: Theory, methods and practice (2nd ed.). London and Thousand Oaks, CA: Sage.

Simons, H. ( 1971 ). Innovation and the case study of schools.   Cambridge Journal of Education , 3 , 118–123.

Simons, H. (Ed.). ( 1980 ). Towards a science of the singular: Essays about case study in educational research and evaluation . Occasional Papers No. 10. Norwich, UK: Centre for Applied Research, University of East Anglia.

Simons, H. ( 1987 ). Getting to know schools in a democracy: The politics and process of evaluation . Lewes, UK: Falmer Press.

Simons, H. ( 1996 ). The paradox of case study.   Cambridge Journal of Education , 26 (2), 225–240.

Simons, H. ( 2000 ). Damned if you do, damned if you don’t: ethical and political dilemmas in evaluation. In H. Simons & R. Usher (Eds.) Situated ethics in educational research (pp.39– 55) London and New York: Routledge/Falmer.

Simons, H. ( 2002 ). School self-evaluation in a democracy. In D. Nevo (Ed.), School-based evaluation: An international perspective . Advances in Program Evaluation. London: Sage.

Simons, H. ( 2006 ). Ethics and evaluation. In I. F. Shaw , J. C. Greene , & M. M. Mark (Eds.), The international handbook of evaluation (pp. 243–265). London and Thousand Oaks, CA Sage.

Simons, H. ( 2009 ). Case study research in practice . London: Sage.

Simons, H. (2010). Democratic evaluation: Theory and practice. Paper prepared for Virtual Evaluation Conference, University of the Witwatersrand, Johannesburg, South Africa, May, 2010.

Simons, H. , Kushner, S. , Jones, K. , & James, D. ( 2003 ). From evidence-based practice to practice-based evidence: The idea of situated generalization.   Research Papers in Education: Policy and Practice , 18 (4), 347–364.

Simons, H. , & McCormack, B. ( 2007 ). Integrating arts-based inquiry in evaluation methodology.   Qualitative Inquiry , 13 (2) 292–311.

Simons, H. , & Usher, R. (Eds.). ( 2000 ). Situated ethics in educational research . London and New York: Routledge/Falmer.

Smith, L. M. , & Pohland, P. A. ( 1974 ). Education, technology, and the rural highlands. In R. H. P. Kraft ., L. M. Smith ., P. A. Pohland ., C. J. Brauner , & C. Gjerde (Eds.), Four evaluation examples: Anthropological, economic, narrative and portrayal (pp. 5–54), AERA Monograph Series on Curriculum Evaluation 7. Chicago: Rand McNally.

Sparkes, A. ( 2002 ). Telling tales in sport and physical activity: A qualitative journey . Champaign, IL: Human Kinetics Press.

Sparkes, A. C. , & Douglas, K. ( 2007 ). Making the case for poetic representations: An example in action.   The Sport Psychologist , 21(2) , 170–190.

Spouse, J. ( 2000 ). Talking pictures: Investigating personal knowledge though illuminating artwork.   Nursing Times Research Journal , 5 (4), 253–261.

Stake, R. E. ( 1978 ) The case study method in social inquiry.   Educational Researcher , 7(2), 5–9.

Stake, R. E. ( 1995 ). The art of case study research . Thousand Oaks, CA and London: Sage.

Stake, R. E. ( 2010 ). Qualitative research: Studying how things work . New York & London: Guildford Press.

Stenhouse, L. ( 1978 ). Case study and case records: Towards a contemporary history of education.   British Educational Research Journal , 4 (2), 21–39.

Thomas, G. ( 2011 b)). A typology for the case study in social science following a review of definition, discourse and structure.   Qualitative Inquiry , 17 (6) , 511–521.

Thomas, G. ( 2011 a). How to do your case study: A guide for students and researchers . London: Sage.

Walker, R. ( 1993 ). Finding a silent voice for the researcher: Using photographs in evaluation and research. In M. Schratz (Ed.), Qualitative voices in educational research (pp. 72–92). Lewes, UK: Falmer Press.

Wilson, E. G. ( 2008 ). Against happiness . New York: Sarah Crichton Books.

Yin, R. K. ( 2004 ). Case study research: Design and methods . Thousand Oaks, CA and London: Sage.

Zucker, D. M. ( 2001 ). Using case study methodology in nursing research.   Qualitative Report , 6 (2) June.

• About Oxford Academic
• Publish journals with us
• University press partners
• What we publish
• New features  
• Open access
• Institutional account management
• Rights and permissions
• Get help with access
• Accessibility
• Advertising
• Media enquiries
• Oxford University Press
• Oxford Languages
• University of Oxford

Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide

• Copyright © 2024 Oxford University Press
• Cookie settings
• Cookie policy
• Privacy policy
• Legal notice

This Feature Is Available To Subscribers Only

Sign In or Create an Account

This PDF is available to Subscribers Only

For full access to this pdf, sign in to an existing account, or purchase an annual subscription.

Research Writing and Analysis

• NVivo Group and Study Sessions
• SPSS This link opens in a new window
• Statistical Analysis Group sessions
• Using Qualtrics
• Dissertation and Data Analysis Group Sessions
• Defense Schedule - Commons Calendar This link opens in a new window
• Research Process Flow Chart
• Research Alignment Chapter 1 This link opens in a new window
• Step 1: Seek Out Evidence
• Step 2: Explain
• Step 3: The Big Picture
• Step 4: Own It
• Step 5: Illustrate
• Annotated Bibliography
• Literature Review This link opens in a new window
• Systematic Reviews & Meta-Analyses
• How to Synthesize and Analyze
• Synthesis and Analysis Practice
• Synthesis and Analysis Group Sessions
• Problem Statement
• Purpose Statement
• Conceptual Framework
• Theoretical Framework
• Locating Theoretical and Conceptual Frameworks This link opens in a new window
• Quantitative Research Questions
• Qualitative Research Questions
• Trustworthiness of Qualitative Data
• Analysis and Coding Example- Qualitative Data
• Thematic Data Analysis in Qualitative Design
• Dissertation to Journal Article This link opens in a new window
• International Journal of Online Graduate Education (IJOGE) This link opens in a new window
• Journal of Research in Innovative Teaching & Learning (JRIT&L) This link opens in a new window

Writing a Case Study

What is a case study?

A Case study is: 

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

What are the different types of case studies?

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

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

Who are your case study participants?

What is triangulation ? 

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

How to write a Case Study?

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

Was this resource helpful?

• << Previous: Thematic Data Analysis in Qualitative Design
• Next: Journal Article Reporting Standards (JARS) >>
• Last Updated: May 29, 2024 8:05 AM
• URL: https://resources.nu.edu/researchtools

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

• View all journals
• My Account Login
• Explore content
• About the journal
• Publish with us
• Sign up for alerts
• Open access
• Published: 05 June 2024

Classroom communications post pandemic: a case study

• Marwa Abdelmonem 1 &
• Sherin Karawia 1  

Humanities and Social Sciences Communications volume  11 , Article number:  728 ( 2024 ) Cite this article

1 Altmetric

Metrics details

• Environmental studies

This cross-sectional case study ( n  = 20) took place in Qatar over a 3-month period spanning from September until the end of November in 2021. It examined the impacts of a post-COVID classroom arrangement that incorporated preventive measures like social distancing and the use of face coverings. Using the case study methodology, we employed two qualitative research methods, namely non-participant observation and semi-structured interviews, to gather primary data. We also conducted an extensive literature review to identify the key themes for investigation in the field. The primary focus of our study was on proxemics (personal space and crowding), technology (Zoom), non-verbal communication, and ergonomics (lighting and acoustics). Our study uncovered new areas for future research, particularly in how proxemics change in socially distanced classrooms, affecting personal space and perceptions of crowding. Additionally, it highlighted themes in post-pandemic classroom design, emphasizing the impact of factors like seating arrangements and available amenities (e.g., pinup walls) on student engagement, especially in design-studio classrooms. The study also revealed unexpected challenges, such as issues with microphone usage due to users’ lack of familiarity with their operation. In summary, the research underscores the ongoing importance of adaptable learning methods and communication strategies, particularly in response to preventive measures like social distancing and face-covering, which have reshaped our concept of personal space and emphasized the crucial role of telecommunication in crisis resilience for communities and organizations.

Similar content being viewed by others

Preparing undergraduates for the post-pandemic workplace: Teams of education and engineering students teach engineering virtually

Emergent transition from face-to-face to online learning in a South African University in the context of the Coronavirus pandemic

Perceived functional resilience in schools according to key stakeholders

Introduction.

The COVID-19 pandemic, caused by the novel coronavirus (SARS-CoV-2), was declared a global pandemic by the World Health Organization (WHO) due to its rapid spread to multiple countries ( WHO Director-General’s Opening Remarks at the Media Briefing on COVID-19 - 11 March 2020 , 2020 ). It is important to note that COVID-19 is not an isolated event in history, as previous pandemics like the 1918 American Polio epidemic, the 1918 Spanish flu, the 1957 Asian flu, the 1981 AIDS pandemic, the 2009 H1N1 Swine flu, the 2014 West African Ebola, and the 2014 Zika Virus epidemic have occurred (Cennimo, 2020 ; Jarus, 2023 ). COVID-19 can have severe health consequences, particularly for the elderly and those with pre-existing health conditions (World Health Organization, n.d. ) .

Preventing the transmission of COVID-19 involves a combination of physical and medical interventions. The WHO recommends physical measures such as handwashing, social distancing, and wearing face coverings (Centers for Disease Control and Prevention, n.d. ). Medical interventions include vaccines, although their long-term effectiveness is still being studied (Frequently Asked Questions about COVID-19 Vaccination, 2023 ). Vaccines have proven effective in reducing hospitalization rates by 92–96% (Robson, 2021 ), but ongoing research is examining their long-term impacts.

The COVID-19 pandemic led to significant changes in the operations of various institutions, including educational establishments. Measures like remote work and restricted access to buildings were implemented, and as vaccines were developed, some restrictions were lifted. In Qatar, strict COVID-19 measures included travel bans and public place closures, and the use of the Ehteraz app for exposure alerts (Al Khal et al., 2020 ). Mandatory face masks, protective equipment distribution, and clear public communication highlighted preventive measures, linking access to public facilities with a healthy Ehteraz status during the lockdown (Al Khal et al., 2020 ). The gradual reopening and removal of restrictions occurred in four phases, commencing on May 21, 2021 (Government Communications Office, 2020 ). Our study coincided with the second phase, marked by the partial lifting of restrictions, enabling a return to campus within designated daily hours and specific building capacities that varied across different structures.

The transition back to in-person learning has brought challenges in ensuring safety in alignment with WHO guidelines, including social distancing measures within classrooms. Given the mixed sentiments surrounding the reopening, communication within the classroom under setups adhering to WHO guidelines was unforeseen and unfamiliar to everyone. With varied opinions on the reopening, communication within classrooms following WHO guidelines was unexpected. Hence, our research study aimed to explore classroom communication post-online learning during the pandemic, as there is limited existing research on the effects of preventive measures on this aspect.

Student engagement is related to academic performance, and a conducive learning environment plays a crucial role in fostering effective communication and learning (Shernoff et al., 2016 , as cited in Kelly, 2008; Kopec, 2012 ). Therefore, this study aims to investigate the effects of preventive measures like face-covering and social distancing on classroom communication in a post-pandemic, socially-distanced classroom setting. In essence, our study seeks to answer the research question: “What impact do preventive measures have on classroom communication within a post-pandemic classroom environment?” This study was conducted on two interconnected classrooms, which were intentionally furnished to comply with social distancing requirements and create a cohesive socially distanced learning environment, prompting further exploration of this phenomenon.

Literature review

To investigate how preventive measures might impact classroom communication dynamics, our study conducted a review of the literature to identify and extract certain themes from this body of work. These predetermined themes were integral to addressing the aforementioned research question. Out of more than 50 studies examined, only 29 were selected to form the basis of the literature review for this study. Additional sources were incorporated for specific definitions and concepts. The literature selection criteria included original works in environmental design pertaining to proxemics, exploration of blended learning and technology use, considerations in classroom design, and aspects of verbal and non-verbal communication in classrooms.

Personal space

Due to the physical nature of the social distancing measure, literature on personal space was reviewed to better understand the impact of the changing proxemics. The first scholar to introduce the concept of personal space was Edward Hall in 1959 (Beaulieu, 2004 , p. 794). Hall defined personal space as “an invisible three-dimensional zone surrounding a person, which allows that person to regulate his interactions with the outside world” (Beaulieu, 2004 , p. 294). Research shows that “the idea of personal space is actually an interpersonal phenomenon” (Kopec, 2012 ). In other words, it requires the existence of others in order to occur. This was the definition pertaining to the psychological nature of this entity. However, it is also defined based on its physical characteristics as the variable and subjective distance at which one person feels comfortable talking to another ( Dictionary.com | Meanings & Definitions of English Words , 2021 ).

According to Hall ( 1990 ), the hidden boundaries of personal space are not fixed and can vary from one culture to another, as culture plays an important role in defining personal space. Nevertheless, in a socially distanced classroom, personal space that was long referred to as an invisible bubble has become well-identified with its visible physical boundaries after the COVID-19 pandemic. Spacing mechanisms used in design, in general, and in a socially distanced classroom, in particular, serve to maintain one’s perception of their personal space (Kopec, 2012 ).

The importance of the concept of personal space lies in regulating communication and human interaction. Research shows that “the concept of personal space is viewed as variable and permeable in different settings” (Beaulieu, 2004 , p. 297). According to Hall ( 1990 ), interpersonal distance zones, which govern our interactions, can be categorized into four zones. The first category is the intimate, which ranges from 0 to 18”, typically reserved for individuals with close relationships, such as family members or individuals in deeply connected interpersonal bonds (Kopec, 2012 ). The second interpersonal zone is the personal which can range from 18” up to 4’ (Kopec, 2012 , p. 78). This zone is usually used in casual interactions between friends and acquaintances (Kopec, 2012 ). The third level is social , which is usually maintained in business relations between coworkers (Beaulieu, 2004 ) and ranges from 4’ to 12’ (Kopec, 2012 , p. 78). Lastly, the public zone which is usually used by people in public places where they find themselves surrounded by a number of strangers (Kopec, 2012 ). This zone varies from 12’ to 25’ (Kopec, 2012 . p. 78). In a recent study, Mehta ( 2020 ) investigated Hall’s proxemics in urban settings, focusing on changes in street and public space dynamics in residential areas during COVID-19. The research highlighted how residents in mid- to low-density areas repurpose spaces, fostering sociability despite social distancing measures.

In our study, we chose to explore the personal space perceived by participants in an attempt to analyze the various elements that define this concept within the new classroom setup. Our study was mostly exploratory and was not focused on a certain type of interpersonal distance.

Crowding concept

We also explored another concept in environmental psychology that is closely related to personal space, which is Crowding. In normal situations, the occupant load, which is “the number of people that a building code assumes will occupy a given building or a portion of a building”, is based on the building classification (Ballast, 2013 ). The number, placement, and capacity of exits are based on more than just occupant load. The type of occupancy and use, travel distance and remoteness or separation of exits are examples of other factors typically considered when designing a building.

As Kopec ( 2012 , p. 77) indicated, “spacing mechanisms used in design serve to help maintain an individual’s sense of personal space”. To put it differently, the use of physical boundaries such as partitions, furniture and layout allows the individual to identify their own personal space. Crowding, on the other hand, is defined as the “psychological tension produced in environments of high population density, especially when individuals feel that the amount of space available to them is insufficient for their needs” (American Psychological Association, n.d. ). In that sense, it can be argued that implementing social distancing in a classroom can potentially eliminate any sensation of crowding. However, our study examines this concept further, as the perception of crowding can be subjective in nature.

Some researchers such as Evans and Wener ( 2007 ) analyzed the concept of personal space and crowding in trains. According to their review of the literature, incursions into personal space by unfamiliar individuals lead to greater stress compared to those committed by individuals with positive interpersonal relationships. Evans and Wener ( 2007 ) suggested that crowding occurs when the regulation of social interaction fails, leading to a higher level of social interaction than desired. Worchel and Teddie ( 1976 ) also asserted that a feeling of overcrowding is associated with violations of personal space. Crowding can have negative impacts on mental health, causing decreased performance on complex tasks, stress aftermaths, and increased physiological stress (American Psychological Association, n.d. ). The lack of control over social interaction (i.e. privacy) and the decline of socially supportive relationships are considered to be two key mechanisms that contribute to crowding (American Psychological Association, n.d. ).

Upon reviewing the existing literature, specific inquiries emerge concerning the concept of crowding. Our principal emphasis lies in examining how the notion of crowding, closely intertwined with the concept of personal space, has evolved within a socially distanced classroom environment.

Communication

According to Wahyuni ( 2018 ), teachers are required to excel in specific nonverbal communication skills, which encompass body language, the utilization of eye contact, maintaining appropriate distance from students, and the use of touch. Wahyuni ( 2018 ), who further cited Darn (Darn, n.d. ), noted that nearly 75% of classroom management relies on nonverbal communication. In this research, our objective was to investigate the alterations in both verbal and nonverbal communication within the new setup. This change was prompted by the introduction of social distancing measures through the rearrangement of furniture and the adoption of Zoom as an auxiliary tool to facilitate communication between two interconnected classrooms.

Non-verbal communication

It is evident that nonverbal communication plays an important role in classroom interaction (Hall et al., 1977 ). French ( 1977 ) described the non-verbal experience as a multi-dimensional, multi-sensory experience. In his study, French ( 1977 ) emphasized the need for incorporating the non-verbal experience into curriculum development. “The non-verbal experience focused both on self and others”, which requires “an active engagement rather than a passive one” (French, 1977 , p. 176). French’s ( 1977 ) findings resonate well with Astin’s ( 1984 ) regarding the degree of student involvement. Astin ( 1984 ) defines student involvement as the extent of physical and psychological energy invested in the college experience, including academic absorption, extracurricular participation, and interaction with faculty. Education literature distinguishes between student engagement and involvement. Engagement , according to Campus Intelligence (Gay, 2019 ), entails dedicating time and effort to educationally purposeful activities, surpassing mere involvement. Engaged students actively pursue endeavors that contribute to their educational goals, going beyond classroom actions like note-taking and questioning. In their recent research, Walker and Koralesky ( 2021 ) employed the definition of student engagement found in various scholarly reviews, indicating that student engagement is a multi-dimensional construct with three interconnected dimensions: affective, behavioral, and cognitive engagement (Walker and Koralesky, 2021 ; as cited in Chapman, 2002; Fredricks et al., 2004 ; Mandernach, 2015 ; Trowler, 2010 ). Our comprehension of the distinction between these two terms aided us in pinpointing the themes of observation. This is because engagement, in this context, is not the behavior we are focusing on; instead, we are interested in examining classroom dynamics and communication.

Hall et al. ( 1977 ) indicated that non-verbal communication involves a sender and a recipient. Hall et al. ( 1977 ) highlighted that there are some variables that make this sending-receiving type of interaction more effective. Among those variables that Hall et al. ( 1977 ) listed is the “climate”, which refers to how friendly the teacher is in interacting with students. Students are encouraged to actively participate in class discussions if they receive these cues about friendliness and positivity through the sender’s facial expressions and voice tone (Hall et al., 1977 ). This coincides with Zeki’s ( 2009 ) findings that the teacher’s non-verbal communication creates a comfortable and relaxing climate, which consequently enables the students to effectively and confidently engage in class discussions.

In the literature, we discovered another element that affects the student’s engagement in class, which is the locus of control (Astin, 1984 ; Richmond and McCroskey, 2012 , p. 13). According to Astin ( 1984 ), “students’ degree of involvement in learning tasks can be influenced by whether they believe that their behavior is controlled by internal or by external factors.” This is related to belief systems, which are often rooted in one’s locus of control (Kopec, 2012 ). Those who have “a strong external locus of control believe that they are controlled by external forces” (Kopec, 2012 , p. 98). On the other hand, people who have an “internal locus of control believe that their actions, choices, and pursuits control their destiny” (Kopec, 2012 , p. 98). This can be an indicative measure of the student’s level of motivation (Zeki, 2009 ). A number of studies (Zeki, 2009 ; Kopec, 2012 ; Hall, 1959 ) stated that the components of non-verbal communication include, but are not limited to; facial expressions (i.e. mimics), eye contact, angulation, and gestures (i.e. body language). The amount of information one receives from their surroundings comes from all senses but mainly from the eyes and ears (Zeki, 2009 ). This highlights the importance of visual and auditory environmental cues in a classroom.

Verbal communication

Additionally, we sought to comprehend the influence of the new environment on verbal communication. Consequently, we delved into the literature pertaining to physical ergonomics, such as classroom layout, acoustics, and lighting within the field of environmental design.

Classroom layout

Through an examination of early literature centered on the physical ergonomics of classroom configurations, we came across a notable study conducted by Sommer ( 1977 ) that underscored the significance of classroom layout as a means of non-verbal communication. Sommer emphasized that a classroom should not be viewed as a single homogeneous space but rather as a collection of interconnected micro-environments. Elements such as windows, lighting, heating vents, blackboards, and display equipment were identified as factors influencing interactions within the classroom. Additionally, the arrangement of classroom furniture was found to impact body angulation, which in turn affects nonverbal communication (Kopec, 2012 ).

In the realm of classroom design, the establishment of structures known as “affordances” gives rise to opportunities for engagement or limitations in that regard (Metzger and Langley, 2020 ). Affordances pertain to both the perceived and tangible characteristics of objects or surroundings, influencing how they can be employed (Metzger and Langley, 2020 , as cited in Gibson, 1979). In other words, these affordances represent resources within an environment for those who perceive and interact with them. In the context of our study, affordances are represented by movable chairs, movable tables, Zoom technology, and microphones. These affordances are meant to enhance communication while also imposing limitations on social proximity.

Verbal communication in a classroom involves the teacher conveying speech to students through a combination of direct and reflected sound (Berg et al., 1996 ). Effective acoustics are achieved when the reflected sound enhances the quality of the direct sound (Berg et al., 1996 ). Sound within the classroom space exhibits three behaviors: reflection off obstacles, diffraction around obstacles, and transmission into obstacles or new media (Timeline: Sound Wave, n.d. ). Reflected sound can lead to two issues: echoes or reverberation (Timeline: Sound Wave, n.d. ). An echo occurs when a reflected sound wave reaches the ear more than 0.1 s after the original sound wave was heard (Timeline: Sound Wave, n.d. ). On the other hand, reverberation is the prolongation of sound as it repeatedly bounces off hard surfaces (Ballast, 2013 ). Reverberation is generally preferred in classroom acoustics as it enhances speech intelligibility in the interior environment (Ballast, 2013 ). To achieve good acoustics in a classroom, a well-designed space includes an appropriate combination of absorbent, reflective, and diffusive materials (Berg et al., 1996 ).

Classroom acoustics can be affected by sound transmission through barriers, such as HVAC systems and external noise from corridors or streets (Ballast, 2013 ). Research efforts have been directed towards exploring issues such as listening problems among special students, student disengagement, the teacher’s voice, and teacher fatigue (Berg et al., 1996 ). This information is relevant to our study as it pertains to the investigation of a socially distanced classroom setup. We also aimed to investigate acoustics because of its significant impact on both verbal and nonverbal communication, especially when considering the use of face coverings.

Daytime light exposure, particularly from sunlight, full-spectrum LEDs, and digital screens, is significant for learning as it affects both vision and a non-visual system tied to sleep-wake cycles and cognitive performance. Blue light has the most powerful impact on alertness and reduced sleepiness compared to other wavelengths, influencing hormonal secretion in the non-visual system (Uncapher, 2016 ).

In their case study, Tureková et al. ( 2018 ) aimed to show how the school environment significantly affects students’ academic performance. They found that factors like accurate lighting influence visual comfort and fatigue during visual tasks. Assessing the daylight factor in a university classroom revealed insufficient values, prompting the design of a potential software-based alternative to improve visual comfort. They also highlighted that natural light’s impact goes beyond academics, influencing physiological, psychological, and behavioral aspects of both students and workers (Tureková et al., 2018 ).

Al-Sallal ( 2010 ) studied daylighting in UAE classrooms, analyzing visual performance and quality. His research involved data collection from architectural drawings, compliance documents, site visits, and photography. Crucial design issues affecting visual quality, such as space size, depth-to-height ratio, window orientation, lighting direction, and desk position, were investigated through simulation. The study revealed design issues impacting daylighting and visual quality, including depth, glazing area, orientation, and daylighting direction. Visual discomfort was found due to contrasting luminance, high window brightness, and uneven daylight distribution. Mitigation strategies discussed focused on solar shading, glare protection, and daylight redirection, considering UAE climate design requirements. This study holds great relevance to our research because Qatar and the UAE share a similar climate. Our objective was to investigate whether there are any unexpected issues related to lighting in the new setup.

Joia and Lorenzo ( 2021 ) investigated the effectiveness of using Zoom, a popular choice for virtual communication during the pandemic (Joia and Lorenzo, 2021 ). The study’s findings emphasize the importance of a teacher’s digital proficiency on the platform and the availability of metacognitive support within the digital environment as key factors in achieving successful pedagogical objectives. Additionally, the research highlights that disciplines involving hard skills are more prone to not meeting their educational goals when transitioning to technology-mediated environments compared to soft skill disciplines undergoing a similar transition (Joia and Lorenzo, 2021 ).

Another study highlighted the benefits of video communication platforms, including expanding educational reach and enabling multimedia-based pedagogy (Earon, n.d. ). Online learning via Zoom showed satisfactory student levels in a study conducted in Pakistan (Minhas et al., 2021 ), but some students reported dissatisfaction due to technical issues (Kim, 2020 ). While online learning cannot replace face-to-face instruction (Ramadani and Xhaferi, 2020 ; Alawamleh et al., 2020 ), instructors’ digital competence and metacognitive support on Zoom can enhance the online experience (Joia and Lorenzo, 2021 ). The potential of using Zoom in a socially distanced classroom requires further exploration, given the COVID-19 pandemic’s impact and new social distancing measures. In our study, we aim to explore the use of Zoom as a supplementary communication medium in socially distanced classrooms.

To bridge the research gap on socially distanced classrooms that are specific to the context of Qatar, we embraced the philosophy of Epistemic Contextualism, asserting that knowledge attribution varies based on context (Rysiew, 2021 ). Following Morgan et al.’s ( 2016 ) recommendation, we adopted the case study methodology, drawing inspiration from the Case Study Observational Research (CSOR) approach. This approach entails conducting observations before interviews to delve deeper into aspects within the contextual framework. Our choice of a case study methodology aligns with qualitative research principles, suitable for exploring new fields or theorizing important issues (Jamshed, 2014 ). Consequently, we employed two data collection methods: observations followed by semi-structured interviews. Semi-structured interviews, rooted in the belief in socially constructed reality, offer flexibility for cross-verification within and between interviews (Azungah, 2018 ). The main objective was to investigate the impact of socially distanced classrooms on student engagement and classroom communication. This cross-sectional study was conducted within a three-month timeframe. Data were analyzed using thematic analysis (Lawless and Chen, 2018 ) for both the observation and interviews. The study was conducted in a unique setting. Prior to the COVID-19 pandemic, the classroom was designed as a studio for a single group, separated into two interconnected classrooms, illustrated in Fig. 1 as Classroom A and Classroom B. Additionally, two vestibules were designated as break areas for students. Classroom A had a dual function, serving as both a studio space and a location where students assembled their tables in the center for lectures. However, in response to the COVID-19 pandemic, social distancing measures were implemented, mandating that each student remain in their assigned seat even during lectures. In other words, students were assigned to design-studio classrooms A and B. The instructor’s workstation, which contained all the necessary equipment, was located in classroom A. As a result, Classroom A was equipped with a TV screen for presentations, while Classroom B was equipped with a projector. Both the screen and the projector were connected to the audio/speakers’ area that was located next to the instructor’s workstation in Classroom A (see Fig. 2 ).

This figure demonstrates Pre- and Post-COVID layouts showcasing a floor plan of the two design-studio classrooms (A and B) interconnected by two vestibules, forming a unified socially distanced classroom. It also illustrates the locations of screens and instructor’s workstation in both classrooms.

A floor plan depicting the layout of design-studio classrooms A and B , along with four perspectives from both classrooms viewed from various camera angles (angles A , B , C , and D ).

Non-participant observations

Observational documentation spanned three months, from September to November, commencing at the start of the semester before obtaining Institutional Review Board (IRB) approval for interviews, as no direct participant contact was required. Field notes encompassed written observations, hand sketches, and circulation maps, providing visual representations of classroom communications. The observer, the second researcher, attended the bi-weekly class sessions for approximately 60 min, ensuring comprehensive consideration of any potential confounding variables. The observation method was guided by findings from the literature review, shaping the framework for the study.

The observations involved observing students without actively participating, providing an overview of the setting and narrowing focus to specific elements of interest (Non-participant Observation, n.d. ). Students were closely monitored in their natural environments, with observations aligned with several themes derived from the literature review mentioned earlier. Field notes were recorded, specifically focusing on non-verbal communication aspects like angulation, body language, and gestures. Additionally, the observer examined any unanticipated data that had not been emphasized in the literature review. The aim of this method was to examine our predetermined themes extracted from the literature review and explore the emerging themes resulting from the new setup. Data were collected through field notes, sketches, and movement mapping over a period of three months.

Access to the classrooms was granted by both the Interim Chair of the Department and the Research Department. The first author served as the instructor for a lecture-based course during the research period, while the second author conducted the non-participant observations and subsequent semi-structured interviews. To maintain confidentiality, only data that had been de-identified and coded were provided to the first author for the purpose of data analysis.

It’s important to mention that we initially piloted a participant-observation method at the start of the semester, involving observations from both researchers. However, this proved impractical as the first researcher was also the course instructor, heavily engaged in fulfilling teaching obligations. Consequently, we opted for a non-participant observation approach, allowing one researcher to fully immerse in observing and documenting the identified variables from the literature review. Generally, “observational data can be integrated as auxiliary or confirmatory research” (Jamshed, 2014 , p. 88). Essentially, the use of observational data is intended to confirm the applicability of the predetermined themes identified in our literature review and to identify any unforeseen themes.

Semi-structured interviews

The second method utilized involved the conducting of face-to-face semi-structured interviews with college students who were pursuing a major in interior design. This was carried out following the approval granted by a national Institutional Review Board. Data was collected from a group of students ( n  = 20) aged between 18 and 20 years old. Ultimately, a total of 17 interviews were conducted, with three participants choosing to withdraw due to scheduling conflicts that arose during the final weeks of the semester. The inclusion and exclusion criteria can be found below in Table 1 .

Interviews were recorded and transcribed verbatim, with each session lasting approximately 30 min (Jamshed, 2014 ). The interview questions, derived from the literature review and observations, were intentionally designed as semi-structured to provide participants with the opportunity to elaborate on their responses. The inquiries primarily consisted of open-ended questions, aiming to delve into participants’ authentic feelings and attitudes regarding the new setup. However, close-ended questions were also incorporated to ensure clarity and consistency in responses.

The interviewing process employed a funnel approach, focusing on building trust and rapport and presenting questions in an unbiased manner to minimize biases from both the interviewer and interviewee (Azungah, 2018 ).

Data analysis

We adopted the inductive/deductive hybrid thematic analysis approach. According to Proudfoot ( 2022 ), thematic analysis that combines elements of both inductive and deductive approaches presents promising prospects for researchers. We initiated the coding process with a deductive approach, employing pre-established themes crafted before engaging with the collected data. These themes were formulated based on the literature review findings, detailed in Tables 2 and 3 . As we analyzed the interview data, we identified new themes that emerged from the study. Consequently, we adopted an inductive coding approach to highlight these additional insights.

Observations

During a 3-month period, the various movements of communication behaviors were captured with sketches. Video or audio recordings were not viable options due to cultural considerations. The outcomes of the non-participant observations align with the previously identified findings from literature review as shown below in Table 2 .

Based on our field observations, the instructor’s position within the room has a significant impact on student engagement. When the instructor is physically present in the room, it positively influences student-instructor interaction. Some students actively participate in class discussions and take notes only when the instructor is within their line of sight. However, there are other students who seem eager to participate regardless of the instructor’s location. While this observation might seem apparent, it proved valuable as it allowed us to connect it to the concept of locus of control. We were particularly interested in exploring whether student engagement stemmed from an internal or external source. Although this observation didn’t offer in-depth information, it provided an insight into how some students might possess an internal locus of control, motivating them to participate actively in class discussions regardless of classroom conditions or arrangements.

Additionally, our observations highlight that establishing eye contact plays a significant role in enhancing verbal communication and increasing student engagement. It is quite normal to see students eagerly joining classroom discussions by raising their hands, especially when they are in a position where the instructor can easily see them. In instances where students cannot recall technical terms for architectural concepts (e.g., forms, shapes, etc.), they resort to using hand gestures to convey their ideas. However, this might pose a challenge for those participating in the class discussion through Zoom from the adjacent room (classroom A or B), as they may not be able to see or interpret these hand gestures effectively. Body language encompasses a broad spectrum of non-verbal cues involving different parts of the body. Emphasizing the significance of hands in particular, they play a pivotal role in enhancing the effectiveness of verbal communication. Our observations also reveal that students commonly adjust their body position, specifically their angulation, to enhance their ability to actively engage in classroom discussions. This adjustment often involves orienting themselves towards key focal points within the classroom, which typically include the instructor’s position or the screen/display, particularly in lecture-style classes. This angulation adjustment may have potential musculoskeletal consequences, which is an aspect we aimed to explore further during the interviews.

This setup is relatively novel and has yet to receive attention in the existing literature. Our field observations underscore the significance of technology utilization in a socially distanced classroom setting. It notably reduces the time spent on communication between two separate rooms. Without the aid of microphones and speakers, instructors are required to repeat discussions for both rooms, effectively duplicating their verbal communication efforts. This duplication of effort can lead to fatigue, occasionally diminishing the instructor’s overall productivity in a socially distanced classroom. Conversely, the positioning of the microphone held significant importance for student engagement. Students seated in closer proximity to the microphone or those with unobstructed access to it demonstrated higher levels of participation in class activities and discussions as illustrated in the mapping diagram (Fig. 3 ).

A mapping diagram that layers the instructor’s movement and students’ movement in the classrooms. In this diagram, the instructor’s movement frequency is highlighted with purple hexagons, while student movements are depicted with green hexagons.The dark microphone symbol denotes the primary location of the microphone, while the gray microphone symbol indicates changes in its position based on student movement.

Personal space and crowding

We also aimed to investigate the concept of crowding concerning personal space within the socially distanced setup. Most responses indicated that this feeling was barely experienced within the new arrangement. It appears that some students confused the psychological meaning of crowding with the physical aspects of overcrowding, and a follow-up question might have been helpful to clarify the investigation’s focus. Nonetheless, we suggest that the absence of the feeling of crowding could be attributed to individual personality traits, particularly whether one is a screener or non-screener (Kopec, 2012 ). Screeners are skilled at filtering out irrelevant stimuli and are less easily distracted or upset (“The Oxford Dictionary of Sports Science & Medicine,” 2006 ), while non-screeners have difficulty shifting attention and tend to experience higher levels of anxiety and empathy ( Nonscreener , n.d. ). Participant 4 exhibited a generally calm demeanor and a resilience to the influence of environmental factors. This disposition may shed light on the coping strategy that was observed, which includes either texting or stepping outside the classroom as a response to feeling overwhelmed. This coping strategy was also highlighted by participant 17.

Participant 17: “I actually try to take a break and try to go to the toilet or get a coffee, just a five-minute break, try to look to my phone to distract myself” .

Regarding the concept of personal space, the majority of participants perceived it positively in the socially distanced classroom. They appreciated the spaciousness of the setup and the generous size of their workspace, aligning with existing literature findings related to the concept of personal space as indicated below in Table 3 .

Furniture arrangement was generally perceived positively by 11 out of 20 participants, who appreciated the spacious personal space it provided in studio classes. However, some participants found the layout inconvenient, especially during lecture classes. The availability of a personal pin-up wall was appreciated by some students, but those sitting in the middle of the classroom, such as participant 13, felt disadvantaged due to the lack of this feature. Socially distanced classrooms were better tolerated in studio classes than in lecture classes, with students enjoying the increased personal space regardless of their location in the classroom.

Participant 13: “It is good, but at the same time I feel I don’t like it. I need a corner to sit in, in my area I sit in the middle, so I don’t have a pin up wall. Like in the Junior studio, I feel it is better because they have more corners, their tables are arranged in a U-shape, so most of them have corners and the area in the middle is empty. Having our tables in the middle, ok it is good for me to concentrate during the lecture classes, but in the studio classes it is uncomfortable” .

One drawback of this layout was the limited number of electrical outlets, which could become crowded when students needed to charge their laptops simultaneously. Another concern raised was the L-shaped table setup, which provided more space but required students to frequently turn their bodies and necks to view the screen during lectures, leading to potential musculoskeletal problems as emphasized by participant 14.

Participant 14: “The L-shape table setup is nice, because it gives us more space. However, the layout is not good, because we are not facing the screen, so we have to turn our bodies and neck in order to see the screen, which is very tiring. To open the laptop, take notes, following the lectures on the big screen with a layout that is not comfortable makes me lose focus” .

Instructors moving between the two rooms during class meetings to ensure equal engagement posed a distraction for some participants. They described maintaining two classrooms simultaneously as overwhelming for the instructor. Furthermore, some students found communication with instructors more convenient through Zoom compared to the socially distanced setup.

Nonverbal communication

Body language significantly influences a student’s attentiveness, as highlighted by 16 participants who emphasized that they are more focused when the instructor is physically present in the same classroom. Participant 14 expressed that seeing the instructor’s body language and personality creates a more engaging experience compared to feeling like they are listening to a machine, which helps them concentrate better. The term “focus” was used by those 16 participants to describe their level of engagement in class. Regardless of whether the interactions are one-way or two-way conversations, most students indicated that body language plays a vital role in keeping them attentive during class. However, it is essential to note that in-class participation does not always imply complete engagement with the class content. Rather, it is a term we used to assess the effectiveness of communication within this setting.

Participant 14: “Because focusing makes me understand the class materials, for example, if he or she (referring to the instructor) is here, I will be able to focus and understand, however, if they are in the other room, I try to listen to them but I cannot focus much “ .

Participant 13 emphasized the significance of body language, especially eye contact, in enhancing vocal communication. She mentioned that being able to see the instructor in front of her helps her understand the class materials better compared to when the instructor is in another room, and she struggles to maintain focus. This aligns with the observation that students tend to be more engaged when the instructor is within their line of sight.

Non-verbal communication or body language encompasses various aspects such as eye contact, gestures, voice, facial expressions, touch, space, and body movement/posture (Segal et al., 2023 ). Among these elements, the eyes and ears are the most utilized in any form of vocal communication, whether in one-way or two-way conversations. Hall’s ( 1966 ) findings indicate that the unaided ear’s effective coverage is limited, making visual cues crucial for effective communication.

Participant 14 mentioned relying more on visual cues than auditory ones, suggesting that visual learners may find it challenging to adapt to socially distanced classroom environments, especially when they cannot consistently see the speaker. This lack of human connection, as described by Participant 16, can hinder effective communication between the speaker and the audience.

Participant 10 emphasized the significance of visual access provided by Zoom in a socially distanced classroom. She expressed that when the instructor makes eye contact with the camera, it creates a sense of direct connection and engagement. To her, establishing eye contact is essential for comprehending lessons and establishing a connection with the instructor. She also noted that recalling the instructor’s body language while reviewing PowerPoint slides after class enhances information retention compared to audio-only classes, where relying on notes is necessary.

Additionally, Participant 10 highlighted the importance of eye contact, even in virtual settings, through the Zoom camera. When the instructor looks directly at the camera, it gives the remote audience the impression of maintained eye contact. This effort allows visually inaccessible students to stay involved and potentially engaged with the class content. Furthermore, the participant mentioned that body language helps in mentally noting information for better retention.

Participant 10: “somehow it does work, especially if the instructor is making eye contact with the camera or something. It makes me feel she is directed towards the students and she is looking at us. And for me eye contact is very important in communication, especially when it comes to understanding a lesson. Also, it is like having a relationship with the instructor, it is not just audio, but it is visual as well. Sometimes, when I go over the PowerPoint slides again after class to study, I sort of remember the instructor’s body language and it is like remembering the information that was said during the class. I feel I retain the information better, however, if it was only audio, I feel I will need to go back to my notes to remember and to refresh my memories.”

Participant 1 mentioned the advantage of immediate interaction in studio or graphics classes, where movement and questions are encouraged. However, there was confusion between audience etiquette and lack of participation, as remaining silent during a lecture is expected to avoid distractions. Questions were facilitated through raised hands, achieved by sharing screens via Zoom to connect both rooms. The perception of student engagement may have been skewed because of the room’s dual function (serving as both a studio and a lecture room), potentially causing some misinterpretation.

Three participants mentioned that the socially distanced setup facilitated effective communication with their classmates within the same classroom more than with those in other classrooms. Participant 6 expressed developing stronger relationships and feeling comfortable talking to nearby classmates, whereas communication with students in the other room was less frequent. This sentiment was shared by other participants, highlighting that student-to-student communication was confined within microenvironments, typically within a 1-m radius.

The type of course, whether studio-based or lecture-based, played a significant role in defining student-to-student communication. Studio classes held in those classrooms allowed for more walking around and talking, leading to increased interactions among students. On the other hand, lecture courses tended to limit communication to those sitting nearby or using microphones for questions.

Participant 10 acknowledged the ease of communication within their class but found it challenging to interact with students in the other room. However, efforts were made to maintain personal connections and engage in group discussions, even with students in the adjacent room. Similar experiences were shared by other participants, who expressed greater communication with those sitting closer to them, particularly in lecture classes.

Student location

The quality of a student’s learning experience is correlated with their location in the classroom, as indicated by several responses. Participants mentioned that being closer to the instructor’s position resulted in a better learning experience, allowing for comfortable, conversational distance and improved concentration.

Apart from proximity to the instructor, students also considered other factors when choosing their seats, such as adequate daylighting. Some preferred corner spots for privacy, storage space, and access to pinup walls, while middle spots were perceived as lacking privacy due to the absence of vertical partitions. However, certain desk locations led to musculoskeletal issues for students as they tried to adjust their positions to see the screen or instructor clearly. Participants 5 and 17 pointed out that poor ergonomics could result in disengagement from class activities.

Participant 17: “As a social distance I have no issues. But after the midterms I changed my location because I got neck issues. My table was facing the wall, so I had to twist my whole body to follow the lecture on the screen and that was very tiring”. She added, “…. and after the midterms, I did not like my grades, they were average but I did not like them. So, I felt I had to change, I had to be more comfortable, so I can focus more. Then I found another available place” .

Participant 6 indicated that the instructors’ movement between classrooms was influenced by the layout, with the primary workstation attracting them to stay longer in that room. This affected student engagement and communication with the instructor during class.

Participant 6 said, “Now that I think about it, I mainly talk with people sitting closer to me. However, my location is near the junior partition, which is annoying because I can hear everything through a little crack in the partition—their lectures, jokes, fights, everything.” The external noise from adjacent rooms with similar setups poses additional distractions, especially for students sitting on the wall-side. Despite having absorptive materials (fabric) on the pinup walls, the doors in between the classrooms require further treatment to address noise issues, considering the use of microphones and speakers as part of the socially distanced setup. Acoustics are significantly impacted by the flooring in the classroom, and footsteps and flooring noises can also contribute to distractions.

Circulation

Some participants described the circulation as tight, with Participant 1 stating, “I think the circulation is a bit tight, but overall it is good.” This perception may be attributed to the limited pathways intentionally designed to restrict each student’s space and minimize potential areas of congregation. On the other hand, other participants found the circulation to be convenient for their work and overall smooth. Participant 5 expressed appreciation for the circulation, particularly the provision of two desks for each student, which was beneficial for their work and required ample space. They also found the circulation easy to navigate, with no challenges in moving around the classroom.

Upon analyzing the layout and comparing the seating positions of Participant 1 and Participant 5, we observed that both locations were unobstructed and conveniently accessible from the classroom entrance. Both participants were equidistant from the instructor’s position and the TV screen. However, it is worth mentioning that while Participant 5 was seated near a window, Participant 1 occupied a seat in the middle of classroom A. Despite this difference, they were still relatively close to each other. This variation in seating may have influenced their perceptions of the room’s overall circulation, with the window-side location potentially contributing to a greater sense of spaciousness.

Participant 1 expressed a preference for dimmer environments during lecture courses, stating, “Sometimes when I see it is dark there, I wish I was in the other room. My side has too much light.” This suggests that there is a variation in lighting preferences among students in a classroom setting. The proximity to windows is considered a privilege by some students, providing them with a view and the ability to control daylight, as described by Participant 1. Participant 14, on the other hand, mentioned being situated far from the window and lacking direct sunlight. Additionally, she found the artificial lighting in her class to be either excessively bright or too dim. As someone who enjoys natural light, she expressed a desire for more sunlight in her space. The quality of light, whether natural or artificial, significantly impacts students’ perceptions of the environment. For instance, Participant 14 attributed feelings of lethargy and tiredness during afternoon classes to the absence of sunlight. She believed that more windows would increase her energy and alertness. Participant 5 indicated that having her desk somehow close to the window and receiving sunlight in the morning helps awaken her, suggesting a positive association between productivity and good daylighting. However, Participant 12 pointed out that sitting near windows could be overwhelming in hot weather, expressing a preference for blinds to regulate natural light and maintain a comfortable temperature. Surprisingly, glare was not as problematic as initially thought, as students found ways to adjust their seating to avoid it, utilizing the spacious workspaces provided. In fact, several participants, including Participant 1, stated they had no glare issues due to the L-shaped tables, which allowed them to adjust their laptops accordingly.

While many participants appreciated the adequate amount of daylight in their classroom, they felt that the artificial lighting was inadequate and, to some extent, contributed to feelings of drowsiness. For instance, Participant 16 mentioned that the artificial light in her class (referring to classroom B) was low and dull. Furthermore, Participant 6, who occupies a seat in classroom B, found screen light during presentations or lectures to be bothersome for her eyes despite not receiving direct sunlight due to her window being closed. The room’s darkness and strong light from the screen caused discomfort and eye irritation for her.

The placement of microphones and their limited number discouraged several students from actively participating in class discussions during lecture-based courses. Participant 14 expressed frustration, describing walking to the fixed microphone location as a “nightmare.” A significant issue, pointed out by 12 participants, is the challenging distance between their desks and the microphone, which hinders their ability to engage in class discussions effectively. Participants used terms like “time-consuming” and “waste of time” to describe the inconvenience of walking to the microphone, which can impact the overall communication in the class.

Some students prefer to participate in discussions while remaining seated, especially if the microphone’s location is prominently visible in the room. Shyness was identified as a reason for some students’ hesitance to use the fixed microphone. It is speculated that shyness may stem from cultural factors or personality traits, but further investigation is required to understand the underlying reasons behind this sentiment.

Another theme that emerged from the interviews is that students intentionally refrain from participating due to spatial and technical challenges. For example, participant 4 explained that she holds back from answering questions because she believes others in the second room will reach the microphone faster or the instructor will notice them first. As a result, she remains silent and stays in her place. Participant 10 echoed a similar sentiment, stating that sometimes it takes the instructor time to realize that they want to ask or answer a question, leading to a reluctance to disturb the class or interrupt the instructor. The time required to walk to the microphone makes them hesitant, as by the time they reach there, the instructor might have moved on to the next topic. This situation can be embarrassing for students, as they do not want to interrupt the lecture inadvertently.

Participant 6 shared a similar experience, stating that she refrained from participating altogether during lecture classes due to the effort and stress involved. The process of walking to the microphone, ensuring it works, and repeating herself to those in the other room feels overwhelming. Participant 12 also acknowledged this challenge, indicating that she often weighs whether her question or comment is worth the time and potential disruption to the class.

Participant 3 expressed that she avoids participation due to the lengthy process involved in a socially distanced classroom. She feels that someone else will answer, so she does not need to speak up. Similarly, Participant 4 chooses not to participate in certain situations, believing that others will answer before her.

We propose that this pattern of hesitating to participate may be linked to a concept known as “learned helplessness.” This phenomenon occurs when individuals are repeatedly exposed to uncontrollable stressors, leading them to develop a belief that they lack control over their environment. Thus, this diminished sense of control can reduce their motivation to take action or attempt to change the situation ( APA Dictionary of Psychology , n.d.)

Microphone manners

One emerging sub-theme from the study is the intimidation some users, especially students, experience when using microphones. Instructors are also not effectively trained in microphone usage. Participants reported instances where they could not hear the instructor clearly due to audio volume fluctuations. This was attributed to instructors holding the microphone too far away or pointing it at their chin instead of their mouth, causing acoustic issues for students in the other classroom. Consequently, students tended to zone out when unable to hear clearly, impacting their engagement in class discussions.

Participant 5 mentioned that although instructors were generally audible, there were instances of sound cut-offs or distractions when the microphone was too close to the professor’s mouth, picking up unwanted sounds like breathing. Participant 7 also noted that some students had soft voices even when using the microphone, affecting clarity.

Zoom was deliberately chosen to visually connect people in both rooms for this study, as the transition from full online learning for two years made it a suitable platform. However, interview results revealed two main perspectives on using Zoom in a socially distanced classroom. Some participants found Zoom distracting, perceiving it as a reminder of online classes, while others appreciated its usefulness, especially visual learners who could easily view lecture slides through the sharing feature.

Distraction emerged as a recurring concern among several participants, particularly related to visual and auditory stimuli. These distractions encompassed factors such as noise originating from neighboring classrooms, the movements of the instructor, and technical issues. Notably, some students, like Participant 14, disclosed that they had Attention Deficit Hyperactivity Disorder (ADHD) and experienced heightened sensitivity to various forms of movement, which made both virtual and in-person classes equally challenging in terms of maintaining focus. Conversely, some participants held a positive perspective regarding Zoom’s role in enhancing communication between the two interconnected classrooms. For example, participant 10 expressed gratitude for the opportunity to observe the lecturer’s body language, which contributed to a sense of human interaction, even within a semi-virtual learning environment.

Technical issues occasionally led to student disengagement, but Zoom proved helpful for those in the no-instructor classroom. Students utilized Zoom’s sharing feature to follow lecture slides and virtually raise their hands for participation. However, overall, students preferred face-to-face interaction over Zoom communication, finding the latter tiring and distracting. Observations during the study supported this preference for face-to-face interaction.

Locus of control

Four participants indicated that they had little control over their classroom location and settled for what was available. However, some, like Participant 5, displayed an internal locus of control, stating she could teach herself and adapt to any situation. Participant 5 emphasized that the physical presence of the instructor was not crucial for her learning, indicating a strong internal strength and adaptability.

Conversely, Participant 17 exhibited a blend of external and internal locus of control. Initially, her seat choice was influenced by the location of her friends, reflecting an external factor. However, she later opted to change her seat with the goal of “improving her grades,” indicating a degree of internal control in her decision-making process.

Participant 17: “At the beginning I was just walking with my friends, and they sat so I sat. So, we sat and we were chatting, then I realized oh ok this is my place. But then I felt I cannot continue, and after the midterms, I did not like my grades, they were average but I did not like them. So, I felt I had to change, I had to be more comfortable, so I can focus more. Then I found another available place” .

Participant 15, on the other hand, favored keeping her laptop active during lectures, utilizing Zoom’s sharing feature to manage slides and search for answers when necessary. In doing so, she demonstrated an external locus of control, relying on available resources such as Zoom to address technical and acoustic challenges.

To our knowledge, this study is the first exploration of post-pandemic classroom design and its effects on classroom communication and student engagement under preventive measures such as face covering and social distancing. To investigate the research question in this case study, a thorough examination of both old and recent literature was methodically undertaken. This approach serves as both a limitation and a strength. The absence of pertinent studies prior to the research in 2021 posed a significant challenge. Nevertheless, delving into well-established older literature proved instrumental in overcoming this hurdle and establishing the groundwork for this exploratory research.

With the implementation of social distancing and the redefined proxemics, our study aimed to investigate the variations in the concept of personal space in this context. Hall’s work provided the foundation for our research in this specific area. While reviewing several studies referencing proxemics theory, none closely resembled ours. Thus, we utilized the original work as a starting point for exploration. This approach mirrors Mehta’s study ( 2020 ), which explored the impact of COVID-19 measures in urban settings, noting the transformation of spaces in response to social distancing. Mehta’s findings on sociable spaces resonated with our results regarding furniture arrangement and classroom layout. Our findings on the redefined proxemics in the new setup reveal that the post-pandemic classroom was widely praised for its redefined personal space. A majority of 11 out of 17 participants expressed positive sentiments about the spaciousness and convenience of the newly defined personal space (Table 3 ). Crowding, a psychological concept associated with personal space, was seldom experienced in the new setup. Some participants mentioned that crowding was only felt when there was limited access to charging outlets for their laptops. Additionally, individuals who experienced any form of stress in class identified checking their phones or taking short breaks as coping strategies.

Our findings also show that the furniture arrangement of the post-pandemic classroom is key in facilitating class communication. While being in close proximity to the instructor in the front or middle of the classroom is deemed conducive to student engagement, as it enables close and direct communication that helps students stay on task (Berg et al., 1996 ; as cited by Gullup, 1986), our study reveals that these middle seats do not cater to the spatial requirements of design students in studio classes, mainly due to the absence of pin-up walls. The findings indicate insufficient attention to the needs of students situated in the middle, exposing them to more visibility and diminished privacy compared to their counterparts along the perimeter. This situation is akin to the airplane aisle and window seats’ dilemma. While middle-seat students benefit from being close to the lecturer as a source of information, wall-side students enjoy privacy, access to a pin-up wall, and window advantages. A socio-petal (Mehta, 2020 ) furniture arrangement is recommended as it can provide equal opportunities and amenities for art and design students while facilitating communication in a socially distanced classroom.

The results of interviews and observations highlight the substantial influence of the instructor’s positioning in the classroom on communication with students, encompassing both verbal and non-verbal aspects. The students are more inclined to engage in class discussion if the instructor’s location in the classroom, as well as their body language are visually accessible. This highlights Kopec’s insights about the benefits of a rectangular classroom layout and how it supports the instructor’s capacity to establish eye contact with students since they fall within “the instructor’s primary visual field” (Kopec, 2012 , p. 224). Moreover, our research shows that 80% of the interview responses highlight the positive impact of body language on students’ attentiveness and engagement. This finding is consistent with the established literature, specifically Zeki’s ( 2009 ), emphasizing the significance of body language in non-verbal communication within the classroom. Put differently, the arrangement of the classroom is pivotal for both verbal and non-verbal communication, both in a general classroom setting and specifically in the post-pandemic classroom. Our study contributes to the existing knowledge by examining the utilization of Zoom to enhance body language, including eye contact, in a scenario involving the coordination of two or more classrooms simultaneously, necessitated by insufficient space in the facility. Fifteen percent of our sample expressed positive perceptions of using Zoom as an alternative to face-to-face communication to address spatial challenges in this context (Table 3 ). Based on these findings, we propose that new hidden dimensions arise, shaping communication and interactions within socially distanced classrooms. The noted expansion of personal, social, and public spheres, with the public sphere arguably encompassing the use of Zoom, prompts further exploration in these settings. The distances between students and instructors have the potential to redefine proxemics in post-pandemic classroom arrangements.

Our investigation explored lighting aspects, revealing that they had the least impact on the socially distanced classroom setup. Students’ main concerns revolved around having more control over lighting levels in their designated spaces. Responses showed diverse preferences for lighting conditions, with some favoring dim lighting and others opting for brighter classrooms. The L-shaped workspace effectively addressed glare issues, allowing students to adjust their positions for control if the problem arose. In a prior UAE study (Al-Sallal, 2010 ), it was observed that simulation runs revealed three key issues causing visual discomfort: sharp contrasts in luminance between the task surface (e.g., whiteboard) and nearby surfaces, excessive brightness from windows and uneven distribution of daylight in the space. In his study, the student’s sitting location was identified as a crucial factor influencing visual quality. The most problematic location was reported to be “the rear, opposite side of the windows” (Al-Sallal, 2010 , p. 208) in terms of acceptable luminance. While our study primarily addressed lighting preferences and emerging behaviors impacting post-pandemic classroom communications, certain findings resonate with Al-Sallal’s ( 2010 ), especially those related to student location. Six out of 17 students favored daylighting and found glare issues insignificant, attributing this to their ability to adjust positions within the spacious workspace. Additionally, four out of 17 participants expressed a preference for more control and the ability to adjust lighting levels according to their individual needs to enhance attention and focus (Table 3 ). Some participants positively associated proximity to windows with productivity, as highlighted in the lighting results subsection. To prioritize confidentiality, our study analyzed responses without linking them to specific student locations, resulting in a lack of specificity in our results. This limitation is acknowledged, but the decision was made to safeguard confidentiality, especially since one researcher served as the course instructor, creating a potential challenge in handling information related to student locations. This aspect is worth exploring in future research to understand the correlation between lighting and student location in post-pandemic classrooms.

In addition, we investigated acoustics in this distinctive setup utilizing technology to facilitate the operation of two classrooms simultaneously, aiming to improve verbal communication. Our research focused on exploring the consequences of preventive measures on classroom communication in a post-pandemic setting. Considering earlier research in the field, notably Berg et al.’s ( 1996 ) review article, which synthesized results from diverse studies, emphasizing the influence of noisy classrooms on students’ effective listening, impacting task engagement, discipline, and cooperation. They highlighted that teachers adjust their vocal approach, exhibiting variations in strength (Berg et al., 1996 ; as cited in Gallup, 1986; Ray, 1990). While some effectively project their voices, individuals with weaker voices may encounter stress when elevating their vocal levels (Berg et al., 1996 ; as cited in Berg, 1993). These findings proved valuable as we sought to comprehend the challenges faced by instructors in both general and specific settings. Our findings show that the adoption of microphones eliminated the need for vocal exertion by instructors. One of the acoustic concerns pointed out by some participants was noise. In this setup, noise primarily originated from adjacent classrooms and internal sources, such as speakers’ echoing sound and unwanted noise resulting from improper microphone use (e.g., instructor breathing). Seven out of 17 interviewees expressed more concern about noise related to technical issues, while three out of 17 interviewees identified external noise as more distracting (Table 3 ). For instance, participant 6 mentioned that her location is mainly distracting due to external noise from the neighboring classroom. These findings emphasize emerging challenges in temporary arrangements for socially distanced classrooms, suggesting areas for further exploration, such as the impact of using speakers in acoustically unprepared lecture spaces during emergencies.

This research uncovered novel findings not present in existing literature. One such discovery is the concept of microphone etiquette, an aspect not previously addressed in the specific context of our study. This introduces a new avenue for exploration by researchers and designers. The intentional inclusion of microphones in this setting aimed to improve verbal communication between two interconnected classrooms. Further investigation into blended learning or hybrid approaches utilizing microphones could be valuable, potentially mitigating challenges during local or global outbreaks.

An aspect warranting future exploration in research is students’ perceptions of microphone usage. Approximately 70.6% of participants indicated that microphone location affected their level of engagement in class. Three out of 17 participants explicitly reported abstaining from engagement due to recurrent technical issues, leading to delayed verbal communication. Students refrained from participating due to shyness, as they had to walk to the microphone location and their apprehension that technical problems might arise (Table 3 ). Arguably, this behavior can be attributed to learned helplessness, which is defined as “occurring when an individual continuously faces a negative, uncontrollable situation and stops trying to change their circumstances, even when they have the ability to do so” (Psychology Today, n.d. ). This finding resonates with Polat’s study ( 2022 , p. 95), which suggests that the students’ “individual uncertainties” can lead to learned helplessness, diminishing motivation and resulting in decreased academic performance and passive behaviors. However, given the sample’s size and homogeneity, it remains challenging to definitively associate learned helplessness with the socially-distanced setup or other variables in this case study. Additional data is needed to establish this as a dependent variable specific to this context. The locus of control was also identified within the responses, as outlined in the results section. A more comprehensive understanding of the data regarding locus of control could have been achieved with a larger sample and the incorporation of additional qualitative methods, such as surveys. The four responses collected in this aspect may be influenced by unanticipated variables specific to this context beyond the locus of control.

It is essential to recognize that the findings derived from this case study are highly contextual. If a similar setup is implemented in a different context or country, the results, especially concerning student attitudes toward microphone usage and privacy concerns, may vary. The transferability of our findings may be constrained both geographically and across disciplines. Since the study exclusively targeted interior design students, its relevance to other fields in the hard sciences may be restricted due to the unique nature of their work. It is noteworthy that cultural aspects were not explicitly addressed within the scope of this research.

It is worth mentioning that the non-participant observation method proved valuable in aligning predetermined themes from the literature review with the research question. Given this unprecedented environmental context, we opted for deductive coding to stay within the scope of this research study on classroom communication post-pandemic. However, the semi-structured interviews revealed unexpected themes, providing opportunities for further research, as mentioned earlier. Hence, we utilized a hybrid approach, incorporating both deductive and inductive coding, to identify patterns in the interview responses. This method facilitated the emergence of new themes, including the consideration of microphone etiquette.

In addressing potential biases arising from observations, we took measures to clearly delineate the role of each researcher (Glesne, 2011 ) to ensure transparency and maintain participant data confidentiality. Throughout the study, we consistently practiced reflexivity ( Reflexivity , n.d. ), allowing us to continually scrutinize our own biases and perspectives during data collection and analysis. The decision to employ a single observer was influenced by regulations limiting classroom capacity and other restrictions related to external visitors. Additionally, we incorporated the Devil’s Advocate approach (Trochim, 2020 ) during data analysis, actively challenging our interpretations of the findings.

This research holds relevance for administrators as they strategize for campus emergencies. Future studies could delve into the optimization of furniture arrangement, considering aspects like privacy and body language, particularly in emergency scenarios necessitating preventive measures like face covering and social distancing. The insights gleaned from our findings might aid administrators in effectively organizing designated spaces for concurrent use or incorporating hybrid modes to ensure instructional continuity during emergencies. A deeper understanding of enhancing hybrid learning environments post-pandemic could contribute to user satisfaction and reduce reliance on lockdown measures.

Conclusions

The pandemic has instilled in us the importance of carefully designing successful learning experiences and programs for our students. It forced us to reevaluate our priorities and life choices, leading to significant changes in communication due to preventive measures like face coverings and social distancing. In times of hardship and uncertainty, telecommunication has become indispensable for businesses, governments, and communities to sustain themselves. As a result, interior environments should be adaptable to accommodate such emergencies.

Our study investigated communication dynamics within a classroom environment adapted to mitigate the spread of the coronavirus while ensuring instructional continuity. We conclude that the impact of preventive measures on classroom communication in a post-pandemic setting is multifaceted and context-dependent. While we have delved into specific aspects we believe are linked to communication, there may be more to consider. Among these aspects, we have explored proxemics, which have evolved beyond its cultural definition to incorporate new physical dimensions to accommodate social distancing. Our findings indicated that psychological concepts like crowding in this socially distanced setting require reassessment. The increased spaciousness in classrooms resulting from the setup with social distancing has reduced crowding. Interestingly, the use of cell phones during class, not resulting in disciplinary action, has served as a positive distraction for students experiencing crowding or stress.

Furthermore, post-COVID spacing mechanisms, including occupant load and furniture arrangement with social distancing in mind, have reshaped our perception of personal space. People became less concerned with non-verbal cues that differ across cultures and define their personal space. Instead, the COVID-preventative measures have introduced new hidden dimensions to our understanding of personal space. These new hidden dimensions encompass factors such as proximity to microphones, the instructor’s desk, the pinup walls, and/or windows, all of which regulate communication within a socially distanced classroom. For instance, adopting a socio-petal layout in the classroom could significantly enhance these new hidden dimensions, thereby facilitating communication in a socially distanced setting. Our findings indicate that crowding, often associated with personal space and spatial density, is less prevalent in the post-COVID setup, as each student benefits from a more spacious personal area dictated by COVID protocols. This reduction in crowding contributes to improved performance as individuals regain control over their social interactions.

In times of emergency, like the pandemic, technology becomes essential to facilitate both verbal and non-verbal communication. This exploratory case study highlights the significance of technology in socially distanced setups in design-studio classrooms, particularly in addressing the communication challenges identified. However, further research is needed to investigate the potential for tailored technology usage and its effectiveness within these distinctive educational environments.

Data availability

The data supporting the findings of this study are accessible upon request from the corresponding author (MA). The data cannot be publicly released as they may contain information that could compromise the privacy or consent of research participants.

Alawamleh M, Al-Twait LM, Al-Saht GR (2020) The effect of online learning on communication between instructors and students during Covid-19 pandemic. Asian Educ Dev Stud 11(2):380–400

Article   Google Scholar  

Al-Sallal KA (2010) Daylighting and visual performance: evaluation of classroom design issues in the UAE. Int J Low-Carbon Technol 5(4):201–209. https://doi.org/10.1093/ijlct/ctq025

American Psychological Association. (n.d.). Crowding. In APA Dictionary of Psychology . Retrieved from https://dictionary.apa.org/crowding

American Psychological Association. (n.d.). Learned helplessness. In APA Dictionary of Psychology . Retrieved from https://dictionary.apa.org/learned-helplessness

Astin AW (1984) Student involvement: a developmental theory for higher education. J Coll Stud Pers 25(4):297–308

Google Scholar  

Azungah T (2018) Qualitative research: deductive and inductive approaches to data analysis. Qual Res J 18(4):383–400. https://doi.org/10.1108/QRJ-D-18-00035

Ballast DK (2013) Interior design reference manual: everything you need to know to pass the NCIDQ® Exam. Professional Publications Incorporated

Beaulieu C (2004) Intercultural study of personal space: a case study. J Appl Soc Psychol 34(4):794–805. https://doi.org/10.1111/j.1559-1816.2004.tb02571.x

Berg FS, Blair JC, Benson PV (1996) Classroom acoustics. Lang Speech Hear Serv Sch 27(1):16–20. https://doi.org/10.1044/0161-1461.2701.16

Centers for Disease Control and Prevention. (n.d.). How COVID-19 spreads. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/easy-to-read/prevent-gettingsick/how-covid-spreads.html

Cennimo DJ (2020) Coronavirus Disease 2019 (COVID-19): practice essentials, background, route of transmission. EMedicine https://emedicine.medscape.com/article/2500114-overview#a1

Darn, S. (n.d.). Nonverbal communication. The Internet TESL Journal . Retrieved from http://iteslj.org/Articles/Darn-Nonverbal/

Dictionary.com Meanings & Definitions of English Words (2021) Dictionary.com. https://www.dictionary.com/browse/personal-space

Earon SA (n.d.) The value of video communications in education. https://explore.zoom.us/docs/doc/The%20Value%20of%20Video%20Communications%20in%20Education.pdf

Evans GW, Wener RE (2007) Crowding and personal space invasion on the train: please don’t make me sit in the middle. J Environ Psychol 27(1):90–94. https://doi.org/10.1016/j.jenvp.2006.10.002

Fredricks JA, Blumenfeld PC, Paris AH (2004) School engagement: potential of the concept, state of the evidence. Rev Educ Res 74(1):59–109. https://doi.org/10.3102/00346543074001059

French RL (1977) Teaching the nonverbal experience. Theory Pract 16(3):176–182. https://doi.org/10.1080/00405847709542695

Frequently Asked Questions about COVID-19 Vaccination (2023) Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/faq.html?s_cid=10492:what%20is%20in%20covid%20vaccine:sem.ga:p:RG:GM:gen:PTN:FY21

Gay A (2019) Upgrading from student involvement to engagement. Adobe Blog. https://blog.adobe.com/en/publish/2019/04/12/upgrading-from-student-involvement-to-engagement#:~:text=your%20students%20are.-,Educators%20recognize%20that%20student%20engagement%20goes%20beyond%20attention%20and%20involvement,prepared%20for%20the%20modern%20workplace

Government Communications Office (2020) Statement by the Supreme Committee for Crisis Management on Phase Four of the Gradual Lifting of Coronavirus Restrictions. Supreme Committee for Crisis Management. https://www.gco.gov.qa/en/top-news/phase-4-statement/

Glesne C (2011) Becoming qualitative researchers: an introduction, 4th edn. Pearson, Boston, MA

Hall ET (1966) The hidden dimension. Doubleday, Garden City, NY

Hall ET (1990) The hidden Dimension. Anchor

Hall ET (1959) The silent language . New York, NY: Anchor

Hall JA, Rosenthal R, Archer D, DiMatteo MR, Rogers PL (1977) Nonverbal, skills in the classroom. Theory Pract 16(3):162–166. https://doi.org/10.1080/00405847709542692

Jamshed S (2014) Qualitative research method-Interviewing and observation. J Basic Clin Pharm 5(4):87. https://doi.org/10.4103/0976-0105.141942

Article   PubMed   PubMed Central   Google Scholar  

Joia LA, Lorenzo M (2021) Zoom in, zoom out: the impact of the COVID-19 pandemic in the classroom. Sustainability 13(5):2531. https://doi.org/10.3390/su13052531

Jarus O (2023) The worst epidemics and pandemics in history. livescience.com . https://www.livescience.com/worst-epidemics-and-pandemics-in-history.html

Khal AA, Al-Kaabi S, Checketts RJ (2020) Qatar’s response to COVID-19 pandemic. Heart Views 21(3) https://doi.org/10.4103/HEARTVIEWS.HEARTVIEWS_161_20

Kim H (2020) The efficacy of zoom technology as an educational tool for English reading comprehension achievement in EFL classroom. https://doi.org/10.17703/ijact.2020.8.3.198

Kopec D (2012) Environmental psychology for design. Fairchild Books

Lawless B, Chen YW (2018) Developing a method of critical thematic analysis for qualitative communication inquiry. Howard J Commun 30(1):92–106. https://doi.org/10.1080/10646175.2018.1439423

Mandernach BJ, Gonzales RM, Garrett AL (2006) An examination of online instructor presence via threaded discussion participation. J Online Learning Technol 2(4):248–260

Mehta V (2020) The new proxemics: COVID-19, social distancing, and sociable space. J Urban Des 25(6):669–674. https://doi.org/10.1080/13574809.2020.1785283

Minhas S, Hussain T, Sajid K (2021) Exploring Students Online Learning: A Study of Zoom Application. Gazi Univ J Sci 34(2). https://doi.org/10.35378/gujs.691705

Metzger KJ, Langley D (2020) The room itself is not enough: student engagement in active learning classrooms. Coll Teach 68(3):150–160. https://doi.org/10.1080/87567555.2020.1768357

Morgan SJ, Pullon SRH, Macdonald LM, McKinlay EM, Gray BV (2017) Case Study Observational Research: A Framework for Conducting Case Study Research Where Observation Data Are the Focus. Qual Health Res 27(7):1060–1068. https://doi.org/10.1177/1049732316649160

Article   PubMed   Google Scholar  

Non-participant observation (n.d.) Better evaluation. https://www.betterevaluation.org/methods-approaches/methods/non-participant-observation

Nonscreener. (n.d.). Oxford Reference. https://www.oxfordreference.com/display/10.1093/oi/authority.20110803100237930

Polat M (2022) A case study of preservice teachers’ classroom management dilemma in a climate of uncertainty during the COVID-19 pandemic. Int J Educ Lit Stud 10(1):90. https://doi.org/10.7575/aiac.ijels.v.10n.1p.90

Proudfoot K (2022) Inductive/deductive hybrid thematic analysis in mixed methods research. J Mixed Methods Res 17(3):155868982211268

Psychology Today (n.d.) Learned helplessness. https://www.psychologytoday.com/us/basics/learned-helplessness#:~:text=Learned%20helplessness%20occurs%20when%20an,try%20and%20fail%20to%20quit

Ramadani A, Xhaferi B (2020) Teachers’ experiences with online teaching using the zoom platform with EFL teachers in high schools in Kumanova. SEEU Rev 15(1):142–155. https://doi.org/10.2478/seeur-2020-0009

Reflexivity (n.d.) Melbourne Medical School. https://medicine.unimelb.edu.au/school-structure/medical-education/research/qualitative-journey/themes/reflexivity#:~:text=Reflexivity%20is%20about%20acknowledging%20your

Richmond VP, McCroskey JC (2012) Power in the classroom: communication, control, and concern. Routledge

Rysiew P (2021) Epistemic contextualism. In: Zalta EN (ed) Stanford encyclopedia of philosophy. Metaphysics Research Lab, Stanford University

Robson D (2021) Why some people don’t want a Covid-19 vaccine. BBC https://www.bbc.com/future/article/20210720-the-complexities-of-vaccine-hesitancy

Sommer R (1977) Classroom layout. Theory Pract 16(3):174–175. https://doi.org/10.1080/00405847709542694

Shernoff DJ, Kelly S, Tonks SM, Anderson B, Cavanagh RF, Sinha S, Abdi B (2016) Student engagement as a function of environmental complexity in high school classrooms. Learn Instr 43:52–60. https://doi.org/10.1016/j.learninstruc.2015.12.003

Segal J, Smith M, Robinson L, Boose G (2023) Nonverbal communication and body language. HelpGuide. https://www.helpguide.org/articles/relationships-communication/nonverbal-communication.htm

The Oxford Dictionary of Sports Science & Medicine. (2006). In Oxford University Press eBooks. https://doi.org/10.1093/acref/9780198568506.001.0001

Timeline: Sound Wave and Music—Lesson 3 behavior of sound waves: reflection, refraction, and diffraction (n.d.). The Physics Classroom. https://www.physicsclassroom.com/class/sound/Lesson-3/Reflection,-Refraction,-and-Diffraction

Trochim WMK (2020) The research methods knowledge base. Conjointly.com ; Conjoint.ly . https://conjointly.com/kb/qualitative-validity/

Trowler V (2010) Student engagement literature review. The Higher Education Academy

Tureková I, Lukáčová D, Bánesz G (2018) Quality assessment of the university classroom lighting—a case study. TEM J 7(4):829–836. https://doi.org/10.18421/TEM74-21

Uncapher M (2016) The science of effective learning spaces. https://www.edutopia.org/article/science-of-effective-learning-spaces-melina-uncapher . Accessed 3 Oct 2021

Wahyuni A (2018) The power of verbal and nonverbal communication in learning. https://doi.org/10.2991/icigr-17.2018.19

Walker KA, Koralesky KE (2021) Student and instructor perceptions of engagement after the rapid online transition of teaching due to COVID‐19. Nat Sci Educ 50(1):e20038. https://doi.org/10.1002/nse2.20038

WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020. (2020) https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020

World Health Organization. (n.d.). COVID-19 vaccines: Advice. Retrieved from https://www.who.int/emergencies/diseases/novel-coronavirus-2019/covid-19-vaccines/advice

Worchel S, Teddie C (1976) The experience of crowding: a two-factor theory. J Personal Soc Psychol 34(1):30–40. https://doi.org/10.1037/0022-3514.34.1.30

Article   CAS   Google Scholar  

Zeki CP (2009) The importance of non-verbal communication in classroom management. Procedia–Soc Behav Sci 1(1):1443–1449. https://doi.org/10.1016/j.sbspro.2009.01.254

Download references

Acknowledgements

We thank all the students who participated in this study for sharing their time and valuable insights. We also appreciate the support and funding provided by Virginia Commonwealth School of the Arts in Qatar for this research.

Author information

Authors and affiliations.

Virginia Commonwealth School of the Arts in Qatar, Doha, Qatar

Marwa Abdelmonem & Sherin Karawia

You can also search for this author in PubMed   Google Scholar

Contributions

Conceptualization, MA, methodology, MA; formal analysis, MA; investigation, MA, SK; data curation, MA, SK; writing—original draft preparation, MA, SK; writing—review and editing, MA, SK; visualization, SK; supervision, MA.

Corresponding author

Correspondence to Marwa Abdelmonem .

Ethics declarations

Competing interests.

The authors declare no competing interests.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Qatar Biomedical Research Institute (QBRI) Institutional Review Board at Hamad Bin Khalifa University (Date: 23 November 2021/No. QBRI-IRB-2022-40).

Informed consent

The authors confirm obtaining informed consent from all study participants, ensuring a thorough process. Comprehensive details on the research’s purpose, procedures, risks, and benefits were provided. Importantly, participants willingly joined after understanding the information, highlighting voluntary involvement. The consent process adhered to ethical guidelines, assuring participants’ full awareness and the freedom to withdraw without repercussions. The authors emphasize their commitment to ethical research, prioritizing participant rights and well-being.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ .

Reprints and permissions

About this article

Cite this article.

Abdelmonem, M., Karawia, S. Classroom communications post pandemic: a case study. Humanit Soc Sci Commun 11 , 728 (2024). https://doi.org/10.1057/s41599-024-03171-6

Download citation

Received : 14 November 2023

Accepted : 13 May 2024

Published : 05 June 2024

DOI : https://doi.org/10.1057/s41599-024-03171-6

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Quick links

• Explore articles by subject
• Guide to authors
• Editorial policies

• Open access
• Published: 03 June 2024

Co-production of a systematic review on decision coaching: a mixed methods case study within a review

• Janet Jull   ORCID: orcid.org/0000-0002-0404-4313 1 , 2 ,
• Maureen Smith 3 ,
• Meg Carley 2 ,
• Dawn Stacey 2 , 4 ,
• Ian D. Graham 2 , 5 &

The Cochrane Decision Coaching Review Team

Systematic Reviews volume  13 , Article number:  149 ( 2024 ) Cite this article

70 Accesses

1 Altmetric

Metrics details

Co-production is a collaborative approach to prepare, plan, conduct, and apply research with those who will use or be impacted by research (knowledge users). Our team of knowledge users and researchers sought to conduct and evaluate co-production of a systematic review on decision coaching.

We conducted a mixed-methods case study within a review to describe team co-production of a systematic review. We used the Collaborative Research Framework to support an integrated knowledge translation approach to guide a team through the steps in co-production of a systematic review. The team agreed to conduct self-study as a study within a review to learn from belonging to a co-production research team. A core group that includes a patient partner developed and conducted the study within a review. Data sources were surveys and documents. The study coordinator administered surveys to determine participant preferred and actual levels of engagement, experiences, and perceptions. We included frequency counts, content, and document analysis.

We describe co-production of a systematic review. Of 17 team members, 14 (82%) agreed to study participation and of those 12 (86%) provided data pre- and post-systematic review. Most participants identified as women ( n  = 9, 75.0%), researchers ( n  = 7, 58%), trainees ( n  = 4, 33%), and/or clinicians ( n  = 2, 17%) with two patient/caregiver partners (17%). The team self-organized study governance with an executive and Steering Committee and agreed on research co-production actions and strategies. Satisfaction for engagement in the 11 systematic review steps ranged from 75 to 92%, with one participant who did not respond to any of the questions (8%) for all. Participants reported positive experiences with team communication processes ( n  = 12, 100%), collaboration ( n  = 12, 100%), and negotiation ( n  = 10–12, 83–100%). Participants perceived the systematic review as co-produced ( n  = 12, 100%) with collaborative ( n  = 8, 67%) and engagement activities to characterize co-production ( n  = 8, 67%). Participants indicated that they would not change the co-production approach ( n  = 8, 66%). Five participants (42%) reported team logistics challenges and four (33%) were unaware of challenges.

Conclusions

Our results indicate that it is feasible to use an integrated knowledge translation approach to conduct a systematic review. We demonstrate the importance of a relational approach to research co-production, and that it is essential to plan and actively support team engagement in the research lifecycle.

Peer Review reports

Introduction

Well-conducted and rigorous research can contribute to more effective, safe, appropriate, and sustainable health services to strengthen health systems and ultimately promote healthy societies [ 1 , 2 ]; however, these potential benefits are often not realized [ 3 , 4 , 5 ]. In response, there has been growing support to include those who will use or be impacted by research such as patients and families, healthcare providers, health systems managers, policy makers, and other healthcare systems users (known hereafter as “knowledge users”) in research [ 6 , 7 ]. Knowledge users work with researchers to co-produce knowledge and select outcomes that reflect a knowledge democracy [ 8 , 9 ].

We adopt the term “co-production” in research as a collaborative approach across the research lifecycle that responds to the needs of knowledge users [ 6 , 10 , 11 ]. A synthesis of frameworks about engagement of knowledge users as co-producers of knowledge in health research identified 15 concepts related to the lifecycle of research studies: prepare, plan, conduct, and apply. The study authors proposed that common to co-production processes is a form of partnered negotiation that takes place at the start and throughout research studies [ 6 ]. The assumption is that there is a link between knowledge and practice, and co-production is more likely to result in the generation of knowledge that is useful and able to be used in practice and in policy. We (authors on this paper) adopt the term “engagement” in research as an arrangement in the governance of the research process where those who influence, administer, and/or use healthcare systems partner with one another as equals on a team to co-produce knowledge [ 12 , 13 ]. Knowledge users and researchers work together as equals on the team to attain co-production.

There are many terms used to describe approaches to co-production including collaborative research, action research, participatory research [ 14 ], engaged scholarship [ 15 ], mode 2 research (that is, working with end users) [ 16 ], and integrated knowledge translation [ 14 ]. The term used for co-production depends on the field in which the study is being conducted, what is being produced, and who is involved [ 17 ]. Our team chose integrated knowledge translation as the research approach to structure co-production as it supports collaboration between researchers and knowledge users to develop solutions to complex issues [ 18 ]. According to the Canadian Institutes of Health Research (CIHR), integrated knowledge translation engages knowledge users as part of the research team, from defining the research question to applying the findings [ 16 ]. It is described as “meaningful engagement of the right (members of the research team) at the right time throughout the research process” [ 19 ]. Current shortcomings of co-production are conceptual (what is meant when discussing co-production) and methodological (co-production strategies and how to measure co-production) [ 20 , 21 ]. In co-production, researchers and knowledge users share decisions with mutual exchange of information and learning throughout the entire research project [ 6 ], [ 10 , 22 ]. Our team co-produced a systematic review to facilitate reporting on and evaluation of research processes.

Co-production and knowledge synthesis

There is growing interest in the engagement of knowledge users in the conduct of knowledge syntheses, such as systematic reviews. Engagement of knowledge users is more likely to reduce research waste, result in evidence that addresses end-users’ needs, and improve the translation of evidence into policy and practice [ 23 , 24 ]. The study of co-production processes in the conduct of a knowledge synthesis is, however, a newer field. Pollock et al. [ 25 ] assessed the conduct of systematic reviews by teams that included knowledge users across 32 studies [ 25 ]. They found that knowledge user engagement was usually reported for the initial (frame the question and plan the systematic review) and the final (interpret, publish, and disseminate findings) steps of a systematic review. It was less common to report knowledge user engagement during the conduct of the systematic review (search, screen, abstract, and analyze data) [ 25 , 26 ], a finding that aligns with the general literature about engagement of knowledge users in research [ 6 ]. There is no one strategy for engagement of knowledge users with researchers in systematic reviews [ 27 ]. Devane et al. [ 28 ] identify “studies within a review” as important to address the issues related to (1) uncertainties about the evidence base for how evidence syntheses are planned, conducted, and shared, and (2) the need for high-quality evidence to inform decisions for the conduct of evidence syntheses [ 28 ]. Little is known about team members’ experiences of using a co-production approach to conduct a systematic review.

The research context

We are a team with members from eight different countries and include those who experience chronic health conditions (patient/caregiver partners, here referred to as Cochrane consumers) and researchers, many of whom hold additional roles (for example, healthcare professionals, health systems administrator, educator, role with a health advocacy organization). We hold common interests in interventions to support shared decision-making processes for people seeking healthcare for themselves or for family members. Shared decision-making is a process where the patient and their clinician(s) work together to use the best available evidence, clinical expertise, and the patient’s informed preferences to make a decision that is tailored to the individual patient needs [ 29 , 30 ]. An intervention called decision coaching holds potential to facilitate shared decision-making processes [ 31 ]. We decided that a systematic review was needed to understand the effectiveness of decision coaching and to identify research gaps. In addition, we wanted to understand how to conduct the systematic review to generate evidence in ways that can be considered useful and able to be used in policy and practice and set up a study within a review. Thus, we sought to conduct and evaluate the co-production of a systematic review on decision coaching for people facing treatment and screening healthcare decisions for themselves or family members.

Our study objectives were to:

describe the co-production approach to conduct the systematic review;

explore the experiences of team members with the co-production of the systematic review;

elicit perceptions of team members about the co-production of the systematic review.

Study design

We chose to evaluate ourselves to learn from our own systematic review team members’ experiences and perceptions, that is, to conduct a self-study of belonging to a co-production research team [ 32 , 33 ]. We consider our study to be an example of a study within a review [ 28 ] as there is uncertainty in the methodology for engaging knowledge users in co-production, as well as the methods for evaluation of co-production. Here, we describe an approach to the co-production of a systematic review and present an evaluation of methods we used for organizing the co-production of a systematic review. We bound our work in time and context, and report on events that occurred between August 2019 and February 2022 when we conducted a mixed methods case study in the context of an international, interdisciplinary team conducting co-production of a systematic review [ 34 , 35 , 36 ]. We structured our work with the pragmatic intent to produce knowledge that is useful and could be used in practice and policy by team members and wider networks interested in shared decision-making interventions. The University of Ottawa’s Research Ethics Board approved the self-study (#20,190,408-01H).

We used the Collaborative Research Framework [ 37 ] to support an integrated knowledge translation approach, to guide partnering of knowledge users and researchers to prepare, plan, and conduct the systematic review. We were limited to dissemination of the systematic review findings due to time and complexity of the task, and did not complete the “apply” step [ 6 ] (Fig.  1 ).

The co-production of a systematic review with an integrated knowledge translation approach

The framework assumption is that facilitation of integrated knowledge translation processes is possible with the preparation of team members to engage in iterative processes of knowledge exchange and learning throughout the research study and following replicable research steps: first, establish the guiding features for co-production with a team governance structure; and second, define research actions to be operationalized by the team to support the co-production of research evidence [ 16 ]. The framework has been used previously to guide research processes that include knowledge synthesis [ 38 , 39 , 40 , 41 , 42 ].

To ensure transparency and completeness in our work, we used the Guidance for Reporting Involvement of Patients and the Public 2 (GRIPP2) to report on the systematic review team engagement as it is a checklist to report on engagement in general health and social care research [ 43 ] (Supplemental file #1). We report on our self-study with the Standards for Reporting Qualitative Research (SRQR) reporting guideline [ 44 ] (Supplementary file #2).

Setting, participants

Prior to the conduct of the systematic review, two authors on this paper (JJ, DS) initiated processes to “prepare” and “plan” the systematic review to better understand decision coaching as an intervention [ 31 ]. JJ and DS held conversations with Cochrane consumers and researchers, many who held dual roles as healthcare providers, educators, policy makers, and all with common interests on the topic of decision coaching. For example, a meeting was held with Cochrane consumers who were familiar with systematic reviews as peer reviewers, to explain the project, opportunities for involvement, and their preferences. JJ and DS then assembled a team to prepare and plan the systematic review proposal (“the team”). With one person coordinating activities (JJ), the team engaged in an iterative series of conversations to negotiate:

common language, definitions, and concepts to describe our systematic review topic (that is, decision coaching);

the systematic review question, approach, and procedures;

the strategies for working together, that is, to co-produce the systematic review.

The team described the systematic review, and plans for self-study to evaluate co-production processes, in a funding application. While we considered all team members to be of equal value, we did not expect that they all contribute in the same manner. Team members brought a range of skills that could be helpful for activities in relation to their knowledge, occupational roles, and in relation to life experiences. Throughout the review, training was offered to team members on an “as-needed” basis and often took the form of one-on-one conversations to explain concepts or review steps.

After our team received funding from the Canadian Institutes of Health Research (CIHR) (April 1, 2019), the “conduct” phase of the systematic review began. We hired a study coordinator (MC) to support the systematic review and study within a review tasks. Compensation to support the participation of Cochrane consumers was arranged according to CIHR guidelines [ 45 ]. The team disseminated systematic review findings following a plan developed for the systematic review protocol, with presentations [ 46 , 47 ], and following publication of the systematic review (November 2021) [ 48 ] with plain language reports [ 49 , 50 , 51 ], and communications to network partners. The systematic review and study within a review tasks were coordinated through the University of Ottawa and Ottawa Hospital Research Institute, in Ottawa, Ontario, Canada.

We (full team) agreed to the conduct of a study within a review to learn from team members’ belonging to a co-production research team. Systematic review team members with expertise in the use of an integrated knowledge translation approach to co-production that includes a Cochrane consumer (MS, IDG, DS, JJ) formed a core group that included the study coordinator to collaborate in the development, conduct, and analysis of the study. The full team was consulted by the core group on the final plans for the self-study [ 52 ]. All 17 team members (excluding the study coordinator) of the systematic review were eligible to participate in the study. The study occurred immediately before initiation of and then after the “conduct” phase of the systematic review.

Procedures for self-study recruitment, engagement and data collection

The study data sources included surveys and documents related to the systematic review. Prior to the conduct of the systematic review, and to begin the study, the study coordinator sent an email to all team members inviting them to participate. Of those who indicated interest in participation, the study coordinator sent further information explaining the study, data management (protection and storage), and seeking their consent to participate. Team members were informed that agreement or refusal to participate would have no effect on their status as a member of the team.

The team members who provided consent were asked to participate in a survey. In the survey, they were asked to respond to open- and closed-ended questions on preferred level of engagement during the conduct of the systematic review, and their experiences and perceptions co-producing the systematic review. Participants in the study were sent an email with a link to a baseline survey. At 1 and 2 weeks after the initial request, email reminders to complete the baseline survey were sent to participants [ 53 ]. Then, the study coordinator invited participants to be involved in the various steps of the systematic review based on their preferred level of engagement reported in the baseline self-study survey; the remainder of the systematic review team members were sent a general invitation to be involved at the various steps of the systematic review. The study coordinator arranged meetings and engagement in the tasks. If participants wanted to co-lead a step of the systematic review, they were invited to join the executive committee to conduct tasks. If they wanted to participate in a particular step of the systematic review, they were provided with the resources to participate (for example, access to Covidence to screen studies). Participants were reassured that there would be no repercussions if their availability or interest in participation with the steps of the systematic review changed from the baseline survey to when the systematic review task needed to be done. Upon completion of the systematic review, an end of self-study survey was administered to participants with the same procedures. We report on our survey [ 54 ] with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) [ 55 ] (Supplementary file #3). Members of the core group that led the conduct of the study within a review (MC, JJ) collected systematic review documents (for example, meeting notes, systematic review paperwork, researcher journal).

Survey instrument

The core group in the development and conduct of the study with the study coordinator led the development and pilot testing of the online surveys. We could not identify an instrument to evaluate how well our team worked on conducting the systematic review. Overall, the instrument consisted of seven pages of questions, with between one to 17 items per page of the survey, for a total of 39 items. The survey took between 15 and 30 min to complete and participants had the option to answer or skip questions as they preferred.

We view the process of co-production to require consideration of the people in the research partnership, and the contexts in which they are situated, and wanted our evaluation to reflect their realities as participants:

Our approach to co-production involved assessment of participants’ preferred levels of engagement (that is, role) in the systematic review steps (baseline self-study survey) (for example, reviewing the search strategy, screening citations), and confirmation of participants’ actual levels of engagement (end of self-study survey), based on Arnstein’s Ladder of Citizen Participation and the Strategy for Patient-Oriented Research – Patient Engagement Framework [ 56 , 57 ] and previous research [ 58 , 59 ] about engagement in research. There were options for preferred level of engagement for each systematic review step, and open-ended questions that asked for any additional comments about their level of engagement in the steps of the systematic review. At the completion of the systematic review, participants were asked questions about their satisfaction with each step of the systematic review (end of self-study survey) [ 40 ].

To explore participants’ experiences with the co-production of the systematic review, we used the 36 item Partnership Indicators Questionnaire (PIQ) instrument adapted with permission of the PIQ lead author [ 60 , 61 , 62 ]. The PIQ is designed to assess the performance of researcher-health policy maker partnerships. Three lists of indicators include the following: common partnership indicators, early partnership indicators, and mature partnership indicators. The dimensions include the following: (common partnership indicators) communication, collaboration in research, dissemination of research, (early partnership indicators) research findings, negotiation, partnership enhancement, (mature partnership indicators) meeting information needs, level of rapport and commitment. The selected PIQ questions focused on the concepts of communication, collaboration, and negotiation and included an open text option for additional comments (baseline, end of self-study surveys).

We elicited the perceptions of participants about co-production of the systematic review with closed and open-ended questions with a focus on challenges, benefits, and impacts, at baseline and upon completion of the systematic review (end of self-study survey) [ 40 , 63 ].

We collected participant demographic characteristics.

Study documents

We utilized team documents that included meeting notes, systematic review paperwork, and a researcher journal, to conduct the document analysis method [ 64 ]. The aim was to report on engagement of the team members, following completion of the systematic review. We used the A uthors and C onsumers T ogether I mpacting on eVidencE (ACTIVE) framework to describe and report on Cochrane consumer engagement across team activities in the steps of systematic reviews. The ACTIVE framework is used to define whether and how knowledge users are engaged in systematic reviews, for example, the method of recruitment, the approach, format, and stage of engagement [ 25 , 26 ].

The core group in the development and conduct of the study with the study coordinator conducted the analysis. The study coordinator provided frequency counts for quantitative survey data. One researcher (JJ) conducted the frequency counts of open-text responses, and content analysis. A panel of second reviewers (MS, MC, DS, IDG) confirmed the work through interpretation and discussion [ 65 ] with reflection on concepts related to engagement [ 6 ]. Survey responses to closed-ended questions were tabulated; content analysis was used to analyze responses to open-ended questions, which involved segmenting responses by topics and into categories. Each question was considered to be a topic and the responses and development of codes defined the content in each category [ 66 ]. We report the frequency counts of the type of responses with illustrative quotes.

The team documents were reviewed for evidence that the systematic review was co-produced. One researcher (JJ) with the support of a second (MS) engaged in a three-stage analysis process of skimming, reading, and interpretation [ 66 ] to reach consensus, reported using the ACTIVE framework [ 25 ], and confirmed by a panel of reviewers (MC, DS, IDG). The analysis includes the ways in which decisions were made, meetings conducted, and information communicated [ 25 ]. While data analyses were initially conducted separately, findings were interpreted by corroborating quantitative and qualitative findings [ 67 ]. As part of the mixed methods, quantitative data findings were identified as the main data source with qualitative findings used to supplement and explain the quantitative findings.

Data collection commenced after we received ethics approval in August 2019 to evaluate the co-production of the systematic review and was completed in February 2022, after publication of the systematic review by the Cochrane Library [ 31 ]. First, we provide the characteristics of participants. Then, we describe the co-production approach to the conduct of the systematic review (the context for co-producing the systematic review, and participant engagement) (objective 1), explore the experiences of team members with co-production of the systematic review (objective 2), and elicit perceptions of team members about co-production of the systematic review (objective 3).

Characteristics of the participants

Of 17 team members, 14 (82% response rate) consented to participate and completed the baseline self-study survey, and of the participants 12 (86% response rate) completed the post self-study survey. We report on the 12 participants who completed both surveys.

Of 12 participants, most self-identified as women ( n  = 9, 75%), were born between 1950 and 1980, and all had graduate level of education (see Table  1 ). There were seven researchers, four researcher trainees, two clinicians, two patient/caregiver partners (Cochrane consumers), and three researchers who reported that they held additional roles (administrator in a health system, health educator, patient advocate with an organization) and team members may have belonged to more than one category. Participants reported a broad range of experiences with decision coaching, systematic review methods, and shared decision-making. All participants indicated that they would be able to act on the findings of the systematic review, and two indicated that they might also be impacted by the findings.

Objective 1: describe the co-production approach to the conduct of the systematic review

The context for co-producing the decision coaching systematic review

We conducted all study tasks remotely, due to the pandemic. To operationalize co-production of the systematic review, we (the team) assembled and self-organized a governance structure with an executive team (MS, SK, DS, JJ), of which one was a Cochrane consumer, and a Steering Committee consisting of the remaining 13 team members. The study coordinator supported the team. The executive team was tasked with operationalizing the systematic review and the Steering Committee with providing direction to the systematic review and engagement in systematic review tasks as they preferred. In the 15 months of the systematic review, the executive team met online every 2 weeks and the Steering Committee met online four times. The team members committed to roles and processes for systematic review governance and negotiated terms of reference document based on a previously developed format [ 40 ] (Supplementary file # 4).

The team agreed on features for the conduct of the systematic review in two stages: (1) ethical guidance, theoretical perspective, and (2) research actions. The team agreed on concept definitions for shared decision-making and decision coaching [ 16 , 31 , 68 ]. Finally, the team agreed upon an integrated knowledge translation approach to structure research actions and engage team members in co-production with support strategies such as communication, collaboration, and negotiation [ 61 ]:

During the conduct of the systematic review, the study coordinator and executive team maintained communication with the Steering Committee through email to support engagement in systematic review team activities at the level participants had indicated they wanted to be involved (individual 1:1, and group). In addition, the study coordinator shared systematic review progress summaries monthly with the team.

The study coordinator used the information from the baseline self-study survey to provide a structured approach to collaboration, with an individualized approach to engaging team members for the systematic review steps.

The team members had the opportunity to indicate their preferred level of engagement in the systematic review throughout the study.

We adjusted our plans for assessment of preferred and actual levels of engagement with each step in the systematic review. We originally asked participants about their preferred levels of engagement for all eleven systematic review research steps. There were four steps in which we did not end up involving team members who volunteered for those steps: (1) “conduct literature search” was done by the librarian and did not engage team members; (3) “pull full text articles” was done by the study coordinator; (8) “conduct analysis” consisted of the study coordinator adding extracted outcome data to Review Manager [ 69 ] (RevMan Web 2023) and leading the conduct of meta-analyses according to the protocol with support of other team members (DS, JJ), and followed with team review and confirmation; and (9) “draft the systematic review article” was co-led by two team members (JJ, DS). For the study of the systematic review conduct, as we were only just initiating the systematic review and the baseline results (although all extremely positive) were not a relevant indicator of team function, we only report the end of systematic review survey results for satisfaction with the level of engagement.

Participant engagement

Participants’ actual roles in the systematic review steps were mostly consistent with their preferred roles but there was a slight overall move towards greater engagement (“invite me [to participate]”) (see Table  2 ).

Eight participants provided more detailed responses to the open-ended question that asked for any additional comments about their level of engagement in the steps of the systematic review. Four participants explained their decision to engage with the systematic review tasks due to a positive experience with the team (for example, “ opportunity to reach out if we had any questions ,” a “ collegial approach ” and “ wonderful experience in knowledge synthesis and IKT ,” “ many learning opportunities and the team made it clear that it was a mutual learning experience which was very gratifying ”). Of these eight participants, three reported that their level of engagement was due to the project management of the systematic review: “ great project management ,” “ project team leads’ efforts to engage team members…for example, email updates [newsletters] were effective for the progress of the review ,” “ I participated in regular team calls .” Two participants identified factors which impacted their engagement: one participant identified perceptions of their role with the systematic review process, “ I was actually able to participate more than I had envisioned ”; the other alluded to factors external to the systematic review that limited engagement, “I would have liked to have had the time and opportunity to prioritize having been even more involved in the project .”

Of 12 participants, 11 were satisfied with their level of engagement at each step of the systematic review and one did not respond. There were two exceptions: for the step “search grey literature” with slightly lower participant satisfaction scores with most satisfied ( n  = 9, 82%), one indicating they were not satisfied (9%) and one indicating “not applicable” (9%), and “conduct analysis” with most satisfied ( n  = 10, 90.0%) and one indicating they were not satisfied (9%). If the systematic review was to be conducted again, eight indicated wanting to have the same level of engagement and four indicated that they would want to be more engaged. Five participants indicated that they were very satisfied and seven totally satisfied, with the extent to which they were engaged in the project.

Using the ACTIVE framework to report on the systematic review team engagement, team members were recruited by the study coordinator to engage in the conduct of the systematic review using a closed (by invitation) strategy. The mode of engagement was defined as continuous, with team members engaged during all steps of the systematic review, and with leading or controlling levels of influence on the conduct of the systematic review [ 25 ] (Supplemental file #5).

Objective 2: explore the experiences of team members with co-production of the systematic review

Participants reported on team processes that supported their ability to participate in co-producing the systematic review, these processes being communication, collaboration, and negotiation. With few exceptions, self-study participants reported positive experiences, mostly strongly agreeing or agreeing with the survey statement [ 61 ]. None responded with disagree or strongly disagree (see Table  3 ).

One participant provided a comment in the open text about communication: “communication was consistent – concise and informative.” Another participant related a comment about team collaboration: “Research team provided accommodations to a team member to ensure their meaningful contributions.” While most participants strongly agreed or agreed they had positive experiences co-producing the systematic review, some participants indicated a neutral response for three items about documentation of roles and responsibilities for their participation in the study processes, systematic review terms of reference, and documentation of team member needs. In addition, one participant reported that the “In-person meeting with co-PI to negotiate my role was very helpful and set the tone for the review . ”

Objective 3: elicit perceptions of team members about co-production of the systematic review

Overall, participants indicated that the integrated knowledge translation approach was successful in leading to co-production of the systematic review. Participants reported a strong positive team experience (see Table  4 ).

Eight participants reported that collaborative activities and engagement of team members align with a co-production approach: “We had a patient on the executive. We had team members that had various roles . ” Eight participants reported that they would not change anything about the co-production approach, and of the four that indicated being unsure, two suggested more opportunities for communication and inclusion.

Challenges to co-production were reported by five participants to be due to team logistics: “ We are many people and from the whole of the world .” Four participants reported not being aware of any team challenges. Eight participants described the inclusion of a range of perspectives as the benefit of the co-production approach, and four participants reported the co-production approach was a way to “optimize the relevance, the usefulness of the systematic review output . ” Eleven of the 12 participants indicated that they would work on another project with the same team. When asked for additional comments five participants reported a strong positive or “good experience.”

Our international and interdisciplinary team that included two Cochrane consumers organized study governance and agreed on research actions and strategies to support co-production of the systematic review about decision coaching. Overall, our results indicate that it is feasible to use an integrated knowledge translation approach to conduct a systematic review. Participants reported satisfaction with their engagement in the steps of the systematic review and positive experiences with and perceptions of team processes. Our study reveals that planning and actively supporting team member engagement in the research lifecycle led all team members to perceive the systematic review as co-produced.

A relational approach to research is crucial for the success of co-production

Our study demonstrates the importance of a relational approach for co-production, meaning that there must be interactive processes among team members that leads to relationship building. Our findings about the relational nature of co-production align with recent work on integrated knowledge translation guiding principles that include the following [ 19 ]: (1) partners (knowledge users with researchers) develop and maintain relationships based on trust, respect, dignity, and transparency; (2) partners share in decision-making; (3) partners foster open, honest, and responsive communication; (4) partners recognize, value, and share their diverse expertise and knowledge; (5) partners are flexible and receptive in tailoring the research approach to match the aims and context of the project; (6) partners can meaningfully benefit by participating in the partnership; (7) partners address ethical considerations; and (8) partners respect the practical considerations and constraints of all partners.

In our study, team members who indicated wanting to be involved with systematic review steps at the start of the study reported high satisfaction with their levels of engagement in the systematic review and attributed their positive experiences with the team for their levels of engagement. Some participants indicated not being satisfied with the steps for which there was limited opportunity for engagement. The engagement of knowledge users with researchers in research has distinct and important benefits that include the generation of knowledge that is useful and able to be used in practice and policy [ 23 , 24 , 70 , 71 ]. Based on our findings, we propose that there is potential for very positive and enjoyable inter- and intrapersonal benefits for those who participate in co-production.

Team engagement in the research lifecycle of a systematic review

It is essential to plan for and actively support collaboration, communication, and opportunities to negotiate engagement of team members who want to co-produce a systematic review. We chose an integrated knowledge translation approach to create opportunities for team members to share decisions, exchange information, and learn from one another. Other studies have described teams as challenged by co-production, due to the potential for a lack of clarity about study motivations and outcomes [ 72 ]. There is also the potential for those in the research partnership to experience risks that are practical (for example, time, money), personal (for example, interpersonal conflict, stress), and professional (for example, impacts on reputation) [ 21 , 73 , 74 ]. The participation by team members in the conduct of the systematic review was voluntary, and our team benefitted from an experienced study coordinator. When work or personal factors had an impact on team members’ ability to participate, the study coordinator was able to manage the logistics of scheduling meetings or study tasks to accommodate team members’ changing availabilities and needs. The study coordinator also ensured that there were regular and productive communications to the team to ensure its’ progress with tasks. Team members must have clearly defined strategies for co-production to structure and attain agreed-upon outcomes [ 21 ].

Our team used a framework to guide the conduct of our work together [ 37 ], and is one example of how research teams can organize themselves to operationalize concepts important for co-producing research across the research lifecycle [ 6 ]. Teams of knowledge users and researchers are striving to explain and evaluate co-production, with a growing theoretical and practical knowledge base in support of a relational approach to research [ 75 , 76 , 77 ].

We describe a team approach to collaboration (for example, define, agree upon team governance, research activities and roles) and communication (for example, sustained, consistent) among individuals and groups, and in a range of forms (for example, written, email, spoken). Furthermore, we sought to create opportunities for team members to determine their engagement with tasks as the systematic review proceeded. We assured all team members that they could adjust their preferred levels of engagement over time, and supported people to engage in their preferred manner. Work has been done to understand what knowledge, skills, and attitudes (“competencies”) are helpful for research teams that include families/caregivers as equal partners with researchers, healthcare providers, and decision-makers. While trends in competencies are identified across the different categories of team members, common findings across the team members are attitudes demonstrating the inclination to conduct the work [ 78 ].

The strategies we applied to support meaningful engagement of all team members are described elsewhere as creating “space to talk” (team members share views and recognize one another as bringing important knowledge) and “space to change” (in response to the shared knowledge, taking action in the study and how the team works together) [ 79 ]. We worked together to meet the needs of our international and interdisciplinary team members, to design an approach to co-production that established a culture and expectation of mutual respect [ 80 ].

We note some limitations and strengths of our work. We conducted a self-study as a study within a review and there is no established approach to determine the quality of self-study or a study within a review, as there currently there are no guidelines specific to self-study [ 81 ] or studies within a review. In response, we provide clear and detailed descriptions of how we collected and reported data, used available reporting guidelines, and more than one source of data to triangulate and represent the findings of the self-study. Another potential limitation is that we adapted an instrument that was developed for use with researcher-health policy maker partnerships rather than an interdisciplinary team. Our ability to measure co-production using this adapted instrument was limited due to the lack of a validated tool which is a recognized paucity within the co-production literature [ 82 , 83 ].

We did draw on previous work conducted with international and interdisciplinary teams, and with the leadership of team members who have experience in the conduct of collaborative research. As the study relied on self-reports from participants, our study may be prone to self-reporting bias that include social desirability and recall bias. We were fortunate to have a study coordinator to support participants and ensure that they could participate anonymously. In addition, we may not have fully captured the experiences of team members and a fulsome description of an international and interdisciplinary team experience may not have been conveyed. Our team and circumstances are very specific to the conduct of a systematic review; for this reason, the transferability of findings to other teams and settings may be limited. We were fortunate to have had two Cochrane consumers participate on the team, willing to bring their knowledge and perspectives to the conduct of our work.

There were some lessons learned regarding set up of the initial survey. We did not engage team members in all eleven steps as originally planned. Step 1 “Conduct the search in databases and remove duplicates” was executed according to the study protocol by the librarian. In the future, we might omit this question from the initial survey or revise it to read “Review the search strategy to be used in electronic databases.” Step 2 “Pull full text articles” was done by the study coordinator given it is a mundane task, requires access to an institutional library for access to subscription articles not otherwise publicly available, and we felt that team member expertise and resources could be better used for other tasks. In the future, we would likely omit this item from the initial survey. Step 8 “Conduct analysis” involved adding extracted outcome data to RevMan Web and conducting meta-analyses according to the protocol. We were advised by Cochrane to only allow a limited number of people to revise the report in RevMan Web; therefore, this step was done by the study coordinator and data verified by another team member. In the future, we might omit this question from the initial survey or revise it to read “Discuss the analysis.” Step 9 “Draft the systematic review article” was led by two team members only (JJ, DS) given that there are challenges with involving many people in writing the first draft of an article. In the future, we would discuss how we planned to involve team members in drafting the systematic review prior to deciding whether to include or exclude this item in the initial survey.

Our mixed methods case study shows that it is feasible to co-produce a systematic review. We used a framework to guide knowledge users and researchers partnering on the systematic review and the conduct of a self-study as a study within a review of a co-production process. We describe the co-production approach used to conduct a systematic review, and report on the experiences and perceptions of international and interdisciplinary team members that include Cochrane consumers. The participants in our self-study reported overall high levels of satisfaction with their engagement in co-production of the systematic review.

We confirm that a relational approach to research is important for co-production. We propose that clearly defined strategies are essential for the co-producing a systematic review such as determining common interests, reaching agreement on the systematic review parameters (study purpose and plan, team organization), and planning and providing supports for communication, collaboration, and opportunities to negotiate participation during the systematic review lifecycle. Although approaches to co-production are assumed to have an influential role in the development of applicable research evidence, high-quality evaluations of co-production processes and outcomes are limited [ 77 , 83 , 84 ]. Our study can contribute to a knowledge base that is a foundation for future methodological studies that investigate co-production within evidence syntheses [ 28 ]. An important contribution of our study is that it describes how to structure, report on, and evaluate research processes used in co-producing a systematic review. Further studies that are focused on rigorous evaluations, such as intervention studies, to examine approaches to co-production of systematic reviews by international and interdisciplinary team members and consider team member interests, preferences, and circumstances are needed.

Availability of data and materials

The datasets used and/or analyzed during the self-study are available from the corresponding author on reasonable request.

Canadian Institutes of Health Research (CIHR). CIHR Strategic Plan 2021–2031: a vision for a Healthier Future. The best health for all, powered by outstanding research [cited August 28, 2023]. Available from: https://cihr-irsc.gc.ca/e/52331.html .

World Health Organization. Everybody business: strengthening health systems to improve health outcomes: WHO’s framework for action. Geneva: Switzerland; 2007.

Google Scholar  

Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington (DC): National Academies Press (US); 2001.

Hanna TP, King WD, Thibodeau S, Jalink M, Paulin GA, Harvey-Jones E, et al. Mortality due to cancer treatment delay: systematic review and meta-analysis BMJ. 2020;371:m4087.

PubMed   Google Scholar  

Damschroder LJ, Aron DC, Keith RE, Kirsch SR, Alexandra JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50.

Article   PubMed   PubMed Central   Google Scholar  

Jull JE, Davidson L, Dungan R, Nguyen T, Woodward KP, Graham I. A review and synthesis of frameworks for engagement in health research to identify concepts of knowledge user engagement. BMC Med Res Methodol. 2019;19:211.

Parry D, Salsberg J, Macauley AC. Guide to researcher and knowledge-user collaboration in health research 2015. Available from: https://cihr-irsc.gc.ca/e/44954.html#s2 . Cited 2023 April 17.

Jull J, Giles A, Graham ID. Community-based participatory research and integrated knowledge translation: advancing the co-creation of knowledge. Implement Science. 2017;12(1):150.

Article   Google Scholar  

Felipe A, Renedo A, Marston C. The coproduction of what? Knowledges, values, and social relations in health care. PLoS Bioly. 2017;15(5):e2001403.

Kothari A, Rycorft-Malone J, McCutcheon C, Graham ID. Chapter 1 Introduction. 2022. In: Research coproduction in healthcare. Wiley.

Ostrom E. Crossing the great divide: coproduction, synergy, and development. World Dev. 1996;24(6):1073–87.

Sheridan S, Schrandt S, Forsythe L, Hilliard TS, Paez KA. The PCORI engagement rubric: promising practices for partnering in research. Ann Fam Med. 2017;15(2):165–70.

Canadian Institutes of Health Research. Patient engagement: what is patient engagement? : Government of Canada; 2018. Available from: http://www.cihr-irsc.gc.ca/e/45851.html .

Tetroe J. Knowledge Translation at the Canadian Institutes of Health Research: a primer. Focus Technical Brief. 2007;18:1–8.

Van De Ven AH, Johnson PE. Knowledge for theory and practice. Acad Manag Rev. 2006;31(4):802–21.

Canadian Institutes of Health Research (CIHR). Guide to knowledge translation planning at CIHR: integrated and end-of-grant approaches 2015 Available from: http://www.cihr-irsc.gc.ca/e/45321.html .

Filipe ARA, Marston C. The coproduction of what? Knowledge, values, and social relations in health care. PLoS Biol. 2017;15(5): e2001403.

Straus S, Tetroe J, Graham ID. Knowledge translation in health care: moving from evidence to practice. UK: Wiley-Blackwell Publishing Ltd; 2009.

Book   Google Scholar  

The University of Brtitish Columbia. IKT Guiding Principles UBC Available from: https://ikt.ok.ubc.ca/ .

Verschuere B, Brandsen T, Pestoff V. Co-production: the state of the art in research and the future agenda. VOLUNTAS. 2012;23(4):1083–101.

Oliver K, Kothari A, Mays N. The dark side of coproduction: do the costs outweigh the benefits for health research? Health Res Policy Syst. 2019;17(1):33.

Kothari A, Wathen NC. A second critical look at knowledge translation. Health Policy. 2013;109(2):187–91.

Article   PubMed   Google Scholar  

SPOR Evidence Alliance. Strategy for Patient Oriented Research (SPOR) Alliance: a Canadian Modeul to Build Learning Health Systems 2023. Available from: https://sporevidencealliance.ca .

Cochrane Collaboration. Cochrane framework for engagement and involvement of patients, carers, and the public 2023. Available from: https://www.cochrane.org/news/cochrane-framework-engagement-and-involvement-patients-carers-and-public .

Pollock A, Campbell P, Struthers C, Synnot A, Nunn J, Hill S, Goodare H, Morris J, Watts C, Morely R. Development of the ACTIVE framework to describe stakeholder involvement in systematic reviews. J Health Serv Res Policy. 2019;24(4):245–55.

Pollock A, Ccampbell P, Struthers C, Synnot A, Nunn J, Hill S, Goodare H, Morris J, Watts C, Morley R. Stakeholder involvement in systematic reviews: a scoping review. Syst Rev. 2018;7:208.

Pollock A, Campbell P, Synnot A, Smith M, Morley R. Patient and public involvement in systematic reviews. GIN; 2021.

Devane D, Burke NN, Treweek S, Clarke S, Thomas J, Booth A, Tricco AC, Saif-Ur-Rahman KM. Study within a review (SWAR). Journal of Evidence Based Medicine. 2022;15:328–32. https://doi.org/10.1111/jebm.12505 .

Coulter A, Collins A. Making shared decision-making a reality: no decision about me, without me. London: The King’s Fund; 2011.

National Institute for Health and Care Excellence (NICE). Shared decision making 2024. Available from: https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines/shared-decision-making .

Jull J, Kopke S, Boland L, Coulter A, Dunn S, Graham ID, Hutton B, Kasper J, Kienlin SM, Légaré F, Lewis KB, Lyddiatt A, Osaka W, Rader T, Rahn AC, Rutherford C, Smith M, Stacey D. Decision coaching for people making healthcare decisions. Cochrane Database Syst Rev. 2019;7:CD013385.

Woods J. Self-study: a method for continuous professional learning and a methodology for knowledge transfer. Qual Advance Nurs Educ. 2021;7(2):7.

Pitthouse-Morgan K. Self-study in teaching and teacher education: characteristics and contributions. Teaching Teach Educ. 2022;119:103880.

Miles MB, Huberman A, Saldaña J. Qualitative data analysis: a methods sourcebook. 3rd ed. Thousand Oaks, California: SAGE; 2014.

Yin R. Case study research design: design and methods. 6th ed. Thousand Oaks, California: SAGE; 2018.

Walton JB, Plano Clark VL, Foote LA, Johnson CC. Navigating intersecting roads in a mixed methods case study: a dissertation journey. J Mixed Methods Res. 2020;14(4):436–55.

Jull J, Giles A, Boyer Y, Stacey D, Minwaashin Lodge - The Aboriginal Women’s Support Centre. Development of a collaborative research framework: an example of a study conducted by and with a first nations, inuit and métis women’s community and its research partners. ACME. 2018;17(3):671–86.

Jull J, Giles A, Boyer Y, Stacey D. Cultural adaptation of a shared decision making tool with Aboriginal women: a qualitative study. BMC Med Inform Decis Mak. 2015;15:1.

Funnell S, Jull J, Mbuagbaw L, Welch V, Dewidar O, et al. Improving social justice in observational studies: protocol for the development of a global and Indigenous STROBE-equity reporting guideline. Int J Equity Health. 2023;22(1):55.

Jull J, Graham ID, Kristjansson E, Moher D, Petkovic J, Yoganathan M, Tugwell P, Welch VA, Members of the, Consort-Equity Boston Equity, Symposium. Taking an integrated knowledge translation approach in research to develop the CONSORT-Equity 2017 reporting guideline: an observational study. BMJ Open. 2019;9(7):e026866.

Jull J, Crispo J, Welch V, MacDonald H, Brascoupe S, Boyer Y, et al. Interventions for indigenous peoples making health decisions: a systematic review. Pimatisiwin. 2013;11(3):539–54.

Jull J, Fairman K, Oliver S, Hesmer B, Pullattayil AK, The Not Deciding Alone Team. Interventions for Indigenous Peoples making health decisions: a systematic review. Arch Public Health. 2023;81:174.

Staniszewska S, Brett J, Simera I, Seers K, Mockford C, Goodlad S, Altman DG, Moher D, Barber R, Denegri S, Entwistle A, Littlejohns P, Morris C, Suleman R, Thomas V, Tysall C. GRIPP2 reporting checklists: tools to improve reporting of patient and public involvement in research. The BMJ. 2017;358:j3453.

Article   CAS   PubMed   PubMed Central   Google Scholar  

O’Brien B, Harris I, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research (SRQR). Acad Med. 2014;89(9):1245–51.

Canadian Institutes of Health Research. Considerations when paying patient partners in research 2022. Available from: https://cihr-irsc.gc.ca/e/51466.html .

Morley R, Smith M, Morley K, Meader N, Jull J. Ready, set, go! Consumer involvement in systematic reviews Evidence Synthesis Ireland 2021. Available from: https://evidencesynthesisireland.ie/webinar/webinarcochraneconsumerinvolvement/ .

Jull J, Köpke S, Rahn A, Finderup J, Boland L, Lewis K, et al. Decision coaching for people preparing to make health care decisions: a systematic review using an integrated knowledge translation approach. SMDM 2020; October 6 2020; Virtual conference2020.

Jull J, Köpke S, Smith M, Carley M, Finderup J, Rahn AC, Boland L, Dunn S, Dwyer AA, Kasper J, Kienlin SM, Légaré F, Lewis KB, Lyddiatt A, Rutherford C, Zhao J, Rader T, Graham ID, Stacey D. Decision coaching for people making healthcare decisions. Cochrane Database Syst Rev. 2021;11(11):CD013385.

Finderup J. Shared decision making-the cornerstone in person-centred care. J Ren Care. 2021;47(3):144–5.

Jull J, Köpke S, Smith M, Carley M, Finderup J, Rahn AC, et al. Cochrane consumers and communication: Cochrane library. 2021. Available from: https://cccrg.cochrane.org/news/new-review-decision-coaching-people-making-healthcare-decisions . Cited 2023.

Jull J, Stacey D, Kopke S. Support and collaboration with health-care providers can help people make health decisions. The Conversation. 2021 September 16 2023. Available from: https://theconversation.com/support-and-collaboration-with-health-care-providers-can-help-people-make-health-decisions-169816 .

International Association for Public Participation (IAP2): Advancing the practice of public participation. IAP2; n.d. Available from: https://www.iap2.org/page/pillars

Dillman DA, Smyth JD, Christian LM. Internet, phone, mail, and mixed-mode surveys: the tailored design method: John Wiley & Sons. 2014.

Latour JM, Tume L. How to do and report survey results robustly: a helpful mnemonic SURVEY. Nurs Crit Care. 2021;26:313–4.

Gunther E. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res. 2004;6(3): e34.

Arnstein S. A ladder of citizen participation. J Am Plann Assoc. 1969;35(4):216–24.

Canadian Institutes of Health Research. Strategy for patient-oriented research - patient engagement framework: Government of Canada; 2019. Available from: https://cihr-irsc.gc.ca/e/48413.html .

PCORI. Ways of Engaging- ENgagement Activity Tool (WE-ENACT) - Patients and Stakeholders 3.0 Item Pool2016 March 2, 2023. Available from: https://www.pcori.org/sites/default/files/PCORI-WE-ENACT-3-0-Patients-Stakeholders-Item-Pool-080916.pdf .

PCORI. Evaluating Our Engagement in Research Initiatives: PCORI; 2023 [Available from: https://www.pcori.org/about/evaluating-our-work/evaluating-key-aspects-our-work/evaluating-our-engagement-research-initiatives .

Kothari A, MacLean L, Edwards N, Hobbs A. Indicators at the interface: managing policymaker-researcher collaboration. Knowl Manag Res Pract. 2011;9:203–14.

Kothari A, Sibbald S, Wathen N. For the PreVAiL Research Network. PreVAiL Partnership Evaluation Project Phase 1 Final Report. 2013.

Kothari A, Sibbald S, Wathen N. Evaluation of partnerships in a transnational family violence prevention network using an integreated knowledge translation and exchange model: a mixed methods study. Health Res Policy Syst. 2014;12:25.

Jull J, CONSORT Equity Team. The value of an integrated knowledge translation approach for developing reporting guidelines: engaging knowledge users interested in equity-relevant decision making. Toronto: Knowledge Translation Canada Scientific Meeting; 2016.

Bowen G. Document analysis as a qualitative research method. Qual Res J. 2009;9(2):27–40.

Birt L, Scott S, Cavers D, Campbell C, Walter F. Member checking: a tool to enhance trustworthiness or merely a nod to validation? Qual Health Res. 2016;26(13):1802–11.

Elo S, Kyngas H. The qualitative content analysis. Journal of Advance Nursing. 2008;62(1):107–15.

Fetters M, Curry LA, Creswell JW. Achieving integration in mixed methods designs-principles and practices. Health Serv Res. 2013;48(6):2136–56.

O’Connor AM, Tugwell P, Wells GA, Elmslie T, Jolly E, Hollingworth G, McPherson R, Bunn H, Graham I, Drake E. A decision aid for women considering hormone therapy after menopause: decision support framework and evaluation. Patient Educ Couns. 1998;33(3):267–79.

Review Manager Web (RevMan Web). Version 4.27.0. The Cochrane Collaboration, 2023. Available at revman.cochrane.org.

Involve. Briefing notes for researchers: involving the public in NHS, public health and social care research INVOLVE, Eastleigh 2012. Available from: http://www.invo.org.uk/wp-content/uploads/2012/04/INVOLVEBriefingNotesApr2012.pdf .

Norström AV, Cvitanovic C, Löf MF, West S, Wyborn C, Balvanera P, et al. Principles for knowledge co-production in sustainability research. Nature Sustainability. 2020;3:182–90.

Jenkins N, Matthews P. When methods meet: coproduction and participatory research Scottish Graduate School of Social Science Sgoil Cheumnaichean Saidheans Sòisealta na h-Alba 2020. Available from: https://www.sgsss.ac.uk/methods-resource/co-production-and-participatory-research/ .

Flinders M, Woods M, Cunningham M. The politics of co-production: risks, limits and pollution. Evidence & Policy: A Journal of Research, Debate and Practice. 2016;12(2):261–79.

Rycroft-Malone Burton CR, Bucknall T, Graham ID, Hutchinson AM, Stacey D. Collaboration and co-production of knowledge in healthcare: opportunities and challenges. Int J Health Policy Manag. 2016;5(4):221–3.

Graham ID, Kothari A, McCutcheon C. Moving knowledge into action for more effective practice, programmes and policy: protocol for a research programme on integrated knowledge translation. Implement Sci. 2018;13:22.

NHS England. Co-production n.d. Available from: https://www.england.nhs.uk/always-events/co-production/ .

McLean R, Tucker J. Evaluation of CIHR’s knoweldge translation funding program: Government of Canada; 2013. Available from: https://cihr-irsc.gc.ca/e/47332.html#a3.1 .

Fisch N, Atherton P, Doyle-Waters MM, MacLeod M, Mallidou A, Sheane V, Ward J, Woodley J. Patient-oriented research competencies in health (PORCH) for researchers, patients, healthcare providers, and decision makers: results of a scoping review. Research Involvement and Engagement. 2020;6 (4):  https://doi.org/10.1186/s40900-020-0180-0

Knowles SE, Allen D, Donnelly A, Flynn J, Gallacher K, Lewis A, et al. More than a method: trusting relationships, productive tensions, and two-way learning as mechanisms of authentic co-production. Res Involve Engagem. 2021;7:34.

Witteman O, Dansokho SC, Colquhoun H, Fagerlin A, Giguere AM, Glouberman S, et al. Twelve lessons learned for effective research partnerships between patients, caregivers, clinicians, academic researchers, and other stakeholders. J Gen Intern Med. 2018;33(4):558–62.

Feldman A. Validity and quality in self study. Educational Researcher. 2003;32(3):26–8.

Nordin A, Kjellstrom S, Robert G, Masterson D, Areskoug JK. Measurement and outcomes of co-production in health and social care: a systematic review of empirical studies. BMJ Open. 2023;13: e073808. https://doi.org/10.1136/bmjopen-2023-073808 .

Norton MJ. Corproduction and mental health service provision: a protocol for a scoping review. BMJ Open. 2022;12(5): e058428. https://doi.org/10.1136/bmjopen-2021-058428 .

Durose C, Needham C, Mangan C, Rees J. Generating ‘good enough’ evidence for co-production. Evidence & Policy: A Journal of Research, Debate and Practice. 2017;13(1):135–51.

Download references

Acknowledgements

The authors acknowledge Tamara Rader, MLIS Information Specialist Consultant, for creating the search strategies and general librarian support for the project. We thank Brittany Hesmer for her work to develop the manuscript figure.

Consortium authors list

Members of the Cochrane Decision Coaching Review Team:

Janet Jull, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

Maureen Smith, Cochrane Consumer Network Executive, Ottawa, Ontario, Canada.

Meg Carley, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

Dawn Stacey, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.

Ian D. Graham, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada.

Laura Boland, IKTRN, Ottawa Hospital Research Institute, Ottawa Ontario, Canada; Western University, School of Health Sciences, London, Ontario, Canada; Evidence Synthesis and Knowledge Translation Unit, Applied Research Division, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada.

Sandra Dunn, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; BORN Ontario, Ottawa, Ontario, Canada; School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.

Andrew A. Dwyer, Boston College William F. Connell School of Nursing, Chestnut Hill, Massachusetts, USA; Massachusetts General Hospital – Harvard Center for Reproductive Medicine, Boston, Massachusetts, USA.

Jeanette Finderup, Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.

Jürgen Kasper, Department of Nursing Sciences and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.

Simone Kienlin, Faculty of Health Sciences, Department of Health and Caring Sciences, University of Tromsø, Langnes, Norway; The South-Eastern Norway Regional Health Authority, Department of Medicine and Healthcare, Hamar, Norway.

Sascha Köpke, Institute of Nursing Science, University of Cologne, Medical Faculty; University Hospital Cologne, Cologne, Germany.

France Légaré, Department of Family Medicine and Emergency Medicine, Faculty of Medicine Laval University, Québec, Canada.

Krystina Lewis, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.

Anne Christin Rahn, Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany.

Claudia Rutherford, Faculty of Medicine and Health, Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia.

Junqiang Zhao, Waypoint Research Institute, Waypoint Centre for Mental Health Care 500 Church Street, Penetanguishene, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.

The study we report on here was funded by a Canadian Institutes of Health Research (CIHR) grant #PJT-162135.

Canadian Institutes of Health Research,FRN# PJT-162135

IDG is a recipient of a CIHR Foundation Grant (FDN # 143,237).

FL is a Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Mobilization.

Author information

Authors and affiliations.

School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada

Ottawa Hospital Research Institute, Ottawa, ON, Canada

Janet Jull, Meg Carley, Dawn Stacey & Ian D. Graham

Cochrane Consumer Network Executive, Ottawa, ON, Canada

Maureen Smith

School of Nursing, University of Ottawa, Ottawa, ON, Canada

Dawn Stacey

School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, ON, Canada

Ian D. Graham

You can also search for this author in PubMed   Google Scholar

• , Maureen Smith
• , Meg Carley
• , Dawn Stacey
• , Ian D. Graham
• , Laura Boland
• , Sandra Dun
• , Andrew A. Dwyer
• , Jeanette Finderup
• , Jürgen Kasper
• , Simone Kienlin
• , Sascha Köpke
• , France Légaré
• , Krystina Lewis
• , Anne Christin Rahn
• , Claudia Rutherford
•  & Junqiang Zhao

Contributions

JJ, IDG, DS, and MS conceived and led the design of the work described in the manuscript. MC made substantial contributions to the acquisition of data. JJ with MS and JJ with IDG, DS, MS, and MC participated in and provided substantial contributions to the analysis and interpretation during development of the work described in the manuscript, with all authors (JJ, IDG, DS, MS, MC with the Cochrane Decision Coaching Review Team) reviewing and providing final confirmation of results. JJ led the writing of the first version of the manuscript and was responsible for revisions with IDG, DS, MS, and MC. All authors (JJ, IDG, DS, MS, MC with the Cochrane Decision Coaching Review Team) made contributions to the drafts of this manuscript and have reviewed and revised the manuscript for important intellectual content. All authors (JJ, IDG, DS, MS, MC with the Cochrane Decision Coaching Review Team) approved the final version of the manuscript.

Corresponding author

Correspondence to Janet Jull .

Ethics declarations

Ethics approval and consent to participate.

The Ottawa Health Science Network Research Ethics Board (REB) and University of Ottawa REB approved the self-study (#20190408-01H; #A07-12–02).

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Supplementary material 1., supplementary material 2., supplementary material 3., supplementary material 4., supplementary material 5., rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Jull, J., Smith, M., Carley, M. et al. Co-production of a systematic review on decision coaching: a mixed methods case study within a review. Syst Rev 13 , 149 (2024). https://doi.org/10.1186/s13643-024-02563-8

Download citation

Received : 18 October 2023

Accepted : 16 May 2024

Published : 03 June 2024

DOI : https://doi.org/10.1186/s13643-024-02563-8

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Integrated knowledge translation
• Knowledge synthesis
• Patient-centered research
• Research co-production
• Study within a review
• Systematic reviews

Systematic Reviews

ISSN: 2046-4053

• Submission enquiries: Access here and click Contact Us
• General enquiries: [email protected]

Home — Essay Samples — Science — Research Methods — Case Study Pros And Cons

Case Study Pros and Cons

• Categories: Case Study Research Methods

About this sample

Words: 816 |

Published: Jun 6, 2024

Words: 816 | Pages: 2 | 5 min read

Table of contents

Advantages of case studies, disadvantages of case studies, balancing the pros and cons.

Cite this Essay

Let us write you an essay from scratch

• 450+ experts on 30 subjects ready to help
• Custom essay delivered in as few as 3 hours

Get high-quality help

Verified writer

• Expert in: Education Science

+ 120 experts online

By clicking “Check Writers’ Offers”, you agree to our terms of service and privacy policy . We’ll occasionally send you promo and account related email

No need to pay just yet!

Related Essays

5 pages / 2207 words

2 pages / 746 words

2 pages / 783 words

1 pages / 678 words

Remember! This is just a sample.

You can get your custom paper by one of our expert writers.

121 writers online

Still can’t find what you need?

Browse our vast selection of original essay samples, each expertly formatted and styled

Related Essays on Research Methods

The importance of research in education cannot be overstated. Research serves as the foundation upon which effective teaching strategies, educational policies, and curriculum development are built. In the realm of education, [...]

The importance of research in my education as a student has been transformative and enlightening. Research has served as a guiding light, illuminating the path of learning and deepening my understanding of various subjects. This [...]

Quantitative methods are an integral part of research in various academic disciplines, as they offer a systematic and objective approach to studying phenomena. This essay will analyze the strengths and weaknesses of quantitative [...]

Keyword research is very important when it comes to SEO and any branch of digital marketing. Keywords are very important for every business website as they drive targeted web traffic to your business for free. Without spending [...]

Modeling a cylinder in water flow was done using methods of dimensional analysis. Looking at the velocity profile of air in a wind tunnel allowed us to find its drag force and drag coefficient. We measured the voltage change [...]

In this chapter, details of the Problem Definition of the Research Approaches, Project methodology, Data collection, Data analysis are discussed. Problem Definition According to Clifford Woody, Research comprises defining [...]

Related Topics

By clicking “Send”, you agree to our Terms of service and Privacy statement . We will occasionally send you account related emails.

Where do you want us to send this sample?

By clicking “Continue”, you agree to our terms of service and privacy policy.

Be careful. This essay is not unique

This essay was donated by a student and is likely to have been used and submitted before

Download this Sample

Free samples may contain mistakes and not unique parts

Sorry, we could not paraphrase this essay. Our professional writers can rewrite it and get you a unique paper.

Please check your inbox.

We can write you a custom essay that will follow your exact instructions and meet the deadlines. Let's fix your grades together!

Get Your Personalized Essay in 3 Hours or Less!

We use cookies to personalyze your web-site experience. By continuing we’ll assume you board with our cookie policy .

• Instructions Followed To The Letter
• Deadlines Met At Every Stage
• Unique And Plagiarism Free

CRITIC-PROMETHEE II-Based Evaluation of Smart Community Services: A Case Study of Shenzhen, China

• Published: 04 June 2024

Cite this article

• Tiantian Gu 1 ,
• Enyang Hao 1 ,
• Chenyang Wang 1 ,
• Shiyao Zhu 2 &
• Yongchao Wang 1  

35 Accesses

Explore all metrics

In the process of constructing smart communities, smart community services are frequently emphasized as a crucial aspect that directly impacts the residents’ quality of life. While numerous studies focus on developing advanced technologies to modernize smart community services, little research evaluates the level of smart community services. Therefore, this paper develops an evaluation method for smart community services to increase the effectiveness of developing smart community services. Through a systematic literature review and expert interviews, an evaluation indicator system comprising 27 indicators across five dimensions for evaluating smart community services was developed. Subsequently, a novel hybrid evaluation method integrating CRITIC and PROMETHEE II approaches was established and employed to analyze the smart community service levels, highlighting that the Yucun community exhibited the highest level of smart services among the five surveyed communities. A sensitivity analysis further validated the robustness of evaluation results, ensuring the reliability of the decision-making process. Finally, several recommendations have been put forward to promote the development of smart community services, including drawing on advanced experience from demonstration communities, establishing close collaboration with the public sectors, and enriching service content to meet the needs of different residents by utilizing new technologies. This study not only proposes a comprehensive evaluation method that enriches the smart community services knowledge system but also provides cost-effective guidance for their sustainable development.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price includes VAT (Russian Federation)

Instant access to the full article PDF.

Rent this article via DeepDyve

Institutional subscriptions

Similar content being viewed by others

A novel taxonomy of smart sustainable city indicators

Comparison of Both Old and New Versions of the Evaluation Standard for Green Building in China with LEED in American

Green Sustainable Urban Systems: The Case of Jeddah

Data availability.

The original data come from the field survey conducted in smart communities. We confirm that the data and method used in the research are proprietary, and the derived data supporting the findings of this study are available from the first author on request.

Abedi, M., Ali Torabi, S., Norouzi, G.-H., Hamzeh, M., & Elyasi, G.-R. (2012). PROMETHEE II: A knowledge-driven method for copper exploration. Computers & Geosciences, 46 , 255–263. https://doi.org/10.1016/j.cageo.2011.12.012

Article   Google Scholar  

Alabdulatif, A., Khalil, I., Forkan, A. R. M., & Atiquzzaman, M. (2019). Real-time secure health surveillance for smarter health communities. IEEE Communications Magazine, 57 (1), 122–129. https://doi.org/10.1109/MCOM.2017.1700547

Beştepe, F., & Yildirim, S. Ö. (2022). Acceptance of IoT-based and sustainability-oriented smart city services: A mixed methods study. Sustainable Cities and Society, 80 , 103794. https://doi.org/10.1016/j.scs.2022.103794

Bezerra, P. R. S., Schramm, F., & Schramm, V. B. (2021). A multicriteria model, based on the PROMETHEE II, for assessing corporate sustainability. Clean Technologies and Environmental Policy, 23 (10), 2927–2940. https://doi.org/10.1007/s10098-021-02211-y

Bolaños, M., Collazos, C., & Gutiérrez, F. (2021). Reference framework for measuring the level of technological acceptance by the elderly: A case study of virtual assistants. TecnoLógicas, 24 (50), e1791. https://doi.org/10.22430/22565337.1791

Brans, J.-P., & Mareschal, B. (2005). Promethee methods. In Multiple criteria decision analysis: State of the art surveys (pp. 163–186). Springer-Verlag. https://doi.org/10.1007/0-387-23081-5_5

Chapter   Google Scholar  

Brans, J. P., & Vincke, P. (1985). A preference ranking organization method. The PROMETHEE method for MCDM. Management Science, 31 (6), 647–656. https://doi.org/10.1287/mnsc.31.6.647

Chen, H., Zhang, Y., & Wang, L. (2023). A study on the quality evaluation index system of smart home care for older adults in the community ——based on Delphi and AHP. BMC Public Health, 23 (1). https://doi.org/10.1186/s12889-023-15262-1

Cheng, J., Chen, M., & Tang, S. (2023). Shenzhen – a typical benchmark of Chinese rapid urbanization miracle. Cities, 140 , 104421. https://doi.org/10.1016/j.cities.2023.104421

Cyberspace Administration of China. (2021). The Central Cyberspace Administration and eight other departments jointly announced the list of national smart social governance experimental bases. https://www.cac.gov.cn/2021-09/29/c_1634507963276896.htm . Accessed 11 May 2024

Dhara, A., Kaur, G., Kishan, P. M., Majumder, A., & Yadav, R. (2022). An efficient decision support system for selecting very light business jet using CRITIC-TOPSIS method. Aircraft Engineering and Aerospace Technology, 94 (3), 458–472. https://doi.org/10.1108/AEAT-04-2021-0135

Diakoulaki, D., Mavrotas, G., & Papayannakis, L. (1995). Determining objective weights in multiple criteria problems: The critic method. Computers & Operations Research, 22 (7), 763–770. https://doi.org/10.1016/0305-0548(94)00059-H

Dong, F., Yin, J., Xiang, J., Chang, Z., Gu, T., & Han, F. (2023). EWM-FCE-ODM-based evaluation of smart community construction: From the perspective of residents’ sense of gain. Sustainability, 15 (8), 6587. https://doi.org/10.3390/su15086587

Fan, Y. M. (2022). Technology empowers grassroots governance, and smart community construction makes life more “smart.” https://www.gmw.cn/xueshu/2022-07/08/content_35869758.htm . Accessed 12 February 2023

Fu, Y., Sui, Y., Luo, H., & Han, B. (2020). Application of social choice theory to modify the value measure of health systems. Social Indicators Research, 148 (3), 1005–1019. https://doi.org/10.1007/s11205-019-02221-w

Gondokusuma, M. I. C., Kitagawa, Y., & Shimoda, Y. (2019). Smart community guideline: Case study on the development process of smart communities in Japan. IOP Conference Series: Earth and Environmental Science, 294 ). Institute of Physics Publishing. https://doi.org/10.1088/1755-1315/294/1/012017

Gu, T., Xu, Q., Song, X., Hao, E., Cui, P., & Xie, M. (2024). Analysis of influencing factors and their inner mechanism of the market participation in the smart community construction of China. Ain Shams Engineering Journal , 102761. https://doi.org/10.1016/j.asej.2024.102761

Hsu, W. L., Wu, X., Yu, F. C., & Sun, K. S. (2021). Research on Shanghai smart city evaluation system in the era of 5G Internet of Things. In 3rd IEEE International Conference on Architecture, Construction, Environment and Hydraulics 2021, ICACEH 2021 (pp. 1–4). Institute of Electrical and Electronics Engineers Inc. https://doi.org/10.1109/ICACEH54312.2021.9768847

Khaef, S., & Zebardast, E. (2016). Assessing quality of life dimensions in deteriorated inner areas: A case from Javadieh neighborhood in Tehran metropolis. Social Indicators Research, 127 (2), 761–775. https://doi.org/10.1007/s11205-015-0986-6

Khan, S., & Purohit, L. (2022). An integrated methodology of ranking based on PROMETHEE-CRITIC and TOPSIS-CRITIC in web service domain. In 2022 IEEE 11th International Conference on Communication Systems and Network Technologies (CSNT) (pp. 335–340). IEEE. https://doi.org/10.1109/CSNT54456.2022.9787620

Li, C., & Yu, X. (2021). A hybrid model based on PROMETHEE and PLTSs for the assessment of public participation in community meteorological disaster prevention and mitigation. Journal of Intelligent & Fuzzy Systems, 40 (5), 9583–9595. https://doi.org/10.3233/JIFS-202026

Li, H., Chen, P., & Grant, R. (2021). Built environment, special economic zone, and housing prices in Shenzhen, China. Applied Geography, 129 , 102429. https://doi.org/10.1016/j.apgeog.2021.102429

Li, Z., Zhang, H., O’Brien, L., Cai, R., & Flint, S. (2017). On evaluating commercial cloud services: A systematic review. https://doi.org/10.1016/j.jss.2013.04.021

Liu, X., Mu, Y., Jiang, Y. G., & Luo, J. (2017). VSCC’2017: Visual analysis for smart and connected communities. In MM 2017 - Proceedings of the 2017 ACM Multimedia Conference (pp. 1976–1977). Association for Computing Machinery, Inc. https://doi.org/10.1145/3123266.3132053

Ministry of Civil Affairs of the People’s Republic of China. (2022). Nine departments issued a notice on the in-depth promotion of the construction of intelligent communities. http://www.gov.cn/zhengce/zhengceku/2022-05/21/content_5691593.htm . Accessed 28 February 2023

Mohamadghasemi, A., Hadi-Vencheh, A., & Hosseinzadeh Lotfi, F. (2020). The multiobjective stochastic CRITIC–TOPSIS approach for solving the shipboard crane selection problem. International Journal of Intelligent Systems, 35 (10), 1570–1598. https://doi.org/10.1002/int.22265

Mohammadi, M. H., Hejazi, Z., Saeedi, M. A., & Giordani, E. (2023). Using AHP and PROMETHEE multicriteria decision-making approaches to rank available fruit crops for orchard expansion in Nangarhar, Afghanistan. Erwerbs-Obstbau, 65 (5), 1837–1847. https://doi.org/10.1007/s10341-023-00902-y

Nishi, H. (2018). Information and communication platform for providing smart community services system implementation and use case in Saitama City. In 19th IEEE International Conference on Industrial Technologies (ICIT) (pp. 1375–1380). Lyon, FRANCE. https://doi.org/10.1109/ICIT.2018.8352380

Paskaleva, K., & Cooper, I. (2018). Open innovation and the evaluation of internet-enabled public services in smart cities. Technovation, 78 , 4–14. https://doi.org/10.1016/j.technovation.2018.07.003

Pinto, M. C., Crespi, G., Dell’Anna, F., & Becchio, C. (2023). Combining energy dynamic simulation and multi-criteria analysis for supporting investment decisions on smart shading devices in office buildings. Applied Energy, 332 , 120470. https://doi.org/10.1016/j.apenergy.2022.120470

Popereshnyak, S., & Yurchuk, I. (2021). Car parking data processing technique for smart parking system as part of smart city. In Advances in intelligent systems and computing (Vol. 1246 AISC, pp. 183–194). Springer. https://doi.org/10.1007/978-3-030-54215-3_12

Qi, L., & Guo, J. (2019). Development of smart city community service integrated management platform. International Journal of Distributed Sensor Networks, 15 (6). https://doi.org/10.1177/1550147719851975

Saxena, P., Kumar, V., & Ram, M. (2022). A novel CRITIC-TOPSIS approach for optimal selection of software reliability growth model (SRGM). Quality and Reliability Engineering International, 38 (5), 2501–2520. https://doi.org/10.1002/qre.3087

Shenzhen Special Zone Daily. (2020). “New era and new fishing village” goes out of the party building leading grassroots governance new path (in Chinese). http://sztqb.sznews.com/MB/content/202012/21/content_966484.html . Accessed 29 April 2023

Shi, W., Li, J., Ding, Y., & Zhou, K. (2019). Research on intelligent access control system based on interactive face liveness detection and machine vision. IOP Conference Series: Materials Science and Engineering, 563 ). Institute of Physics Publishing. https://doi.org/10.1088/1757-899X/563/5/052094

Sotirelis, P., Nakopoulos, P., Valvi, T., Grigoroudis, E., & Carayannis, E. (2022). Measuring smart city performance: A multiple criteria decision analysis approach. Journal of the Knowledge Economy, 13 (4), 2957–2985. https://doi.org/10.1007/s13132-021-00847-1

State Information Center. (2021). The Smart Community Construction and Operation Guide (2021) was officially released. http://www.sic.gov.cn/News/567/11165.htm . Accessed 23 February 2023

The Paper. (2021). China city daily focuses on Luohu: Creating a leading (in Chinese) demonstration community and exploring a new road for grassroots governance. https://www.thepaper.cn/newsDetail_forward_11454591 . Accessed 29 April 2023

Tong, L., Pu, Z., Chen, K., & Yi, J. (2020). Sustainable maintenance supplier performance evaluation based on an extend fuzzy PROMETHEE II approach in petrochemical industry. Journal of Cleaner Production, 273 , 122771. https://doi.org/10.1016/j.jclepro.2020.122771

Tong, L. Z., Wang, J., & Pu, Z. (2022). Sustainable supplier selection for SMEs based on an extended PROMETHEE II approach. Journal of Cleaner Production, 330 , 129830. https://doi.org/10.1016/j.jclepro.2021.129830

Wan, L., & Jiang, S. (2022). Research on the influencing factors of sustainable development of smart community. Mathematical Problems in Engineering, 2022 . https://doi.org/10.1155/2022/8420851

Wang, C., Wang, L., Gu, T., Yin, J., & Hao, E. (2023). CRITIC-TOPSIS-based evaluation of smart community safety: A case study of Shenzhen, China. Buildings, 13 (2). https://doi.org/10.3390/buildings13020476

Wang, J., Ding, S., Song, M., Fan, W., & Yang, S. (2018). Smart community evaluation for sustainable development using a combined analytical framework. Journal of Cleaner Production, 193 , 158–168. https://doi.org/10.1016/j.jclepro.2018.05.023

Xinhua News Agency. (2022). Continuously strengthening the functions of communities for the people, convenience, and safety - interpretation of the “14th Five-Year Plan for the Construction of Urban and Rural Community Service System” (in Chinese). http://www.gov.cn/zhengce/2022-02/09/content_5672811.htm . Accessed 22 April 2023

Yang, H., Zhang, X., Fu, K., Sun, X., Hou, S., & Tan, Y. (2023). Comprehensive evaluation of urban water supply security based on the VIKOR-TOPSIS method. Environmental Science and Pollution Research, 30 (3), 8363–8375. https://doi.org/10.1007/s11356-022-24493-5

Yang, Hongshan. (2009). The multi center supply mechanism of urban community services (in Chinese). Theory and Reform, 03, 56–57.

Yang, Y. (2020). Smart community security monitoring based on artificial intelligence and improved machine learning algorithm. Journal of Intelligent & Fuzzy Systems, 38 (6), 7351–7363. https://doi.org/10.3233/JIFS-179809

Yin, J., Wang, J., Wang, C., Wang, L., & Chang, Z. (2023). CRITIC-TOPSIS based evaluation of smart community governance: A case study in China. Sustainability, 15 (3). https://doi.org/10.3390/su15031923

Yuan, Y., & Liu, T. (2014). Evaluation model and indicator system of informationization applications and services in smart cities. In Proceedings - 2014 International Conference on Intelligent Environments, IE 2014 (pp. 95–101). Institute of Electrical and Electronics Engineers Inc. https://doi.org/10.1109/IE.2014.21

Zhang, J., Hu, J., Wang, X., Fang, L., Jin, Y., Li, M., et al. (2023). Quantifying transport safety success at the regional level: A guide to policy and practice on investment for G20. Socio-Economic Planning Sciences, 89 , 101715. https://doi.org/10.1016/j.seps.2023.101715

Zhang, N., Zhao, X., & He, X. (2020). Understanding the relationships between information architectures and business models: An empirical study on the success configurations of smart communities. Government Information Quarterly, 37 (2). https://doi.org/10.1016/j.giq.2019.101439

Zhao, Y., & Xu, L. (2009). Fuzzy comprehensive evaluation on community service based on improved algorithm. In 2009 2nd International Conference on Future Information Technology and Management Engineering, FITME 2009 (pp. 48–52). https://doi.org/10.1109/FITME.2009.18

Zhou, Y., Hao, L., & Liu, W. (2016). Extenics-based study on evaluation of urban community home-care service for the elderly. Procedia Computer Science, 91 , 576–580. https://doi.org/10.1016/j.procs.2016.07.146

Zhu, H., Shen, L., & Ren, Y. (2022). How can smart city shape a happier life? The mechanism for developing a happiness driven smart city. Sustainable Cities and Society, 80 , 103791. https://doi.org/10.1016/j.scs.2022.103791

Zhu, S., Li, D., Feng, H., Gu, T., & Zhu, J. (2019). AHP-TOPSIS-based evaluation of the relative performance of multiple neighborhood renewal projects: A case study in Nanjing, China. Sustainability, 11 (17). https://doi.org/10.3390/su11174545

Zou, T., Su, Y., & Wang, Y. (2018). Research on the hybrid ANP-FCE approach of urban community sustainable construction problem. Mathematical Problems in Engineering, 2018 , 1–10. https://doi.org/10.1155/2018/8572498

Download references

Acknowledgements

The authors hereby express their special gratitude to all the respondents who presented the needed data with great patience, as well as the surveyors and interviewers who did their best in terms of data collection.

This research paper is financially supported by the National Natural Science Foundation of China (Grant No.72104233) and China Postdoctoral Science Foundation (Grant No.2023M743767).

Author information

Authors and affiliations.

School of Mechanics and Civil Engineering, China University of Mining and Technology, Xuzhou, 221116, China

Tiantian Gu, Enyang Hao, Chenyang Wang & Yongchao Wang

Faculty of Forestry, University of British Columbia, Vancouver, Canada

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Tiantian Gu .

Ethics declarations

Conflict of interest.

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Gu, T., Hao, E., Wang, C. et al. CRITIC-PROMETHEE II-Based Evaluation of Smart Community Services: A Case Study of Shenzhen, China. J Knowl Econ (2024). https://doi.org/10.1007/s13132-024-02114-5

Download citation

Received : 08 December 2023

Accepted : 16 May 2024

Published : 04 June 2024

DOI : https://doi.org/10.1007/s13132-024-02114-5

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Smart community services
• Evaluation method
• CRITIC method
• PROMETHEE II method
• Find a journal
• Publish with us
• Track your research

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• BMC Med Res Methodol

The case study approach

Sarah crowe.

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

Kathrin Cresswell

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

Ann Robertson

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

Anthony Avery

Aziz sheikh.

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

Introduction

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

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

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

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

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

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

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

What is a case study?

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

Definitions of a case study

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

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

What are case studies used for?

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

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

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

How are case studies conducted?

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

Defining the case

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

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

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

Selecting the case(s)

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

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

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

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

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

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

Collecting the data

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

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

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

Analysing, interpreting and reporting case studies

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

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

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

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

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

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

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

Potential pitfalls and mitigating actions when undertaking case study research

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

Conclusions

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

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

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

Pre-publication history

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

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

Acknowledgements

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

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