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• What Is a Case Study? | Definition, Examples & Methods

What Is a Case Study? | Definition, Examples & Methods

Published on May 8, 2019 by Shona McCombes . Revised on June 22, 2023.

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

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

Table of contents

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

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

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

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

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

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

TipIf your research is more practical in nature and aims to simultaneously investigate an issue as you solve it, consider conducting action research instead.

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

Example of an outlying case studyIn the 1960s the town of Roseto, Pennsylvania was discovered to have extremely low rates of heart disease compared to the US average. It became an important case study for understanding previously neglected causes of heart disease.

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

Example of a representative case studyIn the 1920s, two sociologists used Muncie, Indiana as a case study of a typical American city that supposedly exemplified the changing culture of the US at the time.

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

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

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

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

Example of a mixed methods case studyFor a case study of a wind farm development in a rural area, you could collect quantitative data on employment rates and business revenue, collect qualitative data on local people’s perceptions and experiences, and analyze local and national media coverage of the development.

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

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

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

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

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

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

• Normal distribution
• Degrees of freedom
• Null hypothesis
• Discourse analysis
• Control groups
• Mixed methods research
• Non-probability sampling
• Quantitative research
• Ecological validity

Research bias

• Rosenthal effect
• Implicit bias
• Cognitive bias
• Selection bias
• Negativity bias
• Status quo bias

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Definition of case study

Examples of case study in a sentence.

These examples are programmatically compiled from various online sources to illustrate current usage of the word 'case study.' Any opinions expressed in the examples do not represent those of Merriam-Webster or its editors. Send us feedback about these examples.

Word History

1914, in the meaning defined at sense 1

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What Is a Case Study?

An in-depth study of one person, group, or event

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

Cara Lustik is a fact-checker and copywriter.

Verywell / Colleen Tighe

Benefits and Limitations

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

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

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

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

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

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

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

On the negative side, a case study:

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

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

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

Case Study Examples

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

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

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

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

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

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

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

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

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

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

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

Where to Find Data

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

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

Section 1: A Case History

This section will have the following structure and content:

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

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

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

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

Section 2: Treatment Plan

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

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

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

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

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

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

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

A Word From Verywell

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

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

Simply Psychology. Case Study Method .

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

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

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

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

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• Volume 21, Issue 1
• What is a case study?
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• Roberta Heale 1 ,
• Alison Twycross 2
• 1 School of Nursing , Laurentian University , Sudbury , Ontario , Canada
• 2 School of Health and Social Care , London South Bank University , London , UK
• Correspondence to Dr Roberta Heale, School of Nursing, Laurentian University, Sudbury, ON P3E2C6, Canada; rheale{at}laurentian.ca

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

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What is it?

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

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

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

Benefits and limitations of case studies

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

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

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

Examples of case studies

Example 1: nurses’ paediatric pain management practices.

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

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

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

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

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

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

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

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

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

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

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

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

• Gustafsson J
• Calanzaro M
• Sandelowski M

Competing interests None declared.

Provenance and peer review Commissioned; internally peer reviewed.

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What Is a Case Study and Why You Should Use Them

Case studies can provide more insights into your business while helping you conduct further research with robust qualitative data analysis to learn more.

If you're in charge of running a company, then you're likely always looking for new ways to run your business more efficiently and increase your customer base while streamlining as many processes as possible.

Unfortunately, it can sometimes be difficult to determine how to go about implementing the proper program in order to be successful. This is why many business owners opt to conduct a case study, which can help significantly. Whether you've been struggling with brand consistency or some other problem, the right case study can identify why your problem exists as well as provide a way to rectify it.

A case study is a great tool that many businesses aren't even aware exists, and there are marketing experts like Mailchimp who can provide you with step-by-step assistance with implementing a plan with a case study. Many companies discover that not only do they need to start a blog in order to improve business, but they also need to create specific and relevant blog titles.

If your company already has a blog, then optimizing your blog posts may be helpful. Regardless of the obstacles that are preventing you from achieving all your professional goals, a case study can work wonders in helping you reverse this issue.

What is a case study?

A case study is a comprehensive report of the results of theory testing or examining emerging themes of a business in real life context. Case studies are also often used in the healthcare industry, conducting health services research with primary research interest around routinely collected healthcare data.

However, for businesses, the purpose of a case study is to help small business owners or company leaders identify the issues and conduct further research into what may be preventing success through information collection, client or customer interviews, and in-depth data analysis.

Knowing the case study definition is crucial for any business owner. By identifying the issues that are hindering a company from achieving all its goals, it's easier to make the necessary corrections to promote success through influenced data collection.

Why are case studies important?

Now that we've answered the questions, "what is a case study?" Why are case studies important? Some of the top reasons why case studies are important include:

• Understand complex issues: Even after you conduct a significant amount of market research , you might have a difficult time understanding exactly what it means. While you might have the basics down, conducting a case study can help you see how that information is applied. Then, when you see how the information can make a difference in business decisions, it could make it easier to understand complex issues.
• Collect data: A case study can also help with data tracking . A case study is a data collection method that can help you describe the information that you have available to you. Then, you can present that information in a way the reader can understand.
• Conduct evaluations: As you learn more about how to write a case study, remember that you can also use a case study to conduct evaluations of a specific situation. A case study is a great way to learn more about complex situations, and you can evaluate how various people responded in that situation. By conducting a case study evaluation, you can learn more about what has worked well, what has not, and what you might want to change in the future.
• Identify potential solutions: A case study can also help you identify solutions to potential problems. If you have an issue in your business that you are trying to solve, you may be able to take a look at a case study where someone has dealt with a similar situation in the past. For example, you may uncover data bias in a specific solution that you would like to address when you tackle the issue on your own. If you need help solving a difficult problem, a case study may be able to help you.

Remember that you can also use case studies to target your audience . If you want to show your audience that you have a significant level of expertise in a field, you may want to publish some case studies that you have handled in the past. Then, when your audience sees that you have had success in a specific area, they may be more likely to provide you with their business. In essence, case studies can be looked at as the original method of social proof, showcasing exactly how you can help someone solve their problems.

What are the benefits of writing a business case study?

Although writing a case study can seem like a tedious task, there are many benefits to conducting one through an in depth qualitative research process.

• Industry understanding: First of all, a case study can give you an in-depth understanding of your industry through a particular conceptual framework and help you identify hidden problems that are preventing you from transcending into the business world.
• Develop theories: If you decide to write a business case study, it provides you with an opportunity to develop new theories. You might have a theory about how to solve a specific problem, but you need to write a business case study to see exactly how that theory has unfolded in the past. Then, you can figure out if you want to apply your theory to a similar issue in the future.
• Evaluate interventions: When you write a business case study that focuses on a specific situation you have been through in the past, you can uncover whether that intervention was truly helpful. This can make it easier to figure out whether you want to use the same intervention in a similar situation in the future.
• Identify best practices: If you want to stay on top of the best practices in your field, conducting case studies can help by allowing you to identify patterns and trends and develop a new list of best practices that you can follow in the future.
• Versatility: Writing a case study also provides you with more versatility. If you want to expand your business applications, you need to figure out how you respond to various problems. When you run a business case study, you open the door to new opportunities, new applications, and new techniques that could help you make a difference in your business down the road.
• Solve problems: Writing a great case study can dramatically improve your chances of reversing your problem and improving your business.
• These are just a few of the biggest benefits you might experience if you decide to publish your case studies. They can be an effective tool for learning, showcasing your talents, and teaching some of your other employees. If you want to grow your audience , you may want to consider publishing some case studies.

What are the limitations of case studies?

Case studies can be a wonderful tool for any business of any size to use to gain an in-depth understanding of their clients, products, customers, or services, but there are limitations.

One limitation of case studies is the fact that, unless there are other recently published examples, there is nothing to compare them to since, most of the time, you are conducting a single, not multiple, case studies.

Another limitation is the fact that most case studies can lack scientific evidence.

Types of case studies

There are specific types of case studies to choose from, and each specific type will yield different results. Some case study types even overlap, which is sometimes more favorable, as they provide even more pertinent data.

Here are overviews of the different types of case studies, each with its own theoretical framework, so you can determine which type would be most effective for helping you meet your goals.

Explanatory case studies

Explanatory case studies are pretty straightforward, as they're not difficult to interpret. This type of case study is best if there aren't many variables involved because explanatory case studies can easily answer questions like "how" and "why" through theory development.

Exploratory case studies

An exploratory case study does exactly what its name implies: it goes into specific detail about the topic at hand in a natural, real-life context with qualitative research.

The benefits of exploratory case studies are limitless, with the main one being that it offers a great deal of flexibility. Having flexibility when writing a case study is important because you can't always predict what obstacles might arise during the qualitative research process.

Collective case studies

Collective case studies require you to study many different individuals in order to obtain usable data.

Case studies that involve an investigation of people will involve many different variables, all of which can't be predicted. Despite this fact, there are many benefits of collective case studies, including the fact that it allows an ongoing analysis of the data collected.

Intrinsic case studies

This type of study differs from the others as it focuses on the inquiry of one specific instance among many possibilities.

Many people prefer these types of case studies because it allows them to learn about the particular instance that they wish to investigate further.

Instrumental case studies

An instrumental case study is similar to an intrinsic one, as it focuses on a particular instance, whether it's a person, organization, or something different.

One thing that differentiates instrumental case studies from intrinsic ones is the fact that instrumental case studies aren't chosen merely because a person is interested in learning about a specific instance.

Tips for writing a case study

If you have decided to write case studies for your company, then you may be unsure of where to start or which type to conduct.

However, it doesn't have to be difficult or confusing to begin conducting a case study that will help you identify ways to improve your business.

Here are some helpful tips for writing your case studies:

1. Your case study must be written in the proper format

When writing a case study, the format that you should be similar to this:

Administrative summary

The executive summary is an overview of what your report will contain, written in a concise manner while providing real-life context.

Despite the fact that the executive summary should appear at the beginning of your case studies, it shouldn't be written until you've completed the entire report because if you write it before you finish the report, this summary may not be completely accurate.

Key problem statement

In this section of your case study, you will briefly describe the problem that you hope to solve by conducting the study. You will have the opportunity to elaborate on the problem that you're focusing on as you get into the breadth of the report.

Problem exploration

This part of the case study isn't as brief as the other two, and it goes into more detail about the problem at hand. Your problem exploration must include why the identified problem needs to be solved as well as the urgency of solving it.

Additionally, it must include justification for conducting the problem-solving, as the benefits must outweigh the efforts and costs.

Proposed resolution

This case study section will also be lengthier than the first two. It must include how you propose going about rectifying the problem. The "recommended solution" section must also include potential obstacles that you might experience, as well as how these will be managed.

Furthermore, you will need to list alternative solutions and explain the reason the chosen solution is best. Charts can enhance your report and make it easier to read, and provide as much proof to substantiate your claim as possible.

Overview of monetary consideration

An overview of monetary consideration is essential for all case studies, as it will be used to convince all involved parties why your project should be funded. You must successfully convince them that the cost is worth the investment it will require. It's important that you stress the necessity for this particular case study and explain the expected outcome.

Execution timeline

In the execution times of case studies, you explain how long you predict it will take to implement your study. The shorter the time it will take to implement your plan, the more apt it is to be approved. However, be sure to provide a reasonable timeline, taking into consideration any additional time that might be needed due to obstacles.

Always include a conclusion in your case study. This is where you will briefly wrap up your entire proposal, stressing the benefits of completing the data collection and data analysis in order to rectify your problem.

2. Make it clear and comprehensive

You want to write your case studies with as much clarity as possible so that every aspect of the report is understood. Be sure to double-check your grammar, spelling, punctuation, and more, as you don't want to submit a poorly-written document.

Not only would a poorly-written case study fail to prove that what you are trying to achieve is important, but it would also increase the chances that your report will be tossed aside and not taken seriously.

3. Don't rush through the process

Writing the perfect case study takes time and patience. Rushing could result in your forgetting to include information that is crucial to your entire study. Don't waste your time creating a study that simply isn't ready. Take the necessary time to perform all the research necessary to write the best case study possible.

Depending on the case study, conducting case study research could mean using qualitative methods, quantitative methods, or both. Qualitative research questions focus on non-numerical data, such as how people feel, their beliefs, their experiences, and so on.

Meanwhile, quantitative research questions focus on numerical or statistical data collection to explain causal links or get an in-depth picture.

It is also important to collect insightful and constructive feedback. This will help you better understand the outcome as well as any changes you need to make to future case studies. Consider using formal and informal ways to collect feedback to ensure that you get a range of opinions and perspectives.

4. Be confident in your theory development

While writing your case study or conducting your formal experimental investigation, you should have confidence in yourself and what you're proposing in your report. If you took the time to gather all the pertinent data collected to complete the report, don't second-guess yourself or doubt your abilities. If you believe your report will be amazing, then it likely will be.

5. Case studies and all qualitative research are long

It's expected that multiple case studies are going to be incredibly boring, and there is no way around this. However, it doesn't mean you can choose your language carefully in order to keep your audience as engaged as possible.

If your audience loses interest in your case study at the beginning, for whatever reason, then this increases the likelihood that your case study will not be funded.

Case study examples

If you want to learn more about how to write a case study, it might be beneficial to take a look at a few case study examples. Below are a few interesting case study examples you may want to take a closer look at.

• Phineas Gage by John Martin Marlow : One of the most famous case studies comes from the medical field, and it is about the story of Phineas Gage, a man who had a railroad spike driven through his head in 1848. As he was working on a railroad, an explosive charge went off prematurely, sending a railroad rod through his head. Even though he survived this incident, he lost his left eye. However, Phineas Gage was studied extensively over the years because his experiences had a significant, lasting impact on his personality. This served as a case study because his injury showed different parts of the brain have different functions.
• Kitty Genovese and the bystander effect : This is a tragic case study that discusses the murder of Kitty Genovese, a woman attacked and murdered in Queens, New York City. Shockingly, while numerous neighbors watched the scene, nobody called for help because they assumed someone else would. This case study helped to define the bystander effect, which is when a person fails to intervene during an emergency because other people are around.
• Henry Molaison and the study of memory : Henry Molaison lost his memory and suffered from debilitating amnesia. He suffered from childhood epilepsy, and medical professionals attempted to remove the part of his brain that was causing his seizures. He had a portion of his brain removed, but it completely took away his ability to hold memories. Even though he went on to live until the age of 82, he was always forced to live in the present moment, as he was completely unable to form new memories.

Case study FAQs

When should you do a case study.

There are several scenarios when conducting a case study can be beneficial. Case studies are often used when there's a "why" or "how" question that needs to be answered. Case studies are also beneficial when trying to understand a complex phenomenon, there's limited research on a topic, or when you're looking for practical solutions to a problem.

How can case study results be used to make business decisions?

You can use the results from a case study to make future business decisions if you find yourself in a similar situation. As you assess the results of a case study, you can identify best practices, evaluate the effectiveness of an intervention, generate new and creative ideas, or get a better understanding of customer needs.

How are case studies different from other research methodologies?

When compared to other research methodologies, such as experimental or qualitative research methodology, a case study does not require a representative sample. For example, if you are performing quantitative research, you have a lot of subjects that expand your sample size. If you are performing experimental research, you may have a random sample in front of you. A case study is usually designed to deliberately focus on unusual situations, which allows it to shed new light on a specific business research problem.

Writing multiple case studies for your business

If you're feeling overwhelmed by the idea of writing a case study and it seems completely foreign, then you aren't alone. Writing a case study for a business is a very big deal, but fortunately, there is help available because an example of a case study doesn't always help.

Mailchimp, a well-known marketing company that provides comprehensive marketing support for all sorts of businesses, can assist you with your case study, or you can review one of their own recently published examples.

Mailchimp can assist you with developing the most effective content strategy to increase your chances of being as successful as possible. Mailchimp's content studio is a great tool that can help your business immensely.

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• Case Study | Definition, Examples & Methods

Case Study | Definition, Examples & Methods

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

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

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

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.

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

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

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.

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Designing and Conducting Case Studies

This guide examines case studies, a form of qualitative descriptive research that is used to look at individuals, a small group of participants, or a group as a whole. Researchers collect data about participants using participant and direct observations, interviews, protocols, tests, examinations of records, and collections of writing samples. Starting with a definition of the case study, the guide moves to a brief history of this research method. Using several well documented case studies, the guide then looks at applications and methods including data collection and analysis. A discussion of ways to handle validity, reliability, and generalizability follows, with special attention to case studies as they are applied to composition studies. Finally, this guide examines the strengths and weaknesses of case studies.

Definition and Overview

Case study refers to the collection and presentation of detailed information about a particular participant or small group, frequently including the accounts of subjects themselves. A form of qualitative descriptive research, the case study looks intensely at an individual or small participant pool, drawing conclusions only about that participant or group and only in that specific context. Researchers do not focus on the discovery of a universal, generalizable truth, nor do they typically look for cause-effect relationships; instead, emphasis is placed on exploration and description.

Case studies typically examine the interplay of all variables in order to provide as complete an understanding of an event or situation as possible. This type of comprehensive understanding is arrived at through a process known as thick description, which involves an in-depth description of the entity being evaluated, the circumstances under which it is used, the characteristics of the people involved in it, and the nature of the community in which it is located. Thick description also involves interpreting the meaning of demographic and descriptive data such as cultural norms and mores, community values, ingrained attitudes, and motives.

Unlike quantitative methods of research, like the survey, which focus on the questions of who, what, where, how much, and how many, and archival analysis, which often situates the participant in some form of historical context, case studies are the preferred strategy when how or why questions are asked. Likewise, they are the preferred method when the researcher has little control over the events, and when there is a contemporary focus within a real life context. In addition, unlike more specifically directed experiments, case studies require a problem that seeks a holistic understanding of the event or situation in question using inductive logic--reasoning from specific to more general terms.

In scholarly circles, case studies are frequently discussed within the context of qualitative research and naturalistic inquiry. Case studies are often referred to interchangeably with ethnography, field study, and participant observation. The underlying philosophical assumptions in the case are similar to these types of qualitative research because each takes place in a natural setting (such as a classroom, neighborhood, or private home), and strives for a more holistic interpretation of the event or situation under study.

Unlike more statistically-based studies which search for quantifiable data, the goal of a case study is to offer new variables and questions for further research. F.H. Giddings, a sociologist in the early part of the century, compares statistical methods to the case study on the basis that the former are concerned with the distribution of a particular trait, or a small number of traits, in a population, whereas the case study is concerned with the whole variety of traits to be found in a particular instance" (Hammersley 95).

Case studies are not a new form of research; naturalistic inquiry was the primary research tool until the development of the scientific method. The fields of sociology and anthropology are credited with the primary shaping of the concept as we know it today. However, case study research has drawn from a number of other areas as well: the clinical methods of doctors; the casework technique being developed by social workers; the methods of historians and anthropologists, plus the qualitative descriptions provided by quantitative researchers like LePlay; and, in the case of Robert Park, the techniques of newspaper reporters and novelists.

Park was an ex-newspaper reporter and editor who became very influential in developing sociological case studies at the University of Chicago in the 1920s. As a newspaper professional he coined the term "scientific" or "depth" reporting: the description of local events in a way that pointed to major social trends. Park viewed the sociologist as "merely a more accurate, responsible, and scientific reporter." Park stressed the variety and value of human experience. He believed that sociology sought to arrive at natural, but fluid, laws and generalizations in regard to human nature and society. These laws weren't static laws of the kind sought by many positivists and natural law theorists, but rather, they were laws of becoming--with a constant possibility of change. Park encouraged students to get out of the library, to quit looking at papers and books, and to view the constant experiment of human experience. He writes, "Go and sit in the lounges of the luxury hotels and on the doorsteps of the flophouses; sit on the Gold Coast settees and on the slum shakedowns; sit in the Orchestra Hall and in the Star and Garter Burlesque. In short, gentlemen [sic], go get the seats of your pants dirty in real research."

But over the years, case studies have drawn their share of criticism. In fact, the method had its detractors from the start. In the 1920s, the debate between pro-qualitative and pro-quantitative became quite heated. Case studies, when compared to statistics, were considered by many to be unscientific. From the 1930's on, the rise of positivism had a growing influence on quantitative methods in sociology. People wanted static, generalizable laws in science. The sociological positivists were looking for stable laws of social phenomena. They criticized case study research because it failed to provide evidence of inter subjective agreement. Also, they condemned it because of the few number of cases studied and that the under-standardized character of their descriptions made generalization impossible. By the 1950s, quantitative methods, in the form of survey research, had become the dominant sociological approach and case study had become a minority practice.

Educational Applications

The 1950's marked the dawning of a new era in case study research, namely that of the utilization of the case study as a teaching method. "Instituted at Harvard Business School in the 1950s as a primary method of teaching, cases have since been used in classrooms and lecture halls alike, either as part of a course of study or as the main focus of the course to which other teaching material is added" (Armisted 1984). The basic purpose of instituting the case method as a teaching strategy was "to transfer much of the responsibility for learning from the teacher on to the student, whose role, as a result, shifts away from passive absorption toward active construction" (Boehrer 1990). Through careful examination and discussion of various cases, "students learn to identify actual problems, to recognize key players and their agendas, and to become aware of those aspects of the situation that contribute to the problem" (Merseth 1991). In addition, students are encouraged to "generate their own analysis of the problems under consideration, to develop their own solutions, and to practically apply their own knowledge of theory to these problems" (Boyce 1993). Along the way, students also develop "the power to analyze and to master a tangled circumstance by identifying and delineating important factors; the ability to utilize ideas, to test them against facts, and to throw them into fresh combinations" (Merseth 1991).

In addition to the practical application and testing of scholarly knowledge, case discussions can also help students prepare for real-world problems, situations and crises by providing an approximation of various professional environments (i.e. classroom, board room, courtroom, or hospital). Thus, through the examination of specific cases, students are given the opportunity to work out their own professional issues through the trials, tribulations, experiences, and research findings of others. An obvious advantage to this mode of instruction is that it allows students the exposure to settings and contexts that they might not otherwise experience. For example, a student interested in studying the effects of poverty on minority secondary student's grade point averages and S.A.T. scores could access and analyze information from schools as geographically diverse as Los Angeles, New York City, Miami, and New Mexico without ever having to leave the classroom.

The case study method also incorporates the idea that students can learn from one another "by engaging with each other and with each other's ideas, by asserting something and then having it questioned, challenged and thrown back at them so that they can reflect on what they hear, and then refine what they say" (Boehrer 1990). In summary, students can direct their own learning by formulating questions and taking responsibility for the study.

Types and Design Concerns

Researchers use multiple methods and approaches to conduct case studies.

Types of Case Studies

Under the more generalized category of case study exist several subdivisions, each of which is custom selected for use depending upon the goals and/or objectives of the investigator. These types of case study include the following:

Illustrative Case Studies These are primarily descriptive studies. They typically utilize one or two instances of an event to show what a situation is like. Illustrative case studies serve primarily to make the unfamiliar familiar and to give readers a common language about the topic in question.

Exploratory (or pilot) Case Studies These are condensed case studies performed before implementing a large scale investigation. Their basic function is to help identify questions and select types of measurement prior to the main investigation. The primary pitfall of this type of study is that initial findings may seem convincing enough to be released prematurely as conclusions.

Cumulative Case Studies These serve to aggregate information from several sites collected at different times. The idea behind these studies is the collection of past studies will allow for greater generalization without additional cost or time being expended on new, possibly repetitive studies.

Critical Instance Case Studies These examine one or more sites for either the purpose of examining a situation of unique interest with little to no interest in generalizability, or to call into question or challenge a highly generalized or universal assertion. This method is useful for answering cause and effect questions.

Identifying a Theoretical Perspective

Much of the case study's design is inherently determined for researchers, depending on the field from which they are working. In composition studies, researchers are typically working from a qualitative, descriptive standpoint. In contrast, physicists will approach their research from a more quantitative perspective. Still, in designing the study, researchers need to make explicit the questions to be explored and the theoretical perspective from which they will approach the case. The three most commonly adopted theories are listed below:

Individual Theories These focus primarily on the individual development, cognitive behavior, personality, learning and disability, and interpersonal interactions of a particular subject.

Organizational Theories These focus on bureaucracies, institutions, organizational structure and functions, or excellence in organizational performance.

Social Theories These focus on urban development, group behavior, cultural institutions, or marketplace functions.

Two examples of case studies are used consistently throughout this chapter. The first, a study produced by Berkenkotter, Huckin, and Ackerman (1988), looks at a first year graduate student's initiation into an academic writing program. The study uses participant-observer and linguistic data collecting techniques to assess the student's knowledge of appropriate discourse conventions. Using the pseudonym Nate to refer to the subject, the study sought to illuminate the particular experience rather than to generalize about the experience of fledgling academic writers collectively.

For example, in Berkenkotter, Huckin, and Ackerman's (1988) study we are told that the researchers are interested in disciplinary communities. In the first paragraph, they ask what constitutes membership in a disciplinary community and how achieving membership might affect a writer's understanding and production of texts. In the third paragraph they state that researchers must negotiate their claims "within the context of his sub specialty's accepted knowledge and methodology." In the next paragraph they ask, "How is literacy acquired? What is the process through which novices gain community membership? And what factors either aid or hinder students learning the requisite linguistic behaviors?" This introductory section ends with a paragraph in which the study's authors claim that during the course of the study, the subject, Nate, successfully makes the transition from "skilled novice" to become an initiated member of the academic discourse community and that his texts exhibit linguistic changes which indicate this transition. In the next section the authors make explicit the sociolinguistic theoretical and methodological assumptions on which the study is based (1988). Thus the reader has a good understanding of the authors' theoretical background and purpose in conducting the study even before it is explicitly stated on the fourth page of the study. "Our purpose was to examine the effects of the educational context on one graduate student's production of texts as he wrote in different courses and for different faculty members over the academic year 1984-85." The goal of the study then, was to explore the idea that writers must be initiated into a writing community, and that this initiation will change the way one writes.

The second example is Janet Emig's (1971) study of the composing process of a group of twelfth graders. In this study, Emig seeks to answer the question of what happens to the self as a result educational stimuli in terms of academic writing. The case study used methods such as protocol analysis, tape-recorded interviews, and discourse analysis.

In the case of Janet Emig's (1971) study of the composing process of eight twelfth graders, four specific hypotheses were made:

• Twelfth grade writers engage in two modes of composing: reflexive and extensive.
• These differences can be ascertained and characterized through having the writers compose aloud their composition process.
• A set of implied stylistic principles governs the writing process.
• For twelfth grade writers, extensive writing occurs chiefly as a school-sponsored activity, or reflexive, as a self-sponsored activity.

In this study, the chief distinction is between the two dominant modes of composing among older, secondary school students. The distinctions are:

• The reflexive mode, which focuses on the writer's thoughts and feelings.
• The extensive mode, which focuses on conveying a message.

Emig also outlines the specific questions which guided the research in the opening pages of her Review of Literature , preceding the report.

Designing a Case Study

After considering the different sub categories of case study and identifying a theoretical perspective, researchers can begin to design their study. Research design is the string of logic that ultimately links the data to be collected and the conclusions to be drawn to the initial questions of the study. Typically, research designs deal with at least four problems:

• What questions to study
• What data are relevant
• What data to collect
• How to analyze that data

In other words, a research design is basically a blueprint for getting from the beginning to the end of a study. The beginning is an initial set of questions to be answered, and the end is some set of conclusions about those questions.

Because case studies are conducted on topics as diverse as Anglo-Saxon Literature (Thrane 1986) and AIDS prevention (Van Vugt 1994), it is virtually impossible to outline any strict or universal method or design for conducting the case study. However, Robert K. Yin (1993) does offer five basic components of a research design:

• A study's questions.
• A study's propositions (if any).
• A study's units of analysis.
• The logic that links the data to the propositions.
• The criteria for interpreting the findings.

In addition to these five basic components, Yin also stresses the importance of clearly articulating one's theoretical perspective, determining the goals of the study, selecting one's subject(s), selecting the appropriate method(s) of collecting data, and providing some considerations to the composition of the final report.

Conducting Case Studies

To obtain as complete a picture of the participant as possible, case study researchers can employ a variety of approaches and methods. These approaches, methods, and related issues are discussed in depth in this section.

Method: Single or Multi-modal?

To obtain as complete a picture of the participant as possible, case study researchers can employ a variety of methods. Some common methods include interviews , protocol analyses, field studies, and participant-observations. Emig (1971) chose to use several methods of data collection. Her sources included conversations with the students, protocol analysis, discrete observations of actual composition, writing samples from each student, and school records (Lauer and Asher 1988).

Berkenkotter, Huckin, and Ackerman (1988) collected data by observing classrooms, conducting faculty and student interviews, collecting self reports from the subject, and by looking at the subject's written work.

A study that was criticized for using a single method model was done by Flower and Hayes (1984). In this study that explores the ways in which writers use different forms of knowing to create space, the authors used only protocol analysis to gather data. The study came under heavy fire because of their decision to use only one method.

Participant Selection

Case studies can use one participant, or a small group of participants. However, it is important that the participant pool remain relatively small. The participants can represent a diverse cross section of society, but this isn't necessary.

For example, the Berkenkotter, Huckin, and Ackerman (1988) study looked at just one participant, Nate. By contrast, in Janet Emig's (1971) study of the composition process of twelfth graders, eight participants were selected representing a diverse cross section of the community, with volunteers from an all-white upper-middle-class suburban school, an all-black inner-city school, a racially mixed lower-middle-class school, an economically and racially mixed school, and a university school.

Often, a brief "case history" is done on the participants of the study in order to provide researchers with a clearer understanding of their participants, as well as some insight as to how their own personal histories might affect the outcome of the study. For instance, in Emig's study, the investigator had access to the school records of five of the participants, and to standardized test scores for the remaining three. Also made available to the researcher was the information that three of the eight students were selected as NCTE Achievement Award winners. These personal histories can be useful in later stages of the study when data are being analyzed and conclusions drawn.

Data Collection

There are six types of data collected in case studies:

• Archival records.
• Interviews.
• Direct observation.
• Participant observation.

In the field of composition research, these six sources might be:

• A writer's drafts.
• School records of student writers.
• Transcripts of interviews with a writer.
• Transcripts of conversations between writers (and protocols).
• Videotapes and notes from direct field observations.
• Hard copies of a writer's work on computer.

Depending on whether researchers have chosen to use a single or multi-modal approach for the case study, they may choose to collect data from one or any combination of these sources.

Protocols, that is, transcriptions of participants talking aloud about what they are doing as they do it, have been particularly common in composition case studies. For example, in Emig's (1971) study, the students were asked, in four different sessions, to give oral autobiographies of their writing experiences and to compose aloud three themes in the presence of a tape recorder and the investigator.

In some studies, only one method of data collection is conducted. For example, the Flower and Hayes (1981) report on the cognitive process theory of writing depends on protocol analysis alone. However, using multiple sources of evidence to increase the reliability and validity of the data can be advantageous.

Case studies are likely to be much more convincing and accurate if they are based on several different sources of information, following a corroborating mode. This conclusion is echoed among many composition researchers. For example, in her study of predrafting processes of high and low-apprehensive writers, Cynthia Selfe (1985) argues that because "methods of indirect observation provide only an incomplete reflection of the complex set of processes involved in composing, a combination of several such methods should be used to gather data in any one study." Thus, in this study, Selfe collected her data from protocols, observations of students role playing their writing processes, audio taped interviews with the students, and videotaped observations of the students in the process of composing.

It can be said then, that cross checking data from multiple sources can help provide a multidimensional profile of composing activities in a particular setting. Sharan Merriam (1985) suggests "checking, verifying, testing, probing, and confirming collected data as you go, arguing that this process will follow in a funnel-like design resulting in less data gathering in later phases of the study along with a congruent increase in analysis checking, verifying, and confirming."

It is important to note that in case studies, as in any qualitative descriptive research, while researchers begin their studies with one or several questions driving the inquiry (which influence the key factors the researcher will be looking for during data collection), a researcher may find new key factors emerging during data collection. These might be unexpected patterns or linguistic features which become evident only during the course of the research. While not bearing directly on the researcher's guiding questions, these variables may become the basis for new questions asked at the end of the report, thus linking to the possibility of further research.

Data Analysis

As the information is collected, researchers strive to make sense of their data. Generally, researchers interpret their data in one of two ways: holistically or through coding. Holistic analysis does not attempt to break the evidence into parts, but rather to draw conclusions based on the text as a whole. Flower and Hayes (1981), for example, make inferences from entire sections of their students' protocols, rather than searching through the transcripts to look for isolatable characteristics.

However, composition researchers commonly interpret their data by coding, that is by systematically searching data to identify and/or categorize specific observable actions or characteristics. These observable actions then become the key variables in the study. Sharan Merriam (1988) suggests seven analytic frameworks for the organization and presentation of data:

• The role of participants.
• The network analysis of formal and informal exchanges among groups.
• Historical.
• Thematical.
• Ritual and symbolism.
• Critical incidents that challenge or reinforce fundamental beliefs, practices, and values.

There are two purposes of these frameworks: to look for patterns among the data and to look for patterns that give meaning to the case study.

As stated above, while most researchers begin their case studies expecting to look for particular observable characteristics, it is not unusual for key variables to emerge during data collection. Typical variables coded in case studies of writers include pauses writers make in the production of a text, the use of specific linguistic units (such as nouns or verbs), and writing processes (planning, drafting, revising, and editing). In the Berkenkotter, Huckin, and Ackerman (1988) study, for example, researchers coded the participant's texts for use of connectives, discourse demonstratives, average sentence length, off-register words, use of the first person pronoun, and the ratio of definite articles to indefinite articles.

Since coding is inherently subjective, more than one coder is usually employed. In the Berkenkotter, Huckin, and Ackerman (1988) study, for example, three rhetoricians were employed to code the participant's texts for off-register phrases. The researchers established the agreement among the coders before concluding that the participant used fewer off-register words as the graduate program progressed.

Composing the Case Study Report

In the many forms it can take, "a case study is generically a story; it presents the concrete narrative detail of actual, or at least realistic events, it has a plot, exposition, characters, and sometimes even dialogue" (Boehrer 1990). Generally, case study reports are extensively descriptive, with "the most problematic issue often referred to as being the determination of the right combination of description and analysis" (1990). Typically, authors address each step of the research process, and attempt to give the reader as much context as possible for the decisions made in the research design and for the conclusions drawn.

This contextualization usually includes a detailed explanation of the researchers' theoretical positions, of how those theories drove the inquiry or led to the guiding research questions, of the participants' backgrounds, of the processes of data collection, of the training and limitations of the coders, along with a strong attempt to make connections between the data and the conclusions evident.

Although the Berkenkotter, Huckin, and Ackerman (1988) study does not, case study reports often include the reactions of the participants to the study or to the researchers' conclusions. Because case studies tend to be exploratory, most end with implications for further study. Here researchers may identify significant variables that emerged during the research and suggest studies related to these, or the authors may suggest further general questions that their case study generated.

For example, Emig's (1971) study concludes with a section dedicated solely to the topic of implications for further research, in which she suggests several means by which this particular study could have been improved, as well as questions and ideas raised by this study which other researchers might like to address, such as: is there a correlation between a certain personality and a certain composing process profile (e.g. is there a positive correlation between ego strength and persistence in revising)?

Also included in Emig's study is a section dedicated to implications for teaching, which outlines the pedagogical ramifications of the study's findings for teachers currently involved in high school writing programs.

Sharan Merriam (1985) also offers several suggestions for alternative presentations of data:

• Prepare specialized condensations for appropriate groups.
• Replace narrative sections with a series of answers to open-ended questions.
• Present "skimmer's" summaries at beginning of each section.
• Incorporate headlines that encapsulate information from text.
• Prepare analytic summaries with supporting data appendixes.
• Present data in colorful and/or unique graphic representations.

Issues of Validity and Reliability

Once key variables have been identified, they can be analyzed. Reliability becomes a key concern at this stage, and many case study researchers go to great lengths to ensure that their interpretations of the data will be both reliable and valid. Because issues of validity and reliability are an important part of any study in the social sciences, it is important to identify some ways of dealing with results.

Multi-modal case study researchers often balance the results of their coding with data from interviews or writer's reflections upon their own work. Consequently, the researchers' conclusions become highly contextualized. For example, in a case study which looked at the time spent in different stages of the writing process, Berkenkotter concluded that her participant, Donald Murray, spent more time planning his essays than in other writing stages. The report of this case study is followed by Murray's reply, wherein he agrees with some of Berkenkotter's conclusions and disagrees with others.

As is the case with other research methodologies, issues of external validity, construct validity, and reliability need to be carefully considered.

Commentary on Case Studies

Researchers often debate the relative merits of particular methods, among them case study. In this section, we comment on two key issues. To read the commentaries, choose any of the items below:

Strengths and Weaknesses of Case Studies

Most case study advocates point out that case studies produce much more detailed information than what is available through a statistical analysis. Advocates will also hold that while statistical methods might be able to deal with situations where behavior is homogeneous and routine, case studies are needed to deal with creativity, innovation, and context. Detractors argue that case studies are difficult to generalize because of inherent subjectivity and because they are based on qualitative subjective data, generalizable only to a particular context.

Flexibility

The case study approach is a comparatively flexible method of scientific research. Because its project designs seem to emphasize exploration rather than prescription or prediction, researchers are comparatively freer to discover and address issues as they arise in their experiments. In addition, the looser format of case studies allows researchers to begin with broad questions and narrow their focus as their experiment progresses rather than attempt to predict every possible outcome before the experiment is conducted.

Emphasis on Context

By seeking to understand as much as possible about a single subject or small group of subjects, case studies specialize in "deep data," or "thick description"--information based on particular contexts that can give research results a more human face. This emphasis can help bridge the gap between abstract research and concrete practice by allowing researchers to compare their firsthand observations with the quantitative results obtained through other methods of research.

Inherent Subjectivity

"The case study has long been stereotyped as the weak sibling among social science methods," and is often criticized as being too subjective and even pseudo-scientific. Likewise, "investigators who do case studies are often regarded as having deviated from their academic disciplines, and their investigations as having insufficient precision (that is, quantification), objectivity and rigor" (Yin 1989). Opponents cite opportunities for subjectivity in the implementation, presentation, and evaluation of case study research. The approach relies on personal interpretation of data and inferences. Results may not be generalizable, are difficult to test for validity, and rarely offer a problem-solving prescription. Simply put, relying on one or a few subjects as a basis for cognitive extrapolations runs the risk of inferring too much from what might be circumstance.

High Investment

Case studies can involve learning more about the subjects being tested than most researchers would care to know--their educational background, emotional background, perceptions of themselves and their surroundings, their likes, dislikes, and so on. Because of its emphasis on "deep data," the case study is out of reach for many large-scale research projects which look at a subject pool in the tens of thousands. A budget request of $10,000 to examine 200 subjects sounds more efficient than a similar request to examine four subjects.

Ethical Considerations

Researchers conducting case studies should consider certain ethical issues. For example, many educational case studies are often financed by people who have, either directly or indirectly, power over both those being studied and those conducting the investigation (1985). This conflict of interests can hinder the credibility of the study.

The personal integrity, sensitivity, and possible prejudices and/or biases of the investigators need to be taken into consideration as well. Personal biases can creep into how the research is conducted, alternative research methods used, and the preparation of surveys and questionnaires.

A common complaint in case study research is that investigators change direction during the course of the study unaware that their original research design was inadequate for the revised investigation. Thus, the researchers leave unknown gaps and biases in the study. To avoid this, researchers should report preliminary findings so that the likelihood of bias will be reduced.

Concerns about Reliability, Validity, and Generalizability

Merriam (1985) offers several suggestions for how case study researchers might actively combat the popular attacks on the validity, reliability, and generalizability of case studies:

• Prolong the Processes of Data Gathering on Site: This will help to insure the accuracy of the findings by providing the researcher with more concrete information upon which to formulate interpretations.
• Employ the Process of "Triangulation": Use a variety of data sources as opposed to relying solely upon one avenue of observation. One example of such a data check would be what McClintock, Brannon, and Maynard (1985) refer to as a "case cluster method," that is, when a single unit within a larger case is randomly sampled, and that data treated quantitatively." For instance, in Emig's (1971) study, the case cluster method was employed, singling out the productivity of a single student named Lynn. This cluster profile included an advanced case history of the subject, specific examination and analysis of individual compositions and protocols, and extensive interview sessions. The seven remaining students were then compared with the case of Lynn, to ascertain if there are any shared, or unique dimensions to the composing process engaged in by these eight students.
• Conduct Member Checks: Initiate and maintain an active corroboration on the interpretation of data between the researcher and those who provided the data. In other words, talk to your subjects.
• Collect Referential Materials: Complement the file of materials from the actual site with additional document support. For example, Emig (1971) supports her initial propositions with historical accounts by writers such as T.S. Eliot, James Joyce, and D.H. Lawrence. Emig also cites examples of theoretical research done with regards to the creative process, as well as examples of empirical research dealing with the writing of adolescents. Specific attention is then given to the four stages description of the composing process delineated by Helmoltz, Wallas, and Cowley, as it serves as the focal point in this study.
• Engage in Peer Consultation: Prior to composing the final draft of the report, researchers should consult with colleagues in order to establish validity through pooled judgment.

Although little can be done to combat challenges concerning the generalizability of case studies, "most writers suggest that qualitative research should be judged as credible and confirmable as opposed to valid and reliable" (Merriam 1985). Likewise, it has been argued that "rather than transplanting statistical, quantitative notions of generalizability and thus finding qualitative research inadequate, it makes more sense to develop an understanding of generalization that is congruent with the basic characteristics of qualitative inquiry" (1985). After all, criticizing the case study method for being ungeneralizable is comparable to criticizing a washing machine for not being able to tell the correct time. In other words, it is unjust to criticize a method for not being able to do something which it was never originally designed to do in the first place.

Annotated Bibliography

Armisted, C. (1984). How Useful are Case Studies. Training and Development Journal, 38 (2), 75-77.

This article looks at eight types of case studies, offers pros and cons of using case studies in the classroom, and gives suggestions for successfully writing and using case studies.

Bardovi-Harlig, K. (1997). Beyond Methods: Components of Second Language Teacher Education . New York: McGraw-Hill.

A compilation of various research essays which address issues of language teacher education. Essays included are: "Non-native reading research and theory" by Lee, "The case for Psycholinguistics" by VanPatten, and "Assessment and Second Language Teaching" by Gradman and Reed.

Bartlett, L. (1989). A Question of Good Judgment; Interpretation Theory and Qualitative Enquiry Address. 70th Annual Meeting of the American Educational Research Association. San Francisco.

Bartlett selected "quasi-historical" methodology, which focuses on the "truth" found in case records, as one that will provide "good judgments" in educational inquiry. He argues that although the method is not comprehensive, it can try to connect theory with practice.

Baydere, S. et. al. (1993). Multimedia conferencing as a tool for collaborative writing: a case study in Computer Supported Collaborative Writing. New York: Springer-Verlag.

The case study by Baydere et. al. is just one of the many essays in this book found in the series "Computer Supported Cooperative Work." Denley, Witefield and May explore similar issues in their essay, "A case study in task analysis for the design of a collaborative document production system."

Berkenkotter, C., Huckin, T., N., & Ackerman J. (1988). Conventions, Conversations, and the Writer: Case Study of a Student in a Rhetoric Ph.D. Program. Research in the Teaching of English, 22, 9-44.

The authors focused on how the writing of their subject, Nate or Ackerman, changed as he became more acquainted or familiar with his field's discourse community.

Berninger, V., W., and Gans, B., M. (1986). Language Profiles in Nonspeaking Individuals of Normal Intelligence with Severe Cerebral Palsy. Augmentative and Alternative Communication, 2, 45-50.

Argues that generalizations about language abilities in patients with severe cerebral palsy (CP) should be avoided. Standardized tests of different levels of processing oral language, of processing written language, and of producing written language were administered to 3 male participants (aged 9, 16, and 40 yrs).

Bockman, J., R., and Couture, B. (1984). The Case Method in Technical Communication: Theory and Models. Texas: Association of Teachers of Technical Writing.

Examines the study and teaching of technical writing, communication of technical information, and the case method in terms of those applications.

Boehrer, J. (1990). Teaching With Cases: Learning to Question. New Directions for Teaching and Learning, 42 41-57.

This article discusses the origins of the case method, looks at the question of what is a case, gives ideas about learning in case teaching, the purposes it can serve in the classroom, the ground rules for the case discussion, including the role of the question, and new directions for case teaching.

Bowman, W. R. (1993). Evaluating JTPA Programs for Economically Disadvantaged Adults: A Case Study of Utah and General Findings . Washington: National Commission for Employment Policy.

"To encourage state-level evaluations of JTPA, the Commission and the State of Utah co-sponsored this report on the effectiveness of JTPA Title II programs for adults in Utah. The technique used is non-experimental and the comparison group was selected from registrants with Utah's Employment Security. In a step-by-step approach, the report documents how non-experimental techniques can be applied and several specific technical issues can be addressed."

Boyce, A. (1993) The Case Study Approach for Pedagogists. Annual Meeting of the American Alliance for Health, Physical Education, Recreation and Dance. (Address). Washington DC.

This paper addresses how case studies 1) bridge the gap between teaching theory and application, 2) enable students to analyze problems and develop solutions for situations that will be encountered in the real world of teaching, and 3) helps students to evaluate the feasibility of alternatives and to understand the ramifications of a particular course of action.

Carson, J. (1993) The Case Study: Ideal Home of WAC Quantitative and Qualitative Data. Annual Meeting of the Conference on College Composition and Communication. (Address). San Diego.

"Increasingly, one of the most pressing questions for WAC advocates is how to keep [WAC] programs going in the face of numerous difficulties. Case histories offer the best chance for fashioning rhetorical arguments to keep WAC programs going because they offer the opportunity to provide a coherent narrative that contextualizes all documents and data, including what is generally considered scientific data. A case study of the WAC program, . . . at Robert Morris College in Pittsburgh demonstrates the advantages of this research method. Such studies are ideal homes for both naturalistic and positivistic data as well as both quantitative and qualitative information."

---. (1991). A Cognitive Process Theory of Writing. College Composition and Communication. 32. 365-87.

No abstract available.

Cromer, R. (1994) A Case Study of Dissociations Between Language and Cognition. Constraints on Language Acquisition: Studies of Atypical Children . Hillsdale: Lawrence Erlbaum Associates, 141-153.

Crossley, M. (1983) Case Study in Comparative and International Education: An Approach to Bridging the Theory-Practice Gap. Proceedings of the 11th Annual Conference of the Australian Comparative and International Education Society. Hamilton, NZ.

Case study research, as presented here, helps bridge the theory-practice gap in comparative and international research studies of education because it focuses on the practical, day-to-day context rather than on the national arena. The paper asserts that the case study method can be valuable at all levels of research, formation, and verification of theories in education.

Daillak, R., H., and Alkin, M., C. (1982). Qualitative Studies in Context: Reflections on the CSE Studies of Evaluation Use . California: EDRS

The report shows how the Center of the Study of Evaluation (CSE) applied qualitative techniques to a study of evaluation information use in local, Los Angeles schools. It critiques the effectiveness and the limitations of using case study, evaluation, field study, and user interview survey methodologies.

Davey, L. (1991). The Application of Case Study Evaluations. ERIC/TM Digest.

This article examines six types of case studies, the type of evaluation questions that can be answered, the functions served, some design features, and some pitfalls of the method.

Deutch, C. E. (1996). A course in research ethics for graduate students. College Teaching, 44, 2, 56-60.

This article describes a one-credit discussion course in research ethics for graduate students in biology. Case studies are focused on within the four parts of the course: 1) major issues, 2 )practical issues in scholarly work, 3) ownership of research results, and 4) training and personal decisions.

DeVoss, G. (1981). Ethics in Fieldwork Research. RIE 27p. (ERIC)

This article examines four of the ethical problems that can happen when conducting case study research: acquiring permission to do research, knowing when to stop digging, the pitfalls of doing collaborative research, and preserving the integrity of the participants.

Driscoll, A. (1985). Case Study of a Research Intervention: the University of Utah’s Collaborative Approach . San Francisco: Far West Library for Educational Research Development.

Paper presented at the annual meeting of the American Association of Colleges of Teacher Education, Denver, CO, March 1985. Offers information of in-service training, specifically case studies application.

Ellram, L. M. (1996). The Use of the Case Study Method in Logistics Research. Journal of Business Logistics, 17, 2, 93.

This article discusses the increased use of case study in business research, and the lack of understanding of when and how to use case study methodology in business.

Emig, J. (1971) The Composing Processes of Twelfth Graders . Urbana: NTCE.

This case study uses observation, tape recordings, writing samples, and school records to show that writing in reflexive and extensive situations caused different lengths of discourse and different clusterings of the components of the writing process.

Feagin, J. R. (1991). A Case For the Case Study . Chapel Hill: The University of North Carolina Press.

This book discusses the nature, characteristics, and basic methodological issues of the case study as a research method.

Feldman, H., Holland, A., & Keefe, K. (1989) Language Abilities after Left Hemisphere Brain Injury: A Case Study of Twins. Topics in Early Childhood Special Education, 9, 32-47.

"Describes the language abilities of 2 twin pairs in which 1 twin (the experimental) suffered brain injury to the left cerebral hemisphere around the time of birth and1 twin (the control) did not. One pair of twins was initially assessed at age 23 mo. and the other at about 30 mo.; they were subsequently evaluated in their homes 3 times at about 6-mo intervals."

Fidel, R. (1984). The Case Study Method: A Case Study. Library and Information Science Research, 6.

The article describes the use of case study methodology to systematically develop a model of online searching behavior in which study design is flexible, subject manner determines data gathering and analyses, and procedures adapt to the study's progressive change.

Flower, L., & Hayes, J. R. (1984). Images, Plans and Prose: The Representation of Meaning in Writing. Written Communication, 1, 120-160.

Explores the ways in which writers actually use different forms of knowing to create prose.

Frey, L. R. (1992). Interpreting Communication Research: A Case Study Approach Englewood Cliffs, N.J.: Prentice Hall.

The book discusses research methodologies in the Communication field. It focuses on how case studies bridge the gap between communication research, theory, and practice.

Gilbert, V. K. (1981). The Case Study as a Research Methodology: Difficulties and Advantages of Integrating the Positivistic, Phenomenological and Grounded Theory Approaches . The Annual Meeting of the Canadian Association for the Study of Educational Administration. (Address) Halifax, NS, Can.

This study on an innovative secondary school in England shows how a "low-profile" participant-observer case study was crucial to the initial observation, the testing of hypotheses, the interpretive approach, and the grounded theory.

Gilgun, J. F. (1994). A Case for Case Studies in Social Work Research. Social Work, 39, 4, 371-381.

This article defines case study research, presents guidelines for evaluation of case studies, and shows the relevance of case studies to social work research. It also looks at issues such as evaluation and interpretations of case studies.

Glennan, S. L., Sharp-Bittner, M. A. & Tullos, D. C. (1991). Augmentative and Alternative Communication Training with a Nonspeaking Adult: Lessons from MH. Augmentative and Alternative Communication, 7, 240-7.

"A response-guided case study documented changes in a nonspeaking 36-yr-old man's ability to communicate using 3 trained augmentative communication modes. . . . Data were collected in videotaped interaction sessions between the nonspeaking adult and a series of adult speaking."

Graves, D. (1981). An Examination of the Writing Processes of Seven Year Old Children. Research in the Teaching of English, 15, 113-134.

Hamel, J. (1993). Case Study Methods . Newbury Park: Sage. .

"In a most economical fashion, Hamel provides a practical guide for producing theoretically sharp and empirically sound sociological case studies. A central idea put forth by Hamel is that case studies must "locate the global in the local" thus making the careful selection of the research site the most critical decision in the analytic process."

Karthigesu, R. (1986, July). Television as a Tool for Nation-Building in the Third World: A Post-Colonial Pattern, Using Malaysia as a Case-Study. International Television Studies Conference. (Address). London, 10-12.

"The extent to which Television Malaysia, as a national mass media organization, has been able to play a role in nation building in the post-colonial period is . . . studied in two parts: how the choice of a model of nation building determines the character of the organization; and how the character of the organization influences the output of the organization."

Kenny, R. (1984). Making the Case for the Case Study. Journal of Curriculum Studies, 16, (1), 37-51.

The article looks at how and why the case study is justified as a viable and valuable approach to educational research and program evaluation.

Knirk, F. (1991). Case Materials: Research and Practice. Performance Improvement Quarterly, 4 (1 ), 73-81.

The article addresses the effectiveness of case studies, subject areas where case studies are commonly used, recent examples of their use, and case study design considerations.

Klos, D. (1976). Students as Case Writers. Teaching of Psychology, 3.2, 63-66.

This article reviews a course in which students gather data for an original case study of another person. The task requires the students to design the study, collect the data, write the narrative, and interpret the findings.

Leftwich, A. (1981). The Politics of Case Study: Problems of Innovation in University Education. Higher Education Review, 13.2, 38-64.

The article discusses the use of case studies as a teaching method. Emphasis is on the instructional materials, interdisciplinarity, and the complex relationships within the university that help or hinder the method.

Mabrito, M. (1991, Oct.). Electronic Mail as a Vehicle for Peer Response: Conversations of High and Low Apprehensive Writers. Written Communication, 509-32.

McCarthy, S., J. (1955). The Influence of Classroom Discourse on Student Texts: The Case of Ella . East Lansing: Institute for Research on Teaching.

A look at how students of color become marginalized within traditional classroom discourse. The essay follows the struggles of one black student: Ella.

Matsuhashi, A., ed. (1987). Writing in Real Time: Modeling Production Processes Norwood, NJ: Ablex Publishing Corporation.

Investigates how writers plan to produce discourse for different purposes to report, to generalize, and to persuade, as well as how writers plan for sentence level units of language. To learn about planning, an observational measure of pause time was used" (ERIC).

Merriam, S. B. (1985). The Case Study in Educational Research: A Review of Selected Literature. Journal of Educational Thought, 19.3, 204-17.

The article examines the characteristics of, philosophical assumptions underlying the case study, the mechanics of conducting a case study, and the concerns about the reliability, validity, and generalizability of the method.

---. (1988). Case Study Research in Education: A Qualitative Approach San Francisco: Jossey Bass.

Merry, S. E., & Milner, N. eds. (1993). The Possibility of Popular Justice: A Case Study of Community Mediation in the United States . Ann Arbor: U of Michigan.

". . . this volume presents a case study of one experiment in popular justice, the San Francisco Community Boards. This program has made an explicit claim to create an alternative justice, or new justice, in the midst of a society ordered by state law. The contributors to this volume explore the history and experience of the program and compare it to other versions of popular justice in the United States, Europe, and the Third World."

Merseth, K. K. (1991). The Case for Cases in Teacher Education. RIE. 42p. (ERIC).

This monograph argues that the case method of instruction offers unique potential for revitalizing the field of teacher education.

Michaels, S. (1987). Text and Context: A New Approach to the Study of Classroom Writing. Discourse Processes, 10, 321-346.

"This paper argues for and illustrates an approach to the study of writing that integrates ethnographic analysis of classroom interaction with linguistic analysis of written texts and teacher/student conversational exchanges. The approach is illustrated through a case study of writing in a single sixth grade classroom during a single writing assignment."

Milburn, G. (1995). Deciphering a Code or Unraveling a Riddle: A Case Study in the Application of a Humanistic Metaphor to the Reporting of Social Studies Teaching. Theory and Research in Education, 13.

This citation serves as an example of how case studies document learning procedures in a senior-level economics course.

Milley, J. E. (1979). An Investigation of Case Study as an Approach to Program Evaluation. 19th Annual Forum of the Association for Institutional Research. (Address). San Diego.

The case study method merged a narrative report focusing on the evaluator as participant-observer with document review, interview, content analysis, attitude questionnaire survey, and sociogram analysis. Milley argues that case study program evaluation has great potential for widespread use.

Minnis, J. R. (1985, Sept.). Ethnography, Case Study, Grounded Theory, and Distance Education Research. Distance Education, 6.2.

This article describes and defines the strengths and weaknesses of ethnography, case study, and grounded theory.

Nunan, D. (1992). Collaborative language learning and teaching . New York: Cambridge University Press.

Included in this series of essays is Peter Sturman’s "Team Teaching: a case study from Japan" and David Nunan’s own "Toward a collaborative approach to curriculum development: a case study."

Nystrand, M., ed. (1982). What Writers Know: The Language, Process, and Structure of Written Discourse . New York: Academic Press.

Owenby, P. H. (1992). Making Case Studies Come Alive. Training, 29, (1), 43-46. (ERIC)

This article provides tips for writing more effective case studies.

---. (1981). Pausing and Planning: The Tempo of Writer Discourse Production. Research in the Teaching of English, 15 (2),113-34.

Perl, S. (1979). The Composing Processes of Unskilled College Writers. Research in the Teaching of English, 13, 317-336.

"Summarizes a study of five unskilled college writers, focusing especially on one of the five, and discusses the findings in light of current pedagogical practice and research design."

Pilcher J. and A. Coffey. eds. (1996). Gender and Qualitative Research . Brookfield: Aldershot, Hants, England.

This book provides a series of essays which look at gender identity research, qualitative research and applications of case study to questions of gendered pedagogy.

Pirie, B. S. (1993). The Case of Morty: A Four Year Study. Gifted Education International, 9 (2), 105-109.

This case study describes a boy from kindergarten through third grade with above average intelligence but difficulty in learning to read, write, and spell.

Popkewitz, T. (1993). Changing Patterns of Power: Social Regulation and Teacher Education Reform. Albany: SUNY Press.

Popkewitz edits this series of essays that address case studies on educational change and the training of teachers. The essays vary in terms of discipline and scope. Also, several authors include case studies of educational practices in countries other than the United States.

---. (1984). The Predrafting Processes of Four High- and Four Low Apprehensive Writers. Research in the Teaching of English, 18, (1), 45-64.

Rasmussen, P. (1985, March) A Case Study on the Evaluation of Research at the Technical University of Denmark. International Journal of Institutional Management in Higher Education, 9 (1).

This is an example of a case study methodology used to evaluate the chemistry and chemical engineering departments at the University of Denmark.

Roth, K. J. (1986). Curriculum Materials, Teacher Talk, and Student Learning: Case Studies in Fifth-Grade Science Teaching . East Lansing: Institute for Research on Teaching.

Roth offers case studies on elementary teachers, elementary school teaching, science studies and teaching, and verbal learning.

Selfe, C. L. (1985). An Apprehensive Writer Composes. When a Writer Can't Write: Studies in Writer's Block and Other Composing-Process Problems . (pp. 83-95). Ed. Mike Rose. NMY: Guilford.

Smith-Lewis, M., R. and Ford, A. (1987). A User's Perspective on Augmentative Communication. Augmentative and Alternative Communication, 3, 12-7.

"During a series of in-depth interviews, a 25-yr-old woman with cerebral palsy who utilized augmentative communication reflected on the effectiveness of the devices designed for her during her school career."

St. Pierre, R., G. (1980, April). Follow Through: A Case Study in Metaevaluation Research . 64th Annual Meeting of the American Educational Research Association. (Address).

The three approaches to metaevaluation are evaluation of primary evaluations, integrative meta-analysis with combined primary evaluation results, and re-analysis of the raw data from a primary evaluation.

Stahler, T., M. (1996, Feb.) Early Field Experiences: A Model That Worked. ERIC.

"This case study of a field and theory class examines a model designed to provide meaningful field experiences for preservice teachers while remaining consistent with the instructor's beliefs about the role of teacher education in preparing teachers for the classroom."

Stake, R. E. (1995). The Art of Case Study Research. Thousand Oaks: Sage Publications.

This book examines case study research in education and case study methodology.

Stiegelbauer, S. (1984) Community, Context, and Co-curriculum: Situational Factors Influencing School Improvements in a Study of High Schools. Presented at the annual meeting of the American Educational Research Association, New Orleans, LA.

Discussion of several case studies: one looking at high school environments, another examining educational innovations.

Stolovitch, H. (1990). Case Study Method. Performance And Instruction, 29, (9), 35-37.

This article describes the case study method as a form of simulation and presents guidelines for their use in professional training situations.

Thaller, E. (1994). Bibliography for the Case Method: Using Case Studies in Teacher Education. RIE. 37 p.

This bibliography presents approximately 450 citations on the use of case studies in teacher education from 1921-1993.

Thrane, T. (1986). On Delimiting the Senses of Near-Synonyms in Historical Semantics: A Case Study of Adjectives of 'Moral Sufficiency' in the Old English Andreas. Linguistics Across Historical and Geographical Boundaries: In Honor of Jacek Fisiak on the Occasion of his Fiftieth Birthday . Berlin: Mouton de Gruyter.

United Nations. (1975). Food and Agriculture Organization. Report on the FAO/UNFPA Seminar on Methodology, Research and Country: Case Studies on Population, Employment and Productivity . Rome: United Nations.

This example case study shows how the methodology can be used in a demographic and psychographic evaluation. At the same time, it discusses the formation and instigation of the case study methodology itself.

Van Vugt, J. P., ed. (1994). Aids Prevention and Services: Community Based Research . Westport: Bergin and Garvey.

"This volume has been five years in the making. In the process, some of the policy applications called for have met with limited success, such as free needle exchange programs in a limited number of American cities, providing condoms to prison inmates, and advertisements that depict same-sex couples. Rather than dating our chapters that deal with such subjects, such policy applications are verifications of the type of research demonstrated here. Furthermore, they indicate the critical need to continue community based research in the various communities threatened by acquired immuno-deficiency syndrome (AIDS) . . . "

Welch, W., ed. (1981, May). Case Study Methodology in Educational Evaluation. Proceedings of the Minnesota Evaluation Conference. Minnesota. (Address).

The four papers in these proceedings provide a comprehensive picture of the rationale, methodology, strengths, and limitations of case studies.

Williams, G. (1987). The Case Method: An Approach to Teaching and Learning in Educational Administration. RIE, 31p.

This paper examines the viability of the case method as a teaching and learning strategy in instructional systems geared toward the training of personnel of the administration of various aspects of educational systems.

Yin, R. K. (1993). Advancing Rigorous Methodologies: A Review of 'Towards Rigor in Reviews of Multivocal Literatures.' Review of Educational Research, 61, (3).

"R. T. Ogawa and B. Malen's article does not meet its own recommended standards for rigorous testing and presentation of its own conclusions. Use of the exploratory case study to analyze multivocal literatures is not supported, and the claim of grounded theory to analyze multivocal literatures may be stronger."

---. (1989). Case Study Research: Design and Methods. London: Sage Publications Inc.

This book discusses in great detail, the entire design process of the case study, including entire chapters on collecting evidence, analyzing evidence, composing the case study report, and designing single and multiple case studies.

Related Links

Consider the following list of related Web sites for more information on the topic of case study research. Note: although many of the links cover the general category of qualitative research, all have sections that address issues of case studies.

• Sage Publications on Qualitative Methodology: Search here for a comprehensive list of new books being published about "Qualitative Methodology" http://www.sagepub.co.uk/
• The International Journal of Qualitative Studies in Education: An on-line journal "to enhance the theory and practice of qualitative research in education." On-line submissions are welcome. http://www.tandf.co.uk/journals/tf/09518398.html
• Qualitative Research Resources on the Internet: From syllabi to home pages to bibliographies. All links relate somehow to qualitative research. http://www.nova.edu/ssss/QR/qualres.html

Becker, Bronwyn, Patrick Dawson, Karen Devine, Carla Hannum, Steve Hill, Jon Leydens, Debbie Matuskevich, Carol Traver, & Mike Palmquist. (2005). Case Studies. Writing@CSU . Colorado State University. https://writing.colostate.edu/guides/guide.cfm?guideid=60

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The case study approach

Sarah crowe.

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

Kathrin Cresswell

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

Ann Robertson

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

Anthony Avery

Aziz sheikh.

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

Introduction

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

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

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

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

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

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

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

What is a case study?

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

Definitions of a case study

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

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

What are case studies used for?

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

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

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

How are case studies conducted?

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

Defining the case

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

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

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

Selecting the case(s)

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

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

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

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

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

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

Collecting the data

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

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

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

Analysing, interpreting and reporting case studies

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

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

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

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

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

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

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

Potential pitfalls and mitigating actions when undertaking case study research

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

Conclusions

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

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

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

Pre-publication history

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

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

Acknowledgements

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

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Organizing Your Social Sciences Research Assignments

• Annotated Bibliography
• Analyzing a Scholarly Journal Article
• Group Presentations
• Dealing with Nervousness
• Using Visual Aids
• Grading Someone Else's Paper
• Types of Structured Group Activities
• Group Project Survival Skills
• Leading a Class Discussion
• Multiple Book Review Essay
• Reviewing Collected Works
• Writing a Case Analysis Paper
• Writing a Case Study
• About Informed Consent
• Writing Field Notes
• Writing a Policy Memo
• Writing a Reflective Paper
• Writing a Research Proposal
• Generative AI and Writing
• Acknowledgments

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

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

How to Approach Writing a Case Study Research Paper

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

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

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

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

Structure and Writing Style

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

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

I.  Introduction

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

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

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

II.  Literature Review

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

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

III.  Method

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

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

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

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

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

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

IV.  Discussion

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

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

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

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

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

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

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

V.  Conclusion

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

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

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

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

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

Problems to Avoid

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

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

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

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

Writing Tip

At Least Five Misconceptions about Case Study Research

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

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

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

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

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What the Case Study Method Really Teaches

• Nitin Nohria

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

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

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

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

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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.

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Muhammad Hassan

Researcher, Academic Writer, Web developer

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Case Study Research Method in Psychology

Saul Mcleod, PhD

Educator, Researcher

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, Ph.D., is a qualified psychology teacher with over 18 years experience of working in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

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Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

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Case studies are in-depth investigations of a person, group, event, or community. Typically, data is gathered from various sources and by using several different methods (e.g., observations & interviews).

The case study research method originated in clinical medicine (the case history, i.e., the patient’s personal history). In psychology, case studies are often confined to the study of a particular individual.

The information is mainly biographical and relates to events in the individual’s past (i.e., retrospective), as well as to significant events which are currently occurring in his or her everyday life.

The case study is not itself a research method, but researchers select methods of data collection and analysis that will generate material suitable for case studies.

Case studies are widely used in psychology, and amongst the best known were the ones carried out by Sigmund Freud, including Anna O and Little Hans .

Freud (1909a, 1909b) conducted very detailed investigations into the private lives of his patients in an attempt to both understand and help them overcome their illnesses.

Even today, case histories are one of the main methods of investigation in abnormal psychology and psychiatry.

This makes it clear that the case study is a method that should only be used by a psychologist, therapist, or psychiatrist, i.e., someone with a professional qualification.

There is an ethical issue of competence. Only someone qualified to diagnose and treat a person can conduct a formal case study relating to atypical (i.e., abnormal) behavior or atypical development.

The procedure used in a case study means that the researcher provides a description of the behavior. This comes from interviews and other sources, such as observation.

The client also reports detail of events from his or her point of view. The researcher then writes up the information from both sources above as the case study and interprets the information.

The research may also continue for an extended period of time, so processes and developments can be studied as they happen.

Amongst the sources of data the psychologist is likely to turn to when carrying out a case study are observations of a person’s daily routine, unstructured interviews with the participant herself (and with people who know her), diaries, personal notes (e.g., letters, photographs, notes) or official document (e.g., case notes, clinical notes, appraisal reports).

The case study method often involves simply observing what happens to or reconstructing ‘the case history’ of a single participant or group of individuals (such as a school class or a specific social group), i.e., the idiographic approach .

The interview is also an extremely effective procedure for obtaining information about an individual, and it may be used to collect comments from the person’s friends, parents, employer, workmates, and others who have a good knowledge of the person, as well as to obtain facts from the person him or herself.

Most of this information is likely to be qualitative (i.e., verbal description rather than measurement), but the psychologist might collect numerical data as well.

The data collected can be analyzed using different theories (e.g., grounded theory, interpretative phenomenological analysis, text interpretation, e.g., thematic coding).

All the approaches mentioned here use preconceived categories in the analysis, and they are ideographic in their approach, i.e., they focus on the individual case without reference to a comparison group.

Interpreting the information means the researcher decides what to include or leave out. A good case study should always clarify which information is the factual description and which is an inference or the researcher’s opinion.

• Provides detailed (rich qualitative) information.
• Provides insight for further research.
• Permitting investigation of otherwise impractical (or unethical) situations.

Case studies allow a researcher to investigate a topic in far more detail than might be possible if they were trying to deal with a large number of research participants (nomothetic approach) with the aim of ‘averaging’.

Because of their in-depth, multi-sided approach, case studies often shed light on aspects of human thinking and behavior that would be unethical or impractical to study in other ways.

Research that only looks into the measurable aspects of human behavior is not likely to give us insights into the subjective dimension of experience, which is important to psychoanalytic and humanistic psychologists.

Case studies are often used in exploratory research. They can help us generate new ideas (that might be tested by other methods). They are an important way of illustrating theories and can help show how different aspects of a person’s life are related to each other.

The method is, therefore, important for psychologists who adopt a holistic point of view (i.e., humanistic psychologists ).

Limitations

• Lacking scientific rigor and providing little basis for generalization of results to the wider population.
• Researchers’ own subjective feeling may influence the case study (researcher bias).
• Difficult to replicate.
• Time-consuming and expensive.
• The volume of data, together with the time restrictions in place, impacted the depth of analysis that was possible within the available resources.

Because a case study deals with only one person/event/group, we can never be sure if the case study investigated is representative of the wider body of “similar” instances. This means the conclusions drawn from a particular case may not be transferable to other settings.

Because case studies are based on the analysis of qualitative (i.e., descriptive) data , a lot depends on the psychologist’s interpretation of the information she has acquired.

This means that there is a lot of scope for observer bias , and it could be that the subjective opinions of the psychologist intrude in the assessment of what the data means.

For example, Freud has been criticized for producing case studies in which the information was sometimes distorted to fit particular behavioral theories (e.g., Little Hans ).

This is also true of Money’s interpretation of the Bruce/Brenda case study (Diamond, 1997) when he ignored evidence that went against his theory.

Diamond, M., & Sigmundson, K. (1997). Sex Reassignment at Birth: Long-term Review and Clinical Implications. Archives of Pediatrics & Adolescent Medicine , 151(3), 298-304

Freud, S. (1909a). Analysis of a phobia of a five year old boy. In The Pelican Freud Library (1977), Vol 8, Case Histories 1, pages 169-306

Freud, S. (1909b). Bemerkungen über einen Fall von Zwangsneurose (Der “Rattenmann”). Jb. psychoanal. psychopathol. Forsch ., I, p. 357-421; GW, VII, p. 379-463; Notes upon a case of obsessional neurosis, SE , 10: 151-318.

Further Information

• Case Study Approach
• Case Study Method
• Enhancing the Quality of Case Studies in Health Services Research
• “We do things together” A case study of “couplehood” in dementia
• Using mixed methods for evaluating an integrative approach to cancer care: a case study

How to write a case study — examples, templates, and tools

It’s a marketer’s job to communicate the effectiveness of a product or service to potential and current customers to convince them to buy and keep business moving. One of the best methods for doing this is to share success stories that are relatable to prospects and customers based on their pain points, experiences, and overall needs.

That’s where case studies come in. Case studies are an essential part of a content marketing plan. These in-depth stories of customer experiences are some of the most effective at demonstrating the value of a product or service. Yet many marketers don’t use them, whether because of their regimented formats or the process of customer involvement and approval.

A case study is a powerful tool for showcasing your hard work and the success your customer achieved. But writing a great case study can be difficult if you’ve never done it before or if it’s been a while. This guide will show you how to write an effective case study and provide real-world examples and templates that will keep readers engaged and support your business.

In this article, you’ll learn:

What is a case study?

How to write a case study, case study templates, case study examples, case study tools.

A case study is the detailed story of a customer’s experience with a product or service that demonstrates their success and often includes measurable outcomes. Case studies are used in a range of fields and for various reasons, from business to academic research. They’re especially impactful in marketing as brands work to convince and convert consumers with relatable, real-world stories of actual customer experiences.

The best case studies tell the story of a customer’s success, including the steps they took, the results they achieved, and the support they received from a brand along the way. To write a great case study, you need to:

• Celebrate the customer and make them — not a product or service — the star of the story.
• Craft the story with specific audiences or target segments in mind so that the story of one customer will be viewed as relatable and actionable for another customer.
• Write copy that is easy to read and engaging so that readers will gain the insights and messages intended.
• Follow a standardized format that includes all of the essentials a potential customer would find interesting and useful.
• Support all of the claims for success made in the story with data in the forms of hard numbers and customer statements.

Case studies are a type of review but more in depth, aiming to show — rather than just tell — the positive experiences that customers have with a brand. Notably, 89% of consumers read reviews before deciding to buy, and 79% view case study content as part of their purchasing process. When it comes to B2B sales, 52% of buyers rank case studies as an important part of their evaluation process.

Telling a brand story through the experience of a tried-and-true customer matters. The story is relatable to potential new customers as they imagine themselves in the shoes of the company or individual featured in the case study. Showcasing previous customers can help new ones see themselves engaging with your brand in the ways that are most meaningful to them.

Besides sharing the perspective of another customer, case studies stand out from other content marketing forms because they are based on evidence. Whether pulling from client testimonials or data-driven results, case studies tend to have more impact on new business because the story contains information that is both objective (data) and subjective (customer experience) — and the brand doesn’t sound too self-promotional.

Case studies are unique in that there’s a fairly standardized format for telling a customer’s story. But that doesn’t mean there isn’t room for creativity. It’s all about making sure that teams are clear on the goals for the case study — along with strategies for supporting content and channels — and understanding how the story fits within the framework of the company’s overall marketing goals.

Here are the basic steps to writing a good case study.

1. Identify your goal

Start by defining exactly who your case study will be designed to help. Case studies are about specific instances where a company works with a customer to achieve a goal. Identify which customers are likely to have these goals, as well as other needs the story should cover to appeal to them.

The answer is often found in one of the buyer personas that have been constructed as part of your larger marketing strategy. This can include anything from new leads generated by the marketing team to long-term customers that are being pressed for cross-sell opportunities. In all of these cases, demonstrating value through a relatable customer success story can be part of the solution to conversion.

2. Choose your client or subject

Who you highlight matters. Case studies tie brands together that might otherwise not cross paths. A writer will want to ensure that the highlighted customer aligns with their own company’s brand identity and offerings. Look for a customer with positive name recognition who has had great success with a product or service and is willing to be an advocate.

The client should also match up with the identified target audience. Whichever company or individual is selected should be a reflection of other potential customers who can see themselves in similar circumstances, having the same problems and possible solutions.

Some of the most compelling case studies feature customers who:

• Switch from one product or service to another while naming competitors that missed the mark.
• Experience measurable results that are relatable to others in a specific industry.
• Represent well-known brands and recognizable names that are likely to compel action.
• Advocate for a product or service as a champion and are well-versed in its advantages.

Whoever or whatever customer is selected, marketers must ensure they have the permission of the company involved before getting started. Some brands have strict review and approval procedures for any official marketing or promotional materials that include their name. Acquiring those approvals in advance will prevent any miscommunication or wasted effort if there is an issue with their legal or compliance teams.

3. Conduct research and compile data

Substantiating the claims made in a case study — either by the marketing team or customers themselves — adds validity to the story. To do this, include data and feedback from the client that defines what success looks like. This can be anything from demonstrating return on investment (ROI) to a specific metric the customer was striving to improve. Case studies should prove how an outcome was achieved and show tangible results that indicate to the customer that your solution is the right one.

This step could also include customer interviews. Make sure that the people being interviewed are key stakeholders in the purchase decision or deployment and use of the product or service that is being highlighted. Content writers should work off a set list of questions prepared in advance. It can be helpful to share these with the interviewees beforehand so they have time to consider and craft their responses. One of the best interview tactics to keep in mind is to ask questions where yes and no are not natural answers. This way, your subject will provide more open-ended responses that produce more meaningful content.

Whether pulling from client testimonials or data-driven results, case studies tend to have more impact on new business because the story contains information that is both objective (data) and subjective (customer experience) — and the brand doesn’t sound too self-promotional.

4. Choose the right format

There are a number of different ways to format a case study. Depending on what you hope to achieve, one style will be better than another. However, there are some common elements to include, such as:

• An engaging headline
• A subject and customer introduction
• The unique challenge or challenges the customer faced
• The solution the customer used to solve the problem
• The results achieved
• Data and statistics to back up claims of success
• A strong call to action (CTA) to engage with the vendor

It’s also important to note that while case studies are traditionally written as stories, they don’t have to be in a written format. Some companies choose to get more creative with their case studies and produce multimedia content, depending on their audience and objectives. Case study formats can include traditional print stories, interactive web or social content, data-heavy infographics, professionally shot videos, podcasts, and more.

5. Write your case study

We’ll go into more detail later about how exactly to write a case study, including templates and examples. Generally speaking, though, there are a few things to keep in mind when writing your case study.

• Be clear and concise. Readers want to get to the point of the story quickly and easily, and they’ll be looking to see themselves reflected in the story right from the start.
• Provide a big picture. Always make sure to explain who the client is, their goals, and how they achieved success in a short introduction to engage the reader.
• Construct a clear narrative. Stick to the story from the perspective of the customer and what they needed to solve instead of just listing product features or benefits.
• Leverage graphics. Incorporating infographics, charts, and sidebars can be a more engaging and eye-catching way to share key statistics and data in readable ways.
• Offer the right amount of detail. Most case studies are one or two pages with clear sections that a reader can skim to find the information most important to them.
• Include data to support claims. Show real results — both facts and figures and customer quotes — to demonstrate credibility and prove the solution works.

6. Promote your story

Marketers have a number of options for distribution of a freshly minted case study. Many brands choose to publish case studies on their website and post them on social media. This can help support SEO and organic content strategies while also boosting company credibility and trust as visitors see that other businesses have used the product or service.

Marketers are always looking for quality content they can use for lead generation. Consider offering a case study as gated content behind a form on a landing page or as an offer in an email message. One great way to do this is to summarize the content and tease the full story available for download after the user takes an action.

Sales teams can also leverage case studies, so be sure they are aware that the assets exist once they’re published. Especially when it comes to larger B2B sales, companies often ask for examples of similar customer challenges that have been solved.

Case studies are a vital tool for any marketing team as they enable you to demonstrate the value of your company’s products and services to others.

Now that you’ve learned a bit about case studies and what they should include, you may be wondering how to start creating great customer story content. Here are a couple of templates you can use to structure your case study.

Template 1 — Challenge-solution-result format

• Start with an engaging title. This should be fewer than 70 characters long for SEO best practices. One of the best ways to approach the title is to include the customer’s name and a hint at the challenge they overcame in the end.
• Create an introduction. Lead with an explanation as to who the customer is, the need they had, and the opportunity they found with a specific product or solution. Writers can also suggest the success the customer experienced with the solution they chose.
• Present the challenge. This should be several paragraphs long and explain the problem the customer faced and the issues they were trying to solve. Details should tie into the company’s products and services naturally. This section needs to be the most relatable to the reader so they can picture themselves in a similar situation.
• Share the solution. Explain which product or service offered was the ideal fit for the customer and why. Feel free to delve into their experience setting up, purchasing, and onboarding the solution.
• Explain the results. Demonstrate the impact of the solution they chose by backing up their positive experience with data. Fill in with customer quotes and tangible, measurable results that show the effect of their choice.
• Ask for action. Include a CTA at the end of the case study that invites readers to reach out for more information, try a demo, or learn more — to nurture them further in the marketing pipeline. What you ask of the reader should tie directly into the goals that were established for the case study in the first place.

Template 2 — Data-driven format

• Start with an engaging title. Be sure to include a statistic or data point in the first 70 characters. Again, it’s best to include the customer’s name as part of the title.
• Create an overview. Share the customer’s background and a short version of the challenge they faced. Present the reason a particular product or service was chosen, and feel free to include quotes from the customer about their selection process.
• Present data point 1. Isolate the first metric that the customer used to define success and explain how the product or solution helped to achieve this goal. Provide data points and quotes to substantiate the claim that success was achieved.
• Present data point 2. Isolate the second metric that the customer used to define success and explain what the product or solution did to achieve this goal. Provide data points and quotes to substantiate the claim that success was achieved.
• Present data point 3. Isolate the final metric that the customer used to define success and explain what the product or solution did to achieve this goal. Provide data points and quotes to substantiate the claim that success was achieved.
• Summarize the results. Reiterate the fact that the customer was able to achieve success thanks to a specific product or service. Include quotes and statements that reflect customer satisfaction and suggest they plan to continue using the solution.
• Ask for action. Include a CTA at the end of the case study that asks readers to reach out for more information, try a demo, or learn more — to further nurture them in the marketing pipeline. Again, remember that this is where marketers can look to convert their content into action with the customer.

While templates are helpful, seeing a case study in action can also be a great way to learn. Here are some examples of how Adobe customers have experienced success.

Juniper Networks

One example is the Adobe and Juniper Networks case study , which puts the reader in the customer’s shoes. The beginning of the story quickly orients the reader so that they know exactly who the article is about and what they were trying to achieve. Solutions are outlined in a way that shows Adobe Experience Manager is the best choice and a natural fit for the customer. Along the way, quotes from the client are incorporated to help add validity to the statements. The results in the case study are conveyed with clear evidence of scale and volume using tangible data.

The story of Lenovo’s journey with Adobe is one that spans years of planning, implementation, and rollout. The Lenovo case study does a great job of consolidating all of this into a relatable journey that other enterprise organizations can see themselves taking, despite the project size. This case study also features descriptive headers and compelling visual elements that engage the reader and strengthen the content.

Tata Consulting

When it comes to using data to show customer results, this case study does an excellent job of conveying details and numbers in an easy-to-digest manner. Bullet points at the start break up the content while also helping the reader understand exactly what the case study will be about. Tata Consulting used Adobe to deliver elevated, engaging content experiences for a large telecommunications client of its own — an objective that’s relatable for a lot of companies.

Case studies are a vital tool for any marketing team as they enable you to demonstrate the value of your company’s products and services to others. They help marketers do their job and add credibility to a brand trying to promote its solutions by using the experiences and stories of real customers.

When you’re ready to get started with a case study:

• Think about a few goals you’d like to accomplish with your content.
• Make a list of successful clients that would be strong candidates for a case study.
• Reach out to the client to get their approval and conduct an interview.
• Gather the data to present an engaging and effective customer story.

Adobe can help

There are several Adobe products that can help you craft compelling case studies. Adobe Experience Platform helps you collect data and deliver great customer experiences across every channel. Once you’ve created your case studies, Experience Platform will help you deliver the right information to the right customer at the right time for maximum impact.

To learn more, watch the Adobe Experience Platform story .

Keep in mind that the best case studies are backed by data. That’s where Adobe Real-Time Customer Data Platform and Adobe Analytics come into play. With Real-Time CDP, you can gather the data you need to build a great case study and target specific customers to deliver the content to the right audience at the perfect moment.

Watch the Real-Time CDP overview video to learn more.

Finally, Adobe Analytics turns real-time data into real-time insights. It helps your business collect and synthesize data from multiple platforms to make more informed decisions and create the best case study possible.

Request a demo to learn more about Adobe Analytics.

https://business.adobe.com/blog/perspectives/b2b-ecommerce-10-case-studies-inspire-you

https://business.adobe.com/blog/basics/business-case

https://business.adobe.com/blog/basics/what-is-real-time-analytics

Writing A Case Study

Types Of Case Study

Understand the Basic Types of Case Study Here

Published on: Jun 22, 2019

Last updated on: Oct 17, 2023

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A case study is an effective research method that specifically studies a single case over a period of time. Writing a  case study  is a very useful form of study in the educational process.

If students have real-life examples, it can help them learn more and synthesize information in a more effective manner. Such writing projects are one of the best ways of learning in a classroom.

A case study also has different types and forms. As a rule of thumb, all of them require a detailed and convincing answer based on a thorough analysis.

So, in this article, we are going to discuss the different types of case study research methods in detail.

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What is a Case Study?

Case studies are a type of research methodology. They examine subjects, projects or organizations to tell stories and try conclusions about them based on evidence gathered during the process.

It allows you not only explore new avenues but also get insight into what drives any subject’s decisions and actions. Case studies are a great way for first-year students to develop their research skills.

A case study focuses on a single project for an extended period of time, which allows students to explore the topic in depth.

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What are the Types of Case Study?

There are 6 types of case studies used for different purposes. The main purpose of case studies is to analyze problems within the boundaries of a specific organization, environment, or situation.

According to design, case studies can be divided into the following categories:

Illustrative Case Study

Exploratory case study, cumulative case study, critical instance case study, descriptive case study, intrinsic case study.

Refer to the following section for a detailed description of each type of case study with examples.

An illustrative case study is used to examine a familiar case in order to help others to understand it. It is one of the main types of case studies in research methodology and is primarily descriptive.

In this type of case study, usually, one or two instances are utilized to explain what a situation is like.

Type of Case Study Research Design

An exploratory case study is a primary project conducted before a large-scale investigation. These types of case studies are very popular in the social sciences like political science and primarily focus on real-life contexts and situations.

Typically, these are used to identify research questions and methods for a large and complex study. The main purpose of an exploratory case study is to help identify situations for the further research process.

A cumulative case study is one of the main types of case studies in qualitative research. It is used to collect information from different sources at different times.

The aim of this case study is to summarize the past studies without spending additional cost and time on new investigations. So, it is a form of data analysis.

Critical instances case studies are used to determine the cause and consequence of an event.

The main reason for this type of case study is to investigate one or more sources with unique interest and sometimes with no interest in general. A critical case study can also be used to question a universal assertion.

When you have a hypothesis, you can design a descriptive study. This type of report starts with describing what you are studying. It aims is to find connections between the subject being studied and a theory.

After making these connections, the study can be concluded. The results of the descriptive case study will usually suggest how to develop a theory further.

A descriptive report would use the quantitative data as a starting point for more in-depth research.

Intrinsic studies are more common in psychology. This type of case study can also be conducted in healthcare or social work. So, if you were looking for types of case study in sociology, or type of case study in social research, this is it.

The focus of intrinsic studies is on a unique individual. These types can sometimes study groups close to the researcher as well.

The aim of such studies is not only to understand the subject better, but also their history and how they interact with everything around them. Basically, studying the subject with the perspective of their suroundings is what is needed for this type of case study.

Here is a PDF example to help you learn more about different types of case studies.

Types of Case Study PDF

Now you know the different types of case study methods in research. Make sure you follow the right  case study format  for great results.

Remember each type is defined in general terms but keep in mind that many aspects of a case study such as data collection and analysis, qualitative research questions, etc. are dependent on the researcher and what the study is looking to address.

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Types of Subjects of Case Study

In general, there are six types of case studies and 5 types of subjects they address. Every case study whether exploratory, critical, or cumulative, fits into the following subject categories.

This type of study focuses on one subject or individual and can use several research methods to determine the outcome.

This type of study takes into account a group of individuals. This could be a group of friends, coworkers, or family.

The main focus of this type of study is the place. It also takes into account how and why people use the place.

Organization

This study focuses on an organization or company. This could also include the company employees or people who work in an event at the organization.

This type of study focuses on a specific event. It could be societal or cultural and examines how it affects the surroundings.

Review some  case study examples  online before starting working on a specific type of case study. These examples will help you understand how a specific case study is conducted.

Case studies are being used more and more in colleges and universities to help students understand how a hypothetical event can influence a person, group, or organization in real life.

If you're struggling with your case study, it's best to not risk your grades. 

Our professional paper writing service is here to make your academic journey easier. 

Let us worry about your essay and  buy case study today to ease your stress and achieve academic success.

Barbara P (Literature, Marketing)

Dr. Barbara is a highly experienced writer and author who holds a Ph.D. degree in public health from an Ivy League school. She has worked in the medical field for many years, conducting extensive research on various health topics. Her writing has been featured in several top-tier publications.

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Age-Friendly Health Systems

Resources to Practice Age-Friendly Care

Numerous resources are available to help your team and organization practice age-friendly care and to guide your journey toward becoming an Age-Friendly Health System. IHI Insights, in addition to selected news and journal articles, will help you learn more about Age-Friendly Health Systems.  

Getting Started Guides

​​​​​​​​​​guide to using the 4ms in the care of older adults in hospitals and ambulatory practices.

The guide is designed to help care teams test and implement a specific set of evidence-based, geriatric best practices called the "4Ms": What Matters, Medication, Mentation, Mobility.

• Download the Guide

Guide to Care of Older Adults in Nursing Homes

IHI, along with partner nursing homes, has developed the Age-Friendly Health Systems Guide to Care of Older Adults in Nursing Homes and companion document,  Age-Friendly Health Systems Workbook for Nursing Homes Teams. The Guide presents a systems-based approach to implementing the 4Ms throughout the nursing home, and the Workbook is designed by and for point-of-care teams that interact with individual residents each day.

• Download the Workbook

Guide to Recognition for Geriatric Emergency Department Accredited Sites

Geriatric Emergency Department Accredited sites are well aligned with 4Ms care. This guide provides an overview of each initiative, illustrates the overlap between them, and provides guidance on incorporating What Matters to older adults into Geriatric Emergency Department care.

Guide to Recognition for Geriatric Surgery Verification Hospitals

Geriatric Surgery Verification (GSV) Hospitals are well aligned with 4Ms care. This guide provides an overview of each initiative and illustrates the GSV Standards that meet the requirements for recognition as an Age-Friendly Health System when provided to adults ages 65+.

Guide to Using the 4Ms in the Care of Older Adults in the Convenient Care Clinic

This guide contains resources to help convenient care clinics implement the 4Ms (What Matters, Medication, Mentation, and Mobility) into their setting of care.

The Three Keys to Cross-Sector Age-Friendly Care

Improving Public Health and Health Care for Older Adults: The Three Keys to Cross-Sector Age-Friendly Care Implementation Guide and Workbook contains resources to improve how public health and health care organizations work across the care continuum. The accompanying materials also provide guidance and specific recommendations to support efforts to provide age-friendly care to all older adults.

• Download the Implementation Guide and Workbook plus related content

Age-Friendly Health Systems EHR Implementation Guides

• Download the EHR Implementation Guide with Cerner Examples
• Download the EHR Implementation Guide with Epic Examples
• Download the Epic Implementation Guide ​

For feedback or questions about these guides, please email  afhs​@ihi.org .

Age-Friendly Health Systems Measures Guide

​Guidance on how to use and track a series of measures ​​to help study your performance​.

• Download the Measures Guide​

Spreading Age-Friendly Care: From One Care Location to Reach Older Adults Across Your Health System

The guide will help health systems in spreading the 4Ms through all sites of care by discussing international effort and specific activities to reach this goal.

Read these IHI Insights posts to learn how different health systems have spread 4Ms care using the drivers or approaches outlined in the guide. 

• Hartford HealthCare:  Celebrate and tell your stories to drive spread
• University of Texas Health Science Center at Houston: Calculate the financial impact of practicing the 4Ms
• Providence Health: Get specific about which health system priorities are advanced by the 4Ms
• MaineHealth: Gather evidence of impact during piloting of the 4Ms

4Ms Framework ​of an Age-Friendly Health System

The graphics of the "4Ms" Framework of an Age-Friendly Health System may be downloaded and used for related work without requesting permission.

Watch the  Introduction ​to the 4Ms Framework video  from RUSH Center for Excellence in Aging.

• ​Catch-On: A HRSA Geriatric Workforce Enhancement Program
• Age-Friendly Care for Healthcare Professionals: Penn State
• IHIs Open School online course: PFC 203: Providing Age-Friendly Care to Older Adults
• ​ Welcome to Age-Friendly Care, PA
• ​4Ms Brochure_English
• 4Ms Brochure_Spanish
• 4Ms Poster_English
• 4Ms Poster_Spanish​
• CVS MinuteClinic: Age-Friendly Brochure

NICHE Age-Friendly 4Ms Crosswalk

• ​ Download the NICHE ​Article​

AGS CoCare: HELP & Age-Friendly

• Overview of Age-Friendly Health Systems and HELP

Using AGS CoCare: HELP to Achieve Age-Friendly Care

Getting Started resources providing detailed information on how implementing the HELP program can support a hospital in becoming Age-Friendly:

• HELP and the 4Ms Overview
• Crosswalk of HELP Protocols with 4Ms
• Meeting Recordings, and other Age-Friendly Related Resources from AGS CoCare: HELP

Making the Business Case for Age-Friendly Health Systems

The business case methodology will help an organization seeking to become an Age-Friendly Health System identify the relevant data, analyze it, and describe its financial implications.

Download the Business Case

​Organizations may use the accompanying ROI Calculators with their own data to eva​luate their Age-Friendly programs.

*For best results, please use Google Chrome to download the ROI Calculators

• Inpatient ROI Calculator
• Inpatient ROI Calculator Instructions
• Outpatient ROI Calculator
• Outpatient ROI Calculator Instructions

​Video Demonstration​ of ROI Calculators

• ​ Download the 4Ms ​Age-Friendly Care Description worksheet​ ​​​ (​Hospital and Post-acute Long-Term Care Setting)​​​​
• Download the 4Ms ​Age-Friendly Care Description worksheet​ ​​​ (Ambulatory Care Setting)​​
• Frequently Asked Questions about Being Recognized as an Age-Friendly Health System​​
• Evidence-Based Leadership Council Programs and the 4Ms ​
• Work on adopting the 4Ms in the emergency department and become an Accredited Geriat​ric Emergency Department

Learn more about the sponsor role and identifying an Age-Friendly champion

Working with Older Adults

"What Matters” to Older Adults? Toolkit

A toolkit for health systems to design better care with older adults but understanding "what matters" most to each adult.

Download the Toolkit​

How to Have Conversations with Older Adults About “What Matters”: A Guide for Getting Started

A short guide for anyone who cares for older adults, in any setting, to help jumpstart conversations about What Matters most.

Download the Getting Started Guide

Frequently Asked Questions

• ​​ Your Patient Can Tell When You're Not Listening​
• Every Day Is a PDSA: A Veteran Improver's Take on Being a Family Caregiver​

WebMD partnered with The John A. Hartford Foundation to create a series of videos featuring the 4Ms of age-friendly care to help older adults and caregivers take control of their health.

Watch the WebMD VideoSeries: What Matters Is Most Important

"Conversation Ready": A Framework for Improving End-of-Life Care This white paper presents IHI’s "Conversation Ready" approach to help health care organizations and clinicians provide respectful end-of-life care that is concordant with patients’ stated goals, values, and preferences.

Download the IHI White Paper

How to Talk to Your Patients about End-of-Life Care: A Conversation Ready Toolkit  This toolkit is intended to help clinicians address some of the challenges of engaging with patients and families in end-of-life care conversations over time, with the goal of providing respectful end-of-life care that is concordant with patients’ stated goals, values, and preferences.

Download the Toolkit

The Conversation Project The Conversation Project is dedicated to helping people talk about their wishes for end-of-life care. The Conversation Starter Kits are useful tools to help older adults have the conversation with a family member, friend, or other loved one about their end-of-life care wishes.

Visit website

Case Studies

• Banner Health System : Reducing Costs and Increasing Patient Satisfaction in Primary Care
• GWEP-CC Age-Friendly Health Systems : 12 Primary Care Case Studies
• Jefferson Center for Healthy Aging : Creating an Age-Friendly Health Care Ecosystem

MinuteClinic : Minute Clinics Forge Ahead with Scaling Age-Friendly Despite Pandemic 

• Anne Arundel Medical Center : ACO ACE Unit is Perfect Incubator for 4Ms 
• Asan Medical Center : Making Age-Friendly Health Systems Work Across Cultures
• Birmingham VA Health System : A Hospital Finds Their Age-Friendly Champion
• Hurley Medical Center : Finding Synergy in Older Adult Care Initiatives
• Kent Hospital, a member of Care New England  : 4Ms Continues Momentum When Building an ACE Unit
• MaineHealth / Maine Medical Center : Spreading Age-Friendly Through a Hospital
• Rush University Medical Center : The Value of IHI Action Communities & Community Partnership
• Saratoga Hospital : Building an Age-Friendly Grassroots Movement
• Stanford Health Care : Building an Age-Friendly Geriatric Trauma Service — with a Dashboard!
• University of Alabama Hospital : 4Ms Brings Interdisciplinary Team & Leadership Together
• UMPC Mercy : Uniting Geriatric Efforts to Achieve Age-Friendly Care
• St. James Parish Hospital : Cost Savings of Age-Friendly Care in the Pandemic
• St. John's Riverside Hospital : Building on Already Existing 4Ms Care
• Hebrew SeniorLife : A New Way of Framing Nursing Home Care
• The Good Samaritan Society-Quiburi Mission : Communication with Nursing Home Residents Improves with 4Ms Care
• Maryland Baptist : 4Ms Care Brings Small Changes with Big Impact in Nursing Homes
• Mirabella : “What Matters” is Integral to Providing 4Ms Care in the Nursing Home
• Tsali Care Center : Building on a Strong Foundation to Increase 4Ms in the Nursing Home
• AdventHealth Hendersonville : Age-Friendly Care in Outpatient, Inpatient, and Home Health
• Northwell Health : Unlocking and Elevating Age-Friendly Practices for an Entire System

These briefs are designed to help care teams identify ways to embed the 4Ms into their processes.

• Accountable Care Organizations : Focuses on alignment of the 4Ms with models utilized by accountable care Organizations
• Medicare Annual Wellness Visits : Describes the impact of Medicare Annual Wellness Visits inclusive of the 4Ms
• Creating Value with Age-Friendly Health Systems

Equity in Age-Friendly Care

Ensuring Equitable Age-Friendly Care Article (November 2022)

• Focusing on Equity at Every Step of Your Age-Friendly Health Systems Journey : This resource outlines the "Recipe for Equity in the 4Ms," including key considerations to increase equitable and reliable implementation of the 4Ms for all older adults at every step of the journey to becoming an Age-Friendly Health System.
• The Recipe for Equity in the 4Ms  (Figure)

Additional Resources

PFC 203: Providing Age-Friendly Care to Older Adults   This free IHI Open School course, PFC 203: Providing Age-Friendly Care to Older Adults , provides an understanding of the Age-Friendly Health Systems movement, actionable steps to get started, and how to improve the care of older adults in your setting.

Please see our user guide for navigation assistance.

The playlist includes multiple videos describing Age-Friendly Health Systems.

• Lessons Learned: Making Medications Safer for Older Adults
• Making Virtual Rounds Matter for Older Adults
• Using the Age-Friendly 4Ms to Better Advocate for Older Adults (and Geriatric Care)
• Aligning Care with the Goals of Older Patients ​
• Providing High-Quality ​Care Older Adults ​Can Count On ​

More Age-Friendly Insights

• Geriatric Medicine, April 26, 2023: Age-Friendly Health Systems in an ecosystem perspective
• Journal of the American Geriatrics Society, January 23, 2023: GEC continuum of services for aging veterans
• National Library of Medicine, September 22, 2022: Achievement of Age-Friendly Health Systems committed to care excellence designation in a convenient care health care system
• Journal of the American Geriatrics Society, August 22, 2022: What matters when it comes to measuring Age-Friendly Health System transformation
• Health Services Research, 2022: Applying the age-friendly health system 4Ms paradigm to reframe climate-related disaster preparedness for nursing home populations

More Age-Friendly news and journal articles

Join Friends of Age-Friendly Health Systems

Receive updates on the Age-Friendly Health Systems movement, invites to quarterly webinars, access to experts, support on the 4Ms Framework, and more.

• Open access
• Published: 02 November 2023

Effect of using a mobile drug management application on medication adherence and hospital readmission among elderly patients with polypharmacy: a randomized controlled trial

• Hossein Poorcheraghi 1 ,
• Reza Negarandeh 2 ,
• Shahzad Pashaeypoor 1 &
• Javad Jorian 3  

BMC Health Services Research volume  23 , Article number:  1192 ( 2023 ) Cite this article

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Adherence to complex drug regimens and polypharmacy are among the challenges of old age, which may negatively affect their motivation to continue drug therapy or lead to incorrect drug consumption. The present study was conducted to evaluate the effect of using a mobile drug management application on medication adherence and hospital readmission among polypharmacy older adults.

In this randomized controlled trial study conducted in 2022, with Trial Registration Number (IRCT20191231045966N1) (18/07/2021), 192 Iranian older adults with polypharmacy were selected according to the inclusion criteria and allocated to case and control groups using the block randomization method. The data collection tools included a demographic questionnaire, case report form, and Morisky Medication Adherence Scale. The intervention was done using a mobile drug management application. Drug adherence was measured at baseline and both with hospital readmission were measured after 8 weeks. The collected data were entered into the SPSS software version 22 and analyzed using descriptive (frequency, percentage, mean, standard deviation) and inferential (Chi-square, Fisher’s exact test, independent t-test) statistics.

The case and control groups were homogeneous in terms of demographic variables and drug adherence level before the intervention. A significant difference was found in the drug adherence level after using the app (p < 0.001). Moreover, a significant difference was found in adverse events, including re-hospitalization due to disease aggravation, re-hospitalization due to error in medication consumption, falling, hypo or hypertension, and hypo or hyperglycemia, and medication use accuracy between the groups after the intervention (p < 0.05).

The results showed that using a mobile drug management application that meets the specifications of older adults can improve drug adherence, reduce the adverse events and pave the way for a better disease period management.

Peer Review reports

Population ageing has turned into one of the most important public health challenges in recent years, a phenomenon that has affected Iran at a higher speed compared to other countries [ 1 ]. Ageing is associated with changes in different body organs. In this period of life, chronic diseases threaten the elderly person’s health so that the elderly population is the largest drug consumer in different societies [ 2 ]. Under these circumstances, the elderly should take complex drug regimens for their treatment process leading to a phenomenon known as polypharmacy. There are different definitions for polypharmacy; however, it most commonly refers to daily using five medications or more [ 3 ]. Polypharmacy is extensively prevalent in different societies, for example, its prevalence is about 36% in England where older adults above 65 years constitute one-fifth of the population [ 4 ]. The mean prevalence of polypharmacy is 23.1% in Iranian older adults [32.7% in women and 15.2% in men) [ 5 ]. This phenomenon is associated with adverse consequences, including; drug interactions, error in medication consumption, increased side effects, re-hospitalization, falling, functional and cognitive disorders, imposing financial burdens on the health care system, and finally disability and death. Polypharmacy has a direct relationship with reduced physical activity, motion disorder, decreased appetite, and depression in the elderly, and may seriously affect their medication adherence and quality of life [ 6 ].

Medication adherence is one of the challenges associated with polypharmacy in the elderly population. Medication adherence occurs when a patient takes their medications according to the prescribed dosage, time, frequency, and direction [ 7 ]. Effective medication adherence reduces treatment costs, accelerates the recovery process, stops disease progression, and prevents re-hospitalization [ 7 ]. The personal factors related to drug non-adherence are divided to two categories of intentional non-adherence including self-drug discontinuance and unintentional non-adherence including problems such as forgetfulness, visual impairment, and inability to move, among which forgetting is a very important cause of poor medication adherence [ 8 ]. Poor medication adherence has been reported in 26–59% in older adults, depending on the population and methods used to assess drug adherence [ 9 ]. Also a study on 24,000 Iranian elderly patients showed that 62% of them forgot to take their medications [ 10 ]. Poor drug adherence is associated with worsening of the elderly patients’ health condition, increased hospitalization period, and risk of disease progression, disability, and death [ 11 ].

Technology advances have opened new horizons for management of chronic diseases and improvement of health care services. Use of mobile phone facilitates monitoring of treatment process and health care providers-clients’ relationship [ 12 ]. Today, mobile health (mHealth) is one of the most up-to-date types of health care interventions that can play an effective role in promoting older adults’ health. Mobile health apps have features such as; messaging, alarming, and event reminder. These features can be used to overcome problems such as forgetfulness, so it’s one of the most popular method among technology-based strategies for drug use management [ 13 ].

However, many apps that are designed for the general population are not customized for using by the elderly, which comprise a large population with various health needs so little interaction is observed between them and these apps [ 14 ]. Most of older adults suffer from impaired vision and hearing and have tough problems for using smartphones, which are usually ignored in designing these apps [ 15 ]. Moreover, the apps designed for older adults are usually in languages other than Farsi, rendering them practically useless for Iranian older adults. Persian drug reminder apps only remind medication use time and have failed to meet elderly needs. Ease of use, interesting user interface, font adjustment capability, and use of appropriate warm colors to compensate any vision impairment are among the factors that should be considered in designing a suitable app for this age group. In other words, a drug management app should be designed in such a way that even those who are only able to read and write, can use it [ 16 ].

In this regard, the Medisafe, a reminder alarms app, was designed to monitor the older adults’ blood pressure and boost drug adherence level. The results showed that medication adherence improved and blood pressure preserved in the normal range in patients in intervention group. However, despite improving medication adherence among the elderly, the mobile application did not provide features such as information about the drug use instructors [ 17 ]. As another case, the AlerHTA app, an alarm reminder, aiming to increase drug adherence, drug literacy promotion and aiming reminding time of drug use for patients with hypertetion. The results showed higher medication adherence in the elderly patients in the intervention group. Considering medication adherence promotion in studied elderly, this application was not specifically for older adults and only served as a medication reminder [ 14 ]. Additionally, in some cases, the designed apps failed to achieve their objectives completely. For example, in one study, no significant difference was observed in blood pressure control between elderly patients in case and control groups after using an educational app [ 18 ].

Since the available apps do not meet the older adults’ needs for medication use management due to their special conditions, they need an app that has the highest congruence with their physical and mental conditions. A review of the literature suggests that the older adults needed items are not considered in the available apps. Therefore, it was decided to design an app that has the highest congruence with their needs. Furthermore, there are controversies data regarding the effectiveness of drug management apps in promoting drug adherence and its associated consequences. Insights into the potential benefits of an expert-designed mobile application in promoting drug adherence among older adults; this controlled trial study was conducted to evaluate the effect of using a mobile drug management application on medication adherence and hospital readmission among polypharmacy older adults.

Study design, sampling and data collection

A randomized controlled trial study was conducted in April-June 2022. The research population consisted of older adults presenting to a hospital in Tehran, Iran. This hospital is a prominent health center for the geriatric population and has geriatric-specific clinics and services specializing in both acute and chronic diseases. This hospital welcomes clients for routine and periodic health checkups based on their health needs and physician’s order in all days of week.

The inclusion criteria were age above 60 years, daily intake of more than 5 types of drugs, ability to read and write based on being able to fill out necessary forms in clinic, ability to communicate with, having smartphone ownership based on their self-report and a positive history of cardiovascular disease, diabetes, hypertension, or COPD. The exclusion criteria were a history of cognitive diseases, use of expensive and hard-to-find drugs, a positive history of special hard-to-treat diseases like cancer, use of injection drugs (e.g., insulin-dependent diabetic patients were excluded), not receiving clinic follow-up, unwillingness to participate in the study, and death. To calculate the sample size, for an intervention that could reduce poor adherence by 20% with a confidence interval of 95% and power of 80%, 86 participants were needed in each group [ 10 ]. Considering a loss to follow-up of 10%, 96 participants were needed for each group (Fig.  1 ) [ 19 ].

Sample size calculation formula

Recruitment process occurred among inpatient and outpatient clients referring to hospital. The researcher was present in hospital reception to assess the eligible elderly based on inclusion and exclusion criteria checklist. Among these, two hundred and fourteen older adults who were compatible with inclusion and exclusion criteria were selected with simple random method. Finally, 192 older adults volunteer to participate in this study were assigned to case and control groups using block randomization method with a block size of four.

The allocation sequence was generated using www.randomization.com [ 20 ]. An opaque envelope was used for allocation concealment. At the time of enrollment, according to the order by which the participants entered the study, one of the envelopes was opened in order and the allocation group was determined. The primary outcome was medication adherence and the secondary outcome was the adverse events experienced during the study. Medication adherence was measured at baseline and eight weeks after the intervention. The data collection tools were a demographic questionnaire, a researcher-made adverse events questionnaire, and the Morisky Medication Adherence Scale. The demographic questionnaire was used to collect data on age, sex, marital status, education level, income sufficiency, type of disease, list and number of chronic medications used by patients for confirming polypharmacy, method of information acquisition about the consumed drug, and the most used feature in mobile phone. The Morisky Medication Adherence Scale was developed to evaluate medication adherence by Morisky et al. in 2008 [ 21 ]. This scale was translated to Persian according to the Iranian culture and validated by Kooshyar et al. [ 22 ]. This scale contains eight questions. Response categories are yes/no for the first seven items and a 5-point Likert response from never to always for the last item. A score < 6 indicates low adherence, a score of 6 to < 8 shows moderate adherence, and a score of 8 represents high adherence [ 21 ]. In addition, pill count method was also used to assess medication adherence. Pill count method was taken for each intervention group participant. The control group only received medication for their prescriptions. In first visit and after having the application set for older adults in intervention group, the investigator confirmed patient enough pills supply until next visit. In second clinic visit, information was obtained on the number of pills returned and dispensed. The difference between the number of pills received at the previous visit and the number of pills returned represented the number of pills assumed used by pill count. This number was compared with the number of days that had elapsed between the previous visit and the current visit. Ratio ranges between 0 and 1 where the maximum value is 1. Medication correct use was defined as having value ≥ 0/85 − 1 [ 23 , 24 ]. A researcher-made adverse events questionnaire was used to measure the occurrence five complications; re-hospitalization due to disease recurrence, re-hospitalization due to error in medication consumption; determined by doctor, falling from the bed at home by patient report, hypo or hypertension and hypo or hyperglycemia measured by the patient at home or health care providers in hospitals in periodic visits. Accuracy and reliably of patient response to this case report form, was examined by their self-declaration and medical records.

This form was developed for this study and in order to assess the face and content validity of this case report form, a panel of six geriatric experts was asked to rate the relevancy, clarity, simplicity, and necessity of each question using Likert scale. All members of the panel had relevant knowledge in either usability evaluations or elderly needs. Subsequently, the Content Validity Ratio (CVR) and Content Validity Index (CVI) were calculated according to previous studies. Content validity was considered to be acceptable when CVI and CVR were at least 0.78. In order to confirm the reliability of the questionnaire, two methods of internal reliability and test-retest reliability were used. In this sense, Cronbach’s alpha was calculated as the measure of internal reliability. Cronbach’s alpha equal to and above 0.7 was considered as the minimum acceptable value. To measure the test-retest, a total of 20 older adults was asked to score the questionnaire twice with a two-week interval. Then, the Pearson correlation coefficient was calculated between the two sets of scores.

Intervention

In order to design the application used in this study, an in-depth review was conducted on the existing medication reminder application (both in Farsi and English) to identify their week points in order to solve these issues in new design. A drug management app compatible with android operating system with features such as ease of use, adjustable font and text size, use of proper colors in background and app item, saying the name of the drug and showing its picture while playing a reminder for its use, and using phrases like “Dear mother/father! It’s time for your drug” was designed for Iranian older adults in Persian language for the first time. The drugs name and picture was recorded when setting the reminding alarm. All educational content in this app were reviewed and confirmed by three geriatric experts. In order to protect the privacy and security of app users, the most up-to-date programing codes were used to design the app. As a pilot test and finding the possible flaws and ensuring its correct function on mobile phones, it was installed on the mobile phones of 10 elders. They were asked to report any problem and their ideas about app improvement and its ease of use. The comments of geriatric experts in this field and older adults were both used in design phase. After receiving the final correct operability confirmation and obtaining informed consent, the app was installed on the mobile phones of the participants in the intervention group. Face-to-face training on how to use the app was offered to each participant in a 60-minute session and medication use alarms were set. During the intervention, app users were contacted via phone calls or in routine hospital referrals to ask and check if there is any problem using the app to ensure to ensure intervention fidelity. Also the participants could contact the researcher through the phone number given to them to ask their questions. Number and therapeutic category of drugs were similar in the control and intervention groups. The participants in the control group received the routine care of the health center including periodical visits to evaluate the treatment process and required care. Considering the Covid-19 pandemic in Iran and the sensitive conditions of older adults, it was difficult to make the necessary arrangements for participation of the elders in the introduction session, which included various topic such as the objective of the study, using the app, and completing the questionnaire. To address this problem, the participants were grouped into different groups, and Covid-19 related protocols including social distancing, face mask use, and disinfection were strictly considered.

Data analysis

Data were entered into the SPSS software version 22 and analyzed according to per protocol using descriptive (frequency for number of chronic medications, mean for age, percentage and standard deviation for related categories) and inferential (Chi-square for sex, education level, income sufficiency, type of disease, adherence level before and after intervention, Fisher’s exact test for marital status method of information acquisition about the consumed drug and the most used feature in mobile phone and finally independent t-test for age) statistics. In inferential analysis, demographic data of control and intervention group and adherence level before and after intervention in both group were compared with each other at baseline and 8 weeks. The effect size was calculated using the Cramer’s statistic. P values less than 0.05 were considered significant.

The flow of participants in the study (CONSORT Flow Diagram)

In the present study, 214 patients were evaluated according to the inclusion criteria, of whom 13 were excluded due to not meeting the inclusion criteria and 9 due to unwillingness to participate in the study. Then, the remaining 192 patients were randomly assigned to intervention and control groups. During the intervention, 4 patients were excluded from the control group (3 due to death and 1 due to unwillingness to continue the study because of travelling); moreover, 4 patients were also excluded from the intervention group (2 due to death and 2 due to unwillingness to continue the study; one for not clear reason, the other one for having his phone broken). Finally, data of 92 cases and 92 controls were analyzed (Fig.  2 ).

Demographic findings showed that the participants mean age was 69 ± 5.6 and 68.9 ± 5.2 years in the control and intervention group respectively, indicating no significant difference (p = 0.926). Mean total number of medications taken by control group was 6.53 ± 2.3 and 6.67 ± 2.4 at baseline and in follow-up respectively which indicate no significant difference P = 0.839. Also mean total number of medications taken by intervention group was 6.45 ± 2.1 and 6.55 ± 2.3 at baseline and in follow-up respectively which indicate no significant difference P = 0.874. Moreover, the two groups were homogenous in terms of sex, marital status, education level, income sufficiency, cardiovascular disease, hypertension, diabetes, COPD, method of information acquisition about the consumed drug, and the most used feature in mobile phone (p > 0.05) (Tables  1 and 2 ).

Evaluation of drug adherence level showed no significant differences between two groups before the intervention (p = 0.919). However, after the intervention, the difference was significant in the intervention group, and the participants with high adherence increased from 12.5 to 44.56%, indicating a significant difference (p < 0.001). According to the Cramer’s statistic, the effect size of the intervention on drug adherence was above moderate [ 25 ] (Table  3 ).

Comparison of the adverse events between the two groups showed a significant difference in re-hospitalization due to disease aggravation and error in medication consumption, falling, hypo or hypertension, hypo or hyperglycemia, and drug use accuracy according to the prescriber’s order based on the pill count method between the two groups (p < 0.05). Drug use accuracy ranges between 0 and 1 where the maximum value is 1. Medication correct use was defined as having value ≥ 0/85 − 1 (Table  4 ).

The present study was conducted to evaluate the effect of using a drug management app on drug adherence and adverse events in polypharmacy adults. The results showed that using an app customized for the special conditions of the older adults improves medication adherence. In line with results of present study, Najafi et al. conducted a study to investigate the effect of using a mobile phone-based application on medication adherence in patients with heart failure during three months. The results showed a significant increase in the medication adherence score after using the app. Medication adherence changes were more significant in the intervention group compared to the control group, indicating improved medication adherence in people with heart failure after using the app [ 26 ]. The results of the above study were consistent with the results of the present study, suggesting the positive effect of drug management apps on improved medication adherence. Santo K conducted a study to determine the effect of medication reminder applications on drug adherence in patients with coronary heart disease in three months. The primary outcome was the medication adherence level and the secondary outcomes were the blood pressure and cholesterol level control. Mean score of medication adherence was significantly higher in app users compared to control group, which is similar to the present study [ 27 ]. In another study, Li et al. evaluated the effect of a smartphone application on medication adherence in 24 polypharmacy patients with a mean age of 59.5 years for one year in Australia. In this study, app users in intervention group received medication regimen and educational messages through the app. Participants were required to report each time they took a medication via the app. The control group received routine care including routine visits. Both groups were evaluated three times, including one, three, and twelve months after the intervention. The results showed a 4.37 times higher improvement in the medication adherence in the intervention group compared to the control group in the third assessment [ 28 ]. Although Li et al. did not exclusively focus on older adults and the participants age ranges 18–75 years, its results were consistent with the results of the present study, indicating improved medication adherence in drug management app users.

Baghei et al. studied the effect of a mobile educational application on medication adherence in hypertensive older adults. Comparison mean scores of medication adherence components showed significant difference in commitment to treatment and hesitation in implementation of treatment between two groups while no significant difference was observed in the blood pressure status between the intervention and control groups. However, in present study, blood pressure alterations reduced significantly in the intervention group compared to control group; therefore, the results are not consistent. This difference may be due to the follow-up duration. However, it can be concluded that mobile app education can improve medication adherence in older adult app users [ 18 ].

Habib et al. conducted a study to improve medication adherence following hospital discharge using a mobile application in Canada. This study was conducted on 49 patients with a mean age of 64.6 years assigned to two groups. The patients were followed for 30 days’ post-discharge. During the follow-up period, they were evaluated for medication adherence and re-hospitalization. At the time of discharge, the app was installed on the mobile phones of the patients in the intervention group. Drug management app named SAM, an alarm reminder app, with mission to improve medication adherence in older adults. According to the results, the medication adherence rate was 83.7% in the intervention group and 77.8% in the control group, indicating no significant difference [ 29 ]. Although it seems that the results of the above study and our study are not consistent, the reason may be the short follow-up time of this study. Moreover, in this study, only 65.2% of the patients in the intervention group used the app, which could be due to reasons such as failure to design an appropriate app for this group and lack of proper training for its use or not being user friendly.

The results of the present study showed that using the drug management app reduced adverse events including re-hospitalization due to disease aggravation and error in medication consumption, falling, hypo or hypertension, hypo or hyperglycemia, and promote medication use accuracy according to the pill count method. In this regard, Park et al. conducted a study to determine the effect of using digital health monitoring on readmission reduction in patients with health failure in the United States. This study was carried out on 58 patients and readmission rate was measured during 30 days. The results showed that overall 30-day readmission rate was 10% in these patients, while the mean readmission rate was 25% across the country indicating a significant reduction [ 30 ], which was consistent with results of present study. Findings suggest use of new technologies in health care system to have a significant reduction in the re-hospitalization rate. Furthermore, Sartori et al. conducted a study to evaluate the effect of educational intervention using the WhatsApp platform on medication adherence in hypertensive and diabetic patients. Intervention group participants received training in form of audio, image, or video messages with focus on increasing medication adherence via the WhatsApp while the control group received the routine care. Data analysis 16 weeks after initiating the intervention showed no significant difference between the two groups [ 31 ]. The results of this study are not consistent with the results of present study and the use of WhatsApp could not lead to a significant difference between two groups. Differences in structures of these apps, including ease of use and observance of delicate considerations required for older adults regarding using the app, which were carefully implemented in designing the app in the present study might be the reason of this discrepancy. Chandler et al. investigated the impact of mobile phone use on treatment adherence in hypertensive patients in the United States. Three months after using the app, treatment adherence improved markedly in the intervention group while no change was observed in control group. Findings showed a significant reduction in systolic and diastolic blood pressure in intervention group compared to control group [ 32 ]. The results of this study are consistent with the results of the present study; as mentioned earlier, the designed app reduced blood pressure alterations in the intervention group in the present study.

Finally, Athilingam et al. conducted a study to evaluate the effect of enhanced self-care using mobile technology on reducing readmission in patients with congestive heart failure. Results showed that patients in intervention group were not readmitted during the 30 days of study compared to control group. Preliminary results showed the potential effectiveness of app in reducing readmission and improving self-care in heart failure patients [ 33 ], which was similar to the results of the present study. Nonetheless, the sample size was much larger in the present study compared to above study, which improves the generalizability of the results.

Considering that one of the basic goals of the health care system is to prevent the increase of costs and reduce the economic burden that is created by each individual and group of society, investigations such as the present study will provide valuable information about what policies should be implemented to achieve the stated objective. According to the findings of this study, by improving medication adherence, many adverse events such as re-hospitalization, as the major one, will be reduced, so it could a precious data for policy makers to promote older adults’ quality of life and society welfare by familiarize the elderly with new technologies as much as possible in order to take advantage of it and employ them to manage their health condition effectively. Use of health mobile application designed according to the needs and capabilities of the target group improve the patients’ control over their disease and helps them prevent adverse events.

Limitations

There were some limitations in this study. Considering Morisky scale as a subjective tool to assess medication adherence, we used pill count method to avoid internal validity threat. This method was used as an objective and supplementary method, considering its practicality and simplicity. Lack of generalizability due to a single site of study was the other limitation. Also lifestyle-related factors with medicine adherence were seldom examined in this study. Larger studies covering wider areas and focusing more on the lifestyle or other risk factors should be carried out in future. Use of a case report form for assessing adverse events in this study was another limitation. Totally self-reported answers may be exaggerated; respondents may be too embarrassed to reveal private details or even forget needed data. Due to neutralize this effect, the investigator compared the answer with their medical records and physician confirmation. The possibility of cross-group contamination also could have affected our study. Although the investigators planned to have even introduction session with each group in different days to avoid participants’ connection.

Data availability

All data generated in this study are included in the manuscript. Datasets are available upon reasonable request from the corresponding author. Mrs. Pashaeypoor is available for data and materials availability. The available e-mail address is [email protected].

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Acknowledgements

The current research is the result of a master’s thesis in geriatric nursing. We appreciate professor Morisky for giving us permission to use the MMAS-8-Item instrument. The researchers consider it necessary to express their gratitude to the Research Vice-Chancellor of the Faculty of Nursing and Midwifery of Tehran University of Medical Sciences and also the authors wish to thank all of the participants in this study.

This research has been approved and supported by Tehran University of Medical Sciences and Health Services.

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Reza Negarandeh

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HP: design of the study, implementation of study, drafting the manuscript; ShP: analysis and interpretation of data, drafting the manuscript; RN: design of the study, analysis and interpretation of the data, drafting the manuscript. JJ: designing the mobile application. All authors have read and approved the manuscript. HP and ShP are the guarantors of the manuscript.

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Correspondence to Shahzad Pashaeypoor .

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The study was approved by the Ethics Committee of Tehran University of Medical Sciences (IR.TUMS.FNM.REC.1400.068). It was also registered in the Iranian Registry of Clinical Trials (code: IRCT20191231045966N1) (18/07/2021). The participants were assured of data confidentiality and informed written consent was obtained from them. Moreover, based on research ethics principles, the app was also installed on the mobile phones of the participants in the control group at the end of the study. It also should be notified all methods were carried out in accordance with relevant guidelines and regulations.

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Poorcheraghi, H., Negarandeh, R., Pashaeypoor, S. et al. Effect of using a mobile drug management application on medication adherence and hospital readmission among elderly patients with polypharmacy: a randomized controlled trial. BMC Health Serv Res 23 , 1192 (2023). https://doi.org/10.1186/s12913-023-10177-4

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Estimating the cost-effectiveness threshold of advanced non-small cell lung cancer in China using mean opportunity cost and contingent valuation method

• Qian Peng 1 ,
• Yue Yin 1 ,
• Min Liang 2 ,
• Mingye Zhao 1 ,
• Taihang Shao 1 ,
• Yaqian Tang 1 ,
• Zhiqing Mei 1 ,
• Hao Li 1 &
• Wenxi Tang 3  

Cost Effectiveness and Resource Allocation volume  21 , Article number:  80 ( 2023 ) Cite this article

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Monetizing health has sparked controversy and has implications for pricing strategies of emerging health technologies. Medical insurance payers typically set up thresholds for quality-adjusted life years (QALY) gains based on health productivity and budget affordability, but they rarely consider patient willingness-to-pay (WTP). Our study aims to compare Chinese payer threshold and patient WTP toward QALY gain of advanced non-small cell lung cancer (NSCLC) and to inform a potential inclusion of patient WTP under more complex decision-making scenarios.

A regression model was constructed with cost as the independent variable and QALY as the dependent variable, where the regression coefficients reflect mean opportunity cost, and by transforming these coefficients, the payer threshold can be obtained. Patient WTP was elicited through a contingent valuation method survey. The robustness of the findings was examined through sensitivity analyses of model parameters and patient heterogeneity.

The payer mean threshold in the base-case was estimated at 150,962 yuan (1.86 times per capita GDP, 95% CI 144,041–159,204). The two scenarios analysis generated by different utility inputs yielded thresholds of 112,324 yuan (1.39 times per capita GDP) and 111,824 yuan (1.38 times per capita GDP), respectively. The survey included 85 patients, with a mean WTP of 148,443 yuan (1.83 times per capita GDP, 95% CI 120,994–175,893) and median value was 106,667 yuan (1.32 times the GDP per capita). Due to the substantial degree of dispersion, the median was more representative. The payer threshold was found to have a high probability (98.5%) of falling within the range of 1–2 times per capita GDP, while the robustness of patient WTP was relatively weak.

Conclusions

In China, a country with a copayment system, payer threshold was higher than patient WTP, indicating that medical insurance holds significant decision-making authority, thus temporarily negating the need to consider patient WTP.

Introduction

Although the concept of monetizing health raises ethical concerns, it can serve as an efficient and scientifically informed approach to assist decision-makers in allocating limited resources. For instance, it can aid in the pricing strategies for new health technologies by payers in both public and private sectors. Notably, the National Institute for Health and Care Excellence (NICE) has incorporated value-based pricing into the new Pharmaceutical Price Regulation Scheme (PPRS), and value-based assessment has been integrated into the Technology Appraisal Methods Guide [ 20 ]. Moreover, payers in countries such as France, Germany, Sweden, and Canada consider a broader range of value-related attributes in health technology assessments [ 1 , 19 ].

The most prevalent approach to monetizing health involves estimating payer threshold and patient willingness-to-pay (WTP) for quality-adjusted life year (QALY) gains associated with innovative technologies. However, different stakeholders show distinct preferences towards health gains, leading to variations in threshold and WTP. Medical insurance payers, hereafter referred to as payers, typically establish thresholds based on factors such as health productivity, budget affordability, and even key opinion leaders [ 3 ]. In the case of public payers, an accepted and recognized approach involves setting the threshold based on the contribution of health to productivity [ 38 ]. A commonly utilized method to measure health productivity is the opportunity cost approach, which quantifies the marginal benefit foregone when replacing existing health technology with new one [ 18 ]. Patient WTP has been developed over an extended period and can be assessed through several approaches, including the contingent valuation method (CVM), choice experiments method (CEM), and value of statistical life (VSL). Nevertheless, threshold and WTP from these two stakeholder groups (payers and patients) are infrequently measured or compared within the same population.

In China, there has been a significant increase in the listing of new drugs for the treatment of advanced cancer, with a total of 30 drugs being included in the National Reimbursement Drug List (NRDL) during 2019–2021. The Chinese National Healthcare Security Administration, the largest payer in China, paid $59.356 billion for these drugs in 2018, despite the average price reduction of 56.7% compared to the launch prices and 36% lower than global prices(National Healthcare Security [ 22 , 27 ]. The Chinese government has recently realized that the universally accepted threshold of 1–3 times per capita GDP per QALY gain, as recommended by the World Health Organization [ 3 ], is not financially sustainable for Chinese payer. Local studies have shown that both payer thresholds and patient WTP in the general population are below 1.5 times per capita GDP [ 6 , 16 , 28 , 40 ]. However, a single value judgment cannot address all the issues, especially for indications with variable population sizes or more complex payment scenarios. Disease-specific WTP research has been expanding in recent years. Life-saving interventions, such as cancer therapy, are often valued more highly than drugs for common chronic diseases [ 8 , 13 , 14 , 36 ], as evidenced by a study reporting a higher cancer patient WTP of $11,301 (4.4 times Vietnam's GDP per capita) [ 15 ]. NICE also suggests that payer thresholds for end-of-life treatments can be increased by 70% [ 4 ].

This study aims to measure and compare Chinese payer threshold and patient WTP of non-small cell lung cancer (NSCLC), and to provide comprehensive evidence and insights from diverse perspectives, which can inform disease-specific decision-making in a complex and predictable value-based pricing scenario.

We selected NSCLC as the target indication due to the extensive availability of data sources, with a total of 17 drugs listed in recent years, and the presence of patient samples with a notably high prevalence. The payer threshold was figured out using the mean opportunity cost method. Specifically, a linear regression model was employed to derive the elasticity coefficient, which was then used to calculate the payer threshold. Patient WTP was assessed through face-to-face interviews using a self-administered questionnaire based on the contingent valuation method (CVM). The study received approval from the Ethics Committee of Jiangsu Cancer Hospital on March 31, 2022 (2022KY-KS017).

Payer threshold

Model assumption.

The marginal cost of health produced is an extended measure of traditional opportunity cost that is more stable and easier to calculate [ 10 ]. In this study, we refer to the innovative method introduced by Claxton [ 7 ], a regression model based on mean opportunity cost was employed, using treatment cost as a proxy variable for cost and QALY as a proxy variable for health benefit. To ensure the model adhered to the assumptions of a linear model, the logarithms of both the independent and dependent variables were used. Additionally, the influence of population size was controlled to reduce heteroscedasticity by incorporating mean QALY gains and treatment costs into the regression model. The model is represented as follows:

i : sample i , composed of a drug and its indication of NSCLC in NRDL

H i : mean QALY gain of indication i.

E i : mean treatment cost of indication i.

X i : covariates (sex, age, line of treatment, local or overseas drugs, with/without gene mutation, and year of listed) affecting QALYs of indication i.

ε i : disturbance term.

β 1 : H i increases by β 1 % for every 1% increase in E i .

Target population

The study focused on patients with NSCLC who underwent therapy listed in the 2021 National Reimbursement Drug List (NRDL). Additional file 1 : Appendix Table S2 provides detailed information on the specific drugs, indications, and corresponding Randomized Controlled Trials (RCTs) included in the analysis. A total of thirteen drugs and nine indications were considered, covering a population of approximately 520,000 patients.

We specifically included drugs from the 2021 National Reimbursement Drug List (NRDL) negotiation catalog, which encompassed newly added and renewed products. We excluded drugs from the routine catalog since their inclusion was not based on pharmacoeconomic evidence. Consequently, the association between cost and quality-adjusted life years (QALYs) for drugs in the routine catalog does not reflect the payer threshold.

Model input and data source

Cost The treatment cost was divided into two components: the cost during progression-free survival (PFS) and the cost during post-progression survival (PPS), where PPS was calculated as the difference between overall survival (OS) and PFS. The cost during PFS was determined by multiplying the duration of PFS (in months) by the monthly treatment cost. The treatment cost calculation was based on the pricing listed in the medical insurance reimbursement and the recommended dosage and administration instructions provided in the drug label for an adult (weight: 60 kg, body surface area: 1.6 m 2 ). Similarly, for the PPS cost, the same calculation was applied assuming that follow-up treatments, mainly salvage chemotherapy or best supportive care (BSC), were consistent for all patients, simplifying the models [ 39 ]. The exchange rate used for the 2021 average (6.4512 RMB/$) was obtained on June 15, 2022. Since the drugs listed in the 2021 NRDL were officially negotiated and reimbursed at market prices in 2022, all cost data from previous years sourced from the literature were discounted to the year 2022 using a discount rate of 5%.

QALY QALYs = PFS*QoL during PFS + PPS*QoL during PPS. The PFS and PPS data were obtained from the clinical trials conducted for each indication, as listed in Additional file 1 : Appendix Table S2, while the QoL data were sourced from cross-sectional surveys reported in the literature [ 26 ]. It has been shown that there is a disparity between the median OS and PFS reported in clinical trials and the mean OS and PFS used in pharmacoeconomic analysis [ 24 ]. To address this discrepancy, we employed a multiplier factor based on the relationship between the median and mean values in the field of lung cancer [ 24 ] to transform the median values used in this study into mean values. However, considering the significant instability of such estimation, we incorporated mean OS and PFS in sensitivity analysis, which can independently vary within a range of plus or minus 20%. At the start of this study, for some indications, the median overall survival (OS) was not reported in the available data. To address this issue, we employed the following approach:

Initially, we searched the published economic evaluation literature to extract any extrapolated median OS. In cases where no relevant extrapolated median OS data were found, we developed a new model to extrapolate. This modeling approach was chosen based on the criteria of minimum Akaike information criterion (AIC) and Bayesian information criterion (BIC).

For indications where the OS curve was not reported, we assumed that the median OS would be equal to its reported PFS plus the OS data from follow-up treatments. We obtained the published OS data related to these follow-up chemotherapy treatments (salvage chemotherapy and supportive care) from the literature.

Utility values Scenario analysis was conducted to explore the impact of different utility value sources. Base-case: Different utility values were applied to PFS and PPS, which were sourced from relevant economic literature for the corresponding indications [ 26 ] (refer to Additional file 1 : Appendix 1 for details). Studies have indicated that the utility values differ between targeted therapy and combination therapy, as well as across different treatment lines [ 21 , 31 ]. Therefore, these specific utility values were incorporated into the model as part of the scenario analysis. By considering these different utility values, we aimed to explore the potential impact on the outcomes and provide a more comprehensive understanding of the value of different treatment modalities and treatment lines.

Covariates The covariates included in the analysis were sex, age, line of treatment, brand origin (local or overseas), gene mutation status (with or without), and the year of listing for the indication-specific drug. However, socio-economic characteristics were not included as covariates in the analysis due to their minimal impact on quality-adjusted life years (QALYs) as observed in clinical trials.

Data analysis

Treatment cost was considered as an endogenous variable due to the mutual causality between treatment costs and QALY gains. To address this endogeneity issue, instrumental variables (IVs) and two-stage least squares (2SLS) analysis were employed, which are commonly used methods.

IV needs to satisfy two conditions to be considered valid: relevance to the explanatory variable and independence from the error term. The relevance to the explanatory variable can be assessed through an overidentification test, where a first-stage F-statistic > 10, the chosen IVs are strong instruments. The independence from the error term, known as the exogeneity of the instruments, requires comparing the number of instruments with the number of endogenous variables. The Sargan-Hansen test is commonly used for overidentification testing, and if the p-value > 0.05, the null hypothesis is accepted, indicating that the instruments are exogenous and valid. The selection of instrumental variables relies on research experience and expertise.

The estimation of the payer threshold was conducted using the following approach, as described in the study by Vallejo-Torres [ 37 ].

E i represents the treatment cost for indication i.

H i represents the QALY gain of indication i.

n i represents the population size of indication i , Population size was estimated using prevalence rate and kept consistent with published budget impact analysis.

Drugs already listed in the NRDL catalog have both higher and lower incremental cost-effectiveness ratios (ICERs). The shadow price method (traditional cost opportunity method) regards the highest of these ICERs as threshold, while the mean opportunity cost method reflects a mean, stable, and generalized threshold over the long term. Each of these methods has its own advantages and drawbacks. This study exclusively employs the latter method for calculation. When a drug exhibits exceptional added value, it can surpass this mean threshold (those drugs already in the NRDL catalog that exceed this mean threshold). The threshold derived from the combined mean opportunity cost and shadow price methods can be interpreted as dynamically adjusting around the mean threshold within a certain range based on the comprehensive value of the drug.

Robustness test

Deterministic and probabilistic sensitive analyses were conducted to assess the robustness of the results using different model inputs. Probabilities were followed a beta distribution, while cost parameters followed a gamma distribution, as suggested by Briggs [ 5 ]. OS and PFS were varied within a range of plus or minus 20%, the cost of combination therapy was varied within a range of plus or minus 50%, and the remaining parameters were varied within a range of plus or minus 10% (refer to Table 1 in the Appendix). This approach allowed for the exploration of uncertainty and variability in the model, providing a comprehensive assessment of the results.

Patient willingness-to-pay

Patient inclusion and exclusion.

Patients diagnosed with NSCLC were prospectively recruited from the Department of Oncology at Jiangsu Cancer Hospital. All included patients have signed informed consent forms and received a compensation of $15 for their participation. The inclusion criteria for enrollment were as follows:

Over 40 years of age

Diagnosed with NSCLC

Previously received at least one systemic chemotherapy

Outpatient or inpatient

Patients with cognitive impairment were excluded.

Survey process and instrument

The questionnaire design used the payment card approach of the contingent valuation method (CVM). In January 2022, a total of 15 volunteers with professional knowledge from the authors' institute and 15 relatives without professional knowledge volunteered to participate in the study. Each participant was provided with a pre-assigned script containing detailed socio-economic status (SES), disease information, and treatment records. The average interview duration was approximately 1 h. Open-ended questions were used to inquire about the threshold they were willing to pay for the new and old intervention measures. Subsequently, we calculated the upper and lower limits of treatment costs for drugs in the NRDL (using the same method as described in ‘‘ Model input and data source ’’) Sect. By combining these limits and rounding them, the bidding range was determined. Specific bid values within the bidding range were determined based on the distribution of participant choices, as specified in the appendix. The cognitive assessment results indicated that the questionnaire was easily understood. The results of the interviews with the 30 participants are presented in another unpublished study conducted by our team.

From April to June 2022, a group of real patients with NSCLC were recruited for the study. Three pharmacists from Jiangsu Cancer Hospital underwent two training sessions, each lasting 2 h, to familiarize themselves with the study background and enhance their inquiry skills. Face-to-face interviews were conducted with the respondents, with an average duration of 0.75 h. Responses that had logical errors, as determined by both the investigators and researchers, were considered invalid and excluded from the analysis.

The questionnaire was modified after the first round of survey. It ultimately consisted of three sections: baseline characteristics, a QoL survey, and the CVM section. For the detailed questionnaire, please refer to the Appendix.

The concept of quality-adjusted life years (QALYs) encompasses four distinct components: PFS, PPS, quality of life during the PFS period (PFS-QoL), and quality of life during the PPS period (PPS-QoL). When one of these four attributes changes while the other attributes keep constant, four different QALYs are generated. We have designed four questions corresponding to these four QALYs. To isolate the influence of health benefits and allow respondents to express their WTP solely based on attribute preferences, we assumed that the four incremental QALYs are equal. (Refer to Fig.  1 ). The PFS and PPS data were obtained from clinical trials, consistent with ‘‘ Model input and data source ’’ Sect. The mean values of the experimental group and control group were used to represent the PFS and PPS values before and after the use of the new drug, respectively. The QoL data, consistent with ‘‘ Model input and data source ’’ Sect. also originate from clinical trials and was rounded to the nearest whole number to represent QoL during the PFS and PPS phases for patients.

Four types of QALY gains produced by PFS-Qol and PPS improvement

It was assumed that respondents would experience improvements survival benefits if they were to receive the new treatment option. They are then asked whether they are willing to pay a certain amount of money for these improvements. If the answer was ‘‘yes,’’ the respondents are asked to choose their maximum WTP from a series of bidding options. If the maximum WTP exceeds the predetermined boundaries of the bidding options, an open-ended question was used to obtain the maximum WTP value from the patient. The WTP values for each unit of incremental QALY are calculated based on each patient's maximum WTP value and the obtained incremental QALY.

The formula was used to estimate the WTP of each respondent according to their answers [ 25 ], and then the average value was calculated. The formula is shown as follows:

Each participant (n) was presented with the same set of QALY values, based on real clinical scenarios, ensuring consistency across respondents. As the survival time for advanced lung cancer was relatively short, no discounting was applied to the QALY values.

Differences between preferences toward four types of QALY gains were tested by nonparametric tests. Regression model was conducted to discover the influence of SES on WTP (see below).

Patient WTP = β 1 X 1  + β 2 X 2  + β 3 X 3  + β 4 X 4  + β 5 X 5  + β 6 X 6  + β 7 X 7  + β 8 X 8  + ε i (X 1 : Age of each patient; X 2 : Sex; X 3 : Disposable income for treatment; X 4 : QoL; X 5 : Whether the patient stopped working early due to disease; X 6 : Education; X 7 : Adverse events; X 8 : Monetary resources).

A regression equation was established between WTP and SES based on the existing samples. According to the distribution patterns of various SES in the existing samples, each SES was randomly selected 10,000 times from its respective distribution, forming a sample of 10,000 individuals. The sample data was then plugged into the regression equation to calculate the WTP values. All analyses were conducted in EViews 12 Student Version Lite, R 4.2.1 and Excel 365.

The payer threshold

Model input.

A total of 19 samples were included in the regression equation calculation. In the base-case scenario, the QALY gain was lower compared to scenarios 1 and 2, primarily due to poor QoL during PPS. The mean values of OS and PFS were higher than the median values. The treatment cost ranged from 65,620 to 809,909 yuan.

As of August 11, 2022, among the 19 indications, there are 6 indications for which the median overall survival (OS) has not been reported. The extrapolated OS for Alectinib and Tislelizumab in 1L EGFR negative and ALK negative advanced nonsq-NSCLC was obtained from the published cost-effectiveness analysis literature. The extrapolated OS for Sintilimab in 1L advanced sq-NSCLC was calculated based on the published OS curve and relevant parameters. For Tislelizumab in 1L advanced sq-NSCLC, Ensartinib, and Furmonertinib, the median OS was calculated by adding the median OS of subsequent treatments to their respective PFS (refer to ‘‘ Model input and data source ’’ Sect for more details). The extrapolated OS for Sintilimab was conducted in R.4.2.1. The lognormal function was applied to extrapolate the OS survival curve and obtain the median OS. The calculation results of QALY and costs for each indication can be found in Additional file 1 : Appendix Table 2 .

Threshold calculation

In this study, the presence of gene mutation was identified as an instrumental variable after considering factors that could potentially affect treatment costs. The Hausman endogeneity test conducted in the base-case and two scenarios showed evidence of endogeneity. The Cragg-Donald F-statistic value was 12.4553, exceeding the critical values of 15% (based on Stock-Yogo), indicating that the presence of gene mutation was not a weak instrumental variable.

Age ( p  < 0.05) and line of treatment ( p  < 0.05) were retained in models with significant effects (see Table 1 ). The coefficient of treatment cost indicated that a 1% increase in treatment cost would yield a 0.611% increase in QALY gain, from which the payer threshold in base-case was 150,962 yuan (≈1.86 times the GDP per capita). The results of the two scenario analyses exhibit striking similarity (112,324 and 111,824 yuan, 1.39 and 1.38 per capita GDP), yet both significantly diverge from the baseline analysis. This indicates that the outcomes are markedly influenced by QoL during PFS and PPS, rather than treatment combination or not or treatment lines.

A total of 85 patients were interviewed, and 84 questionnaires were ultimately included in the statistical analysis. The average age was 61.3 years, and 69% were male. Other baseline characteristics of the respondents are described in Table 2 .

The response rates for the four types of QALY gains, including PFS, PPS, PFS-QoL, and PPS-QoL, were 86.9%, 85.7%, 83.3%, and 81.0%, respectively. There were 6 individuals who indicated that they were not willing to pay for any type of QALY gain. All of these individuals had an annual income of less than 60,000 yuan, and 5 of them also received financial assistance from others.

Patient preference and WTP toward QALY types

The distribution of WTP among respondents was relatively discrete. Due to small samples, the Shapiro‒Wilk test showed that the results of the four QALY gains did not conform to the normal distribution. Consequently, there was no significant difference detected among QALY type-based WTPs (all P s > 0.05). To be more specific, 21 respondents preferred the QALY gains in PPS or PPS-QOL, while 17 respondents preferred that from PFS extension or PFS-QOL improvement ( p  = 0.522). In addition, the preference of QALY gain resulted from prolonged PFS and PPS was like that from QoL in PFS and PPS ( p  = 0.953). (see Table 3 ).

Since the preferences for the four types of QALY gains were the same, the WTP of the four kinds of QALY gains were incorporated into the WTP for a ‘standard QALY’ by simply adding up, namely:

The average WTP of each incremental ‘standard QALY’ (after trimming the 5% extreme value) was 148,443 yuan (≈1.83 times the GDP per capita, 95% CI [120,994–175,893], and the median value was 106,667 yuan (≈1.32 times the GDP per capita) (see Table 3 ).

Influencing factors

Linear regression analysis was performed to examine the factors influencing WTP, and the results for both the total population and subgroup analysis can be found in Table 3 in the Appendix. In the total population, several factors were found to have a significant impact on WTP, including age, sex, early cessation of work due to cancer, and disposable income for medical treatment.

Interestingly, the results showed that older individuals had higher WTPs, contrary to what might be expected. Additionally, women showed higher WTPs compared to men. Those who had stopped working early due to cancer showed higher WTPs than those who had not.

Regarding disposable income, respondents with positive income for medical treatment had significantly increased WTPs compared to those with debt status. Furthermore, significant differences were observed between respondents with disposable incomes below 30,000 yuan and those above 30,000 yuan.

In the subgroup analysis, it was found that age did not significantly affect WTP in the female subgroup, unlike in the overall population. A higher level of education was associated with higher WTPs in the female subgroup. On the other hand, in the male subgroup, early cessation of work due to cancer had a significant effect on WTP, which differed from the overall population.

These findings provide insights into the various factors influencing WTP and highlight the importance of considering subgroup differences in understanding individuals' WTP for QALY gains.

The deterministic sensitivity analysis revealed that the QoL during PFS had the most significant impact on the results, followed by the cost of salvage chemotherapy. The results of the probabilistic sensitivity analysis are presented in Fig.  2 . The base-case scenario demonstrated greater stability compared to scenarios 1 and 2, and there was a noticeable gap between the base-case and the other scenarios. This further confirmed that the utility value had a substantial influence on the results.

Probabilistic sensitivity analysis of thresholds of base-case and two scenarios

Moreover, 98.5% of the data points in all three scenarios fell within the range of 1 to 2 times the GDP per capita, showing the robustness of the base-case results.

The average WTP of the 10,000 resampled respondents was estimated using the regression coefficients described in ‘‘ Influencing factors ’’, Sect, and the probability distribution of the 10,000 random data points was shown in Fig.  3 . Patient WTP exhibited greater variability and less robustness compared to the payer threshold. To enhance the robustness of the patient WTP estimates, a larger sample size of patients would be necessary.

Cumulative probability of willingness to pay from the enlarged sample compared to the payer willingness to pay

These findings emphasize the importance of conducting sensitivity analyses and highlight the need for larger sample sizes to ensure the reliability and generalizability of the results, particularly when estimating patient WTP.

Payer threshold in our study was nearly three times higher than that of the Chinese general population (0.63 times per capita GDP) using the same approach of mean opportunity cost [ 28 ], tower over what experts use in real medical insurance negotiation (0.5–1 times per capita GDP) (Liaowang [ 23 ], and slightly higher than that of cancer treatment in South Korea (1.4 times per capita GDP) [ 41 ]. Since the cost input we used was from real NRDL prices, we reasonably believed that the Chinese government prioritized cancer drugs. Differences in threshold values across diseases are inherently present, yet it is not necessary for Health Technology Assessment (HTA) decisions to delineate disease-specific thresholds. Instead, disease thresholds would be categorized based on the following distinctions: first, by disease characteristics such as life-threatening diseases, chronic diseases, and infectious diseases, and then by further segmenting based on disease burden, economic burden, clinical unmet needs, and other characteristics.

Given the significant degree of data dispersion, it is deemed that the median value better represents patient WTP. Analogous to payer, mean Patient WTP in our study was slightly higher than that of the Chinese general population (1.2 times per capita GDP) [ 40 ], Chinese chronic patients ($4700–7400 and $8799–9446, 0.8–1.3 and 1.1–1.2 per capita GDP) [ 12 , 42 ] and similar to prior Chinese cancer survey (1.39 per capita GDP) [ 17 ].

According to literature patient WTP was frequently at the high end of the result distribution, which stems from taxpayers' belief in the overall affordability of national medical insurance and their ignorance of whether the medical insurance fund can withstand it [ 36 ]. To date, the countries that have reported payer threshold using mean opportunity cost are Netherlands [ 2 ], South Africa [ 11 ], Spain [ 37 ], Australia [ 9 ], China [ 28 ], the United Kingdom [ 7 ] and Sweden [ 34 ]. Except for Netherlands, all these countries have also conducted WTP researches from patient’s perspective. Among them, patient WTP in Spain [ 29 , 37 ], Australia [ 9 , 33 ], China [ 28 , 40 ] and the UK [ 7 , 33 ] were higher than payer threshold, while only Sweden was the opposite [ 34 , 35 ]. In this study, payer threshold was higher than patient WTP, which contrasts with most countries.

Comparing with the aforementioned countries, China operates on a patient and medical insurance co-payment system, where patients bear a relatively significant heavy disease and economic burden, resulting in a lower WTP [ 32 ]. Our patient WTP aligns with the median patient WTP of a previous study among Chinese cancer patients [ 17 ], confirming the negative attitude to WTP. Meanwhile, given humanitarian, sustaining industry interests and the upward adjustment of cancer threshold by many national healthcare systems, payer provide higher threshold for cancer can be explained when feasible within the financial capacity.

The uncertainty of the literature source data in payer threshold and the limited sample size are the main limitations of our study. To compensate for that, we employed uncertainty analyses to address the parameter sensitivity and generated a large random sample to assess the robustness of patient survey. Additionally, when respondents do not have distinguish between types of small QALY gain, the cognitive bias will be exponentially magnified when directly combined into a ‘standard QALY’ [ 30 ]. In this study, respondents’ preferences for the four kinds of QALY gains were different from their self-reports, implying that respondents had biases in understanding different QALY attributes and the WTP toward a standard QALY may have bias as well.

Our study was the first to assess health value perception from both payer and patient. Cancer patients generally have lower WTP due to their heavy burden. Additionally, our study demonstrated that public payers prioritize listing and payment for drugs that treat cancer patients. In China, a country with a copayment system, the government payer threshold was higher than patient WTP, indicating that medical insurance holds significant decision-making authority, thus temporarily negating the need to consider patient WTP.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

Yan Dan, Director of the Clinical Pharmacy Department of Jiangsu Cancer Hospital, Ding Nianyang, deputy director of the Clinical Pharmacy Department of Jiangsu Cancer Hospital, Xu Silu and Liu Xiaolin, chief pharmacists of the Clinical Pharmacy Department of Jiangsu Cancer Hospital, are thanked for their support and help in the field investigation of patient WTP.

This research was funded by the National Natural Science Foundation of China (NSFC) (72174207, 2022-01-2025/12) and 2023 National innovation and Entrepreneurship project for college students Measurement, comparison and access model of tumor treatment value from the perspective of supply and demand.

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Conception or design of the work: QP, YY, WT. Data collection: QP, YY, ML, YT, ZM, HL. Data analysis and interpretation: QP, YY. Drafting the article: QP. Critical revision of the article: MZ, TS, YY, WT. Final approval of the version to be submitted: QP, YY, MZ, ML, TS, YT, ZM, HL, WT.

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Additional file 1:.

Table S1. Parameters of deterministic and probabilistic analyses. Table S2. Treatment cost, QALY gain, population size, utility and survival data of drugs and indications. Table S3. Impact of baseline characteristics on WTP.

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Peng, Q., Yin, Y., Liang, M. et al. Estimating the cost-effectiveness threshold of advanced non-small cell lung cancer in China using mean opportunity cost and contingent valuation method. Cost Eff Resour Alloc 21 , 80 (2023). https://doi.org/10.1186/s12962-023-00487-z

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The Morning

A case study in abortion politics.

Ohio was at the center of the abortion fight in this year’s election.

By David Leonhardt

Many Democrats have come to believe that abortion access is the solution to their political problems. This week’s election results — with Ohio guaranteeing abortion access in a landslide and Democrats winning in both Virginia and Kentucky — support this notion.

But I continue to think that recent elections offer a more complex picture, and I want to use today’s newsletter to explain. I know that some readers are skeptical.

Widespread abortion access is clearly popular, even in many red states. When Americans have voted directly on the issue since the Supreme Court overturned Roe v. Wade last year, abortion rights have gone seven for seven. What’s less clear is how much abortion politics affect general elections between a Democrat and a Republican. Is the effect large — or usually only enough to tip very close races?

Ohio, the center of the abortion fight in this year’s election, offers a useful case study.

‘It is the issue’

A year ago, the Democratic Party set out to turn Ohio blue by emphasizing the Republican Party’s opposition to abortion.

Tim Ryan, the Democratic Senate nominee, protested outside the Supreme Court the day it eliminated the constitutional right to abortion access. “J.D. Vance wants a national abortion ban,” Ryan said about his Republican opponent later in the campaign. “I think we go back to Roe v. Wade.”

In the Ohio governor’s race, Nan Whaley, the Democratic nominee, went further than Ryan and organized her campaign around the topic, as Jessie Balmert of The Columbus Dispatch reported. “It is the only thing we’re really talking about,” Whaley said three weeks before Election Day. “We think it is the issue.”

None of this worked. Ryan lost to Vance by six percentage points. Whaley lost to Gov. Mike DeWine, the Republican incumbent who had signed abortion restrictions, by 25 points.

These failures were part of a pattern. In Texas, Beto O’Rourke focused on abortion in his campaign for governor last year. So did Stacey Abrams in Georgia, as well as the Democrats trying to defeat Gov. Ron DeSantis and Senator Marco Rubio in Florida. All these Democrats lost, some of them by double digits.

Nationwide, not a single Republican governor or senator has lost re-election since the Supreme Court overturned Roe v. Wade.

That pattern might seem to conflict with this week’s election results, but I don’t think it does. Most Americans support widespread abortion access and will vote for ballot initiatives that protect or establish abortion rights. Yet in an election between two candidates, only a tiny slice of people is likely to vote differently because of any one issue, including abortion.

That slice can still decide some elections. In Virginia this week, Democrats won several swing districts in the state legislature (although not as many as they had hoped, the political analyst J. Miles Coleman says), partly by emphasizing abortion rights. Similarly, two of the few Republican House incumbents who lost last year — one in Ohio, another in New Mexico — struggled to defend their abortion opposition.

But many other examples that Democrats cite as proof of abortion’s political potency are weaker. Yes, Gov. Andy Beshear of Kentucky emphasized abortion during his successful re-election campaign this year, much as Gov. Laura Kelly of Kansas and Gov. Gretchen Whitmer of Michigan did last year. Here’s the thing, though: Almost every incumbent governor, from both parties, who ran for re-election this year or last year won. The only exception was Gov. Steve Sisolak, a Nevada Democrat.

To argue that abortion has become a dominant factor in U.S. politics requires ignoring the results in Florida, Georgia, Ohio, Texas and elsewhere.

Spinning oneself

Perhaps the most common mistake in politics is to believe that one’s own views are more popular than they in fact are . This mistake leads parties and candidates to focus too little on persuading undecided voters and to lose winnable elections.

The Republican Party has certainly damaged itself with its unpopular opposition to abortion, and Democrats can help themselves by highlighting the issue. Many other high-profile issues today — like inflation, immigration and crime — are much less favorable to Democrats, as Nate Cohn, The Times’s chief political analyst, told me. If the Supreme Court hadn’t overturned Roe v. Wade, maybe Republicans would be enjoying a winning streak right now.

Nonetheless, Democrats have not been able to use the popularity of abortion to defeat many Republicans since 2022. And Nate’s latest article offers reason to think that the issue’s effect on the 2024 elections may be even more modest. The electorate next year — for a presidential campaign — is likely to be larger, less liberal and less engaged in politics than this year’s electorate, he explains. It will include more people who vote as much on gut instinct as on policy positions.

To put it another way, if Democrats want to expand abortion access in the U.S., they almost certainly need to win more elections than they have in recent years. And to win more elections, they will probably have to campaign on a popular agenda that includes abortion yet is much broader.

More on the elections

Democratic ads on abortion rights before this week’s election spoke starkly about rape and sexual abuse, a new tone in the party’s messaging .

Suburban voters largely rejected Republican candidates on Tuesday. They sided with Democrats on abortion and social issues .

A Republican won a Bronx seat on the New York City Council for the first time in 40 years after campaigning on crime. Some New York Democrats see “yellow lights blinking.”

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Israel-hamas war.

Secretary of State Antony Blinken said the Palestinian Authority , which oversees the West Bank, should run Gaza after the war.

Blinken’s plan isn’t as simple as it seems , Steven Erlanger and Isabel Kershner explain.

As Israeli troops battled Hamas in Gaza City, tens of thousands of civilians fled south .

While official information about the fighting is limited, Gazans are documenting the war on social media .

Hamas is discussing the release of a small number of hostages , including some Americans, in return for a short pause in Israel’s offensive, officials say.

Republican Debate

Five Republican presidential candidates, minus Donald Trump, debated in Miami . Ron DeSantis criticized Trump for skipping the event, telling the crowd, “He owes it to you to be on this stage.”

The candidates expressed support for Israel and lamented setbacks in Tuesday’s elections. “We’ve become a party of losers,” Vivek Ramaswamy said.

Nikki Haley and DeSantis called each other soft on China. Tim Scott backed a federal abortion ban, while Chris Christie said the issue should be left to the states. Here’s a fact-check .

In the night’s most tense exchange, Ramaswamy mocked Haley’s daughter for using TikTok, leading Haley to call him “scum.”

After the debate ended, Scott’s girlfriend — whom he’s spoken about but never campaigned with — joined him onstage .

Late night hosts mocked the candidates .

More on Politics

House Republicans subpoenaed Hunter and James Biden , the president’s son and brother, as they try to build an impeachment case.

Ivanka Trump testified in the New York civil fraud case against her father, answering questions about his business’s bank loans. Read takeaways from her testimony .

America’s first commercial plant that can pull carbon dioxide from the air has opened.

Climate change is causing extreme drought in Iran, Iraq and Syria, scientists say.

Other Big Stories

The National Zoo in Washington is without pandas for the first time in half a century , after China recalled them.

U.S. warplanes bombed a Syrian weapons facility linked to Iran in retaliation for attacks against American forces in Iraq and Syria.

Russia is trying to recruit veterans of the Wagner group , months after the force marched toward Moscow.

The Justice Department has charged three people accused of running a brothel network used by politicians in Washington and Boston suburbs.

The F.D.A. approved another drug for weight loss: Zepbound. Here’s a guide .

Mark Zuckerberg says Meta’s “next chapter” will focus on WhatsApp .

If young voters view the U.S. as a peacemaker in the Israel-Hamas war, President Biden will benefit, writes John Della Volpe .

Journalists should stay focused on Ukraine , where Russia’s invasion threatens the security of the Eastern Hemisphere, Sasha Dovzhyk argues.

Nikki Haley knows how to work insults like Donald Trump’s to her candidacy’s advantage, Katherine Miller argues.

Here are columns by Charles Blow on Biden , Thomas Friedman on how Israel has changed and Nicholas Kristof on peace activism .

MORNING READS

Gimme a break: The long, criminal trail of 55,000 rare Japanese Kit Kats .

How to be hot: Young men on TikTok are seeking answers to an age-old question .

Lives Lived: Domenico Spano outfitted billionaires and Hollywood stars, and his own dandyish style made him a highly recognizable peacock on New York’s streets. He died at 79 .

M.L.B.: The Los Angeles Angels hired the 71-year-old Ron Washington as their new manager .

Name, image, likeness: Biden met with prominent former college football players to discuss athletes’ rights.

ARTS AND IDEAS

Hollywood returns: After 118 days, the Hollywood strike is coming to an end — the actors’ union and entertainment companies have reached a tentative deal . (The union will vote in the coming days.)

The deal addressed some of the big issues driving the labor stoppage: The studios agreed to increase streaming-service compensation, and promised not to use actors’ A.I. likeness without payment or approval. Analysts expect the studios to make up for higher labor costs by cutting production.

Related: The industry will be stretched trying to make up for months of lost work .

More on culture

A musician accused Neil Portnow , the former head of the Grammy Awards, of drugging and raping her in 2018. A representative for Portnow said the allegations were false.

In a separate lawsuit, a former employee accused the record executive L.A. Reid of sexually assaulting her in the early 2000s.

THE MORNING RECOMMENDS …

Stuff onions with beautiful saffron-tinged rice .

Bring these three items to Thanksgiving dinner .

Roast chicken in a convection toaster oven .

Here is today’s Spelling Bee . Yesterday’s pangram was celibacy .

And here are today’s Mini Crossword , Wordle , Sudoku and Connections .

Thanks for spending part of your morning with The Times. See you tomorrow. — David

Sign up here to get this newsletter in your inbox . Reach our team at [email protected] .

David Leonhardt writes The Morning, The Times’s flagship daily newsletter. He has previously been an Op-Ed columnist, Washington bureau chief, co-host of “The Argument” podcast, founding editor of The Upshot section and a staff writer for The Times Magazine. In 2011, he received the Pulitzer Prize for commentary. More about David Leonhardt

A blockbuster gun rights case lands at the Supreme Court. Here are three justices to watch.

The controversial case tests the limits of a blockbuster second amendment decision that requires gun prohibitions to be grounded in the nation's history..

WASHINGTON − With the nation reeling from the deadliest mass shooting of the year , the Supreme Court this week will hash out a Second Amendment dispute that could have enormous consequences for victims of domestic violence .

On Tuesday, the court will hear oral arguments about a law banning people who are subject to a domestic violence restraining order from owning a gun. Studies indicate that women are five times more likely to die from domestic violence if a gun is present.

The case centers on a Texas man involved in five shootings between 2020 and 2021 who pleaded guilty to a federal crime: possessing a firearm despite being the subject of a domestic violence restraining order. His appeal to the Supreme Court could have sweeping implications for other gun prohibitions.

That's because his attorneys are relying on a blockbuster Supreme Court decision from just over a year ago to challenge the constitutionality of the federal law he was charged with violating. In that case, the court ruled that gun regulations must be "consistent with this nation's historical tradition of firearm regulation" to survive court challenges. Justice Stephen Breyer, who has since retired, noted a study in his dissent about the increased risk for domestic violence victims when guns are present.

"It's common sense: Domestic abusers should not have guns," said Esta Soler, president of Futures without Violence, a group that advocates for ending domestic violence. "When guns and domestic violence mix, women and children die."

LGBTQ rights: Legal fight over gender-affirming care reaches the Supreme Court. Here's what's next.

The Supreme Court will hear arguments in the case, U.S. v. Rahimi, at 10 a.m. EST Tuesday.

Here are three justices to watch − and why − when those arguments get underway.

Kavanaugh: No 'blank check' on guns

Justice Brett Kavanaugh and Chief Justice John Roberts are always important to watch because they sit at the ideological center of the court and can swing the outcome of a case one way or the other .

That could be particularly true on guns. While both conservatives voted to knock down the New York gun licensing law at issue in Bruen , they also both signed onto a concurring opinion that spelled out some limits to that decision. Kavanaugh stressed that the court's landmark decision last year should not be read to cast doubt on prohibitions on the "possession of firearms by felons and the mentally ill."

States, Kavanaugh wrote, could still mandate licenses for gun purchases, requiring people to be fingerprinted and submit to background checks, training and mental health records checks.

Domestic violence wasn't raised in the court's opinion nor Kavanaugh's concurring opinion. Breyer noted the study in his dissent in last year's gun ruling that found a woman is five times more likely to be killed by a partner if he has access to a gun. Justice Samuel Alito asked in a concurring opinion why that was relevant to the questions resolved in Bruen.

Barrett: 'Dangerous people'

Justice Amy Coney Barrett will be important to watch because she addressed similar questions four years ago as an appeals court judge in Chicago. Barrett's position there could give the conservatives a way to rule against Rahimi while still honoring the precedent they set down last year.

"History is consistent with common sense," Barrett wrote in a dissenting opinion in 2019 . "It demonstrates that legislatures have the power to prohibit dangerous people from possessing guns."

The 7th U.S. Circuit Court of Appeals case dealt with a Wisconsin man barred from owning a gun because he was convicted of felony mail fraud in a scheme to defraud Medicare. In a 2-1 decision, the appeals court upheld laws that barred the man from owning a gun because of his conviction. Barrett dissented, writing that people can't be denied rights just because they are felons but that people deemed dangerous might be out of luck.

Eighteen months after Barrett's opinion appeared, President Donald Trump nominated her to the Supreme Court .

Thomas: In search of 'original meaning'

Justice Clarence Thomas is often considered the Supreme Court's foremost proponent of originalism , the practice of interpreting the words of the Constitution as they would have been understood by the framers at the time of the nation's founding. It was Thomas who wrote the majority opinion in Bruen , holding that gun restrictions must be "consistent with  this nation's historical tradition of firearm regulation " in order to survive a legal challenge.

Thomas, who almost always asks the first question in arguments these days, will be closely watched for any sign of attempting to square his originalist ideology with the government's defense of the law on restraining orders.

Critics say the Rahimi case pokes a hole in the wisdom of attempting to understand what the framers had in mind when the Second Amendment was adopted in 1791. Back then, after all, women had fewer legal rights and guns were rarely used in domestic disputes, according to a brief in the case filed by 18 legal historians.

"If domestic violence in the eighteenth century had been strongly linked to firearms, such violence could have and almost certainly would have been regulated as a threat to the public peace," the historians told the court this year.

Related: Guns in America: Supreme Court agrees to hear challenge to Trump-era ban on bump stocks