group discussion on case study

A Step-by-Step Guide To Case Discussion

By ashi jain.

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Are you comfortable in Decision Making in a given situation How aptly you analyze the situation with a logical approach How much time do you take in arriving at a decision How good are you in taking the rightful course of action

Solved Example:

Hari, the only working member of the family has been working an organization for 25 years. His job required long standing hours. One day, while working, he lost his leg in an accident. The company paid for his medical reimbursement.

Since he was a hardworking employee; the company offered him another compensatory job. He refused by saying, ‘Once a Lion, always a Lion’. As an HR, what solution would you suggest?

Identification of the Problem:

Obvious: accident, refusal of job, only earning member, his attitude, and inability to do his current job Hidden: the reputation of the company at stake, the course of action might influence other employees

Action Plan:

As an HR, you are first expected to check the company records and find out how a similar case has been dealt with in the past. Second, you need to take cognizance of the track record of the employee highlighted by the keyword ‘hardworking’.

Given the situation at hand, he is deemed unfit for his current role. However, the problem arises because of his attitude towards the compensatory job. Hence, in such a case, counselling is required.

Here, three levels of Counselling is required: 1.   Ist level is with Hari 2.   IInd level of counselling is required with the Union Leader (if any) to keep the collective interest and the reputation of the company in mind 3.   IIIrd level of counselling is required with his family members as they constitute of the afflicted party

If the counselling does not work, one should also identify a contingency plan or Plan B. In this case, the Contingency Plan would be – hire someone from his family for a compensatory role.

Note that the following options are out of scope and should be avoided: 1.   Increase Hari’s salary so that he gives in and agrees to do the compensatory job 2.   Status Quo – do not bother as long as the Company is making a profit 3.   Replace Hari with someone else

1. Pinpoint the key issues to be solved and identify their cause and effects

2. Start broad and try to work through a range of issues methodically

3. Connect the facts and evidence and focus on the big picture

4. Discuss any trade-offs or implications of your proposed solution

5. Relate your conclusion back to the problem statement and make sure you have answered all the questions

1. Do not be anxious if you are not able to understand the situation well or unable to justify the problem. Read again, a little slowly, it will help you understand better.

2. Do not jump to conclusions; try to move systematically and gradually.

3. Do not panic if you are unable to analyze the situation. Listen carefully to others as the discussion starts, it will help you gauge the problem at hand.

All the best! Ace the GDPI season.

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This Is What You Need to Know to Pass Your Group Case Interview

• Last Updated January, 2024

If you’re on this page, chances are you’ve been told you’re scheduled for a group interview. 

After practicing for weeks to get good at cracking a normal case interview, hearing you have a group interview might make you feel like you’ve scaled a huge mountain only to find that there’s an even higher peak beyond it that you need to climb.

Group case interviews present some different challenges than individual cases, but if you know what those challenges are, you can overcome them. 

We’ll tell you how. 

In this article, we’ll cover what a group case interview is, why consulting firms use them, the key to passing your group interview, and tell you the 6 tips on group interviews you need to know.

If this is your first time to MyConsultingOffer.org, you may want to start with this page  on  Case Interview Prep . But if you’re ready to learn everything you need to know to pass a group case, you’re in the right place.

Let’s get started!

What is a Group Case Interview?

The group needs to come to a collective point of view on what the client’s problem is, how to structure their analysis, and what the final recommendation should be. 

The group should also agree on how the analysis of the case will be conducted at a high level, but the actual number-crunching will need to be divided between group members in order to complete the work in the allotted time.

The group’s analysis and recommendation will be presented to one or more interviewers.

Why Do Consulting Firms Use Group Case Interviews?

It can feel difficult to trust your team members when you know that you’re all competing for the same job, but that’s what the group case is about — it tests teamwork skills in a high-stakes environment.

Management consultants are hired to solve big, thorny business problems, ones that require the work of multiple people to solve. 

While there is a hierarchy on consulting teams with a partner leading the work, consulting partners simultaneously manage multiple clients or multiple studies at one large client. 

They won’t work with your team every day and in their absence, the team still needs to be able to work together effectively.

Even if a partner is leading a team’s problem-solving discussion, each consultant has a responsibility to make sure the team’s best thinking is being put forward to help the client. 

Ideas are both expected from each member of the team and valued. 

Even the newest analyst has a contribution to make.

T he analyst may have been the person to analyze the data and therefore be closest to the information that will drive the solution to the problem. 

The flat power-structure of the team makes it critical that each consultant works well with others on teams.

In assessing each member of a group case team, interviewers will ask themselves:

Does each of the recruits listen as well as lead?

Are they open to other peoples’ ideas?

Can they perform independent analysis and interpret what impact their work has on the overall problem the team is trying to solve?

Can they persuade team members of their points of view?

The Key to Passing the Group Case: Make Sure Your Group Is Organized

A group case must be solved by going through the same 4 steps as individual cases :   the opening, structuring the problem, the analysis, and the recommendation. 

Your team should break down the time you have to solve the case into time allotted to each of these steps to ensure you don’t spend too long in one area and not reach a recommendation. 

Make sure the team agrees on a single statement of the client’s problem.

Take the time for everyone to read the materials, take notes, and suggest what they think is the key question(s) that need to be solved in this case.

Write it on a whiteboard or somewhere else to ensure there’s agreement. You can’t solve the problem together if you don’t agree on what the problem is. 

Usually, someone in the group will take the lead on organizing the group.

If no one does, this is your opportunity to demonstrate your leadership and teamwork skills, but if there are people fighting over the leadership position (unlikely since everyone is on their “best behavior”), then contribute and don’t worry that you aren’t “leading” the discussion just yet.

Create a clear,  MECE  structure to analyze the problem.

This is even more important to solving a group case than an individual one because you need to make sure that when the group breaks up so each member can perform part of the analysis, all the issues are covered and there’s not duplicated effort between team members.

After your group structures the problem, split up the analysis that needs to be done between members of the group.

If no one suggests breaking up the analysis, then volunteer the idea. Be sure to explain how each person’s piece fits into the team effort.

Each person should do their analysis independently to ensure there is sufficient time to complete all the required tasks, though the team should regroup briefly if someone has a problem they need help with or comes up with an insight that could influence the work other group members are doing. 

While you do your own analysis, you’ll need to demonstrate you understand the bigger picture by involving your teammates, sharing how your findings impacts their work, and articulating how all the insights lead to an answer to the client’s problem.

After everyone has completed their analysis, the group should come back together so everyone can report their results and the group can collectively come to a recommendation to present to interviewers.

In addition to the normal 4 parts of the case, group cases usually require you to present your recommendation to the interviewer(s).

Be sure to build time into your schedule for creating slides, deciding who presents what, and practicing your delivery. 

Many groups fail because they begin their presentation without deciding who has which role.

In consulting, this is like going into a client meeting without knowing who is presenting which slide to the client and makes your team look unprofessional.

Presentation

Start with your recommendation and then provide the key pieces of analysis and/or reasoning that support it.

Again, the work will need to be divided between team members to ensure you get slides written in the allotted time.

For more information on writing good slide presentations, see  Written Case Interview  page.

6 Tips to Pass Your Group Case Interview

Tip 1: organize your team.

A disorganized team will not be able to complete their analysis and develop a strong recommendation in the time allotted.

See the previous section for the steps the group needs to complete to solve the case.

If someone else does take charge, don’t fight for control.

Show leadership by making points that help to move the team’s problem solving forward, not fighting so that it goes backwards. 

Tip 2: Move the Problem-Solving Forward

With multiple team members trying to contribute and express their point of view, it’s possible to have a lot of discussion without getting closer to a solution to the client’s business problem. You can overcome this by:

• Summing up what the team has agreed on so far,
• Providing insight into how the team’s discussion impacts the problem you’re tasked with solving, and/or
• Steering the team to discuss the next steps.

If it feels like the team is rehashing the same topics, use these options to move the problem solving forward.

Tip 3: Make Fact-Based Decisions

It’s okay to disagree with team members but always disagree like a consultant. Challenge teammates’ ideas with data, not opinions.

If there is analysis that needs to be done to determine which point of view is correct, table the discussion until the analysis has been completed.

Tip 4: Don't Steamroll Teammates

As mentioned earlier, consulting teams value the ideas and input of every team member.

Because of this, cutting off, interrupting or talking over other team members is more likely to get you turned down for a consulting job than hired.

The quality of your contribution to group discussions is more important than the quantity (or air time) you consume.

Demonstrate your collaboration and interpersonal skills.

Tip 5: Remain Confident When the Team Presents

Keep your poker face on even if your teammates don’t make every point the way you would have made it. 

Like steamrolling teammates in discussions, frowning or shaking your head as they present will make it look like you’re not a team player.

Tip 6: Remember, Everyone Can Get Offers

 In many jobs, there is only one position open.

At consulting firms, a class of new analysts and associates is hired each year.

There aren’t quotas regarding hiring only one person from a group interview team, so working cooperatively to solve the problem is a better strategy than undermining other members of your group to appear smarter than they are.

We’ve seen group interviews where no one gets a job offer and that can be because teammates undermine each other.

Don’t Over-Invest in Prepping for a Group Case Study Interview

Like the  written case interview , group cases come up infrequently. 

The 2 most common types of case interviews are individual interviews: the candidate-led interview or the interviewer-led interview.

In the candidate-led interview , the recruit is responsible for moving the problem solving forward. After they ensure they understand the problem and structure how they’d approach solving it, they pick one piece of the problem to start drilling down on first. Candidate-led cases are commonly used by Bain and BCG.

In the interviewer-led interview , the interviewer will suggest the first part of the case a recruit should probe after they have presented their opening and structured the problem. Interviewer-led interviews are commonly used by  McKinsey .

Because individual cases are much more common than group cases, don’t spend time preparing for a group case unless you’re sure you’ll have one. 

If you’re invited to take part in a group case interview, your preparation on individual cases will ensure you have a good approach cracking the case.

At this point, we hope you feel confident you can pass your group case interview. 

In this article, we’ve covered what a group case interview is, why consulting firms use them, the key to passing your group interview, and the 6 tips on group interviews you need to know.

Still have questions?

If you have more questions about group interviews, leave them in the comments below. One of My Consulting Offer’s case coaches will answer them.

People prepping for a group case interview have also found the following other pages helpful:

• Case Interview Math ,
• Written Case Interview , and 
• Bain One Way Interview . 

Help with Case Study Interview Preparation

Thanks for turning to My Consulting Offer for advice on case study interview prep. My Consulting Offer has helped almost 85% of the people we’ve worked with get a job in management consulting. We want you to be successful in your consulting interviews too.

If you want a step-by-step solution to land more offers from consulting firms, then  grab the free video training series below.  It’s been created by former Bain, BCG, and McKinsey Consultants, Managers and Recruiters.

It contains the EXACT solution used by over 500 of our clients to land offers.

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3 Top Strategies to Master the Case Interview in Under a Week

We are sharing our powerful strategies to pass the case interview even if you have no business background, zero casing experience, or only have a week to prepare.

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Hacking the Case Interview

Consulting group case interviews are given to candidates to assess teamwork in addition to communication skills, quantitative skills, and business acumen. They are used by consulting firms such as Bain, Deloitte, PwC , and EY-Parthenon .

Have an upcoming consulting group case interview? We have you covered. In this article, we'll go through in detail:

• What is a consulting group case interview?
• Different formats of consulting group case interviews
• Why are consulting group case interviews used?
• What do consulting group case interviews assess?
• How to solve consulting group case interviews
• How to stand out in consulting group case interviews
• Consulting group case interview tips

If you’re looking for a step-by-step shortcut to learn case interviews quickly, enroll in our case interview course . These insider strategies from a former Bain interviewer helped 30,000+ land consulting offers while saving hundreds of hours of prep time.

What is a Consulting Group Case Interview?

Consulting group case interviews are a special variant of the traditional case interview. Before preparing for group case interviews, you should first become familiar with how to solve a traditional case interview .

Like a case interview, you’ll still be placed in a hypothetical business situation and asked to develop a recommendation or answer to a business problem. However, for consulting group case interviews, you’ll be put in a group of 3 to 6 people with other candidates that are also interviewing for the same consulting job.

The group will be given materials which contain the case background, objective, and other information needed to solve the case. You’ll initially have some time to read the information independently, but will spend most of the time discussing the case and working together as a group.

During these discussions, the interviewer will be observing and taking notes on each candidate.

For some group case interviews, you will also create a group presentation. As a group, you’ll present your recommendation to the interviewer who will ask follow-up questions on the work and findings.

Consulting group case interviews are much less commonly used than traditional case interviews, but they are as equally as important. They are typically given in second or final round interviews .

For firms and offices that use group case interviews, you will not receive a consulting job offer unless you can pass them.

Different Formats of Consulting Group Case Interviews

There are two different formats of consulting group case interviews:  

Discussion only group case interviews

Presentation group case interviews.

A discussion only group case interview has the following structure:

This format of group case interview has no presentation component. The group will be given materials with the case background information and objective.

You’ll have some time to read the information independently, but then the interviewer will bring the group together and ask the group to discuss different questions related to solving the case.

The interviewer will be heavily involved in the discussion by asking questions for the group to answer and steering the direction of the discussion.

The discussion only group case interview is focused on assessing the answers that candidates contribute to the group and how well candidates communicate with each other.

A presentation group case interview has the following structure:

The group will be given materials that not only contain the case background and objective, but contain other information needed to solve the case. There is typically more material given in this format because you will be given more time to prepare and discuss.

The group will be given about an hour to discuss the case and create a group presentation. During this time, the interviewer will be listening in on the conversations that the group will have, but they will not interfere or answer any questions.

It is up to the group how they want to allocate their time, what topics they want to discuss, and how they want to handle creating and giving the group presentation.

Once time is up, the group will present their work and findings to the interviewer, who will ask follow-up questions.

The presentation group case interview is focused on assessing how well each candidate contributes to the group, how well candidates work with each other, and the quality of the final presentation.

Why are Consulting Group Case Interviews Used?

Consulting group case interviews are used because they are another way for consulting firms to predict which candidates would make the best consultants.

Group case interviews simulate the consulting job by placing you in a hypothetical business situation. You will need to work as a team to analyze and discuss information and then give a presentation on your recommendation. This is what consultants do every day .

These types of case interviews are used in addition to traditional case interviews because they assess a set of skills that traditional case interviews cannot assess.

Group case interviews focus on teamwork and collaboration. By putting candidates into groups, interviewers can assess how candidates work with other people and how open candidates are to other people’s ideas.

They can see how effectively candidates communicate and persuade teammates and how candidates can balance listening and leading.

What do Consulting Group Case Interviews Assess?

There are four major qualities that group case interviews assess.

Logical, structured thinking : Consultants need to be organized and methodical to work efficiently.

• Can you structure complex problems in a clear, simple way?
• Can you use logic and reason to make appropriate conclusions?

Interpersonal skills : Relationships are important in consulting. You’ll be working with teammates and clients every day, so fostering strong relationships is imperative.

• Are you easy to work with?
• Can you handle conflict or disagreement with teammates?

Teamwork skills : Consultants work closely in small teams. To be successful, consultants need to know how to work effectively in groups.

• Can you make meaningful contributions while working in a group?
• Do you bring out the best ideas and qualities in other people?

Presentation skills : Consultants need strong communication skills to present their work in a clear, concise, and persuasive way.

• Can you communicate in a clear and concise way?
• Are you articulate and persuasive in what you are saying?

How to Solve Consulting Group Case Interviews

Solving consulting group case interviews follows the same steps as solving traditional case interviews. There are four main steps:

• Understand the problem
• Create a framework
• Answer quantitative and qualitative questions
• Develop a recommendation

1. Understand the problem

The first step to solving a consulting group case interview is to fully understand the problem or objective. What is the overall business question that the group is trying to answer?

Answering or solving the wrong business problem is the quickest way to fail a group case interview.

2. Create a framework

Next, as a group, you’ll want to create some kind of framework to help you solve the case. A framework is a tool that helps you structure and break down complex problems into simpler, smaller components.

For group case interviews, your framework will help guide the group discussion. The framework collects and organizes all of the topics that the group needs to discuss and all of the questions the group needs to answer.

3. Discuss and answer quantitative and qualitative questions

Once your group has aligned on a framework to use, you can move onto the discussion. During the discussion, you will answer many of the questions that were raised in the framework that was created.

Some of these questions will be qualitative, requiring only business knowledge and judgment to answer. Other questions may be more quantitative, requiring some calculations or estimations from the case information provided.

It is up to the group what order they want to answer and discuss the questions. It is also up to the group whether they want to tackle these questions as an entire group or if they want to split up into smaller groups.

Discussion will continue until the group has reached an answer or conclusion that is accepted by everyone.

4. Develop a recommendation

Once you have finished discussing and answering all of the important questions, you will need to align on an overall recommendation.

To do this, review all of the answers and conclusions that the group has drawn. Identify which recommendation they collectively support.

If the group case interview has a presentation component, you will also need to decide how to split up the presentation across the different members of the group.

How to Stand Out in Consulting Group Case Interviews

The best way to stand out and distinguish yourself in a group case interview is to focus on adding as much value as you can to the group.

There are six different ways you can add value to the group.

Lead or facilitate the discussion

If the interviewer is not leading the discussion and just observing the group, one way to add value is to lead or facilitate the discussion.

You can propose what topics to discuss, the order they should be discussed in, and how much time should be allocated to each topic. When the group gets off track or goes on a tangent, you can bring the group’s focus back together.

Leading or facilitating the discussion establishes you as a group leader, which will leave a positive impression on the interviewer. However, because this role has so much responsibility and visibility, many people will try to take on this role.

Therefore, a group may have multiple leaders or facilitators. When trying to lead the group, make sure you remain respectful and do not interrupt other people when they are speaking.

Expand upon other people’s ideas

Another way to add value is to expand upon other people’s ideas. If a group member suggests a great idea or raises a good point, you can build upon it.

Wait until the group member has finished speaking and then jump in and compliment that person’s idea. Add more details or give more examples to make the idea more concrete.

Synthesize information

Another easy way to add value to the group is to synthesize information that other people have said. A synthesis is simply a reconciliation of different viewpoints and ideas together. This requires minimal effort, but adds tremendous value to the group.

What is the best way to synthesize information?

First, concisely summarize the major ideas that group members have made. Then, state what you like about each idea. Finally, propose an idea that consolidates the best points of each idea.

Synthesizing information does not require much thinking because you are simply repurposing the ideas of other people. This makes it an easy way to contribute to the group.

Keep track of time

Time goes by very quickly in a consulting group case interview. Therefore, a simple way to add value is to be a time keeper and make sure that the team is on track.

In the beginning of the discussion, you can propose a schedule or plan to make the most of the limited time that the group has. You can then volunteer to keep track of the time so that the group can finish discussing and deciding on everything that it needs to.

Play devil’s advocate

Another way to add value to the group is by playing devil’s advocate. You can help the team develop strong points and ideas by testing the team’s thinking and considering potential risks or downsides.

When the team has decided on an idea, bring up potential risks or downsides that the team should consider. This helps the team develop a more fully thought out answer or recommendation.

Be careful when playing devil’s advocate. You do not want to be attacking ideas or bringing them down. Instead, you want to be offering constructive feedback to test the idea and make it stronger.

The final way to add value to the group is to take notes for the team. By taking notes and keeping track of what other people are saying, you’ll be able to recall what has been discussed if any group members have questions.

This way of adding value to the group is not as recommended as the other strategies to add value.

Taking notes deprives you of opportunities to speak. Therefore, it is better to focus on understanding what other people are saying to identify opportunities to speak up rather than to focus on taking the best notes.

Consulting Group Case Interview Tips

Below are the seven biggest group case interview tips. Follow these tips to give yourself an edge over other candidates.

1. Treat your group members as teammates, not competition

While you may feel like you are competing against members of your group for a job offer, this is not the case. Multiple people or even all people in your group can receive job offers.

Rather than treating your group members like competition and trying to make yourself look better than them, treat your group members as teammates. You should think about the group case interview as your team versus the case, not you versus your teammates.

If you work well as a group and deliver an outstanding discussion or presentation, that increases the likelihood that members of the group will receive offers. If the group spends all of their time attacking each other’s comments and fighting for speaking time, the group will likely deliver a poor discussion or presentation, which makes everyone in the group look bad.

The key is to focus on delivering an outstanding result and not to focus on competing with other teammates.

2. Don’t speak too much and don’t speak too little

How much should you speak in a group case interview?

The problem with speaking too little during a group case interview is that you won’t have many opportunities to demonstrate your interpersonal, teamwork, and presentation skills. Interviewers may also think that you are shy and afraid of speaking in a group, qualities that are not ideal for a consultant.

The problem with speaking too much during a group case interview is that you may be seen as too aggressive and controlling. Speaking too much reflects poorly on you because you are taking away opportunities from other teammates to speak and contribute. You may come off as rude and disruptive if you interrupt people and talk over them.

If you were to rank order all of the members in your group by how much each person spoke, you would want to fall right in the middle. That is the perfect balance of speaking and listening.

3. Speak only if you are adding value to the group

Just because you speak a lot during a group case interview does not mean that you are doing well. The quality of what you are saying is much more important than the quantity.

If you are speaking a lot, but not adding that much value to the group, you will be seen as a poor teammate. A great teammate knows when to speak and when to listen.

Therefore, you should only speak if you are adding value to the group. Do not speak just to reach your participation quota.

4. Don’t interrupt or talk over people

The most common way to fail a group case interview is to come off as a jerk. Consultants work closely in small teams and no one wants to work with someone that is a jerk.

How do you avoid this?

First, don’t interrupt or talk over people. If someone is speaking, allow them to finish what they are saying before jumping in with your own thoughts. Second, don’t attack other people’s ideas. You may bring up your concerns and disagreements, but you should never blatantly tell someone that their idea is bad.

As long as you are a nice and respectful teammate, you will be miles ahead of anyone that is overly aggressive, pushy, or rude.

5. Involve other people

An easy way to demonstrate that you are a great teammate is to involve other people.

If you notice that someone has not spoken in a long time, ask them what their thoughts are on the discussion. If you notice that someone was cut off when speaking, ask them to finish their thoughts after the person interrupting them finishes what they are saying.

All of these actions require minimal effort, but add tremendous value to the group while making you look like a great teammate.

6. Don’t spend too much time reading independently

In the beginning of the group case interview, your group will be given materials on the case background, objective, and other information needed to solve the case. Your group members will likely spend the beginning of the group case interview reading the materials by themselves.

Do not spend too much time reading the material independently.

The purpose of the group case interview is to have discussions and work together as a group. The more time your group spends reading the material independently, the less time the group has to demonstrate interpersonal and teamwork skills.

7. You don’t need to have your idea or recommendation chosen

Remember that multiple or even all people in your group can receive job offers. Therefore, you do not need to have your own ideas or recommendations chosen in order to receive an offer.

Fighting or pushing too hard for your own ideas and recommendations may actually harm you. It may suggest that you are not open to other people’s ideas and not willing to support your teammates.

Learn Case Interviews 10x Faster

Here are the resources we recommend to learn the most robust, effective case interview strategies in the least time-consuming way:

• Comprehensive Case Interview Course (our #1 recommendation): The only resource you need. Whether you have no business background, rusty math skills, or are short on time, this step-by-step course will transform you into a top 1% caser that lands multiple consulting offers.
• Hacking the Case Interview Book   (available on Amazon): Perfect for beginners that are short on time. Transform yourself from a stressed-out case interview newbie to a confident intermediate in under a week. Some readers finish this book in a day and can already tackle tough cases.
• The Ultimate Case Interview Workbook (available on Amazon): Perfect for intermediates struggling with frameworks, case math, or generating business insights. No need to find a case partner – these drills, practice problems, and full-length cases can all be done by yourself.
• Case Interview Coaching : Personalized, one-on-one coaching with former consulting interviewers
• Behavioral & Fit Interview Course : Be prepared for 98% of behavioral and fit questions in just a few hours. We'll teach you exactly how to draft answers that will impress your interviewer
• Resume Review & Editing : Transform your resume into one that will get you multiple interviews

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Deloitte Case Interview (questions, process, prep)

Deloitte interviews are pretty challenging compared to regular interviews at large companies. The questions are difficult and the interview format is specific to Deloitte.

But the good news is that with the right preparation it can actually become relatively straightforward to succeed at a Deloitte interview. We've put together this ultimate guide to maximise your chances of success.

Here's an overview of what we'll cover.

• Introduction to Deloitte
• Interview process
• Regular case interviews
• Group case interviews
• Fit and PEI questions
• Preparation plan

Click here to practise 1-on-1 with Deloitte ex-interviewers

1. deloitte consulting is bigger than mckinsey + bcg.

Deloitte is a force to reckon with in consulting. In 2022, it generated ~$26bn in revenue from its consulting business line. This makes it about as big as McKinsey, Bain and BCG combined.

Deloitte Consulting grew through a series of acquisitions. As a result, it's a collection of relatively independent firms operating under the Deloitte Consulting umbrella. Each member firm is managed by local partners who are responsible for their P&L. This is why you get more variation across different offices and regions than you do at a firm such as McKinsey.

Deloitte Consulting has three main practice groups you need to be aware of when applying:

1. Strategy and Operations (S&O) focuses on topics such as corporate strategy, supply-chain improvement, business model transformation, process improvements, etc.

2. Technology consulting focuses on digital strategy, delivery of IT programmes, cyber risks management, designing and building tech-based solutions for clients, etc.

3. Human capital focuses on topics such as organisation transformation, change management, corporate learning and development, diversity and inclusion, etc.

In 2013, Deloitte acquired Monitor which was initially founded by Michael Porter, the father of Porter's five forces . Monitor is now part of Deloitte S&O and that brand is particularly strong in North America.

The type of work Deloitte S&O does is very similar to what you would do at McKinsey , BCG or Bain . If you'd like to learn more about how Deloitte (and the other Big 4 firms) compares to the MBB firms, check out our MBB vs. Big 4 guide . 

2. Deloitte interview process

Your interview process with Deloitte will depend on whether you're applying as an experienced or early career candidate. There is also some variation by country, so we recommend that you ask your local HR contact at Deloitte for more details.

Below is an outline of the most common interview process and will be correct for the majority of candidates.

2.1 Early career candidates 

As an early career candidate you can apply online. You'll need your educational qualifications to hand, and you'll need to meet the minimum requirements.

The next step is an "immersive online assessment". Here you'll be asked to look at work scenarios and answer how you would respond.

Once you've completed it, you'll receive a "bespoke feedback report about your strengths and abilities".

If you fail the assessment, you'll hear back within a couple of days, but if you pass it may take a week or two before Deloitte contacts you - so in this case, no news is good news!

If you pass, you'll go onto the next assessment step: the "job simulation". You’ll answer questions across formats that include writing, video, multiple choice and ranking. Make sure you're dressed correctly and are in a quiet place before starting the simulation.

After you’ve completed the simulation, you'll get an email letting you know how you did within four weeks.

If successful you would then have a "Final stage assessment", which is a video interview with a senior consultant or an online group exercise. This would be the last step in your interview process.

Click here for more information on the interview process for early career applicants.

2.2 Non-early career candidates

If you're an experienced candidate, or at least not an undergraduate or recent graduate, the interview process will probably consist of three steps:

• Resume and cover letter screening
• First round interviews
• Second round interviews

2.2.1 Resume and cover letter screening

First, recruiters will look at your resume and assess if your experience matches the open position. This is the most competitive step in the process—we’ve found that 90% of candidates don’t make it past this stage.

You can use  this free resume guide  and this  free cover letter guide  to help tailor your application to the position you’re targeting. 

And if you’re looking for expert feedback, you can also get input from our  team of  ex-MBB recruiters , who will  cover what achievements to focus on (or ignore), how to fine tune your bullet points, and more.

2.2.2 First round interviews

Your interviewers at Deloitte will consist of a mix of senior consultants, managers and partners. First round interviews may be done in person or via video or phone call. They usually consist of:

• one behavioural interview (30 to 45mins)
• one or two case interviews (30 to 45mins each).

This is quite similar to what you could expect at other consulting firms.

2.2.3 Second round interviews

Second round interviews are similar to first round interviews, though the line of questioning can be a bit tougher. Your final interview is usually with a hiring partner, and before that you may face a group case interview.

• One behavioral interview (30 to 45mins)
• One case interview (30 to 45mins)
• One group case interview (45mins - 1hr)

Now you've seen an overview of the interview process, let's take a detailed look at regular case interviews and group case interviews at Deloitte, and how you should prepare for them.

3. Deloitte case interview questions

Case interviews at Deloitte are candidate-led. The style is therefore similar to what you will experience in a BCG case interview or a Bain case interview . Our research and experience tells us that there 7 types of questions you need to prepare for in candidate-led case interviews:

• Framework development
• Framework exploration
• Quant question – Data provided
• Quant question – No data provided
• Creativity question
• Recommendation

You can learn more about case interviews and how to prepare in our free case interview guide . One unique thing about Deloitte case interviews is that they will occasionally (but not always) give candidates written materials and a few minutes to review before they start the interview. This type of scenario requires the kind of skills you could learn in our free written case interview guide .

Deloitte has produced some very useful material to help candidates prepare. Take a good look through this practice case .

Deloitte has also shared some example case studies that you can work through interactively:

• Deloitte case study 1: Federal health agency needs to respond to Ebola epidemic (Advanced)
• Deloitte case study 2: Talent management for the Civil Cargo Protection Bureau (Advanced)
• Deloitte case study 3: Engagement strategy for a huge federal agency (Undergraduate)
• Deloitte case study 4: Recreation Unlimited, a global apparel and sportswear company, must reverse declining market share (Undergraduate)
• Deloitte case study 5: Federal benefits provider needs to formulate its 10-year vision (Undergraduate)

All these strategy cases can all be found on Deloitte's case interview prep tool, along with some Application Program Analyst cases and Business Technology Solution cases.

4. Deloitte group case interview

As mentioned above, Deloitte also uses group case interviews in its final round. Here is the key information you need to be aware of for this interview format:

• Candidates get divided into groups of 4 to 6
• Each group is given information about a case (i.e. a client facing a problem)
• You are given 10mins to review the materials by yourself or with another person in your group
• You are then asked to discuss a few questions about the case for 20mins with the rest of your group in front of your interviewers
• The interviewers will ask a few questions to the group for 15 to 20mins

This type of case mainly tests your ability to work with others. Interviewers won't intervene during the group discussion. They will just observe the group dynamics and mark each participant based on how they are contributing to the discussion.

Here are the top 3 things you should aim to do in your Deloitte group interview:

• Speak with a purpose. At the beginning of a group discussion, a lot of candidates will want to speak their mind as they know participating is important. But participating is not enough. The QUALITY of your input is crucial. Sometimes, it's better to let two or three people get the discussion started. And to then make a very thoughtful point based on how they started the discussion. Focus on the quality of your input, not the quantity.
• Involve everyone. Another tip that's easy to apply is to keep an eye on who's participating in the conversation and who's not. If you identify a member of the group who's struggling to make themselves heard, you should not hesitate to help them be heard by saying something like: "We haven't heard everyone's opinion on this yet. John, Rebecca what do you think?"
• Summarise. Finally, at the end of the 20 minutes group discussion it's a good idea to summarise the different points people have made. This will position you as the person bringing everyone together and making sure all candidates are on the same page. It is something some partners in consulting like doing with clients in real life and will therefore reflect positively on you.

And the top 3 things you should really avoid doing :

• Looking nervous. Group interviews is the time to put your poker face on. Everyone is stressed in a group interview. But you need to try your best to come across as confident. A good way to do this is to focus on basic body language: look at people in the eye, sit confidently, don't cross your arms, etc.
• Interrupting others. Consultants need to be client-friendly, and interrupting someone in a discussion is not client-friendly at all. You should listen carefully to what others are saying. Try to have a genuine interest in what they think. Before making your point, summarise their point to show that you understand what they mean.
• Dominating the conversation. Finally, some candidates are so eager to participate in the conversation that they end up completely dominating the rest of the group without realising it. A good tip to avoid this is to keep an eye on how much time you talk. If you are in a 5-person group you should aim to speak 20% (1/5th) of the time and really no more than 25%.

Your performance in regular and group case interviews will play a big role in Deloitte's decision to give you an offer. If you'd like to learn more how to approach group interviews, check-out our  separate detailed  guide to group case interviews.

5. Deloitte behavioral questions

Behavioural interview questions asked at Deloitte fall into two categories:

• Fit questions. These are generic questions such as “ Why consulting? ” or “ Why Deloitte? ”.
• Personal Experience Interview (PEI) questions. These are questions such as “Tell me about a time when you led a team through a difficult situation.” Or “Tell me about a time where you had to manage a team conflict”

Here are the top 5 fit and PEI questions you should prepare for at Deloitte and other consulting firms.

Top 5 fit questions:

• Why Deloitte?
• Why consulting?
• Walk me through your resume
• Tell me about something not on your resume
• Tell me about your greatest accomplishment

Top 5 PEI questions. Tell me about a time when ...

• You led a team through a difficult situation
• You worked in a team and had to manage a conflict
• You had a disagreement with a colleague / boss
• You had to change someone's / a group's mind
• You overcame a really difficult challenge

Don't fall into the trap of under-preparing for these types of questions. While they may seem easier than the case interviews, they are extremely important to get right.

You’ll need to prepare several ”stories” or “examples” from your personal and professional experience to demonstrate that you have the traits that Deloitte is looking for.

To learn more, check out our guide to consulting fit / PEI questions .

6. Deloitte case interview preparation plan

Now that you know what to expect in Deloitte interviews, let's discuss the steps you should take to prepare.

6.1 Learn the case interview essentials

The best starting point for your case interview prep is our case interview prep guide . It'll take you through all the different types of questions you may be asked in your case interview, show you how to draw from different frameworks to structure your answer, and give you example cases to practise with.

6.2 Become really confident at maths

You don't have to have a perfect GPA or GMAT score to succeed at case interview maths. However, during your Deloitte  interviews, you will be expected to quickly perform accurate mental maths. 

In order to do this, it’s essential to know the formulas for common metrics, like return on investment or breakeven point. And it’s also helpful to know a few maths shortcuts to help you solve problems more quickly. To learn more about these topics, check out our free guide to case interview maths . 

In our experience, the most successful applicants start their interview preparation by practising maths skills, so make sure you prioritise this step.

6.3 Research the company

Deloitte interviewers want to hire candidates who are deeply motivated to work for their firm. Make sure you're up to date in the latest developments in the area of the company you're applying to join. Here are some useful links to get you started:

• Deloitte's insights page
• Deloitte's selection of business podcasts
• Financial Times' news articles on Deloitte

In addition, do some networking so that you can show you've made the effort to reach out to current staff.

6.4 Do mock interviews

How you solve each case is important, but your interviewers will also be evaluating how you COMMUNICATE your answers. It's important to speak in a structured way that makes it easy to clearly understand your points.

The best way to hone your communication skills is to practise interviewing out loud, and you can do that in three main ways:

• Interview yourself (out loud)
• Practise interviewing with friends or family
• Practise interviewing with ex-interviewers

To help you with this process, here is a  broad  list   of consulting interview questions  you can practice with.  Practising by yourself is a great way to get started, and can help you get more comfortable with the flow of a case interview. However, this type of practice won’t prepare you for realistic interview conditions.

After getting some practice on your own, you should find someone who can do a mock interview with you, like a friend or family member.

We’d also recommend that you practise 1-1 with ex-interviewers from Deloitte . This is the best way to replicate the conditions of a real case interview, and to get feedback from someone who understands the process extremely well. Meet our Deloitte ex-interviewers who’d love to work with you.

The IGotAnOffer team

MBA admission: How to crack case-based group discussions?

• By:Surbhi Jain
• Date: 2018-11-27 14:13:32

Case studies or caselets are now an integral part of admissions to the MBA. Often, candidates should analyze small files during a group discussion (GD), instead of general topics. The idea is to examine the candidate's point of view, logical approach, quick thinking, and his problem-solving attitude before finalizing his/her candidature for the MBA program. The caselets do not require any prior knowledge of the subject. It is considered an effective way of judging the management qualities of a candidate required for admission to the B-School.

Read More- Predict your Percentile/Score through CAT Percentile/ CAT Score Predictor 

Although the Top management institutes (IIMs) have suppressed the group discussions, various leading business schools still continue to conduct case-based GDs some of the institutes are- XLRI-Jamshedpur, SPJIMR, Mumbai and NMIMS, Mumbai, etc. So what happens in a caselet? Mentors will give 10 minutes to the candidates to read a case summary followed by 10 minutes to write whatever we understood after that there will be a group discussion of 20 minutes. Let us figure out more about GD-based case studies in management institutes:

A case study is all about analysis because everyone gives the same information and therefore starts from the same base.

The case study topics are mainly related to current affairs. Current socio-economic environment, government policies, innovations, global economic climate or socio-political debates prevalent in popular media. Learn about as many case study topics as possible.

The purpose of these case-based GDs is to judge the knowledge, communication skills, leadership qualities and the ability of the candidate to make logical arguments and convince the opposing party, qualities needed to be a good manager.

Read more- GD/PI Tips for MBA Colleges in India

Here are some tips for solving case-based group discussions:

Refer to the topics covered in the GDs of your target institute. You can collect this information online or from coaching institutes. Take note of the topics covered over the years, it is very likely that the topics will go in the same direction this year as well.

Read newspapers, journals, magazines and watch current affairs programs to find out what's going on around you. Case-based GDs typically focus on business and economic issues that affect the social and political climate. Read editorials and articles based on hot topics, so you can use them while making your point of view during GD.

Meet up with your friends who are also MBA aspirants, form a group and hold a case-based group discussion. Exchange ideas, observe and develop confidence.

  In case-based GDs, around five minutes are given to prepare, so use this time wisely. If the case is about a topic where the decision is to be made, quickly think of points to back your ‘to’ or ‘for’ stand and choose one. If the subject is such that a decision has already been made and the group has to decide whether it is right or wrong, re-choose aside after quickly weighing your points.

What should be the right approach?

Approach which can identify the crux of the problem, can logically analyze it and can suggest an alternate course of action to solve it, is the right approach.  Know the steps that will lead you to solve it

Step1:  Attentively read the caselet, following the important points Step2:  Understand the objectives of the organization Step3:  Get to the core of the problem and its causes  Step4:  Identify and focus on the obstacles and constraints of the issue in achieving the desired goals Step5:  Find out the alternatives, analyze them and pick out the relevant ones. Step6:  Filter all of the alternatives and choose the most appropriate one. Step7:  Frame the course of action to implement the decision

Read more- CAT Score vs CAT Predictor

A few don’ts for caselet exercises-

• Do not be anxious and hyper even if you are not able to fully understand the situation or unable to identify the problem at first. read again it a little slowly, it will help you better understand.
• Do not jump on the conclusions; try to move step by step.
• Do not panic if you are unable to find an appropriate solution. Your analytical skills, the logical process of identifying the problem and the moving towards its solution will also be evaluated.
• Do not be in a hurry to speak without arriving at some logical analysis and solution strategy. When you speak, be relevant and to the point.

For more details and guidance you can reach at 7772954321 | 8818886504 and write us at [email protected]

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MBA Case Studies - Solved Examples

Need of MBA Case Studies

Case i: chemco case.

• ChemCo is a quality leader in the U.K. car batteries market.
• Customer battery purchases in the automobile market are highly seasonal.
• The fork-lift business was added to utilize idle capacity during periods of inactivity.
• This is a low-growth industry (1% annual growth over the last two years)
• Large customers are sophisticated and buy based on price and quality. Smaller customers buy solely on price.
• There is a Spanish competitor in the market who offers low priced batteries of inferior quality.

Essential MBA GD Guide: Key Topics with Strategies Free

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• Established player in car batteries
• Losing heavily in fork-lift truck batteries
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• Solved Case Studies
• High quality product, but low end customers care more about price than quality
• Mismanaged product diversification in a price sensitive market
• Alternative 1: Establish an Off-Brand for the fork-lift business
• Alternative 2: Educate the customer market about product quality
• Alternative 3: Exit the fork-lift battery business
• Establishing the firm's quality image
• Increase in market share
• Increase in sales
• Cost of the product
• Protect firm's quality image in the automobile industry
• Redesigned product to reduce the cost of manufacture
• Low price to enable it to compete with Spanish producer
• Make use of the quality leadership in car batteries market
• Offer reliability testing, extended warranties etc. to promote quality image
• Set higher prices to extract surplus from these advantages
• A passive strategy, not proactive
• Recommendations: Alternative 1 is recommended in this case. Since the firm operates in an industry which has low growth, hence it can expand market share and sales only by taking the customers from other players. Hence, it needs to tackle the Spanish competitor head-on by aggressively pricing its product. At the same time, launching a low-priced product under the same brand name erodes the high quality image in the car batteries market. Hence, the best option is to go for an off-brand to target the fork-lift customers who are increasingly becoming price sensitive. This will enable the company to ward off the threat in short-term and build its position strongly in the long-term.

Case II: NAKAMURA LACQUER COMPANY

• The Nakamura Lacquer Company: The Nakamura Lacquer Company based in Kyoto, Japan was one of the many small handicraft shops making lacquerware for the daily table use of the Japanese people.
• Mr. Nakamura- the personality: In 1948, a young Mr. Nakamura took over his family business. He saw an opportunity to cater to a new market of America, i.e. GI's of the Occupation Army who had begun to buy lacquer ware as souvenirs. However, he realized that the traditional handicraft methods were inadequate. He was an innovator and introduced simple methods of processing and inspection using machines. Four years later, when the Occupation Army left in 1952, Nakamura employed several thousand men, and produced 500,000 pieces of lacquers tableware each year for the Japanese mass consumer market. The profit from operations was $250,000.
• The Brand: Nakamura named his brand “Chrysanthemum” after the national flower of Japan, which showed his patriotic fervor. The brand became Japan's best known and best selling brand, being synonymous with good quality, middle class and dependability.
• The Market: The market for lacquerware in Japan seems to have matured, with the production steady at 500,000 pieces a year. Nakamura did practically no business outside of Japan. However, early in 1960, when the American interest in Japanese products began to grow, Nakamura received two offers
• The Rose and Crown offer: The first offer was from Mr. Phil Rose, V.P Marketing at the National China Company. They were the largest manufacturer of good quality dinnerware in the U.S., with their “Rose and Crown” brand accounting for almost 30% of total sales. They were willing to give a firm order for three eyes for annual purchases of 400,000 sets of lacquer dinnerware, delivered in Japan and at 5% more than what the Japanese jobbers paid. However, Nakamura would have to forego the Chrysanthemum trademark to “Rose and Crown” and also undertaken to sell lacquer ware to anyone else the U.S. The offer promised returns of $720,000 over three years (with net returns of $83,000), but with little potential for the U.S. market on the Chrysanthemum brand beyond that period.
• The Semmelback offer: The second offer was from Mr. Walter Sammelback of Sammelback, Sammelback and Whittacker, Chicago, the largest supplier of hotel and restaurant supplies in the U.S. They perceived a U.S. market of 600,000 sets a year, expecting it to go up to 2 million in around 5 years. Since the Japanese government did not allow overseas investment, Sammelback was willing to budget $1.5 million. Although the offer implied negative returns of $467,000 over the first five years, the offer had the potential to give a $1 million profit if sales picked up as anticipated.
• Meeting the order: To meet the numbers requirement of the orders, Nakamura would either have to expand capacity or cut down on the domestic market. If he chose to expand capacity, the danger was of idle capacity in case the U.S. market did not respond. If he cut down on the domestic market, the danger was of losing out on a well-established market. Nakamura could also source part of the supply from other vendors. However, this option would not find favor with either of the American buyers since they had approached only Nakamura, realizing that he was the best person to meet the order.
• Decision problem: Whether to accept any of the two offers and if yes, which one of the two and under what terms of conditions?
• To expand into the U.S. market.
• To maintain and build upon their reputation of the “Chrysanthemum” brand
• To increase profit volumes by tapping the U.S. market and as a result, increasing scale of operations.
• To increase its share in the U.S. lacquerware market.
• Profit Maximization criterion: The most important criterion in the long run is profit maximization.
• Risk criterion: Since the demand in the U.S. market is not as much as in Japan.
• Brand identity criterion: Nakamura has painstakingly built up a brand name in Japan. It is desirable for him to compete in the U.S. market under the same brand name
• Flexibility criterion: The chosen option should offer Nakamura flexibility in maneuvering the terms and conditions to his advantage. Additionally, Nakamura should have bargaining power at the time of renewal of the contract.
• Short term returns: Nakamura should receive some returns on the investment he makes on the new offers. However, this criterion may be compromised in favor of profit maximization in the long run.?
• Reject both: React both the offers and concentrate on the domestic market
• Accept RC offer: Accept the Rose and Crown offer and supply the offer by cutting down on supplies to the domestic market or through capacity expansion or both
• Accept SSW: offer; accept the SSW offer and meet it through cutting down on supply to the domestic market or through capacity expansion or both. Negotiate term of supply.
• Reject both: This option would not meet the primary criterion of profit maximization. Further, the objective of growth would also not be met. Hence, this option is rejected.
• Accept RC offer: The RC offer would assure net returns of $283,000 over the next three yeas. It also assures regular returns of $240,000 per year. However, Nakamura would have no presence in the U.S. with its Chrysanthemum brand name The RC offer would entail capacity expansion, as it would not be possible to siphon of 275,000 pieces from the domestic market over three years without adversely affecting operations there. At the end of three years, Nakamura would have little bargaining power with RC as it would have an excess capacity of 275,000 pieces and excess labor which it would want to utilize. In this sense the offer is risky. Further, the offer is not flexible. Long-term profit maximization is uncertain in this case a condition that can be controlled in the SSW offer. Hence, this offer is rejected.
• Accept SSW offer: The SSW offer does not assure a firm order or any returns for the period of contract. Although, in its present form the offer is risky if the market in the U.S. does not pick up as expected, the offer is flexible. If Nakamura were to exhibit caution initially by supplying only 300,000 instead of the anticipated 600,000 pieces, it could siphon off the 175,000 required from the domestic market. If demand exists in the U.S., the capacity can be expanded. With this offer, risk is minimized. Further, it would be competing on its own brand name. Distribution would be taken care of and long-term profit maximization criterion would be satisfied as this option has the potential of $1 million in profits per year. At the time of renewal of the contract, Nakamura would have immense bargaining power.
• Negotiate terms of offer with SSW: The terms would be that NLC would supply 300,000 pieces in the first year. If market demand exists, NLC should expand capacity to provide the expected demand.
• Action Plan: In the first phase, NLC would supply SSW with 300,000 pieces. 125,000 of these would be obtained by utilizing excess capacity, while the remaining would be obtained from the domestic market. If the expected demand for lacquer ware exists in the U.S., NLC would expand capacity to meet the expected demand. The debt incurred would be paid off by the fifth year.
• Contingency Plan:  In case the demand is not as expected in the first year, NLC should not service the U.S. market and instead concentrate on increasing penetration in the domestic market.

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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 November 20, 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.

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

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

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

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

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

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

Research bias

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

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What Is a Case Study?

Weighing the pros and cons of this method of research

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

• Pros and Cons

What Types of Case Studies Are Out There?

Where do you find data for a case study, how do i write a psychology 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 many different fields, including psychology, medicine, education, anthropology, political science, and social work.

The point 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, we got you—here are some rules of APA format to reference.  

At a Glance

A case study, or an in-depth study of a person, group, or event, can be a useful research tool when used wisely. In many cases, case studies are best used in situations where it would be difficult or impossible for you to conduct an experiment. They are helpful for looking at unique situations and allow researchers to gather a lot of˜ information about a specific individual or group of people. However, it's important to be cautious of any bias we draw from them as they are highly subjective.

What Are the Benefits and Limitations of Case Studies?

A case study can have its 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 or impossible to replicate in a lab. Some other benefits of a case study:

• Allows researchers to capture information on the 'how,' 'what,' and 'why,' of something that's implemented
• Gives researchers the chance to collect information on why one strategy might be chosen over another
• Permits researchers to develop hypotheses that can be explored in experimental research

On the other hand, a case study can have some drawbacks:

• It cannot necessarily be generalized to the larger population
• Cannot demonstrate cause and effect
• It may not be scientifically rigorous
• It can lead to bias

Researchers may choose to perform a case study if they want to explore a unique or recently discovered phenomenon. Through their insights, researchers develop additional ideas and study questions that might be explored in future studies.

It's important to remember that the insights 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 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 learning was possible, even after missing critical periods for language development. 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 denied her the opportunity to learn a language at critical points in her development.

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

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

• 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 who live 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 case 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 use depends on the unique characteristics of the situation and the case itself.

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.

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 you need to follow. If you are writing your case study for a professional publication, check with the publisher for their specific guidelines for submitting a case study.

Here is a general outline of what should be included in a case study.

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?

Need More Tips?

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, use 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 .

Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach .  BMC Med Res Methodol . 2011;11:100.

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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Structuring the Case Discussion

Well-designed cases are intentionally complex. Therefore, presenting an entire case to students all at once has the potential to overwhelm student groups and lead them to overlook key details or analytic steps. Accordingly, Barbara Cockrill asks students to review key case concepts the night before, and then presents the case in digestible “chunks” during a CBCL session. Structuring the case discussion around key in-depth questions, Cockrill creates a thoughtful interplay between small group work and whole group discussion that makes for more systematic forays into the case at hand.

Barbara Cockrill , Harold Amos Academy Associate Professor of Medicine

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• CBCL provides students the opportunity to apply course material in new ways. For this reason, you might consider not sharing the case with students beforehand and having them experience it in class with fresh eyes.
• Chunk cases so students can focus on case specifics and gradually build-up to greater complexity and understanding. 
• Introduce variety into case-based discussions. Integrate a mix of independent work, small group discussion, and whole group share outs to keep students engaged and provide multiple junctures for students to get feedback on their understanding.
• Instructor scaffolding is critical for effective case-based learning ( Ramaekers et al., 2011 )
• This resource from the Harvard Business School provides suggestions for questioning, listening, and responding during a case discussion .
• This comprehensive resource on “The ABCs of Case Teaching” provides helpful tips for planning and “running” your case .

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Experiencing the Case as a Student Team

Regulating the Flow of Energy in the Classroom

Designing Focused Discussions for Relevance and Transfer of Knowledge

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Types of Group Discussion: Strategies for Effective Discussions

Last Updated on November 6, 2023 by Milton Campbell

Group discussion is a valuable tool for learning, collaboration, and fostering critical thinking skills. Whether you are a student preparing for an exam, an educator looking for ways to engage your students, or a leader trying to solve a problem, understanding the different types of group discussions, topics, and strategies is essential. In this blog post, we will explore the various types of group discussions, how to choose a suitable topic, and strategies for facilitating meaningful and productive discussions.

Understanding Group Discussion

Group discussions are a form of interactive communication that involves a small group of individuals sharing their thoughts, ideas, and opinions on a specific topic. These discussions can take place in various settings, such as classrooms, organizations, or professional settings, and can serve different purposes, such as problem-solving, decision-making, or brainstorming.

Types of Group Discussion

Group discussions offer a dynamic environment for sharing thoughts, ideas, and opinions. They can be beneficial for learning, collaboration, and developing critical thinking skills . Let’s explore three types of group discussions: case-based discussions, topic-based discussions, and structured group discussions.

1. Case-Based Discussions

In case-based discussions, participants analyze and discuss specific cases or scenarios. They evaluate possible solutions or approaches, which helps develop problem-solving and analytical skills. By actively engaging with real or hypothetical case studies, participants enhance their ability to think critically about complex situations.

2. Topic-Based Discussions

Topic-based discussions center around a specific subject or theme. Participants express their opinions, present arguments, and explore different viewpoints. These discussions improve communication skills and foster critical thinking as participants analyze and evaluate various perspectives on a given topic.

3. Structured Group Discussions

Structured group discussions follow predefined formats or rules. A moderator guides the discussion by posing questions and facilitating conversation. This format ensures active participation and constructive exchanges, providing a framework for focused and productive discussions.

By understanding the different types of group discussions, participants can choose the most suitable format for their goals and create an engaging and interactive environment for meaningful conversations.

Choosing a Suitable Topic

Selecting an appropriate topic is crucial for a successful group discussion. Consider the following factors when choosing a topic:

1. Relevance to the Participants

The topic should be relevant to the participants’ interests, experiences, or areas of study. This helps create a sense of engagement and encourages active participation.

2. Controversial and Thought-Provoking

Controversial topics or those that require critical thinking and analysis can spark lively and meaningful discussions. Avoid vague or overly simplistic topics that do not stimulate thoughtful discussion.

3. Current Affairs and Real-World Issues

Discussing current affairs and real-world issues helps participants develop an understanding of the socio-economic and political landscape. These topics encourage participants to think critically and evaluate different perspectives.

Strategies for Effective Group Discussions

To make group discussions productive and engaging, consider implementing the following strategies:

1. Establish Clear Ground Rules

Start by establishing clear guidelines and expectations for the discussion. These ground rules should emphasize the importance of active listening, respectful communication, and equal participation. By setting a foundation of mutual respect and inclusivity, you create a safe and open environment for all participants to contribute their ideas.

2. Encourage the Expression of Diverse Perspectives

Promote a culture that values and encourages diverse perspectives. Encourage participants to share their unique viewpoints, experiences, and ideas. By actively seeking and embracing different perspectives, you enrich the conversation and foster a deeper understanding of the topic at hand. Remember that diversity of thought leads to more innovative and creative solutions.

3. Foster Lateral Thinking and Problem-Solving

Encourage participants to think critically and approach problems from various angles. Foster an environment that values and promotes lateral thinking, which involves exploring unconventional or alternative solutions. Encourage participants to challenge assumptions and consider different perspectives to generate innovative ideas and solutions.

4. Provide Structured Discussion Prompts

Prepare a list of discussion prompts or questions in advance to guide the conversation. These prompts should cover various aspects of the topic and encourage participants to think critically and express their thoughts. Structured discussion prompts provide a framework and keep the conversation focused and productive. This helps ensure that all important aspects of the topic are explored.

5. Facilitate Active Participation

Actively engage all participants to facilitate their active participation in the discussion. Encourage quieter participants to contribute by directly asking for their input or by creating a supportive environment that encourages them to share their thoughts. By ensuring that everyone feels heard and valued, you create a space for meaningful and collaborative discussions.

By implementing these strategies, you can make your group discussions more effective, inclusive, and thought-provoking. These approaches promote critical thinking, enhance problem-solving skills, and allow for the exploration of multiple perspectives. Remember that an open and respectful environment is key to fostering successful group discussions.

Common Challenges in Group Discussions and How to Overcome Them

Group discussions can be an effective way to generate ideas, facilitate collaboration, and arrive at well-informed decisions. However, there are common challenges that can arise during group discussions. Here are some of these challenges and strategies to overcome them:

1. Dominant Personalities

Some participants may have dominant personalities that can overpower the conversation, making others feel unheard or overshadowed. To prevent dominance, set equal speaking opportunities for everyone. Encourage active listening to make sure everyone’s voice is heard. If someone is dominating the conversation, try direct questions to other participants and redirecting the conversation towards the quieter members.

2. Groupthink

Groupthink occurs when the desire for group harmony leads to conformity and a lack of critical thinking. To avoid it, make sure to encourage diverse opinions, ideas, and perspectives. Assign a designated devil’s advocate whose role is to challenge proposed ideas. Anonymous ideation sessions and setting the tone of every idea is welcome helps in the same.

3. Lack of Focus

Conversations may easily veer off-topic or lack a clear focus, making it difficult to achieve the intended goals. Keep the conversation focused by setting and reviewing an agenda periodically. Encourage participants to take constructive breaks that revitalize their focus. Use summarizing techniques throughout the discussion to align the focus.

4. Unequal Participation

In some situations, certain individuals may dominate conversations while others stay silent. Encourage participation by assigning specific roles, and asking directly for input from quieter participants. Brainstorming techniques can be used like round-robin, think-pair-share, or small groups to ensure equal participation.

5. Conflict Resolution

Conflicts or disagreements may arise during group discussions, leading to stress and uncertainty. To handle conflicts constructively, encourage active listening, acknowledging different perspectives and viewpoints, facilitating open dialogue, and seeking win-win solutions. By creating an open and inclusive space to resolve conflicts, the group’s dynamics and outcomes will enhance positively.

By proactively addressing these common challenges, groups can have meaningful conversations that lead to actionable insights and productive solutions.

Technology and Group Discussions

Technology has revolutionized the way we communicate and collaborate in group settings. With the rise of virtual meetings, video conferencing, and online collaboration tools, it’s now easier than ever to conduct group discussions from anywhere in the world. However, with these benefits come new challenges as well. Here are some ways technology can impact group discussions and how to overcome them.

Pros of Using Technology in Group Discussions

Increased Flexibility and Accessibility : With online tools, group members can join meetings from anywhere, at any time. This allows for greater flexibility and accessibility, making it easier for people to participate in group discussions even if they are not physically present.

Improved Collaboration : Virtual tools allow group members to collaborate in real-time, regardless of their physical location. This makes it easier for members to share ideas and information, and work together to achieve a common goal.

Reduced Costs : Virtual meetings can significantly reduce costs associated with travel and facility rental. This makes it easier for groups with limited resources to conduct discussions without sacrificing the benefits of in-person meetings.

Cons of Using Technology in Group Discussions

Technical Difficulties : Technical difficulties can arise during virtual meetings, which can delay progress and cause frustration. This can be overcome by having all participants test the technology before the meeting and ensuring all participants have a stable internet connection.

Lack of Non-Verbal Cues : During virtual meetings, non-verbal cues such as body language and facial expressions can be difficult to read. To overcome this, group members must be clear and concise with their verbal communication.

Distractions : Since virtual meetings can be conducted from anywhere, it’s easy for participants to become distracted by their surroundings. To overcome this, establish ground rules for participants such as turning off notifications or finding a quiet space to participate in the discussion.

In conclusion, technology has revolutionized the way we conduct group discussions and collaboration. By being aware of the pros and cons of using virtual meetings and online collaboration tools, groups can take advantage of the benefits while mitigating the challenges.

Group discussions are an effective way to promote critical thinking, collaboration, and communication skills . By understanding the different types of group discussions, selecting suitable topics, and implementing effective strategies, educators and students can foster engaging and productive discussions. Remember to establish ground rules, encourage diverse perspectives, and provide structured prompts to make the most out of your group discussions.

Key Takeaways

• Group discussions can take various forms, including case-based and topic-based discussions.
• Choosing a relevant and thought-provoking topic is crucial for effective discussions.
• Strategies such as establishing ground rules and encouraging diverse perspectives enhance the quality of group discussions .
• Active participation and structured discussion prompts facilitate meaningful conversations.

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A local coalition forms a task force to address the rising HIV rate among teens in the community.  A group of parents meets to wrestle with their feeling that their school district is shortchanging its students.  A college class in human services approaches the topic of dealing with reluctant participants.  Members of an environmental group attend a workshop on the effects of global warming.  A politician convenes a “town hall meeting” of constituents to brainstorm ideas for the economic development of the region.  A community health educator facilitates a smoking cessation support group.

All of these might be examples of group discussions, although they have different purposes, take place in different locations, and probably run in different ways.  Group discussions are common in a democratic society, and, as a community builder, it’s more than likely that you have been and will continue to be involved in many of them.  You also may be in a position to lead one, and that’s what this section is about.  In this last section of a chapter on group facilitation, we’ll examine what it takes to lead a discussion group well, and how you can go about doing it.

What is an effective group discussion?

The literal definition of a group discussion is obvious: a critical conversation about a particular topic, or perhaps a range of topics, conducted in a group of a size that allows participation by all members.  A group of two or three generally doesn’t need a leader to have a good discussion, but once the number reaches five or six, a leader or facilitator can often be helpful.  When the group numbers eight or more, a leader or facilitator, whether formal or informal, is almost always helpful in ensuring an effective discussion.

A group discussion is a type of meeting, but it differs from the formal meetings in a number of ways: It may not have a specific goal – many group discussions are just that: a group kicking around ideas on a particular topic.  That may lead to a goal ultimately...but it may not. It’s less formal, and may have no time constraints, or structured order, or agenda. Its leadership is usually less directive than that of a meeting. It emphasizes process (the consideration of ideas) over product (specific tasks to be accomplished within the confines of the meeting itself. Leading a discussion group is not the same as running a meeting.  It’s much closer to acting as a facilitator, but not exactly the same as that either.

An effective group discussion generally has a number of elements:

• All members of the group have a chance to speak, expressing their own ideas and feelings freely, and to pursue and finish out their thoughts
• All members of the group can hear others’ ideas and feelings stated openly
• Group members can safely test out ideas that are not yet fully formed
• Group members can receive and respond to respectful but honest and constructive feedback.  Feedback could be positive, negative, or merely clarifying or correcting factual questions or errors, but is in all cases delivered respectfully.
• A variety of points of view are put forward and discussed
• The discussion is not dominated by any one person
• Arguments, while they may be spirited, are based on the content of ideas and opinions, not on personalities
• Even in disagreement, there’s an understanding that the group is working together to resolve a dispute, solve a problem, create a plan, make a decision, find principles all can agree on, or come to a conclusion from which it can move on to further discussion

Many group discussions have no specific purpose except the exchange of ideas and opinions.  Ultimately, an effective group discussion is one in which many different ideas and viewpoints are heard and considered.  This allows the group to accomplish its purpose if it has one, or to establish a basis either for ongoing discussion or for further contact and collaboration among its members.

There are many possible purposes for a group discussion, such as:

• Create a new situation – form a coalition, start an initiative, etc.
• Explore cooperative or collaborative arrangements among groups or organizations
• Discuss and/or analyze an issue, with no specific goal in mind but understanding
• Create a strategic plan – for an initiative, an advocacy campaign, an intervention, etc.
• Discuss policy and policy change
• Air concerns and differences among individuals or groups
• Hold public hearings on proposed laws or regulations, development, etc.
• Decide on an action
• Provide mutual support
• Solve a problem
• Resolve a conflict
• Plan your work or an event

Possible leadership styles of a group discussion also vary.  A group leader or facilitator might be directive or non-directive; that is, she might try to control what goes on to a large extent; or she might assume that the group should be in control, and that her job is to facilitate the process.  In most group discussions, leaders who are relatively non-directive make for a more broad-ranging outlay of ideas, and a more satisfying experience for participants.

Directive leaders can be necessary in some situations. If a goal must be reached in a short time period, a directive leader might help to keep the group focused. If the situation is particularly difficult, a directive leader might be needed to keep control of the discussion and make

Why would you lead a group discussion?

There are two ways to look at this question: “What’s the point of group discussion?” and “Why would you, as opposed to someone else, lead a group discussion?”  Let’s examine both.

What’s the point of group discussion?

As explained in the opening paragraphs of this section, group discussions are common in a democratic society.  There are a number of reasons for this, some practical and some philosophical.

A group discussion:

• G ives everyone involved a voice .  Whether the discussion is meant to form a basis for action, or just to play with ideas, it gives all members of the group a chance to speak their opinions, to agree or disagree with others, and to have their thoughts heard.  In many community-building situations, the members of the group might be chosen specifically because they represent a cross-section of the community, or a diversity of points of view.
• Allows for a variety of ideas to be expressed and discussed .  A group is much more likely to come to a good conclusion if a mix of ideas is on the table, and if all members have the opportunity to think about and respond to them.
• Is generally a democratic, egalitarian process .  It reflects the ideals of most grassroots and community groups, and encourages a diversity of views.
• Leads to group ownership of whatever conclusions, plans, or action the group decides upon .  Because everyone has a chance to contribute to the discussion and to be heard, the final result feels like it was arrived at by and belongs to everyone.
• Encourages those who might normally be reluctant to speak their minds .  Often, quiet people have important things to contribute, but aren’t assertive enough to make themselves heard.  A good group discussion will bring them out and support them.
• Can often open communication channels among people who might not communicate in any other way .  People from very different backgrounds, from opposite ends of the political spectrum, from different cultures, who may, under most circumstances, either never make contact or never trust one another enough to try to communicate, might, in a group discussion, find more common ground than they expected.
• Is sometimes simply the obvious, or even the only, way to proceed.  Several of the examples given at the beginning of the section – the group of parents concerned about their school system, for instance, or the college class – fall into this category, as do public hearings and similar gatherings.

Why would you specifically lead a group discussion?

You might choose to lead a group discussion, or you might find yourself drafted for the task.  Some of the most common reasons that you might be in that situation:

• It’s part of your job .  As a mental health counselor, a youth worker, a coalition coordinator, a teacher, the president of a board of directors, etc. you might be expected to lead group discussions regularly.
• You’ve been asked to .  Because of your reputation for objectivity or integrity, because of your position in the community, or because of your skill at leading group discussions, you might be the obvious choice to lead a particular discussion.
• A discussion is necessary, and you’re the logical choice to lead it .  If you’re the chair of a task force to address substance use in the community, for instance, it’s likely that you’ll be expected to conduct that task force’s meetings, and to lead discussion of the issue.
• It was your idea in the first place .  The group discussion, or its purpose, was your idea, and the organization of the process falls to you.

You might find yourself in one of these situations if you fall into one of the categories of people who are often tapped to lead group discussions.  These categories include (but aren’t limited to):

• Directors of organizations
• Public officials
• Coalition coordinators
• Professionals with group-leading skills – counselors, social workers, therapists, etc.
• Health professionals and health educators
• Respected community members.  These folks may be respected for their leadership – president of the Rotary Club, spokesperson for an environmental movement – for their positions in the community – bank president, clergyman – or simply for their personal qualities – integrity, fairness, ability to communicate with all sectors of the community.
• Community activists.  This category could include anyone from “professional” community organizers to average citizens who care about an issue or have an idea they want to pursue.

When might you lead a group discussion?

The need or desire for a group discussion might of course arise anytime, but there are some times when it’s particularly necessary.

• At the start of something new . Whether you’re designing an intervention, starting an initiative, creating a new program, building a coalition, or embarking on an advocacy or other campaign, inclusive discussion is likely to be crucial in generating the best possible plan, and creating community support for and ownership of it.
• When an issue can no longer be ignored . When youth violence reaches a critical point, when the community’s drinking water is declared unsafe, when the HIV infection rate climbs – these are times when groups need to convene to discuss the issue and develop action plans to swing the pendulum in the other direction.
• When groups need to be brought together . One way to deal with racial or ethnic hostility, for instance, is to convene groups made up of representatives of all the factions involved.  The resulting discussions – and the opportunity for people from different backgrounds to make personal connections with one another – can go far to address everyone’s concerns, and to reduce tensions.
• When an existing group is considering its next step or seeking to address an issue of importance to it . The staff of a community service organization, for instance, may want to plan its work for the next few months, or to work out how to deal with people with particular quirks or problems.

How do you lead a group discussion?

In some cases, the opportunity to lead a group discussion can arise on the spur of the moment; in others, it’s a more formal arrangement, planned and expected.  In the latter case, you may have the chance to choose a space and otherwise structure the situation.  In less formal circumstances, you’ll have to make the best of existing conditions.

We’ll begin by looking at what you might consider if you have time to prepare.  Then we’ll examine what it takes to make an effective discussion leader or facilitator, regardless of external circumstances.

Set the stage

If you have time to prepare beforehand, there are a number of things you may be able to do to make the participants more comfortable, and thus to make discussion easier.

Choose the space

If you have the luxury of choosing your space, you might look for someplace that’s comfortable and informal.  Usually, that means comfortable furniture that can be moved around (so that, for instance, the group can form a circle, allowing everyone to see and hear everyone else easily).  It may also mean a space away from the ordinary.

One organization often held discussions on the terrace of an old mill that had been turned into a bookstore and café.  The sound of water from the mill stream rushing by put everyone at ease, and encouraged creative thought.

Provide food and drink

The ultimate comfort, and one that breaks down barriers among people, is that of eating and drinking.

Bring materials to help the discussion along

Most discussions are aided by the use of newsprint and markers to record ideas, for example.

Become familiar with the purpose and content of the discussion

If you have the opportunity, learn as much as possible about the topic under discussion.  This is not meant to make you the expert, but rather to allow you to ask good questions that will help the group generate ideas.

Make sure everyone gets any necessary information, readings, or other material beforehand

If participants are asked to read something, consider questions, complete a task, or otherwise prepare for the discussion, make sure that the assignment is attended to and used.  Don’t ask people to do something, and then ignore it.

Lead the discussion

Think about leadership style

The first thing you need to think about is leadership style, which we mentioned briefly earlier in the section.  Are you a directive or non-directive leader?  The chances are that, like most of us, you fall somewhere in between the extremes of the leader who sets the agenda and dominates the group completely, and the leader who essentially leads not at all. The point is made that many good group or meeting leaders are, in fact, facilitators, whose main concern is supporting and maintaining the process of the group’s work.  This is particularly true when it comes to group discussion, where the process is, in fact, the purpose of the group’s coming together.

A good facilitator helps the group set rules for itself, makes sure that everyone participates and that no one dominates, encourages the development and expression of all ideas, including “odd” ones, and safeguards an open process, where there are no foregone conclusions and everyone’s ideas are respected.  Facilitators are non-directive, and try to keep themselves out of the discussion, except to ask questions or make statements that advance it.  For most group discussions, the facilitator role is probably a good ideal to strive for.

It’s important to think about what you’re most comfortable with philosophically, and how that fits what you’re comfortable with personally.  If you’re committed to a non-directive style, but you tend to want to control everything in a situation, you may have to learn some new behaviors in order to act on your beliefs.

Put people at ease

Especially if most people in the group don’t know one another, it’s your job as leader to establish a comfortable atmosphere and set the tone for the discussion.

Help the group establish ground rules

The ground rules of a group discussion are the guidelines that help to keep the discussion on track, and prevent it from deteriorating into namecalling or simply argument.  Some you might suggest, if the group has trouble coming up with the first one or two:

• Everyone should treat everyone else with respect : no name-calling, no emotional outbursts, no accusations.
• No arguments directed at people – only at ideas and opinions .  Disagreement should be respectful – no ridicule.
• Don’t interrupt .  Listen to the whole of others’ thoughts – actually listen, rather than just running over your own response in your head.
• Respect the group’s time .  Try to keep your comments reasonably short and to the point, so that others have a chance to respond.
• Consider all comments seriously, and try to evaluate them fairly .  Others’ ideas and comments may change your mind, or vice versa: it’s important to be open to that.
• Don’t be defensive if someone disagrees with you .  Evaluate both positions, and only continue to argue for yours if you continue to believe it’s right.
• Everyone is responsible for following and upholding the ground rules .

Ground rules may also be a place to discuss recording the session.  Who will take notes, record important points, questions for further discussion, areas of agreement or disagreement?  If the recorder is a group member, the group and/or leader should come up with a strategy that allows her to participate fully in the discussion.

Generate an agenda or goals for the session

You might present an agenda for approval, and change it as the group requires, or you and the group can create one together.  There may actually be no need for one, in that the goal may simply be to discuss an issue or idea.  If that’s the case, it should be agreed upon at the outset.

How active you are might depend on your leadership style, but you definitely have some responsibilities here.  They include setting, or helping the group to set the discussion topic; fostering the open process; involving all participants; asking questions or offering ideas to advance the discussion; summarizing or clarifying important points, arguments, and ideas; and wrapping up the session.  Let’s look at these, as well as some do’s and don’t’s for discussion group leaders.

• Setting the topic . If the group is meeting to discuss a specific issue or to plan something, the discussion topic is already set.  If the topic is unclear, then someone needs to help the group define it.  The leader – through asking the right questions, defining the problem, and encouraging ideas from the group – can play that role.
• Fostering the open process . Nurturing the open process means paying attention to the process, content, and interpersonal dynamics of the discussion all at the same time – not a simple matter. As leader, your task is not to tell the group what to do, or to force particular conclusions, but rather to make sure that the group chooses an appropriate topic that meets its needs, that there are no “right” answers to start with (no foregone conclusions), that no one person or small group dominates the discussion, that everyone follows the ground rules, that discussion is civil and organized, and that all ideas are subjected to careful critical analysis.  You might comment on the process of the discussion or on interpersonal issues when it seems helpful (“We all seem to be picking on John here – what’s going on?”), or make reference to the open process itself (“We seem to be assuming that we’re supposed to believe X – is that true?”). Most of your actions as leader should be in the service of modeling or furthering the open process.

Part of your job here is to protect “minority rights,” i.e., unpopular or unusual ideas.  That doesn’t mean you have to agree with them, but that you have to make sure that they can be expressed, and that discussion of them is respectful, even in disagreement. (The exceptions are opinions or ideas that are discriminatory or downright false.)  Odd ideas often turn out to be correct, and shouldn’t be stifled.

• Involving all participants . This is part of fostering the open process, but is important enough to deserve its own mention. To involve those who are less assertive or shy, or who simply can’t speak up quickly enough, you might ask directly for their opinion, encourage them with body language (smile when they say anything, lean and look toward them often), and be aware of when they want to speak and can’t break in.  It’s important both for process and for the exchange of ideas that everyone have plenty of opportunity to communicate their thoughts.
• Asking questions or offering ideas to advance the discussion . The leader should be aware of the progress of the discussion, and should be able to ask questions or provide information or arguments that stimulate thinking or take the discussion to the next step when necessary. If participants are having trouble grappling with the topic, getting sidetracked by trivial issues, or simply running out of steam, it’s the leader’s job to carry the discussion forward.

This is especially true when the group is stuck, either because two opposing ideas or factions are at an impasse, or because no one is able or willing to say anything.  In these circumstances, the leader’s ability to identify points of agreement, or to ask the question that will get discussion moving again is crucial to the group’s effectiveness.

• Summarizing or clarifying important points, arguments, or ideas . This task entails making sure that everyone understands a point that was just made, or the two sides of an argument.  It can include restating a conclusion the group has reached, or clarifying a particular idea or point made by an individual (“What I think I heard you say was…”).  The point is to make sure that everyone understands what the individual or group actually meant.
• Wrapping up the session .  As the session ends, the leader should help the group review the discussion and make plans for next steps (more discussion sessions, action, involving other people or groups, etc.). He should also go over any assignments or tasks that were agreed to, make sure that every member knows what her responsibilities are, and review the deadlines for those responsibilities.  Other wrap-up steps include getting feedback on the session – including suggestions for making it better – pointing out the group’s accomplishments, and thanking it for its work.

Even after you’ve wrapped up the discussion, you’re not necessarily through. If you’ve been the recorder, you might want to put the notes from the session in order, type them up, and send them to participants. The notes might also include a summary of conclusions that were reached, as well as any assignments or follow-up activities that were agreed on.

If the session was one-time, or was the last of a series, your job may now be done. If it was the beginning, however, or part of an ongoing discussion, you may have a lot to do before the next session, including contacting people to make sure they’ve done what they promised, and preparing the newsprint notes to be posted at the next session so everyone can remember the discussion.

Leading an effective group discussion takes preparation (if you have the opportunity for it), an understanding of and commitment to an open process, and a willingness to let go of your ego and biases. If you can do these things, the chances are you can become a discussion leader that can help groups achieve the results they want.

Do’s and don’ts for discussion leaders

• Model the behavior and attitudes you want group members to employ . That includes respecting all group members equally; advancing the open process; demonstrating what it means to be a learner (admitting when you’re wrong, or don’t know a fact or an answer, and suggesting ways to find out); asking questions based on others’ statements; focusing on positions rather than on the speaker; listening carefully; restating others’ points; supporting your arguments with fact or logic; acceding when someone else has a good point; accepting criticism; thinking critically; giving up the floor when appropriate; being inclusive and culturally sensitive, etc.
• Use encouraging body language and tone of voice, as well as words .  Lean forward when people are talking, for example, keep your body position open and approachable, smile when appropriate, and attend carefully to everyone, not just to those who are most articulate.
• Give positive feedback for joining the discussion .  Smile, repeat group members’ points, and otherwise show that you value participation.
• Be aware of people’s reactions and feelings, and try to respond appropriately . If a group member is hurt by others’ comments, seems puzzled or confused, is becoming angry or defensive, it’s up to you as discussion leader to use the ground rules or your own sensitivity to deal with the situation. If someone’s hurt, for instance, it may be important to point that out and discuss how to make arguments without getting personal.  If group members are confused, revisiting the comments or points that caused the confusion, or restating them more clearly, may be helpful.  Being aware of the reactions of individuals and of the group as a whole can make it possible to expose and use conflict, or to head off unnecessary emotional situations and misunderstandings.
• Ask open-ended questions .  In advancing the discussion, use questions that can’t be answered with a simple yes or no.  Instead, questions should require some thought from group members, and should ask for answers that include reasons or analysis.  The difference between “Do you think the President’s decision was right?” and “Why do you think the President’s decision was or wasn’t right?” is huge.  Where the first question can be answered with a yes or no, the second requires an analysis supporting the speaker’s opinion, as well as discussion of the context and reasons for the decision.
• Control your own biases .  While you should point out factual errors or ideas that are inaccurate and disrespectful of others, an open process demands that you not impose your views on the group, and that you keep others from doing the same.  Group members should be asked to make rational decisions about the positions or views they want to agree with, and ultimately the ideas that the group agrees on should be those that make the most sense to them – whether they coincide with yours or not.  Pointing out bias – including your own – and discussing it helps both you and group members try to be objective.

A constant question that leaders – and members – of any group have is what to do about racist, sexist, or homophobic remarks, especially in a homogeneous group where most or all of the members except the leader may agree with them.  There is no clear-cut answer, although if they pass unchallenged, it may appear you condone the attitude expressed. How you challenge prejudice is the real question.  The ideal here is that other members of the group do the challenging, and it may be worth waiting long enough before you jump in to see if that’s going to happen.  If it doesn’t, you can essentially say, “That’s wrong, and I won’t allow that kind of talk here,” which may well put an end to the remarks, but isn’t likely to change anyone’s mind.  You can express your strong disagreement or discomfort with such remarks and leave it at that, or follow up with “Let’s talk about it after the group,” which could generate some real discussion about prejudice and stereotypes, and actually change some thinking over time. Your ground rules – the issue of respecting everyone – should address this issue, and it probably won’t come up…but there are no guarantees.  It won’t hurt to think beforehand about how you want to handle it.

• Encourage disagreement, and help the group use it creatively .  Disagreement is not to be smoothed over, but rather to be analyzed and used.  When there are conflicting opinions – especially when both can be backed up by reasonable arguments – the real discussion starts.  If everyone agrees on every point, there’s really no discussion at all.  Disagreement makes people think.  It may not be resolved in one session, or at all, but it’s the key to discussion that means something.

All too often, conflict – whether conflicting opinions, conflicting world views, or conflicting personalities – is so frightening to people that they do their best to ignore it or gloss it over.  That reaction not only leaves the conflict unresolved – and therefore growing, so that it will be much stronger when it surfaces later– but fails to examine the issues that it raises.  If those are brought out in the open and discussed reasonably, the two sides often find that they have as much agreement as disagreement, and can resolve their differences by putting their ideas together.  Even where that’s not the case, facing the conflict reasonably, and looking at the roots of the ideas on each side, can help to focus on the issue at hand and provide solutions far better than if one side or the other simply operated alone.

• Keep your mouth shut as much as possible .  By and large, discussion groups are for the group members.  You may be a member of the group and have been asked by the others to act as leader, in which case you certainly have a right to be part of the discussion (although not to dominate).  If you’re an outside facilitator, or leader by position, it’s best to confine your contributions to observations on process, statements of fact, questions to help propel the discussion, and clarification and summarization.  The simple fact that you’re identified as leader or facilitator gives your comments more force than those of other group members.  If you’re in a position of authority or seen as an expert, that force becomes even greater.  The more active you are in the discussion, the more the group will take your positions and ideas as “right,” and the less it will come to its own conclusions.
• Don’t let one or a small group of individuals dominate the discussion .  People who are particularly articulate or assertive, who have strong feelings that they urgently want to express, or who simply feel the need – and have the ability – to dominate can take up far more than their fair share of a discussion.  This often means that quieter people have little or no chance to speak, and that those who disagree with the dominant individual(s) are shouted down and cease trying to make points.  It’s up to the leader to cut off individuals who take far more than their share of time, or who try to limit discussion.  This can be done in a relatively non-threatening way (“This is an interesting point, and it’s certainly worth the time we’ve spent on it, but there are other points of view that need to be heard as well.  I think Alice has been waiting to speak…”), but it’s crucial to the open process and to the comfort and effectiveness of the group.
• Don’t let one point of view override others , unless it’s based on facts and logic, and is actually convincing group members to change their minds.  If a point of view dominates because of its merits, its appeal to participants’ intellectual and ethical sensibilities, that’s fine.  It’s in fact what you hope will happen in a good group discussion.  If a point of view dominates because of the aggressiveness of its supporters, or because it’s presented as something it’s wrong to oppose (“People who disagree with the President are unpatriotic and hate their country”), that’s intellectual bullying or blackmail, and is the opposite of an open discussion.  As leader, you should point it out when that’s happening, and make sure other points of view are aired and examined.

Sometimes individuals or factions that are trying to dominate can disrupt the process of the group. Both Sections 1 and 2 of this chapter contain some guidelines for dealing with this type of situation.

• Don’t assume that anyone holds particular opinions or positions because of his culture, background, race, personal style, etc .  People are individuals, and can’t be judged by their exteriors.  You can find out what someone thinks by asking, or by listening when he speaks.
• Don’t assume that someone from a particular culture, race, or background speaks for everyone else from that situation .  She may or may not represent the general opinion of people from situations similar to hers…or there may not be a general opinion among them.  In a group discussion, no one should be asked or assumed to represent anything more than herself.

The exception here is when someone has been chosen by her community or group to represent its point of view in a multi-sector discussion.  Even in that situation, the individual may find herself swayed by others’ arguments, or may have ideas of her own.  She may have agreed to sponsor particular ideas that are important to her group, but she may still have her own opinions as well, especially in other areas.

• Don’t be the font of all wisdom .  Even if you know more about the discussion topic than most others in the group (if you’re the teacher of a class, for instance), presenting yourself as the intellectual authority denies group members the chance to discuss the topic freely and without pressure.  Furthermore, some of them may have ideas you haven’t considered, or experiences that give them insights into the topic that you’re never likely to have.  Model learning behavior, not teaching behavior.

If you’re asked your opinion directly, you should answer honestly.  You have some choices about how you do that, however.  One is to state your opinion, but make very clear that it’s an opinion, not a fact, and that other people believe differently.  Another is to ask to hold your opinion until the end of the discussion, so as not to influence anyone’s thinking while it’s going on.  Yet another is to give your opinion after all other members of the group have stated theirs, and then discuss the similarities and differences among all the opinions and people’s reasons for holding them. If you’re asked a direct question, you might want to answer it if it’s a question of fact and you know the answer, and if it’s relevant to the discussion.  If the question is less clear-cut, you might want to throw it back to the group, and use it as a spur to discussion.

Group discussions are common in our society, and have a variety of purposes, from planning an intervention or initiative to mutual support to problem-solving to addressing an issue of local concern.  An effective discussion group depends on a leader or facilitator who can guide it through an open process – the group chooses what it’s discussing, if not already determined, discusses it with no expectation of particular conclusions, encourages civil disagreement and argument, and makes sure that every member is included and no one dominates.  It helps greatly if the leader comes to the task with a democratic or, especially, a collaborative style, and with an understanding of how a group functions.

A good group discussion leader has to pay attention to the process and content of the discussion as well as to the people who make up the group.  She has to prepare the space and the setting to the extent possible; help the group establish ground rules that will keep it moving civilly and comfortably; provide whatever materials are necessary; familiarize herself with the topic; and make sure that any pre-discussion readings or assignments get to participants in plenty of time.  Then she has to guide the discussion, being careful to promote an open process; involve everyone and let no one dominate; attend to the personal issues and needs of individual group members when they affect the group; summarize or clarify when appropriate; ask questions to keep the discussion moving, and put aside her own agenda, ego, and biases.

It’s not an easy task, but it can be extremely rewarding.  An effective group discussion can lay the groundwork for action and real community change.

Online resources

Everyday-Democracy . Study Circles Resource Center. Information and publications related to study circles, participatory discussion groups meant to address community issues.

Facilitating Political Discussions from the Institute for Democracy and Higher Education at Tufts University is designed to assist experienced facilitators in training others to facilitate politically charged conversations. The materials are broken down into "modules" and facilitation trainers can use some or all of them to suit their needs.

Project on Civic Reflection provides information about leading study circles on civic reflection.

“ Suggestions for Leading Small-Group Discussions ,” prepared by Lee Haugen, Center for Teaching Excellence, Iowa State University, 1998. Tips on university teaching, but much of the information is useful in other circumstances as well.

“ Tips for Leading Discussions ,” by Felisa Tibbits, Human Rights Education Associates.

Print resources

Forsyth, D . Group Dynamics . (2006). (4th edition).  Belmont, CA: Thomson Wadsworth. 

Johnson, D., & Frank P. (2002). Joining Together: Group theory and group skills . (8th edition).  Boston: Allyn & Bacon.

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Group Discussion & Case Studies

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• Comprehensive E-Book has persona grooming.
• How to crack the group discussion? It’s tips and strategies.
• FAQs of GDPI and two cases from colleges
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This is a power capsule to develop an impressive personality which can crack group discussions & case studies. The course is equipped with 2 Live Lectures for building conceptual understanding along with videos and eBooks.

Get familiar with diverse topics and behavioral/intellectual aspects of discussion. Also understand the equities and mannerism that will help you succeed in the group discussion

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• Tips for Group Discussion
• 15 Don'ts in a Group Discussion
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• Do I change my stand in a Group Discussion GD ?
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• Group Discussion: Parameters for Evaluation

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• Published: 13 April 2024

Reevaluating Adiponectin’s impact on obesity hypertension: a Chinese case-control study

• Ou Wu 1 , 2   na1 ,
• Xi Lu 3   na1 ,
• Jianhang Leng 4 ,
• Xingyu Zhang 5 ,
• Wei Liu 6 ,
• Fenfang Yang 4 ,
• Hu Zhang 7 ,
• Jiajia Li 8 ,
• Saber Khederzadeh 9 , 10 ,
• Xiaodong Liu 11 &
• Chengda Yuan 12  

BMC Cardiovascular Disorders volume  24 , Article number:  208 ( 2024 ) Cite this article

Metrics details

Obesity and hypertension are major risk factors for cardiovascular diseases that affect millions of people worldwide. Both conditions are associated with chronic low-grade inflammation, which is mediated by adipokines such as adiponectin. Adiponectin is the most abundant adipokine that has a beneficial impact on metabolic and vascular biology, while high serum concentrations are associated with some syndromes. This “adiponectin paradox” still needs to be clarified in obesity-associated hypertension. The aim of this study was to investigate how adiponectin affects blood pressure, inflammation, and metabolic function in obesity hypertension using a Chinese adult case-control study.

A case-control study that had finished recruiting 153 subjects divided as four characteristic groups. Adiponectin serum levels were tested by ELISA in these subjects among these four characteristic Chinese adult physical examination groups. Waist circumference (WC), body mass index (BMI), systolic blood pressure (SB), diastolic blood pressure (DB), and other clinical laboratory data were collected. Analyzation of correlations between the research index and differences between groups was done by SPSS.

Serum adiponectin levels in the| normal healthy group (NH group) were significantly higher than those in the newly diagnosed untreated just-obesity group (JO group), and negatively correlated with the visceral adiposity index. With multiple linear egression analysis, it was found that, for serum adiponectin, gender, serum albumin (ALB), alanine aminotransferase (ALT) and high-density lipoprotein cholesterol (HDLC) were the significant independent correlates, and for SB, age and HDLC were the significant independent correlates, and for DB, alkaline phosphatase (ALP) was the significant independent correlate. The other variables did not reach significance in the model.

Conclusions

Our study reveals that adiponectin’s role in obesity-hypertension is multifaceted and is influenced by the systemic metabolic homeostasis signaling axis. In obesity-related hypertension, compensatory effects, adiponectin resistance, and reduced adiponectin clearance from impaired kidneys and liver all contribute to the “adiponectin paradox”.

Peer Review reports

Introduction

Obesity, having an inexorable rise with over 650 million obese worldwide [ 1 ], is globally a significant public health challenge and accounts for 65–78% of cases of primary hypertension [ 2 ]. The pathways through which obesity causes hypertension are complicated, including sympathetic nervous system overactivation, stimulation of the renin-angiotensin-aldosterone system, alterations in adipose-derived cytokines, insulin resistance, and structural and functional renal changes [ 2 ]. Adipose tissue is one of the largest endocrine organs in the body playing multiple intricate roles including secretion of a number of biologically adipokines, of which the most abundant is adiponectin [ 1 ].

Adiponectin, a 28-kDa protein adipocytokine, mainly produced and secreted into the circulation by lean adipocytes [ 3 , 4 ], has been very widely studied, over the past 25 years, since mid-1990s [ 5 ]. The primary function of adiponectin is the regulation of carbohydrate and lipid metabolism [ 6 ]. However, the full extent of its biological action remains to be elucidated, with a variety of effects on different cell and tissue types [ 3 , 7 ]. Adiponectin is initially considered a guardian angel adipocytokine owing to its protective functions against various disease states associated with obesity, such as immune modulatory, insulin­sensitizing, antidiabetic, anti­obesogenic, anti­inflammatory, antiatherogenic, anti-fibrotic, cardio­ and neuroprotective properties [ 3 , 4 , 7 ]. Adeno-viral over-expression of adiponectin in obese KKAy/a mice resulted in reduced blood pressure and reversed salt-induced hypertension [ 8 ]. Contrariwise to its protective effects against various pathological events in different cell types, adiponectin may have links to several systemic diseases and malignancies [ 1 ]. Accumulating reports of results of several meta-analyses demonstrated that elevated serum levels of both total and High Molecular Weight (HMW) adiponectin have been positively associated with both cardiovascular and, what is quite surprising and confusing, even with the all-cause mortality rate in the population above 65 years of age [ 9 ]. The biology underlying this paradox is still being studied [ 9 ].

This “adiponectin paradox” is remained, when coming to the role of adiponectin in hypertension. On one hand, compared to the patients with essential hypertension, adiponectin plasma levels were found to be significantly higher in the normotensive subjects [ 1 , 10 ]. And lower adiponectin levels were associated higher blood pressure or with incident hypertension [ 11 , 12 , 13 , 14 ]. These phenomena may be due to their protecting role on vascular functions through improving the functions of macrophages and endothelial cells. These mechanisms may include attenuating the phenotype of macrophages M1 and to promote the phenotype of macrophages M2 and preventing endothelial dysfunction through enhancing endothelial nitric oxide synthase (eNOS) activity and nitric oxide (NO·) production via adiponectin receptors AdipoR1/R2-AMPK (Adenosine 5′-monophosphate (AMP)-activated protein kinase)-endothelial signaling and cyclooxygenase-2 (COX-2) expression and prostaglandin I2 (PGI2) production by means of calreticulin/CD91-dependent Akt (protein kinase B) signaling [ 15 ]. And adiponectin also can lower blood pressure by decreasing renal sympathetic nervous system activity through its short-lived action on brain in adiponectin knock-out mice [ 15 , 16 , 17 , 18 , 19 , 20 , 21 ].

On the other hand, chronic intracerebroventricular infusion of adiponectin did not alter blood pressure in normotensive or hypertensive rats [ 10 , 22 ]. And Sprague-Dawley rats fed a high salt diet exhibited hypertension associated with elevated levels of adiponectin, suggesting that adiponectin does not play a protective role against salt-induced hypertension [ 20 , 23 ]. Adiponectin KO mice developed hypertension without insulin resistance when maintained on a high-salt diet, indicating that hypoadiponectinemia, per se, is not sufficient for the development of hypertension but contributes to its development under insulin resistance and/or salt overload [ 8 ]. In normotensives and untreated hypertensives with normal kidney function, adiponectin is not associated with blood pressure even after adjustment for many risk factors [ 24 ]. Several longitudinal studies offer mixed insights into adiponectin’s influence on metabolic diseases like hypertension, with some linking high levels to reduced metabolic syndrome risk and others to increased mortality and no protection against hypertension [ 11 , 13 , 25 , 26 , 27 , 28 , 29 ]. These studies highlight the complexity of adiponectin’s role in metabolic health and the need for further research to clarify its impact. This study aimed to provide more clues for distinguishing the antinomy of adiponectin in obesity hypertension.

Data and methods

Study design and participants.

This was a case-control study involving 153 Chinese adults (aged 40.78 ± 11.77 years; 119 men, 34 women) who underwent annual physical examinations in a hospital from September 2012 to July 2014 [ 30 ]. The participants were divided into four groups based on their body mass index (BMI) and blood pressure: the normal healthy (NH) group, the newly diagnosed untreated just-obesity (JO) group, the newly diagnosed untreated just-hypertension (JH) group, and the newly diagnosed untreated obesity-hypertension (OH) group. The inclusion and exclusion criteria for each group were set as previously reported [ 30 , 31 , 32 , 33 , 34 ] and are shown in Table  1 . The number of subjects included in each group is also shown in this table. BMI was obtained by dividing the body weight by the square of the respective subject’s height (weight/height 2 (kg/m 2 )) .

This study followed the Declaration of Helsinki and received approval from the Hangzhou Center for Disease Control and Prevention’s ethical committee. All participants agreed to join this study and signed a free and informed consent form [ 30 , 31 , 32 , 33 , 34 ].

Measurement protocol

The participants’ weight, height, waist circumference (WC) were measured according to standard protocols as previously described [ 30 , 31 , 32 , 33 , 34 ]. Before the measurement, the participants removed their shoes, heavy clothing, belts, and any other items that could interfere with the waist circumference (WC) measurement [ 35 ]. The WC was measured at the midpoint between the lower rib margin and the iliac crest while the participants gently exhaled [ 36 ].

General Obesity was defined as BMI ≥ 28 kg/m 2 and central obesity was defined as WC ≥ 85 cm for males and ≥ 80 cm for females according to the definition created by the Chinese Obesity Working Group [ 30 , 31 , 32 , 33 , 34 ]. In the present study, BMI was used to identify obesity, i.e., the general obesity was used to define the subject groups [ 37 , 38 ]. The visceral adiposity index (VAI) was calculated using a formula that incorporates WC, BMI, triglyceride (TG), and high-density lipoprotein cholesterol (HDLC) levels, i.e.,VAImen = [WC/(39.68 + 1.88 × BMI)] × (TG/1.03) × (1.31/HDLC); VAIwomen = [WC/(36.58 + 1.89 × BMI)] × (TG/0.81) × (1.52/HDLC) [ 39 , 40 ].

The blood pressure is considered a good indicator of the status of the cardiovascular system. The blood pressure can be measured by direct intraarterial and indirect sphygmomanometer methods [ 41 ]. In this study, all participants had blood pressure measured using indirect method with electronic sphygmomanometer (HEM-4021, Omron, Kyoto, Japan) [ 42 , 43 ]. Blood pressure was measured after at least 10 minutes of rest in a seated position using a standard protocol [ 44 ]. And the subject should avoid smoking, drinking caffeine, or exercising within 30 minutes of the test [ 45 ]. The inflatable cuff of the sphygmomanometer wrapped around the right upper arm at the same level as the heart and the arm was supported on a flat surface [ 46 , 47 ]. Three measurements were taken with 5 to 15 minutes intervals and the average of three such systolic and diastolic blood pressure readings was taken as the examination blood pressure for the further analysis [ 44 ].

Hypertension was defined according to the recommendation of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure and the World Health Organization–International Society of Hypertension as a systolic blood pressure of 140 mmHg or higher and/or a diastolic blood pressure of 90 mmHg or higher at each of the three appointments [ 44 , 48 , 49 ].

Serum adiponectin level and other metabolic parameters

The routine clinical laboratory tests were carried out on the subjects’ blood and urine samples. Blood samples were collected after an overnight fast and frozen for later analysis. Serum adiponectin level was quantified using a commercially available ELISA kit that measures the total adiponectin concentration (including all isoforms) [ 31 , 50 ]. According to the anamnesis and other clinical records, general demographic data, such as age and gender, as well as some biochemical parameters (see Table  2 ), were obtained [ 30 , 31 , 32 , 33 , 34 ].

Statistical analysis

R software ( https://www.r-project.org ) and SPSS for Windows V22.0 (IBM Corp., Armonk, NY) were used to perform the statistical analyses. The median and the interquartile range (P25, P75) were reported as descriptive statistics. Pearson’s test were applied to assess the associations between groups when the data (or transformed data) met the normality and equal variance assumptions; otherwise, the Mann–Whitney rank sum test and Spearman’s correlation test were used. The tested index among the four subgroups were compared using the rank-sum or T-test. Logistic regression, partial correlation or Fisher exact test were also employed when appropriate. The significance level at 0.05 was set for two-sided tests. Multiple regression models were fitted to study the independent association of the study variables with serum adiponectin, and SB (or DB).

Characteristics

The table 2 shows the baseline characteristics of the subjects in the four groups, including their general and anthropometric data and biochemical parameters. The table presents the median, the quartiles (P25, P75), and the number of the following variables: GGT, ALB, ALT, LDLC, TG, HDLC, FA, SCR, IB, ALP, CB, GLU, TC, TB, TP, Ua, UREA, age, gender, and WC, BMI, SB, and DB. The full names of these indicators can be found in the notes below the Table 2 .

The relationship between VAI and serum concentrations of adiponectin

The median (P25, P75) of VAI and serum adiponectin levels of the four groups are shown in Table 2 .

After adjustment for gender and age, analysis of covariance (ANCOVA) revealed that the serum adiponectin level in the NH group was significantly higher than in the JO groups ( P  = 0.036). No significant differences of the serum adiponectin between other two groups. The order of serum adiponectin levels among the groups was NH > OH > JH > JO.

The difference of VAI between NH group and JO group (or the OH group) is statistically significant ( P  < 0.05) after adjusting for gender and age. The VAI of NH group is the smallest among the four subgroups. The difference of VAI between NH group and JO group is nearly statistically significant ( P  = 0.071). The P -value for the comparison of VAI between JO and OH groups was 0.376, which means that the difference was not statistically significant after adjustment for gender and age.

And, after adjustment for gender and age, partial correlation analysis revealed that serum adiponectin had a negative association with VAI that was trending towards significance ( P =  0.055, r  = − 0.157). All the data were log-transformed to follow a normal distribution before analysis.

Multiple regression models for the independent association of the study variables with serum adiponectin

A linear regression model towards serum adiponectin is shown in Table  3 ( R 2  = 0.314). Gender, ALB, ALT and HDLC were found to be independent determinants. The other variables did not reach significance in the model ( P  > 0.1). This model was responsible for 31.4% of the original variation of the serum adiponectin.

The difference of serum adiponectin levels between genders in the four group

Table  4 shows the comparisons of the serum adiponectin levels between genders in the four groups of subjects: JO, OH, JH, and NH. The table presents the median and the interquartile range of the serum adiponectin levels for each group and gender. The table also reports the P -values of the differences between males and females within each group. The results indicate that after the age was controlled, the serum adiponectin levels were significantly higher in females than in males in the OH and NH groups, but not in the JO and JH groups. This suggests that there is a sexual difference in the serum adiponectin levels, which may be influenced by the presence or absence of obesity and hypertension.

Multiple regression models for the independent association of the study variables with SB and DB

The linear regression models towards SB and DB are shown in Table  5 ( R 2  = 0.333) and Table  6 ( R 2  = 0.230), respectively. For SB, age and HDLC were found to be independent determinants, and ALB was borderline significant. ALP barely escaped statistical significance The other variables did not reach significance in the model ( P  > 0.08). This model was responsible for 33.3% of the original variation of the SB serum adiponectin. For DB, ALP was found to be the independent determinant, and age had a considerable trend toward significance.

Adiponectin is primarily produced and released by energy-storing cells in adipose tissue (body fat) called adipocytes [ 51 , 52 , 53 , 54 , 55 ]. Yet, other tissues and other types of cells can produce adiponectin, including osteoblasts, myocytes, heart muscle cells, liver parenchyma cells,endothelial cells and placental tissue [ 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ]. Adiponectin is known as the most abundant adipokine and its paradoxical elevation in some disorders is receiving more attention [ 62 , 63 , 64 ]. Adeno-viral over-expression of adiponectin in genetically obese KKAy/a mice with obesity-related hypertension resulted in reduced blood pressure [ 8 ]. However, normal wild-type mice and mice with specific genetic backgrounds may exhibit different mechanisms for obesity-related hypertension and may also show varying roles of adiponectin in the context of this condition [ 65 , 66 ].

This study investigated the role of adiponectin in obesity-hypertension by measuring its serum levels and correlations with various parameters in four groups of Chinese adults: NH, JO, JH, and OH.

Though adiponectin is mainly secreted by adipose tissue (AT), its circulating concentration is decreased in obesity [ 51 , 52 , 53 , 54 , 55 ]. The results in this study also demonstrated that the serum adiponectin level in the NH group is significantly higher than in the JO group. AT can broadly be divided into two types with distinct roles: white AT (WAT) and brown AT (BAT) [ 56 , 67 ]. BAT has smaller lipid droplets and more blood vessels than WAT, resulting in a darker, brown macroscopic look [ 68 , 69 ]. And beige adipose tissue, a type of inducible BAT, intermingles with WAT depots and occurs in response to cold exposure and pharmacological modulation of WAT [ 70 , 71 , 72 ]. This phenomenon of decreased serum adiponectin level in obese people might be attributed to fat cell dysfunction and/or hypermethylation of the adiponectin gene in morbid obesity [ 73 , 74 ]. Some previous literature also shows that the adiponectin paradox, which refers to the paradoxical elevation of adiponectin in some disorders, is more evident in non-obese than in obese patients with diabetic microvascular complications [ 75 ]. The authors suggested that the paradoxical elevation of adiponectin in vascular damage might be a compensatory response, and that the responsive upregulation might be insufficient in obese patients [ 75 ]. Previous studies revealed that the quality of adipose tissue is largely compromised in patients with severe cardiovascular disorders [ 76 , 77 ]. Additionally, during caloric restriction (CR), increased circulating adiponectin is observed to come from bone marrow adipose tissue (MAT) [ 78 , 79 ].

And, it was found in this study that serum adiponectin levels negatively correlated with VAI. VAI is a mathematical formula that estimates the amount and function of visceral adipose tissue (VAT), which is the fat that surrounds the internal organs in the abdomen [ 80 , 81 , 82 , 83 ]. WAT can be divided into two major depots: VAT and subcutaneous adipose tissue (SAT). SAT is located under the skin. The distribution of WAT affects the production and function of adiponectin [ 84 , 85 ]. Generally, VAT is associated with lower adiponectin levels and higher risk of metabolic and cardiovascular complications, such as diabetes, hypertension, and atherosclerosis [ 86 , 87 , 88 ]. This is because VAT is more prone to inflammation, insulin resistance, and lipolysis, which can impair adiponectin secretion and action [ 86 , 87 , 88 ]. On the other hand, SAT is mainly considered to be associated with higher adiponectin levels and lower risk of metabolic diseases [ 89 , 90 ], though with the oppsite results exsiting [ 91 ]. This is because SAT is more responsive to insulin, has anti-inflammatory properties, and can store excess lipids away from harmful sites [ 92 , 93 ]. However, not all SAT depots are equal. Fat on the lower extremities, such as the legs, is more beneficial than fat on the upper body, such as the abdomen [ 93 , 94 ]. This is because lower-body fat has higher adiponectin expression and secretion, and can protect against the adverse effects of VAT [ 84 , 94 , 95 ]. Therefore, the role of WAT distribution in adiponectin levels and metabolic health is complex and depends on the location, amount, and function of different fat depots [ 91 , 93 , 96 , 97 ]. A better understanding of the molecular mechanisms that regulate adipocyte differentiation and adiponectin secretion in different WAT subtypes may lead to new therapeutic strategies for obesity and its related complications [ 91 , 93 , 96 , 97 ]. VAI takes into account waist circumference, body mass index, triglycerides, and HDLC levels, and it is different for men and women [ 80 , 81 , 82 ]. VAI has been shown to be a reliable indicator of visceral fat dysfunction and cardiometabolic risk [ 98 ]. VAI seems to represent a better predictive tool than common clinical parameters for metabolic disorders in Chinese and Caucasian samples [ 82 , 99 , 100 ].

And, in this study, we found that the NH group had a much lower VAI than almost all other groups (JO, JH, OH). The JH group also had a lower VAI than the OH group. Previous study reported weekend warrior activity patterns (WWs) and regular activity patterns offer the same benefits for reducing the VAI [ 101 ]. This suggests that the NH group and JH group might have higher level of physical activity and a larger proportion of muscle mass in their body weight than the other two groups. Aditionally, the serum adiponectin levels negatively correlated with VAI in this study. These results reflect that serum adiponectin levels positively correlated with physical activity and muscle mass proportion of the body. It has been shown that physical exercise can reduce fat mass [ 76 ], especially the accumulation of VAT [ 102 , 103 , 104 ], and lead to hypersecretion of adiponectin [ 102 , 103 , 104 ], which results in increased adiponectin production in adipose tissue and enhanced concentration of adiponectin in the blood [ 105 , 106 , 107 , 108 ]. Our study result accords with the phenomena discovered in those previous literature.

In this study, the comparison of VAI between JO and OH groups revealed no significant difference. This indicates that the VAI, a marker of visceral adiposity and cardiometabolic risk, was similar between the two groups. However, the increase of the serum adiponectin level in OH compared to JO may seem paradoxical, as adiponectin is generally considered to have anti-obesity and anti-hypertensive effects [ 9 , 109 ]. Nevertheless, the result was in line with the phenomenon called “adiponectin paradox” in which adiponectin levels are elevated in some pathological conditions, such as cardiovascular disease, diabetes, and chronic kidney disease [ 76 ]. This may reflect a compensatory response of the body to maintain metabolic homeostasis and protect against further damage [ 9 , 110 ]. Moreover, adiponectin levels may be influenced by other factors, such as gender, albumin, alanine aminotransferase, and high-density lipoprotein cholesterol, as we showed in the multiple regression analysis. And the interaction between adiponectin and other adipokines, such as leptin, resistin, and visfatin, should be taken into account [ 111 , 112 ]. In addition to white adipokines (adipokines produced by WAT), the brown adipokines, adipokines present in brown adipose tissue, such as fibroblast growth factor 21 (FGF21), interleukin-6 (IL-6), neuregulin-4 (NRG4), insulin-like growth factor-1 (IGF-1), and tumor necrosis factor-alpha (TNF-α), may also play a role in the process known as the ‘adiponectin paradox [ 112 , 113 ]. And these adipokines also have tortuous relationship with hypertension. As shown in previous studies, leptin’s effect on Trpm7 (TRP [transient receptor potential] melastatin 7) expression, via epigenetic changes and the pSTAT3(phosphorylated signal transducer and activator of transcription 3)-JAK2(Janus kinase 2) pathway, contributes to obesity-associated hypertension, but leptin’s role is additive, not essential, in the complex regulatory network leading to hypertension in obesity [ 33 , 114 , 115 , 116 ]. Depending on the context, resistin appears to have both protective and detrimental effects to obesity-related hypertension, highlighting the complexity of resistin’s role in obesity and hypertension [ 30 ]. And, IL-6 may have diverse effects in the pathogenesis of obesity and hypertension, depending on the presence or absence of these conditions [ 34 ]. Therefore, the role of adiponectin in obesity-hypertension should be considered in the context of the systemic signaling axis and not in isolation [ 117 ].

Next, with the multiple regression model, it was found serum adiponectin level was significantly higer in females than in males (with std.β = 0.323). This result is in line with many previously studies, which demonstrate that adiponectin levels are generally higher in females than in males, especially in adulthood [ 118 , 119 ]. This may be partly explained by the effects of sex hormones, such as testosterone and estrogen, on adiponectin production and secretion [ 119 , 120 ]. Testosterone has been shown to suppress adiponectin expression in fat cells, whereas estrogen has been shown to stimulate it [ 120 ]. Therefore, during puberty, when sex hormones increase, adiponectin levels tend to decline in males and rise in females [ 119 , 121 ]. However, the sex differences in adiponectin levels are not consistent across different ethnic groups and obesity levels. For example, some studies have found that Hispanic females have lower adiponectin levels than non-Hispanic white females, and that this difference is more pronounced in obese individuals [ 122 , 123 , 124 ]. And dietary patterns may also affect adiponectin levels and the sex differences in this hormone [ 125 , 126 , 127 , 128 ]. Healthy dietary patterns rich in fruits, vegetables, whole grains, fish, nuts, and unsaturated fats are linked to higher adiponectin levels, likely due to their bioactive compounds that promote adipose tissue function and insulin sensitivity [ 128 , 129 , 130 , 131 ]. Conversely, unhealthy diets high in red and processed meats, refined grains, sweets, fast foods, and saturated/trans fats correlate with lower adiponectin levels, potentially due to inflammation, oxidative stress, and insulin resistance that hinder adiponectin secretion and activity [ 128 , 129 , 130 , 131 ]. And a negative association between the Dietary Approaches to Stop Hypertension (DASH) diet index and VAI was reported among older Americans [ 132 ].

And the interaction between diet and genetics may modulate adiponectin levels and metabolic outcomes [ 133 ]. For eample, ADIPOQ variants conferred more metabolic risks in healthy dietary patterns than in adverse dietary patterns [ 133 , 134 ]. And some literature indicated that moderate amounts of ethanol-containing beverages increased adiponectin concentrations, and sex-specific effects might depend on type of beverage consumed [ 135 ]. This may suggest that other factors, such as genetic, environmental, or lifestyle factors, may also influence adiponectin levels and modify the sex differences [ 118 , 136 , 137 , 138 ]. In this study, blood samples were obtained after a 12-hour of fasting, which can avoid the short-term effects of the diet. And, after the age was controlled, the serum adiponectin levels were significantly higher in females than in males in the OH and NH groups, but not in the JO and JH groups. This suggests that there is a sexual difference in the serum adiponectin levels, which may be influenced by the presence or absence of obesity and hypertension [ 139 ].

According to vast majority of reports, adiponectin has been exhibited to have protective effect on vascular functions and thus has negative relationship with blood pressure, against incidence of obesity-hypertension [ 21 , 140 , 141 ]. But the contrary opinion holds that, in different subject groups, the relationships between the adiponectin and blood pressure are various, with positive and non-correlation existing [ 24 , 142 , 143 , 144 ]. The preclinical expriments, longitudinal studies and clinical trials have reported inconsistent outcomes regarding the antihypertensive effects of adiponectin [ 11 , 13 , 25 , 26 , 27 , 28 , 29 , 145 ]. In this study, using the multiple regression model, it was found that adiponectin was not associated with blood pressure (SB and DB) after adjustment for other risk factors (the anthropometric and biochemical characteristics mentioned in Table 2 ) used in multiple linear regression models. Age and HDLC were found to be independently positively correlate with SB, and ALB was at the edge of significance. ALP were found to be independently positively correlate with DB, and age has a considerable trend toward significance.

This study results revealed that ALB independently negatively and ALT, HDLC, and gender positively associate with serum level of adiponectin. These results were in line with many previous research outcomes. Serum adiponectin levels have been recorded to display a sexual difference, being higher in females than in males [ 118 , 146 , 147 , 148 ], and were observed having inverse correlation with circulating albumin [ 120 , 149 , 150 ]. And recently, higher plasma adiponectin abundance was discovered in albumin knockout (KO) mice [ 151 ].

The associations between adiponectin and ALT have been shown to be different. Many research detailed the opposite connections [ 152 , 153 , 154 , 155 ], however positive and non-connections are likewise existing [ 156 , 157 ]. And adiponectin knockout could ablate the significant rise in serum ALT elicited by high-fat diet feeding in mice [ 158 ].

Consistent with our study results, the serum HDLC has been reported to be independently positively associated with serum adiponectin in almost all the previous studies [ 159 , 160 , 161 , 162 , 163 , 164 , 165 ]. Adiponectin could upregulate ATP-binding cassette transporter A1 and G1 expression and hepatic apo-AI (Apolipoprotein A-I), reduce lipid accumulation, and efficiently promote nascent HDLC formation [ 166 , 167 , 168 , 169 , 170 , 171 ]. Lower adiponectin (ADIPOQ) gene expression are associated with diabetic dyslipidemia [ 172 , 173 ].

Accounting for the mentioned above, in this mixed subjects of four Chinese subgroups, adiponectin did not have the dose-response conjunction with the blood pressure after adjustment for potential confounding factors, which was little illustrated in earlier investigations [ 11 ]. These conflicting results in different studies may be mostly due to the diversity of subjects included [ 24 ]. The direct relationship between adiponectin and hypertension (or blood pressure) may be influenced by many factors, among which the liver and kidney dysfunctions are often mentioned. Disorders of kidney or liver can lead to the elevation of the blood pressure and incident of hypertension [ 174 , 175 ]. Meanwhile, the impaired liver function can affect adiponectin’s degradation in the liver, and the kidney dysfunctions can reduce renal clearance of adiponectin [ 174 , 175 , 176 ]. High serum ALT is known to reflect the situation of severe liver disease. In addition, in this study, ALP was found to independently positively correlate with DB and nearly with SB. High levels of ALP in the blood may indicate liver disease or certain bone disorders. Furthermore, in this study, ALB was found to have a negative association with SB that was trending towards significance. Low albumin levels in the blood are known to indicate serious liver and kidney problems.

Another explanation for the increase of adiponectin in individuals with risk towards mortality is that is a failing attempt of the body to do the protection [ 177 ], as pathological adiponectin resistance develops with its receptors down regulation in metabolically active organs including the adipose tissue, the heart, the liver and the vasculature [ 172 , 173 , 178 ]. Adiponectin exerts its both beneficial and detrimental effects via normal or impaired signaling through its receptors: Adiponectin receptor 1 and 2 (AdipoR1 and AdipoR2), T-cadherin and calreticulin [ 1 ]. Adiponectin exists in various isoforms in the circulation, including trimer (~ 67 kDa; low molecular weight, LMW), hexamer (136 kDa; middle molecular weight, MMW), 12-32mer (> 300 kDa, high molecular weight, HMW), and globular forms [ 76 , 179 , 180 ]. Different adiponectin isoforms bind to different receptors, resulting in various functions. Globular adiponectin preferentially binds to AdipoR1, influencing muscle cells [ 56 ]. T-cadherin, a non-transmembrane binding protein, is a key partner for HMW adiponectin, potentially accumulating it in heart, vascular endothelium, and muscle, with its downstream effects being studied [ 181 , 182 , 183 ]. Αdiponectin may bind to calreticulin on macrophage surfaces and other cells [ 184 , 185 ]. AdipoR2 binds full-length adiponectin and is predominantly expressed in the liver [ 186 ]. However, the relative contributions of different adiponectin isoforms to obesity and hypertension are not fully understood and may vary depending on the population and the disease stage [ 180 ].

In general, our research investigated the role of adiponectin in obesity-hypertension using a case-control study with four groups of Chinese adults: normal healthy, just-obesity, just-hypertension, and obesity-hypertension. This design allows for a comprehensive comparison of the serum adiponectin levels and their associations with various anthropometric and biochemical parameters among different subgroups of obesity and hypertension. Thus, this research provided more clues for distinguishing the antinomy of adiponectin in obesity-hypertension by analyzing the correlations between adiponectin and visceral adiposity index, gender, serum albumin (ALB),alanine aminotransferase (ALT) and high-density lipoprotein cholesterol (HDLC), blood pressure, and other indicators. This research also indicated some factors that influence the sex differences in adiponectin. Next, the results of this research suggested that adiponectin may not always have a direct relationship with blood pressure. The importance of adiponectin must be viewed within the framework of the body’s key signaling pathways that regulate metabolic equilibrium in the face of obesity and cardiovascular disorders [ 187 ], such as the modulation by other adipokines (leptin, resistin, and visfatin, as well as brown adipokines, such as FGF21, IL-6, NRG4, IGF-1, and TNF-α). This research also indicated the potential mechanisms of adiponectin in regulating carbohydrate and lipid metabolism, inflammation, and vascular function. Furthermore, Different explanations for the adiponectin paradox have been discussed including adiponectin resistance, compensatory effects of adiponectin to subclinical pathologies, impaired renal function and decreased hepatic clearance of adiponectin [ 188 , 189 , 190 ]. And this research revealed that adiponectin’s role in obesity-hypertension is complex and depends on the systemic metabolic homeostasis signaling axis. And in the end, the results of this research indicated that in the context of obesity-related hypertension, compensatory effects, adiponectin resistance, and decreased adiponectin clearance due to impaired renal and hepatic function occur simultaneously, contributing to the “adiponectin paradox”.

Some limitations and strengths of our study should be addressed. At first, our results need to be interpreted in the context of a few limitations. One limitation is that the cross-sectional design and small sample size of our study and the subjects restricted to Chinese adults may limit the generalizability and causal inference of our findings. Therefore, Our results should be interpreted with caution and should be confirmed by larger, longitudinal studies across various genetic populations in the future. Another limitation is that we did not measure the adiponectin isoforms, which could have provided more nuanced insights into the role of adiponectin in obesity-hypertension. Previous studies have reported conflicting results on the associations of adiponectin isoforms and other adipokines (WAT or BAT adipokines) with blood pressure and metabolic parameters in different populations [ 56 , 112 , 179 , 180 ]. Therefore, further studies are needed to investigate the differential effects of adiponectin isoforms on obesity-hypertension and to explore the potential mechanisms underlying the adiponectin paradox. Third limitation is that while the present study attempts to control for various confounders, there are still potential variables that might influence the results, such as dietary patterns, genetic predispositions, and environmental factors. We did not have comprehensive dietary data and we did not delve into the relationship between adiponectin and other adipokines (other BAT adipokines or other WAT adipokines). Finally, the VAI is not a direct and accurate measure of physical activity and that it may not capture the intensity, duration, and type of physical activity that the participants engaged in.

Notwithstanding these limitations, the multiple strengths of our study should be kept in mind. Firstly, the chosen population in the present study allowed us to investigate the role of adiponectin in obesity-hypertension axis in a relatively homogeneous and early-stage group, without the confounding effects of medication or other comorbidities. Secondly, to minimize the effects of diet, blood samples were obtained after a 12-hour fast in the present study to avoid the short-term effects of recent dietary intake. Thirdly, we have controlled for potential confounding factors, such as age, gender, and other biochemical indicators. And the use of multiple regression models adds rigor to the findings, offering insights into the independent determinants of serum adiponectin levels. Fourthly, the Visceral Adiposity Index (VAI), utilized in this study, serves as a comprehensive indicator of physical activity levels [ 98 , 101 ]. It inversely correlates with physical activity and positively correlates with visceral fat dysfunction and cardiometabolic risk, making it a superior predictive tool for metabolic disorders in both Chinese and Caucasian populations [ 82 , 99 , 100 ]. Fifthly,we believe that our findings may have some relevance and applicability to other populations and settings because of the consistent with some previous studies that have reported no directly associations between adiponectin and blood pressure in different ethnic groups and regions, such as African Americans, Europeans, and Japanese [ 27 , 191 , 192 ]. These studies suggest that the “adiponectin paradox” may be a common phenomenon in obesity-hypertension, regardless of the population characteristics.

In summary, our study findings provide new insights into the “adiponectin paradox”. Adiponectin’s role in obesity-hypertension is multifaceted and is influenced by the systemic metabolic homeostasis signaling axis. In obesity-related hypertension, compensatory effects, adiponectin resistance, and reduced adiponectin clearance from impaired kidneys and liver all contribute to the “adiponectin paradox”.

And to further elucidate the role of adiponectin in obesity-hypertension, more studies are needed to investigate the adiponectin isoforms, the adiponectin receptors, and the signaling pathways involved in different tissues and organs. Moreover, the interactions between adiponectin and other adipokines, hormones, and inflammatory mediators should be explored in the context of obesity-hypertension. Additionally, the genetic, environmental, and lifestyle factors (such as dietary assessments including alcohol intake and direct measurement of physical activity) that influence adiponectin levels and function should be considered [ 173 ]. Finally, the therapeutic potential of adiponectin or its analogues for obesity-hypertension should be evaluated in clinical trials.

Availability of data and materials

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

Abbreviations

Waist circumference

Body mass index

Systolic blood pressure

Diastolic blood pressure

High molecular weight

Endothelial nitric oxide synthase

Nitric oxide

Adenosine 5’-monophosphate (AMP)-activated protein kinase

cyclooxygenase-2

Prostaglandin I2

Protein kinase B

Gamma-glutamyltransferase

Alanine aminotransferase

Low density lipoprotein cholesterol

Triglyceride

High density lipoprotein cholesterol

Fructosamine

Serum creatinine

Indirect bilirubin

• Alkaline phosphatase

Conjugated bilirubin

Fasting blood glucose

Total cholesterol

Total bilirubin

Total protein

• Visceral adiposity index

Adipose tissue

White adipose tissue

Brown adipose tissue

Bone marrow adipose tissue

Caloric restriction

Visceral adipose tissue

Subcutaneous adipose tissue

Fibroblast growth factor 21

Interleukin-6

Neuregulin-4

Insulin-like growth factor-1

Tumor necrosis factor-alpha

TRP [transient receptor potential] melastatin 7

Janus kinase 2

Phosphorylated signal transducer and activator of transcription 3

Apolipoprotein A-I

Low molecular weight

Middle molecular weight

Adiponectin receptor 1

Adiponectin receptor 2

Dietary approaches to stop hypertension

Weekend warrior activity patterns

Analysis of covariance

ATP-binding cassette transporter A1

ATP-binding cassette transporter G1

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Acknowledgements

The authors would like to give special thanks to all participants in this study.

This work was supported by Zhejiang Shuren University Basic Scientific Research Special Funds (2024XZ012), grants from the National Natural Science Foundation of China (81102200/H2610), and “Teacher professional development project” for domestic visiting scholars in colleges and universities of Zhejiang Province in 2020 (043).

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Ou Wu and Xi Lu are the first and co-first author.

Authors and Affiliations

Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, People’s Republic of China

Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China

Hangzhou Vocational and Technical College, Hangzhou, Zhejiang, People’s Republic of China

Department of Central Laboratory/Medical Examination Center of Hangzhou, The Frist People’s Hospital of Hangzhou, Hangzhou, Zhejiang, People’s Republic of China

Jianhang Leng & Fenfang Yang

Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

Xingyu Zhang

JFIntelligent Healthcare Technology Co., Ltd Building No.5-7, No.699 Tianxiang Avenue, Hi-Tech Zone, Nanchang, Jiangxi Province, People’s Republic of China

Department of Thoracic Surgery, Sir Run Run Shaw Hospital Affiliated with Medical College of Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China

Department of Central Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China

Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang, People’s Republic of China

Saber Khederzadeh

Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, Zhejiang, People’s Republic of China

Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, People’s Republic of China

Xiaodong Liu

Department of Dermatology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, People’s Republic of China

Chengda Yuan

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Contributions

Ou Wu: Conceptualization, Data curation, Writing – original draft, Methodology, Supervision, Validation, Funding acquisition, Project administration, Formal analysis. Xi Lu: Conceptualization, Data curation, Writing – original draft, Methodology, Supervision, Validation. Jianhang Leng: Project administration, Data curation. Xingyu Zhang: Writing – review & editing, Software. Wei Liu: Project administration, Data curation. Fenfang Yang: Project administration, Data curation. Hu Zhang: Project administration, Data curation. Jiajia Li: Project administration, Data curation. Saber Khederzadeh: Writing – review & editing, Software. Xiaodong Liu: Resources. Chengda Yuan: Conceptualization, Project administration, Investigation, Writing – review & editing.

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Correspondence to Chengda Yuan .

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Wu, O., Lu, X., Leng, J. et al. Reevaluating Adiponectin’s impact on obesity hypertension: a Chinese case-control study. BMC Cardiovasc Disord 24 , 208 (2024). https://doi.org/10.1186/s12872-024-03865-4

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Creating culturally-informed protocols for a stunting intervention using a situated values-based approach ( WeValue InSitu ): a double case study in Indonesia and Senegal

• Annabel J. Chapman 1 ,
• Chike C. Ebido 2 , 3 ,
• Rahel Neh Tening 2 ,
• Yanyan Huang 2 ,
• Ndèye Marème Sougou 4 ,
• Risatianti Kolopaking 5 , 6 ,
• Amadou H. Diallo 7 ,
• Rita Anggorowati 6 , 8 ,
• Fatou B. Dial 9 ,
• Jessica Massonnié 10 , 11 ,
• Mahsa Firoozmand 1 ,
• Cheikh El Hadji Abdoulaye Niang 9 &
• Marie K. Harder 1 , 2  

BMC Public Health volume  24 , Article number:  987 ( 2024 ) Cite this article

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International development work involves external partners bringing expertise, resources, and management for local interventions in LMICs, but there is often a gap in understandings of relevant local shared values. There is a widespread need to better design interventions which accommodate relevant elements of local culture, as emphasised by recent discussions in global health research regarding neo-colonialism. One recent innovation is the concept of producing ‘cultural protocols’ to precede and guide community engagement or intervention design, but without suggestions for generating them. This study explores and demonstrates the potential of an approach taken from another field, named WeValue InSitu , to generate local culturally-informed protocols. WeValue InSitu engages stakeholder groups in meaning-making processes which ‘crystallize’ their envelope of local shared values, making them communicable to outsiders.

Our research context is understanding and reducing child stunting, including developing interventions, carried out at the Senegal and Indonesia sites of the UKRI GCRF Action Against Stunting Hub. Each national research team involves eight health disciplines from micro-nutrition to epigenetics, and extensive collection of samples and questionnaires. Local culturally-informed protocols would be generally valuable to pre-inform engagement and intervention designs. Here we explore generating them by immediately following the group WeValue InSitu crystallization process with specialised focus group discussions exploring: what local life practices potentially have significant influence on the environments affecting child stunting, and which cultural elements do they highlight as relevant. The discussions will be framed by the shared values, and reveal linkages to them. In this study, stakeholder groups like fathers, mothers, teachers, market traders, administrators, farmers and health workers were recruited, totalling 83 participants across 20 groups. Themes found relevant for a culturally-informed protocol for locally-acceptable food interventions included: specific gender roles; social hierarchies; health service access challenges; traditional beliefs around malnutrition; and attitudes to accepting outside help. The concept of a grounded culturally-informed protocol, and the use of WeValue InSitu to generate it, has thus been demonstrated here. Future work to scope out the advantages and limitations compared to deductive culture studies, and to using other formative research methods would now be useful.

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Although progress has been made towards the SDG of ‘Zero Hunger by 2025’, the global rates of malnutrition and stunting are still high [ 1 ]. Over the past 20 years, researchers have implemented interventions to reduce undernutrition, specifically focussing on the first 1000 days of life, from conception to 24 months [ 2 ]. However, due to both differing determinants between countries [ 3 , 4 ] as well as varying contextual factors, it is clear that no single fixed approach or combination of approaches can be relied on when implementing stunting interventions [ 5 , 6 , 7 ]. Furthermore, when external researchers design interventions for local areas in Low- and Middle-Income Countries (LMICs) they can often overlook relevant local cultural factors that consequently act as barriers to intervention uptake and reduce their effectiveness, such as geographical factors and the levels of migration in certain populations [ 8 , 9 ], or social norms or perceptions relating to accepting outside help, and power dynamics related to gender [ 10 , 11 , 12 ]. The inclusion of cultural level factors in behaviour change interventions has been proposed as a requirement for effective interventions [ 13 ]. However, despite the breadth of literature highlighting the negative impacts from failing to do this, the lack of integration or even regard of local culture remains a persistent problem in Global Health Research [ 14 ], possibly hindering progress towards the SDGs. Thus, there is a need for approaches to integrate local cultural elements into intervention design.

This lack of understanding of relevant local culture, social norms and shared values also has ethical implications. The field of Global Health Ethics was predominantly developed in the Global North, in High Income Countries (HICs), embedding values common in those countries such as the prominence of individual autonomy [ 15 , 16 ]. Researchers from HICs carrying out research in LMICs may wrongly assume that values held in the Global North are universal [ 14 ] and disregard some local values, such as those related to family and collective decision making, which are core to many communities in LMICs. It is therefore important for outside researchers to have an understanding of relevant local values, culture and social norms before conducting research in LMICs so as not to impose values that do not align with local culture and inadvertently cause harm or offence [ 16 , 17 ]. The importance of this is compounded by the colonial history that is often present in relationships between research communities in HICs and LMICs, and the fact that the majority of the funding and leading institutions are still located in the Global North [ 18 , 19 ]. Thus, conscious steps must be taken to avoid neo-colonialism in Global Health Research [ 20 ]. From a health-equity perspective, it is essential to ensure that those in vulnerable communities are not hindered from involvement in interventions to improve nutrition. Encouraging uptake by such communities could be provided if salient local shared values, norms and culture were taken into account [ 21 ].

In a recent paper, Memon et al., (2021) highlight the usefulness of first creating a cultural protocol that can precede and guide subsequent stages of community engagement or intervention design to ensure that salient local values are known to external researchers coming into the community [ 16 ]. We adopt the use of the concept of a cultural protocol, referring to locally-generated guidance about key values, norms, behaviours and customs relevant to working with the local community. However, we prefer the term, ‘culturally-informed protocol’ since this relates to only cultural elements deemed salient by the researchers, and locally, rather than any comprehensive notion of culture, nor extending beyond the research context.

Memon et al. (2021), point out links between the creation of such a protocol and existing codes of practice that have already been created for some cultures such as the Te Ara Tika, a Guideline for Māori Research Ethics [ 22 ]. Currently, research and interventions in Global Health can be informed by a stage of formative research involving one-to-one interviews, focus groups or direct observations, which can sometimes be ethnographic in nature such as within Focussed Ethnographic Studies or Rapid Assessment Procedures [ 23 , 24 , 25 ]. Although these methods can be effective to inform intervention designs, they have disadvantages like: can take long periods to complete [ 26 ], can be resource intensive [ 26 ] and can lack cultural acceptability [ 27 ]. These limitations may account for the frequent neglect of their use generally, highlighted by Aubel and Chibanda (2022) [ 14 ]. Additionally, none of these methods work towards making explicit local values, or towards the creation of a culturally-informed protocol. In brief, the literature suggests a need to develop alternative methods of Formative Research for understanding locally relevant cultural elements, that are less time-consuming and can generate data that is more easily translatable to intervention design. In addition, these approaches must be applicable in different cultures. Additionally, the protocols produced must be actionable and practical not only for guiding interactions between research teams but also for guiding the initial stages of intervention design.

The work presented here aims to address several of these needs. It includes an exploration of the usefulness of the WeValue InSitu ( WVIS ) approach because that has previously been shown, in environmental management domains, to offer a way to gather in-depth values-based perspectives from a target population [ 28 , 29 ] It was first created through action research, and co-designed to enable civil society organisations to better understand and measure the values-based aspects of their work [ 30 ]. The core WeValue InSitu process (detailed in Table 1 ) involves the crystallization of shared values, with a facilitator guiding a group of participants with shared experiences, through cycles of tacit meaning-making (using a stage of photo-elicitation and triggering) [ 31 ], until they can articulate more explicitly their shared values, in concise and precise statements. These statements are then linked together in a framework by the participants. In an example case in Nigeria, the results of the WVIS approach hinted at the creation of a culturally-informed protocol through an analysis of the shared values frameworks to find cultural themes for the creation of an indicator tool that was used to evaluate several development scenarios based on their social acceptability [ 29 ].

Furthermore, it has been found that if a group of WVIS participants take part in a specialised focus group discussion (FGD), named Perspectives EXploration (PEX:FGD) immediately afterward the main workshop, then they easily and articulately express their perspectives on the topics raised for discussion - and with allusions to the shared values they had crystallised just prior. In an example from Shanghai, the PEX:FGDs focussed on eliciting perspectives on climate change, which were shown to be closely linked with the cultural themes existing within the shared values frameworks produced immediately prior [ 32 ]. In that case, the PEX:FGDs allowed the cultural themes generated during the main WVIS workshop to be linked more closely to the research question. Those results suggested that the WVIS plus PEX:FGD approach could be used to create a specialised culturally-informed protocol for improved intervention design.

In the study presented here, the WVIS approach was explored for the purpose of creating culturally-informed protocols to inform the planning of interventions within two localities of the UKRI GCRF Action Against Stunting Hub [ 33 ]. The work was carried out in two parts. Firstly, the WVIS main workshop was used to elicit cultural themes within the target communities, indicating key elements to consider to ensure ethical engagement. Secondly, the PEX focus group discussions focussed on life practices related to stunting which we explored for the purpose of tailoring the culturally-informed protocols to the specific purpose of improving the design of an example intervention. The Action Against Stunting Hub works across three sites where stunting is highly prevalent but via different determinants: East Lombok in Indonesia (estimated 36% of under-fives stunted), Kaffrine in Senegal (estimated 16% of under-fives stunted) and Hyderabad in India (estimated 48% of under-fives stunted) [ 34 ]. We propose that, the information about local shared values in a given site could be used to inform the design of several interventions, but for our specific exploration the focus here is a proposed ‘egg intervention’, in which pregnant women would be provided with an egg three times per week as supplement to their diet. This study proposes that identifying shared values within a community, alongside information about local life practices, provides critical cultural information on the potential acceptability and uptake of this intervention which can be used to generate culturally-informed protocols consisting of recommendations for improved intervention design.

In this paper we aim to explore the use of the WVIS approach to create culturally-informed protocols to guide engagement and inform the design of localised egg interventions to alleviate stunting in East Lombok, Indonesia and Kaffrine, Senegal. We do this by analysing data about local shared values that are crystallized using the WeValue InSitu ( WVIS ) process to provide clear articulation of local values, followed by an analysis of life practices discussed during PEX:FGD to tailor the culturally-informed protocols for the specific intervention design.

Study setting

This research was exploratory rather than explanatory in nature. The emphasis was on demonstrating the usefulness of the WeValue InSitu ( WVIS ) approach to develop culturally-informed protocols of practical use in intervention design, in different cultural sites. This study was set within a broader shared-values workstream within the UKRI GCRF Action Against Stunting Hub project [ 33 ]. The Hub project, which was co-designed and co-researched by researchers from UK, Indonesia, Senegal and India, involves cohorts of 500 women and their babies in each site through pregnancy to 24 months old, using cross-disciplinary studies across gut health, nutrition, food systems, micro-nutrition, home environment, WASH, epigenetics and child development to develop a typology of stunting. Alongside these health studies are studies of the shared values of the communities, obtained via the WVIS approach described here, to understand the cultural contexts of that diverse health data. In this study the data from East Lombok, Indonesia and Kaffrine, Senegal were used: India’s data were not yet ready, and these two countries were deemed sufficient for this exploratory investigation.

The WVIS approach

The WVIS approach is a grounded scaffolding process which facilitates groups of people to make explicit their shared values in their own vocabulary and within their own frames (details in Fig. 1 and activities in Table 1 ). The first stage of the WVIS is Contextualisation, whereby the group identifies themselves and set the context of their shared experiences, for example, as ‘mothers in East Lombok, Indonesia’. Subsequently, there is a stage of Photo Elicitation, in which the group are first asked to consider what is important, meaningful or worthwhile to them about their context (e.g., ‘being mothers in East Lombok, Indonesia’) and then asked to choose photos from a localised set that they can use as props to help describe their answer to the group [ 29 ]. After this, a localised Trigger List is used. This Trigger List consists of 109 values statements that act as prompts for the group. Examples of these values statements are included below but all the statements begin with “it is important to me/us that…”. The group are asked to choose which statements within the trigger list resonate with them, and those are taken forward for group intersubjective discussion. After a topic of their shared values has been explored, the group begin to articulate and write down their own unique statements of them. These also all begin with “It is important to me/us that…”. After discussing all pressing topics, the group links the written statements on the table into a unique Framework, and one member provides a narrative to communicate it to ‘outsiders’. The WVIS provides a lens of each group’s local shared values, and it is through this lens that they view the topics in the focus group discussions which immediately follow, termed Perspectives EXplorations (PEX:FGDs).

Schematic of the macro-level activities carried out during the WeValue InSitu ( WVIS ) main workshop session

This results in very grounded perspectives being offered, of a different nature to those obtained in questionnaires or using external frameworks [ 31 ]. The specific PEX:FGD topics are chosen as pertinent to stunting contextual issues, including eating habits, food systems and environments, early educational environments, and perceptions of stunting. The local researchers ensured that all topics were handled sensitively, with none that could cause distress to the participants. The data for this study were collected over 2 weeks within December 2019–January 2020 in workshops in East Lombok, Indonesia, and 2 weeks within December 2020 in Kaffrine, Senegal.

The PEX:FGDs were kept open-ended so that participants could dictate the direction of the discussion, which allowed for topics that may not have been pre-considered by the facilitators to arise. Sessions were facilitated by local indigenous researchers, guided in process by researchers more experienced in the approach, and were carried out in the local languages, Bahasa in East Lombok, Indonesia and French or Wolof in Kaffrine, Senegal.

Development of localised WVIS materials

Important to the WVIS approach is the development of localised materials (Table 1 ). The main trigger list has been found applicable in globalised places where English is the first language, but otherwise the trigger lists are locally generated in the local language, incorporating local vocabulary and ways of thinking. To generate these, 5–8 specific interviews are taken with local community members, by indigenous university researchers, eliciting local phrases and ways of thinking. This is a necessary step because shared tacit values cannot be easily accessed without using local language. Examples of localised Trigger Statements produced this way are given below: (they all start with: “It is important to me/us that…”):

…there is solidarity and mutual aid between the people

…I can still be in communication with my children, even if far away

…husbands are responsible for the care of their wives and family

…the town council fulfils its responsibility to meet our needs

…people are not afraid of hard, and even manual work

Study participants

The group participants targeted for recruitment, were selected by local country Hub co-researchers to meet two sets of requirements. For suitability for the WVIS approach they should be between 3 and 12 in number; belong to naturally existing groups that have some history of shared experiences; are over 18 years old; do not include members holding significantly more power than others; and speak the same native language. For suitability in the PEX:FGD to offer life practices with relevance to the research topic of stunting, the groups were chosen to represent stakeholders with connections to the food or learning environment of children (which the Action Against Stunting Hub refer to as the Whole Child approach) [ 33 ]. The university researchers specialising in shared values from the UK, and Senegal and Indonesia respectively, discussed together which stakeholder groups might be appropriate to recruit. The local researchers made the final decisions. Each group was taken through both a WVIS workshop and the immediately-subsequent PEX:FGD.

Data collection and analysis

Standard data output from the WeValue session includes i) the jointly-negotiated bespoke Statements of shared values, linked together in their unique Framework, and ii) an oral recording of a descriptive Narrative of it, given by the group. These were digitized to produce a single presentation for each group as in Fig. 2 . It represents the synthesised culmination of the crystallisation process: a portrait of what was ‘important’ to each stakeholder group. Separately, statements from the group about the authenticity/ownership of the statements are collected.

An illustrative example of one digitized Shared Values Framework and accompanying Narrative from a teacher’s group in East Lombok, Indonesia. The “…” refers to each statement being preceded by “It is important to us that…”

When these Frameworks of ‘Statements of Shared Values’ are viewed across all the groups from one locality (Locality Shared Values Statements), they provide portraits of ‘what is important’ to people living there, often in intimate detail and language. They can be used to communicate to ‘outsiders’ what the general cultural shared values are. In this work the researchers thematically coded them using Charmaz constructionist grounded theory coding [ 35 ] to find broad Major Cultural Themes within each separate locality.

The second area of data collection was in the post- WVIS event: the PEX:FGD for each group. A translator/interpreter provided a running commentary during these discussions, which was audio recorded and then transcribed. The specific topics raised for each group to discuss varied depending on their local expertise. This required completely separate workstreams of coding of the dataset with respect to each topic. This was carried out independently by two researchers: one from UK (using NVivo software (Release 1.3.1)) and one from the local country, who resolved any small differences. All the transcripts were then collated and inductively, interpretively analysed to draw out insights that should be relayed back to the Action Against Stunting Hub teams as contextual material.

The extracts of discussion which were identified as relevant within a particular Hub theme (e.g. hygiene) were then meta-ethnographically synthesised [ 36 ] into ‘Hub Theme Statements’ on each topic, which became the core data for later communication and interrogation by other researchers within the Action Against Stunting Hub. These statements are interpretations of participants’ intended meanings, and links from each of them to data quotes were maintained, enabling future interpretations to refer to them for consistency checks between received and intended meaning.

In this investigation, those Hub Theme Statements (derived from PEX:FGD transcripts) were then deductively coded with respect to any topics with potential implications of the egg intervention. Literature regarding barriers and facilitators to nutrition interventions indicated the following topics could be relevant: attitudes to accepting help; community interactions; cooking and eating habits; traditional beliefs about malnutrition; sharing; social hierarchies [ 12 , 37 , 38 ] to which we added anything related to pregnancy or eggs. This analysis produced our Egg Intervention Themes from the data.

The Major Cultural Themes and Egg Intervention Themes were then used to create a set of culture-based recommendations and intervention specific recommendations respectively for each locality. These recommendations were then combined to form specialized culturally-informed protocols for the egg intervention in each locality: East Lombok, Indonesia and Kaffrine, Senegal. The process is displayed schematically in Fig.  3 .

Schematic representation of the method of production of the culturally-informed protocol for each locality

The preparation of the localised WVIS materials at each site took 6 hours of interview field work, and 40 person hours for analysis. The 10 workshops and data summaries were concluded within 10 workdays by two people (80 person hours). The analysis of the PEX:FGD data took a further 80 person hours. Thus, the total research time was approximately 200 person hours.

The stakeholder group types are summarised in Table 2 . The data is presented in three parts. Firstly, the Major Cultural Themes found in East Lombok, Indonesia and in Kaffrine, Senegal are described – the ones most heavily emphasised by participants. Then, the Egg Intervention Themes and finally, the combined set of Recommendations to comprise a culturally-informed protocol for intervention design for each location. Quotations are labelled INDO or SEN for East Lombok, Indonesia and Kaffrine, Senegal, respectively.

Major cultural themes from frameworks and narratives

These were derived from the Locality Shared Values Statements produced in the WVIS .

East Lombok, Indonesia

Religious values.

Islamic values were crucially important for participants from East Lombok, Indonesia and to their way of life. Through living by the Quran, participating in Islamic community practices, and teaching Islamic values to their children, participants felt they develop their spirituality and guarantee a better afterlife for themselves and their children. Participants stated the Quran tells them to breastfeed their children for 2 years, so they do. Despite no explicit religious official curriculum in Kindergarten, the teachers stated that it was important to incorporate religious teaching.

“East Lombok people always uphold the religious values of all aspects of social life.”

“It is important for me to still teach religious values even though they are not clearly stated in the curriculum.” – Workshop 1 INDO (teachers).

“In Quran for instance, we are told to breastfeed our kids for 2 years. We can even learn about that ” – Workshop 3 INDO (mothers).

Related to this was the importance of teaching manners to children and preventing them from saying harsh words. Teachers stated that it was important to create a happy environment for the children and to ensure that they are polite and well-behaved. Similarly, mothers emphasised the need to teach their children good religious values to ensure they will be polite and helpful to their elders.

“Children don’t speak harsh words.”

“My children can help me like what I did to my parents”.

– Workshop 8 INDO (mothers).

Togetherness within families and the community

The Locality Shared Values Frameworks stressed the importance of togetherness, both within family and community. Comments mentioned it being important that people rely heavily on their family and come together in times of need to support each other and provide motivation. This was also important more broadly, in that people in society should support each other, and that children grow up to contribute to society. This was also reflected in comments around roles within the family. Despite women being primary care givers, and men working to finance the family, participants stated that they follow a process of consultation to make decisions, and when facing hardships.

“that we have the sense of kinship throughout our society”.

“We have togetherness as mothers”.

“For the family side, whatever happens we need to be able to be united as a whole family. We need to have the [sense of] forgiveness for the sake of the children” – Workshop 2 INDO (mothers).

Attitudes about extra-marital pregnancy

In East Lombok, Indonesia, it was essential to both mothers and fathers that pregnancy happened within a marriage, this was to ensure that the honour of the family was upheld and that the lineage of the child was clear. The potential danger to health that early pregnancies can cause was also acknowledged.

“If they don’t listen to parents’ advice, there will be the possibility of pre-marital pregnancy happening, which will affect the family [so much].

The affect is going to be ruining the good name, honour and family dignity. When the children [are] born outside [of] marriage, she or he will have many difficulties like getting a birth certificate [and] having a hard time when registering to school or family” - Workshop 4 INDO (mothers).

“ To make sure that our children avoid getting married at a very young age and moreover [avoid] having free sex so that they will not get pregnant before the marriage” - Workshop 9 INDO (fathers).

Kaffrine, Senegal

The Major Cultural Themes which emerged from the Kaffrine data are described below. As these are grounded themes, they are different than those seen in East Lombok, Indonesia.

Access to healthcare

A recurring theme amongst the groups in Kaffrine were aspirations of affordable and easy-to-access healthcare. Community health workers stated the importance of encouraging women to give birth in hospitals and spoke of the importance of preventing early pregnancy which result from early marriages. Giving birth in hospitals was also a concern for Public Office Administrators who highlighted that this leads to subsequent issues with registering children for school. Mothers and fathers stated the importance of being able to afford health insurance and access healthcare so that they could take care of themselves.

“That the women give birth in the hospital” – Workshop 11 SEN (CHWS).

“To have affordable health insurance ” – Workshop 10 SEN (mothers).

“To have access to health care ” – Workshop 3 SEN (fathers).

“It is important that women give birth in the hospital in order to be able to have a certificate that allows us to establish the civil status” – Workshop 9 SEN (administrators).

Additionally, Community health workers spoke of their aspiration to have enough supplements to provide to their community so as to avoid frustration at the lack of supply, and mothers spoke of their desire to be provided with supplements.

“To have dietary supplements in large quantities to give them to all those who need them, so as not to create frustration” – Workshop 11 SEN (CHWS).

Another aspect of access to healthcare, was mistrust between fathers and community health workers. Community health workers explained that sometimes men can blame them when things go wrong in a pregnancy or consider their ideas to be too progressive. Thus, to these community health workers the quality of endurance was very important.

“Endurance (Sometimes men can accuse us of influencing their wives when they have difficulties in conceiving)” – Workshop 5 SEN (CHWs).

Another recurring theme was the importance of having secure employment and a means to support themselves; that there were also jobs available for young people, and that women had opportunities to make money to help support the family. This included preventing early marriages so girls could stay in school. Having jobs was stated as essential for survival and important to enable being useful to the community and society.

“To have more means of survival (subsistence) to be able to feed our families”.

“To have a regular and permanent job”.

“We assure a good training and education for our children so that they will become useful to us and the community”.

“ Our women should have access to activities that will support us and lessen our burden” – Workshop 3 SEN (fathers).

It was considered very important to have a religious education and respect for religious elders. Moreover, living by, and teaching, religious values such as being hard working, humble and offering mutual aid to others, was significant for people in Kaffrine.

“Have an education in the Islamic Culture (Education that aligns with the culture of Islam)”.

“Respect toward religious leaders” – Workshop 3 SEN (fathers).

“ To organize religious discussions to develop our knowledge about Islam ” - Workshop 10 SEN (mothers).

“ Have belief and be prayerful and give good counselling to people ” - Workshop 4 SEN (grandmothers).

Egg intervention themes from each country from perspectives EXplorations focus group discussion data

Below are results of analyses of comments made during the PEX:FGDs in East Lombok, Indonesia and Kaffrine, Senegal. The following codes were used deductively: attitudes to accepting outside help, traditional gender roles, food sharing, traditional beliefs, social hierarchies and understanding of stunting and Other. These topics were spoken about during open discussion and were not the subject of direct questions. For example, topics relating to traditional gender roles came up in East Lombok, during conversations around the daily routine. Thus, in order to more accurately reflect the intended meaning of the participants, these were labelled food practices, under the “Other” theme. If any of the themes were not present in the discussion, they are not shown below.

Attitudes to accepting outside help

Few mentions were made that focussed on participants attitudes to accepting outside help, but participants were sure that they would not make changes to their menus based on the advice of outside experts. Additionally, teachers mentioned that they are used to accepting help from local organisations that could to help them to identify under-developed children.

“ We don’t believe that [the outsiders are] going to change our eating habits or our various menus ” – Workshop 3 INDO (Mothers).

Traditional gender roles

In East Lombok, mothers spoke about how their husbands go to work and then provide them with daily money to buy the food for the day. However, this was discussed in relation to why food is bought daily and is thus discussed below in the topics Other – Food practices.

Food sharing

In East Lombok, Indonesia, in times when they have extra food, they share it with neighbours, in the hope that when they face times of hardship, their neighbours will share with them. Within the household, they mentioned sharing food from their plate with infants and encouraging children to share. Some mothers mentioned the importance of weekly meetings with other mothers to share food and sharing food during celebrations.

“ Sometimes we share our food with our family. So, when we cook extra food, we will probably send over the food to our neighbour, to our families. So, sometimes, with the hope that when we don’t have anything to eat, our neighbour will pay for it and will [share with] us.” – Workshop 3 INDO (Mothers).

“Even they serve food for the kids who come along to the house. So, they teach the kids to share with their friends. They provide some food. So, whenever they play [at their] house, they will [eat] the same.” – Workshop 2 INDO (Mothers).

Understanding of stunting

The teachers in East Lombok were aware of child stunting through Children’s Development Cards provided by local healthcare organizations. They stated that they recognise children with nutrition problems as having no patience period, no expression, no energy for activities and less desire to socialise and play with other children. The teachers said that stunted children do not develop the same as other children and are not as independent as children who are the proper height and weight for their development. They also stated that they recognise stunted children by their posture, pale faces and bloated stomachs. They explained how they usually use the same teaching methods for stunting children, but will sometimes allow them to do some activities, like singing, later, once the other children are leaving.

“ They have no patience period, don’t have any energy to do any of the activities. No expression, only sitting down and not mingling around with the kids. They are different way to learn. They are much slower than the other kids .” – Workshop 1 INDO (teachers).

“ When they are passive in singing, they will do it later when everyone else is leaving, they just do it [by] themselves ” – Workshop 1 INDO (teachers).

Specific views on eggs

In East Lombok, Indonesia, there were no superstitions or traditional beliefs around the consumption of eggs. When asked specifically on their views of eggs, and if they would like to be provided with eggs, women in East Lombok said that they would be happy to accept eggs. They also mentioned that eggs were a food they commonly eat, feed to children and use for convenience. Eggs were considered healthy and were common in their house.

“ We choose eggs instead. If we don’t have time, we just probably do some omelettes or sunny side up. So, it happens, actually when we get up late, we don’t have much time to be able to escort our kids to the school, then we fry the eggs or cook the instant noodles. And it happens to all mothers. So, if my kids are being cranky, that’s what happens, I’m not going to cook proper meals so, probably just eggs and instant noodles.” – Workshop 3 INDO (Mothers).

Other important topics – food practices

Some detailed themes about food practices were heard in East Lombok, Indonesia. The women were responsible for buying and preparing the food, which they purchased daily mainly due to the cost (their husbands were paid daily and so provided them with a daily allowance) and lack of storage facilities. They also bought from mobile vendors who came to the street, because they could buy very small amounts and get occasional credit. The mother decided the menu for the family and cooked once per day in the morning: the family then took from this dish throughout the day. Mothers always washed their fruits and vegetables and tried to include protein in their meals when funds allowed: either meat, eggs, tofu or tempeh.

“ One meal a day. They [the mothers] cook one time and they [the children] can eat it all day long. Yes, they can take it all day long. They find that they like [to take the food], because they tend to feel hungry.” – Workshop 6 INDO (Mothers).

“ They shop every day because they don’t have any storage in their house and the other factor is because the husband has a daily wage. They don’t have monthly wage. In the morning, the husband gives the ladies the money and the ladies go to the shop for the food. ” – Workshop 4 INDO (Mothers).

In Kaffrine, the following themes emerged relating to an egg intervention: they were different in content and emphasis to Lombok and contained uniquely local cultural emphases.

Mothers were welcoming of eggs as a supplement to improve their health during pregnancy and acknowledged the importance of good nutrition during pregnancy. However, they also mentioned that their husbands can sometimes be resistant to accepting outside help and provided an example of a vaccination programme in which fathers were hesitant to participate. However, participants stated that the Government should be the source of assistance to them (but currently was not perceived to be so).

“But if these eggs are brought by external bodies, we will hesitate to take it. For example, concerning vaccination some fathers hesitate to vaccinate their children even if they are locals who are doing it. So, educating the fathers to accept this is really a challenge” – Workshop 11 SEN (CHWs).

Some traditional gender roles were found to be strong. The participants emphasised that men are considered the head of the household, as expected in Islam, with the mother as primary caregiver for children. This is reflected in the comments from participants regarding the importance of Islam and living their religious values. The men thus made the family decisions and would need to be informed and agree to any family participation in any intervention – regardless of the education level of the mother. The paternal grandmother also played a very important role in the family and may also make decisions for the family in the place of the father. Community Health Workers emphasised that educating paternal grandmothers was essential to improve access to healthcare for women.

“There are people who are not flexible with their wives and need to be informed. Sometimes the mother-in-law can decide the place of the husband. But still, the husband’s [permission] is still necessary.” – Workshop 1 SEN (CHWs).

“[We recommend] communication with mothers-in-law and the community. Raise awareness through information, emphasizing the well-being of women and children.” – Workshop 1 SEN (CHWs).

“The [grand]mothers take care of the children so that the daughters in-law will take care of them in return So it’s very bad for a daughter in law not to take care of her mother in-law. Society does not like people who distance themselves from children.” – Workshop 4 SEN (grandmothers).

Social hierarchies

In addition to hierarchies relating to gender/position in the family such as grandmothers have decision making power, there was some mention of social hierarchies in Kaffrine, Senegal. For example, during times of food stress it was said that political groups distribute food and elected officials who choose the neighbourhoods in which the food will be distributed. Neighbourhood leaders then decide to whom the food is distributed, meaning there is a feeling that some people are being left out.

“ It’s political groups that come to distribute food or for political purposes…organizations that often come to distribute food aid, but in general it is always subject to a selection on the part of elected officials, in particular the neighbourhood leaders, who select the people they like and who leave the others ” – Workshop 11 SEN (CHWs).

Participants explained that during mealtimes, the family will share food from one large plate from which the father will eat first as a sign of respect and courtesy. Sometimes, children would also eat in their neighbour’s house to encourage them to eat.

“ Yes, it happens that we use that strategy so that children can eat. Note that children like to imitate so that’s why we [send them to the neighbour’s house]” – Workshop 11 SEN (CHWs)”.

Traditional beliefs about malnutrition

In Kaffrine, Senegal, some participants spoke of traditional beliefs relating to malnutrition, which are believed by fewer people these days. For example, uncovered food might attract bad spirits, and any person who eats it will become ill. There were a number of food taboos spoken of which were thought to have negative consequences for the baby, for example watermelon and grilled meat which were though to lead to birth complications and bleeding. Furthermore, cold water was thought to negatively impact the baby. Groups spoke of a tradition known as “bathie” in which traditional healers wash stunted children with smoke.

“ There are traditional practices called (Bathie) which are practiced by traditional healers. Parents are flexible about the practice of Bathie ” – Workshop 1 SEN (CHWs).

Causes of malnutrition and stunting were thought to be a lack of a balanced diet, lack of vitamin A, disease, intestinal worms, poor hygiene, socio-cultural issues such as non-compliance with food taboos, non-compliance with exclusive breastfeeding and close pregnancies. Malnutrition was also thought by some to be hereditary. Numerous signs of malnutrition were well known amongst the groups in Kaffrine. For example, signs of malnutrition were thought to be a big bloated belly, diarrhoea, oedema of the feet, anaemia, small limbs and hair loss as well as other symptoms such as red hair and a pale complexion. Despite this, malnutrition was thought to be hard to identify in Kaffrine as not all children will visit health centres, but mothers do try to take their babies heights and weights monthly. The groups were aware of the effect of poverty on the likelihood of stunting as impoverished parents cannot afford food. Furthermore, the groups mentioned that there is some stigma towards stunted children, and they can face mockery from other children although most local people feel pity and compassion towards them. Malnourished children are referred to as Khiibon or Lonpogne in the local language of Wolof.

“ It is poverty that is at the root of malnutrition, because parents do not have enough money [and] will have difficulty feeding their families well, so it is the situation of poverty that is the first explanatory factor of malnutrition here in Kaffrine” – Workshop 9 SEN (administrators).

“It can happen that some children are the victim of jokes for example of mockery from children of their same age, but not from adults and older ” – Workshop 9 SEN (administrators).

Pregnancy beliefs

In Kaffrine, Senegal, there were concerns around close pregnancies, and pregnancies in women who were too young, and for home births. Within the communities there was a stigma around close pregnancies, which prevented them from attending antenatal appointments. Similarly, there were superstitions around revealing early pregnancies, which again delayed attendance at health centres.

Groups acknowledged the role of good nutrition, and mentioned some forbidden foods such as salty foods, watermelon and grilled meat (which sometimes related back to a traditional belief that negative impacts would be felt in the pregnancy such as birth complications and bleeding). Similarly, drinking cold water was thought to negatively affect the baby. Beneficial foods mentioned included vegetables and meat, during pregnancy.

“ Often when a woman has close pregnancies, she can be ashamed, and this particularly delays the time of consultation” – Workshop 5 SEN (CHWs).

“Yes, there are things that are prohibited for pregnant women like salty foods” – Workshop 11 SEN (CHWs).

In Kaffrine, Senegal, some participants spoke of a traditional belief that if a pregnant woman consumes eggs then her baby might be overweight, or have problems learning how to talk. Despite this, mothers in Kaffrine said that they would be happy to accept eggs as a supplement, although if supplements are provided that require preparation (such as powdered supplements), they would be less likely to accept them.

“These restrictions are traditional, and more women no longer believe that eggs will cause a problem to the child. But if these eggs are brought by external bodies, we will hesitate to take it.” – Workshop 11 SEN (CHWs).

“They don’t eat eggs before the child starts speaking (the child only eats eggs when he starts talking). This is because it’s very heavy and can cause bloating and may also lead to intestinal problems.” – Workshop 4 SEN (grandmothers).

Other important topics – access to health services

For the participants in Kaffrine, Senegal, accessing health services was problematic, particularly for pre- and post-natal appointments, which faced frequent delays. Some women had access due to poor roads and chose to give birth at home. Access issues were further compounded by poverty and social factors, as procedures in hospitals can be costly, and women with close pregnancies (soon after an earlier one) can feel shame from society and hide their pregnancy.

“Women really have problems of lack of finances. There are social services in the hospital; but those services rarely attend to women without finances. Even when a child dies at birth they will require money to do the necessary procedure ” – Workshop 11 SEN (CHWs).

Creation of the culturally-informed protocols

Recommendations that comprise a culturally-informed protocol for intervention design in each locality are given in Table 3 .

The Major Cultural Themes, and specific Egg Intervention Themes drawn out from only 9–11 carefully planned group sessions in each country provided a rich set of recommendations towards a culturally-informed protocol for the localised design of a proposed Egg Intervention for both East Lombok, Indonesia and Kaffrine, Senegal. A culturally-informed protocol designed in this way comprises cultural insights which are worthy of consideration in local intervention design and should guide future stages of engagement and provide a platform from which good rapport and trust can be built between researchers and the community [ 16 ]. For example, in Kaffrine, Senegal, the early involvement of husbands and grandmothers is crucial, which reflects values around shared decision making within families that are noted to be more prevalent in LMICs, in contrast to individualistic values in HICs [ 16 , 39 ]. Similarly, due to strong religious values in both East Lombok, Indonesia and Kaffrine, Senegal, partnerships with Islamic leaders is likely to improve engagement. Past studies show the crucial role that religious leaders can play in determining social acceptability of interventions, particularly around taboo topics such as birth spacing [ 40 ].

The WVIS plus PEX:FGD method demonstrated here produced both broad cultural themes from shared values, which were in a concise and easy-to-understand format which could be readily communicated with the wider Action Against Stunting Hub, as well as life practices relevant to stunting in Kaffrine, Senegal and in East Lombok, Indonesia. Discussions of shared values during the WVIS main workshop provided useful cultural background within each community. PEX:FGD discussion uncovered numerous cultural factors within local life practices that could influence on the Egg Intervention engagement and acceptability. Combining themes from the WVIS workshop and PEX:FGDs allowed for specific recommendations to be made towards a culturally-informed protocol for the design of an Egg Intervention that included both broad cultural themes and specific Intervention insights (Table 3 ). For example, in Kaffrine, Senegal, to know that the husband’s authoritative family decision-making for health care (specific) is rooted in Islamic foundations (wider cultural) points to an Intervention Recommendation within the protocol, involving consultations with Islamic Leaders to lead community awareness targeting fathers. Similarly, in East Lombok, Indonesia the (specific) behaviour of breastfeeding for 2 years was underpinned by (wider cultural) shared values of living in Islam. This understanding of local values could prevent the imposition of culturally misaligned values, which Bernal and Adames (2017) caution against [ 17 ].

There are a number of interesting overlaps between values seen in the WVIS Frameworks and Narratives and the categories of Schwartz (1992) and The World Values Survey (2023) [ 41 , 42 ]. For example, in both Kaffrine, Senegal and East Lombok, Indonesia, strong religious values were found, and the groups spoke of the importance of practicing their religion with daily habits. This would align with traditional and conservation values [ 41 , 43 ]. Furthermore, in Kaffrine, Senegal participants often mentioned the importance of mutual aid within the community, and similar values of togetherness and respect in the community were found in East Lombok, Indonesia. These would seem to align with traditional, survival and conservation values [ 41 , 43 ]. However, the values mentioned by the groups in the WVIS workshops are far more specific, and it is possible that through asking what is most worthwhile, valuable and meaningful about their context, the participants are able to prioritise which aspects of their values are most salient to their daily lives. Grounded shared values such as these are generally neglected in Global Health Research, and values predominant in the Global North are often assumed to be universal [ 14 ]. Thus, by excluding the use of a predefined external framework, we minimized the risk of imposing our own ideas of values in the community, and increased the relevance, significance and local validity of the elicited information [ 28 ].

Participatory methods of engagement are an essential step in conducting Global Health Research but there is currently a paucity of specific guidance for implementing participatory methods in vulnerable communities [ 16 , 44 ]. In addition, there is acknowledgement in the literature that it is necessary to come into communities in LMICs without assumptions about their held values, and to use bottom-up participatory approaches to better understand local values [ 14 , 16 ]. The WVIS plus PEX:FGD methodology highlighted here exemplifies a method that is replicable in multiple country contexts [ 28 , 32 ] and can be used to crystallize local In Situ Shared Values which can be easily communicated to external researchers. Coupled with the specialised FGD (PEX:FGD), values-based perceptions of specific topics (in this case stunting) can be elicited leading to the creation of specific Culture-based recommendations. This therefore takes steps to answer the call by Memon and colleagues (2021) for the creation of cultural protocols ahead of conducting research in order to foster ethical research relationships [ 16 ]. We believe that the potential usefulness of the WVIS approach to guide engagement and inform intervention design is effectively demonstrated in this study and WVIS offers a method of making explicit local values in a novel and valuable way.

However, we acknowledge that our approach has several limitations. It has relied heavily on the local university researchers to debate and decide which participant stakeholder groups should be chosen, and although they did this in the context of the Whole Child approach, it would have been advantageous to have involved cultural researchers with a deeper understanding of cultural structures, to ensure sufficient opportunities for key cultural elements to emerge. This would have in particular strengthened the intervention design derived from the PEX:FGD data. For example, we retrospectively realised that our study could have been improved if grandmothers had been engaged in East Lombok. Understanding this limitation leads to suggestion for further work: to specifically investigate the overlap of this approach with disciplinary studies of culture, where social interactions and structures are taken into account via formal frameworks.

There are more minor limitations to note. For example, the WVIS approach can only be led by a trained and experienced facilitator: not all researchers can do this. A training programme is currently under development that could be made more widely available through online videos and a Handbook. Secondly, although the groups recruited do not need to be representative of the local population, the number recruited should be increased until theoretical saturation is achieved of the themes which emerge, which was not carried out in this study as we focussed on demonstrating the feasibility of the tool. Thirdly, there is a limit to the number of topics that can be explored in the PEX:FGDs within the timeframe of one focus group (depending on the stamina of the participants), and so if a wider range of topics need formative research, then more workshops are needed. Lastly, this work took place in a large, highly collaborative project involving expert researchers from local countries as well as international experts in WVIS : other teams may not have these resources. However, local researchers who train in WVIS could lead on their own (and in this Hub project such training was available).

The need for better understanding, acknowledgement and integration of local culture and shared values is increasing as the field of Global Health Research develops. This study demonstrates that the WVIS plus PEX:FGD shared values approach provides an efficient approach to contextualise and localise interventions, through eliciting and making communicable shared values and local life practices which can be used towards the formation of a culturally-informed protocols. Were this method to be used for intervention design in future, it is possible that more focus should be given to existing social structures and support systems and a greater variety of stakeholders should be engaged. This study thus contributes to the literature on methods to culturally adapt interventions. This could have significant implications for improving the uptake of nutrition interventions to reduce malnutrition through improved social acceptability, which could help progression towards the goal of Zero Hunger set within the SDGs. The transferability and generalisability of the WVIS plus PEX:FGD approach should now be investigated further in more diverse cultures and for providing formative research information for a wider range of research themes. Future studies could also focus on establishing its scaling and pragmatic usefulness as a route to conceptualising mechanisms of social acceptability, for example a mechanism may be that in communities with strong traditional religious values, social hierarchies involving religious leaders and fathers exist and their buy-in to the intervention is crucial to its social acceptability. Studies could also focus on the comparison or combination of WVIS plus PEX:FGD with other qualitative methods used for intervention design and implementation.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request [email protected], Orcid number 0000–0002–1811-4597. These include deidentified Frameworks of Shared Values and Accompanying Narrative from each Group; deidentified Hub Insight Statements of relevant themes.

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Acknowledgements

We thank the Hub PI, Claire Heffernan, for feedback on a late draft of the manuscript.

The Action Against Stunting Hub is funded by the Medical Research Council through the UK Research and Innovation (UKRI) Global Challenges Research Fund (GCRF), Grant No.: MR/S01313X/1.

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Annabel J. Chapman, Mahsa Firoozmand & Marie K. Harder

Department of Environmental Science and Engineering, Fudan University, Shanghai, People’s Republic of China

Chike C. Ebido, Rahel Neh Tening, Yanyan Huang & Marie K. Harder

Department of Zoology and Environmental Biology, University of Nigeria, Nsukka, Nigeria

Chike C. Ebido

Preventive Medicine and Public Health, Université Cheikh Anta Diop (UCAD), Dakar, Senegal

Ndèye Marème Sougou

Faculty of Psychology, Universitas Islam Negeri Syarif Hidayatullah, Jakarta, Indonesia

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Southeast Asian Ministers of Education Organization Regional Centre for Food and Nutrition (SEAMEO RECFON) Universitas Indonesia, Jakarta, Indonesia

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MKH formulated the initial research question and study design. AJC developed the specific research question. Data collection in Senegal involved CCE, NMS, AHD, FBD, RNT, CEHAN and JM. Data collection in Indonesia involved RA, RK, YH and MKH. Cultural interpretation in Senegal Involved AHD, FBD, NMS, RNT and JM. Analysis involved AJC and MF. AJC and MKH wrote the paper.

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Correspondence to Marie K. Harder .

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Chapman, A.J., Ebido, C.C., Tening, R.N. et al. Creating culturally-informed protocols for a stunting intervention using a situated values-based approach ( WeValue InSitu ): a double case study in Indonesia and Senegal. BMC Public Health 24 , 987 (2024). https://doi.org/10.1186/s12889-024-18485-y

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Climate Forward

‘narco-deforestation’ and the future of the amazon.

The fate of Colombia’s rainforest may lay in the hands of a rebel group linked to drugs and illegal mining.

By Manuela Andreoni

There’s a struggle for law and order in many of the world’s tropical forests, and nature is losing.

Last week, I wrote about the major progress Colombia made in 2023, slashing deforestation rates by 49 percent in a single year. But this week, we learned the trend reversed significantly in the first quarter of this year. Preliminary figures show tree loss was up 40 percent since the start of the year, Colombia’s Minister of Environment, Susana Muhamad, told reporters on Monday .

Why have things changed so quickly? Mostly because a single armed group controls much of Colombia’s rainforests.

Muhamad explained that conflicts with Estado Mayor Central, a group that is thought to run a sprawling cocaine operation among other illegal activities, were partly behind the striking numbers. “In this case, nature is being placed in the middle of the conflict,” she said. According to experts, E.M.C. had largely banned deforestation and in recent months it seems to have allowed it again.

A 2023 United Nations report referred to this entanglement between drug trafficking and environmental crime as “ narco-deforestation .” Perhaps nowhere is that phenomenon more clear than in Colombia, a country that’s both a stage for the decades-old global war on drugs and one of the most biodiverse corners of the planet, where the Andes Mountains meet the vast Amazon rainforest.

But what’s happening in Colombia underscores a growing challenge for many developing countries. Vast pristine forests are both essential to curb climate change and biodiversity loss, and they’re also prized by groups who want to hide illegal activities beneath thick tree canopies.

Today I want to explain why experts on the ground say that there’s no way to protect crucial forests like the Amazon without dealing with the growing power of armed groups.

The Colombian case

Armed groups in Colombia have long prohibited logging in the forest. The main reason, experts say, was to protect the illegal drug operations that the Revolutionary Armed Forces of Colombia, or FARC, ran in the forest.

FARC’s role protecting the forest became clear after 2016, when it signed a peace deal with the Colombian government, which disarmed the group and turned it into a political party called Comunes . When FARC disbanded, a local power vacuum caused deforestation rates to skyrocket as cattle ranchers, illegal miners and dissident groups cut down forests.

But as the dust settled, the Estado Mayor Central, a dissident group controlled by Ivan Mordisco, a former FARC commander , consolidated power in much of the Colombian rainforest. The old FARC tactics of restricting logging seemed to return and deforestation rates started to fall again. Until recently.

Muhamad noted that El Niño may have also made the Amazon more vulnerable to forest fires this year. I called Rodrigo Botero, the director of an environmental nonprofit in Colombia called the Foundation for Conservation and Sustainable Development, to understand what else changed. He told me they can see new roads being opened and ranches expanding in the region. Government agents can’t stop it because the group, which is estimated to have over 3,000 troops , controls access to much of the forest.

It’s not totally clear why the E.M.C. seems to have begun allowing logging again. Botero said he feared the E.M.C. could be trying to use deforestation rates as leverage to get more favorable treatment from the government.

First, they showed the government the benefits they could deliver by forbidding deforestation, he explained. And then, Botero added, it was like they told the government, “if you can’t count on us, look at what we can do.”

It’s a global problem, too

There is no evidence that the E.M.C. were successful in what seems to be an attempt to use the Amazon as a political tool. The government says it’s actively trying to arrest Mordisco .

Politics aside, what the Colombian case made clear to me is that controlling armed groups is now a fundamental part of conservation policy.

Bram Ebus, a consultant at the International Crisis Group and an investigative reporter, has spent years documenting how both drug traffickers and rebel groups like the E.M.C. are expanding their reach in the rainforests of South America in a project called Amazon Underworld .

He told me the illegal trade managed by these powerful criminal groups is no longer restricted to drugs or minerals, though they are still major sources of income. There is growing concern that criminal networks are also tapping into a vast menu of businesses to launder their illegal gains, such as illegal logging, wildlife trafficking, ranching and land grabbing.

Researchers, journalists and government officials have long documented how mining funded conflict in Africa, Asia and Latin Americ a. Nature was collateral damage. Illegal mining operations connected to conflict have been very harmful to biodiversity in the Congo River Basin’s rainforest , for example.

Colombia continues to negotiate for peace, and its Ministry of Environment and Sustainable Development didn’t comment on whether the Amazon was being used as a political tool, but added that violations will be investigated and that it will continue working to curb deforestation. (The E.M.C. could not be reached for comment.) But, in many cases, it’s becoming hard to tell politically motived groups from purely criminal gangs. That’s bad news for nature and whoever dares defend it .

Many countries simply don’t have the resources to protect forests, let alone take on armed groups. Right now, one of the developing countries with the biggest budget for forest protection, Brazil, has so few officers that each worker patrols on average an area the size of Denmark, according to an association of environmental protection officers. They are now striking to protest poor working conditions .

Meanwhile, criminal and rebel groups have continued to expand their reach.

“You see that all these groups who are participating in the conflict have one key objective, which is to expand, to get more troops, to get more money, to get more territorial control,” Ebus told me. “The environment right now is a hostage of war.”

Getting rid of ‘forever chemicals’

What happened : For the first time, the federal government is requiring municipal water systems to remove six synthetic chemicals linked to cancer and other health problems that are present in the tap water of hundreds of millions of Americans, my colleague Lisa Friedman reported.

The Environmental Protection Agency will start requiring that water providers reduce perfluoroalkyl and polyfluoroalkyl substances, known collectively as PFAS, to near-zero levels. The compounds, found in everything from dental floss to firefighting foams to children’s toys, are called “forever chemicals” because they never fully degrade and can accumulate in the body and the environment. The new effort will cost at least $1.5 billion per year.

Where PFAS are found: The chemicals are so ubiquitous that they can be found in the blood of almost every person in the United States. A recent study that tested 45,000 water samples around the world found that about 31 percent of samples that weren’t near any obvious source of contamination had PFAS levels considered harmful to human health, as my colleague Delger Erdenesanaa wrote this week .

Exposure to PFAS has been associated with metabolic disorders, decreased fertility in women, developmental delays in children and increased risk of some prostate, kidney and testicular cancers, according to the E.P.A. (Lisa wrote a helpful explainer on what else we need to know about PFAS .)

The new regulation is “life changing,” Michael S. Regan, the E.P.A. administrator, told Lisa. “We are one huge step closer to finally shutting off the tap on forever chemicals once and for all.”

So what can you do to avoid PFAS? The E.P.A. maintains a list of cleaning products that are safe from these chemicals . And the Environmental Working Group, a nonprofit, has been tracking companies that say they are stripping them from their products. — Manuela Andreoni

More climate news

H&M and Zara are buying cotton linked to environmental destruction and land grabbing in Brazil’s grasslands, according to an investigative report reviewed by Context .

Solar power plants produced more energy in Texas than coal for the first time in March, Canary Media reports .

The Washington Post maps access to nature in neighborhoods across the United States .

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Manuela Andreoni is a Times climate and environmental reporter and a writer for the Climate Forward newsletter. More about Manuela Andreoni

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