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• Case Study | Definition, Examples & Methods

Case Study | Definition, Examples & Methods

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

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

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

Table of contents

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Frequently asked questions.

Yes, in fact a case study is a very good option in your dissertation. There are multiple ways to implement a case study in your thesis. For instance, one main study which is in depth and complex or you could feature multiple case studies.

Case studies are a way to research a particular field, group, people and situation. The topic of research is studied deeply and thoroughly in order to solve a problem or uncover information. Case studies are a type of qualitative research.

If you are ready to find a masters course check out Masters Compare.

Prof Martyn Denscombe, author of “ The Good Research Guide, 6th edition ”, gives expert advice on how to use a case study in your masters dissertation. 

There are two main examples for how to use a case study in your masters dissertation, namely quantitative and qualitative case studies.

First, a case study provides a platform that allows you to study a situation in depth and produce the level of academic inquiry that is expected in a master’s degree. In the context of any master’s programme the dissertation operates as something of a showcase for a student’s abilities.

It can easily make the difference between getting a merit and a distinction in the final award of degree. It is important, therefore, to base the work on an approach that allows things to be explored in sufficient depth and detail to warrant a good grade.

Second, case studies can be useful in a practical sense. It is possible to complete a case study in a relatively short period of intense study and so it is the kind of research that is feasible in terms of the kind of time constraints that face master’s students as they enter the final stages of their programme of study.

Added to which a case study can also be a rather convenient form of research, avoiding the time and costs of travel to multiple research sites. The use of case studies, then, would appear to be an attractive proposition. But it is not an approach that should be used naively without consideration of its limitations or potential pitfalls.

To be a good case study the research needs to consider certain key issues. If they are not addressed it will considerably lower the value of the master’s degree. For instance, a good case study needs to:

• Be crystal clear about the purpose for which the research is being conducted
• Justify the selection of the particular case being studied
• Describe how the chosen case compares with others of its type
• Explain the basis on which any generalizations can be made from the findings

This is where The Good Research Guide, 6th edition becomes so valuable. It not only identifies the key points that need to be addressed in order to conduct a competent questionnaire survey.

It gets right to the heart of the matter with plenty of practical guidance on how to deal with issues. Using plain language, this bestselling book covers a range of alternative strategies and methods for conducting small-scale social research projects. It outlines some of the main ways in which the data can be analysed.

Read Prof Martyn Denscombe’s advice on using a questionnaire survey for your postgraduate dissertation

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What is a Case Study and Why should I Use It in My PhD Dissertation? Understanding the purpose of case studies in research.

A case study can provide appropriate research design in a qualitative or quantitative study to to gain concrete, contextual, in-depth knowledge and multi-faceted understanding of a complex issue in its real-life context. The case study can be a great tool for providing insight and developing theories in the avenue of present research.

What is a case study?

A case study is a structured, focused, in-depth look at a particular issue or topic that reports on the findings and conclusions of researchers who have studied the case. A case study is not intended to be an exploratory analysis or to make sweeping generalizations. Rather, it is an objective, focused, and structured approach to understand the specific circumstances of an issue or the people, places, and things that make up a society. Prepared to the best of the researchers knowledge, a case study is a unique research method. In fact, case studies are the most common type of qualitative research. A case study is often a combination of interviews, focus groups, documentation, and research documentation.

Why do researchers use case study?

Case studies often contain detailed, in-depth examination of a particular issue or topic that reports on the findings and conclusions of researchers who have studied the case. Case studies are excellent for gaining insight and understanding in the following ways: – 

• Focus on one aspect of the phenomena being studied
• Give the researcher a window into the participants’ world 
• Explain the decision making process involved in data collection, analysis, and presentation 
• Allow for in-depth examination of the methodology

How to do a case study in PhD research

To conduct a case study, the students must first adhere to the university requirements and establish a strong subject knowledge in the domain of study. This is to help the researcher design the case study in a controlled environment. The case study must:

Be descriptive – Be specific – Be analytical – Be critical – Be narrative – Be written within required format

Key elements of a successful case study

The basic elements of a successful case study include: – 

• The phenomenon 
• The context 
• The methodology 
• The conclusions 
• The recommendations 
• The detail of resources used  

Research design using cases

Research designs that incorporate the use of case studies are often qualitative or quantitative in nature. A quantitative approach to the study of a phenomenon could involve questionnaires to collect data about the respondents’ experiences. On the other hand, a qualitative approach could involve in-depth interviews to understand the thoughts, feelings, and experiences of people who are experiencing the same phenomenon as the research team. Case studies can also be used in the analysis of the validity of a plan. For example, a case study examining the feasibility of a new project could examine the cost, risks, and benefits of undertaking the study and the study’s design.

The case study can be used in various design settings:

• Explanatory case studies aim to answer ‘how’ or ’why’ questions and involve an accurate description of the event or situation under study rather than the researcher’s thoughts.
• A descriptive case study is one that is focused and detailed to illustrate an unfamiliar subject that the researcher wants the audience to understand and the phenomenon under study is carefully scrutinized.
• Exploratory case studies aim to find answers to the questions of ‘what’ or ‘who’. This is often conducted on the premise of a larger research problem to narrow the focus of the study and reach a specific research objective.

Should I be using case studies in my research?

Eisenhardt (1989) says that case studies are:

“Particularly well suited to new research areas or research areas for

which existing theory seems inadequate. This type of work is highly

complementary to incremental theory building from normal science

research. The former is useful in early stages of research on a topic or

when a fresh perspective is needed, whilst the latter is useful in later

stages of knowledge” (pp.548-549).

There is a certain skepticism about the usefulness of case studies as an objective research method considering its many limitations like the reliability of the respondents and the behavioral differences that can contribute to the inadequacy of the information provided by the subjects of the case, the issue of possibility of generalization of the findings of a case study considering the narrow and focussed approach that case studied utilize and finally the researcher bias which forms the main disadvantage to an objective study. The researcher should also consider the efficiency of using case studies in his or her research because of the detailed nature of this method that is not only dependent on factors beyond control but also intensive in preparation and deduction of conclusions.

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Writing a Case Study

What is a case study?

A Case study is: 

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

What are the different types of case studies?

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

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

Who are your case study participants?

What is triangulation ? 

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

How to write a Case Study?

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

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Library Guides

Dissertations 4: methodology: methods.

• Introduction & Philosophy
• Methodology

Primary & Secondary Sources, Primary & Secondary Data

When describing your research methods, you can start by stating what kind of secondary and, if applicable, primary sources you used in your research. Explain why you chose such sources, how well they served your research, and identify possible issues encountered using these sources.  

Definitions  

There is some confusion on the use of the terms primary and secondary sources, and primary and secondary data. The confusion is also due to disciplinary differences (Lombard 2010). Whilst you are advised to consult the research methods literature in your field, we can generalise as follows:  

Secondary sources 

Secondary sources normally include the literature (books and articles) with the experts' findings, analysis and discussions on a certain topic (Cottrell, 2014, p123). Secondary sources often interpret primary sources.  

Primary sources 

Primary sources are "first-hand" information such as raw data, statistics, interviews, surveys, law statutes and law cases. Even literary texts, pictures and films can be primary sources if they are the object of research (rather than, for example, documentaries reporting on something else, in which case they would be secondary sources). The distinction between primary and secondary sources sometimes lies on the use you make of them (Cottrell, 2014, p123). 

Primary data 

Primary data are data (primary sources) you directly obtained through your empirical work (Saunders, Lewis and Thornhill 2015, p316). 

Secondary data 

Secondary data are data (primary sources) that were originally collected by someone else (Saunders, Lewis and Thornhill 2015, p316).   

Comparison between primary and secondary data   

Use  

Virtually all research will use secondary sources, at least as background information. 

Often, especially at the postgraduate level, it will also use primary sources - secondary and/or primary data. The engagement with primary sources is generally appreciated, as less reliant on others' interpretations, and closer to 'facts'. 

The use of primary data, as opposed to secondary data, demonstrates the researcher's effort to do empirical work and find evidence to answer her specific research question and fulfill her specific research objectives. Thus, primary data contribute to the originality of the research.    

Ultimately, you should state in this section of the methodology: 

What sources and data you are using and why (how are they going to help you answer the research question and/or test the hypothesis. 

If using primary data, why you employed certain strategies to collect them. 

What the advantages and disadvantages of your strategies to collect the data (also refer to the research in you field and research methods literature). 

Quantitative, Qualitative & Mixed Methods

The methodology chapter should reference your use of quantitative research, qualitative research and/or mixed methods. The following is a description of each along with their advantages and disadvantages. 

Quantitative research 

Quantitative research uses numerical data (quantities) deriving, for example, from experiments, closed questions in surveys, questionnaires, structured interviews or published data sets (Cottrell, 2014, p93). It normally processes and analyses this data using quantitative analysis techniques like tables, graphs and statistics to explore, present and examine relationships and trends within the data (Saunders, Lewis and Thornhill, 2015, p496). 

Qualitative research  

Qualitative research is generally undertaken to study human behaviour and psyche. It uses methods like in-depth case studies, open-ended survey questions, unstructured interviews, focus groups, or unstructured observations (Cottrell, 2014, p93). The nature of the data is subjective, and also the analysis of the researcher involves a degree of subjective interpretation. Subjectivity can be controlled for in the research design, or has to be acknowledged as a feature of the research. Subject-specific books on (qualitative) research methods offer guidance on such research designs.  

Mixed methods 

Mixed-method approaches combine both qualitative and quantitative methods, and therefore combine the strengths of both types of research. Mixed methods have gained popularity in recent years.  

When undertaking mixed-methods research you can collect the qualitative and quantitative data either concurrently or sequentially. If sequentially, you can for example, start with a few semi-structured interviews, providing qualitative insights, and then design a questionnaire to obtain quantitative evidence that your qualitative findings can also apply to a wider population (Specht, 2019, p138). 

Ultimately, your methodology chapter should state: 

Whether you used quantitative research, qualitative research or mixed methods. 

Why you chose such methods (and refer to research method sources). 

Why you rejected other methods. 

How well the method served your research. 

The problems or limitations you encountered. 

Doug Specht, Senior Lecturer at the Westminster School of Media and Communication, explains mixed methods research in the following video:

LinkedIn Learning Video on Academic Research Foundations: Quantitative

The video covers the characteristics of quantitative research, and explains how to approach different parts of the research process, such as creating a solid research question and developing a literature review. He goes over the elements of a study, explains how to collect and analyze data, and shows how to present your data in written and numeric form.

Link to quantitative research video

Some Types of Methods

There are several methods you can use to get primary data. To reiterate, the choice of the methods should depend on your research question/hypothesis. 

Whatever methods you will use, you will need to consider: 

why did you choose one technique over another? What were the advantages and disadvantages of the technique you chose? 

what was the size of your sample? Who made up your sample? How did you select your sample population? Why did you choose that particular sampling strategy?) 

ethical considerations (see also tab...)  

safety considerations  

validity  

feasibility  

recording  

procedure of the research (see box procedural method...).  

Check Stella Cottrell's book  Dissertations and Project Reports: A Step by Step Guide  for some succinct yet comprehensive information on most methods (the following account draws mostly on her work). Check a research methods book in your discipline for more specific guidance.  

Experiments 

Experiments are useful to investigate cause and effect, when the variables can be tightly controlled. They can test a theory or hypothesis in controlled conditions. Experiments do not prove or disprove an hypothesis, instead they support or not support an hypothesis. When using the empirical and inductive method it is not possible to achieve conclusive results. The results may only be valid until falsified by other experiments and observations. 

For more information on Scientific Method, click here . 

Observations 

Observational methods are useful for in-depth analyses of behaviours in people, animals, organisations, events or phenomena. They can test a theory or products in real life or simulated settings. They generally a qualitative research method.  

Questionnaires and surveys 

Questionnaires and surveys are useful to gain opinions, attitudes, preferences, understandings on certain matters. They can provide quantitative data that can be collated systematically; qualitative data, if they include opportunities for open-ended responses; or both qualitative and quantitative elements. 

Interviews  

Interviews are useful to gain rich, qualitative information about individuals' experiences, attitudes or perspectives. With interviews you can follow up immediately on responses for clarification or further details. There are three main types of interviews: structured (following a strict pattern of questions, which expect short answers), semi-structured (following a list of questions, with the opportunity to follow up the answers with improvised questions), and unstructured (following a short list of broad questions, where the respondent can lead more the conversation) (Specht, 2019, p142). 

This short video on qualitative interviews discusses best practices and covers qualitative interview design, preparation and data collection methods. 

Focus groups   

In this case, a group of people (normally, 4-12) is gathered for an interview where the interviewer asks questions to such group of participants. Group interactions and discussions can be highly productive, but the researcher has to beware of the group effect, whereby certain participants and views dominate the interview (Saunders, Lewis and Thornhill 2015, p419). The researcher can try to minimise this by encouraging involvement of all participants and promoting a multiplicity of views. 

This video focuses on strategies for conducting research using focus groups.  

Check out the guidance on online focus groups by Aliaksandr Herasimenka, which is attached at the bottom of this text box. 

Case study 

Case studies are often a convenient way to narrow the focus of your research by studying how a theory or literature fares with regard to a specific person, group, organisation, event or other type of entity or phenomenon you identify. Case studies can be researched using other methods, including those described in this section. Case studies give in-depth insights on the particular reality that has been examined, but may not be representative of what happens in general, they may not be generalisable, and may not be relevant to other contexts. These limitations have to be acknowledged by the researcher.     

Content analysis 

Content analysis consists in the study of words or images within a text. In its broad definition, texts include books, articles, essays, historical documents, speeches, conversations, advertising, interviews, social media posts, films, theatre, paintings or other visuals. Content analysis can be quantitative (e.g. word frequency) or qualitative (e.g. analysing intention and implications of the communication). It can detect propaganda, identify intentions of writers, and can see differences in types of communication (Specht, 2019, p146). Check this page on collecting, cleaning and visualising Twitter data.

Extra links and resources:  

Research Methods  

A clear and comprehensive overview of research methods by Emerald Publishing. It includes: crowdsourcing as a research tool; mixed methods research; case study; discourse analysis; ground theory; repertory grid; ethnographic method and participant observation; interviews; focus group; action research; analysis of qualitative data; survey design; questionnaires; statistics; experiments; empirical research; literature review; secondary data and archival materials; data collection. 

Doing your dissertation during the COVID-19 pandemic  

Resources providing guidance on doing dissertation research during the pandemic: Online research methods; Secondary data sources; Webinars, conferences and podcasts; 

• Virtual Focus Groups Guidance on managing virtual focus groups

5 Minute Methods Videos

The following are a series of useful videos that introduce research methods in five minutes. These resources have been produced by lecturers and students with the University of Westminster's School of Media and Communication. 

Case Study Research

Research Ethics

Quantitative Content Analysis 

Sequential Analysis 

Qualitative Content Analysis 

Thematic Analysis 

Social Media Research 

Mixed Method Research 

Procedural Method

In this part, provide an accurate, detailed account of the methods and procedures that were used in the study or the experiment (if applicable!). 

Include specifics about participants, sample, materials, design and methods. 

If the research involves human subjects, then include a detailed description of who and how many participated along with how the participants were selected.  

Describe all materials used for the study, including equipment, written materials and testing instruments. 

Identify the study's design and any variables or controls employed. 

Write out the steps in the order that they were completed. 

Indicate what participants were asked to do, how measurements were taken and any calculations made to raw data collected. 

Specify statistical techniques applied to the data to reach your conclusions. 

Provide evidence that you incorporated rigor into your research. This is the quality of being thorough and accurate and considers the logic behind your research design. 

Highlight any drawbacks that may have limited your ability to conduct your research thoroughly. 

You have to provide details to allow others to replicate the experiment and/or verify the data, to test the validity of the research. 

Bibliography

Cottrell, S. (2014). Dissertations and project reports: a step by step guide. Hampshire, England: Palgrave Macmillan.

Lombard, E. (2010). Primary and secondary sources.  The Journal of Academic Librarianship , 36(3), 250-253

Saunders, M.N.K., Lewis, P. and Thornhill, A. (2015).  Research Methods for Business Students.  New York: Pearson Education. 

Specht, D. (2019).  The Media And Communications Study Skills Student Guide . London: University of Westminster Press.  

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Home » Case Study – Methods, Examples and Guide

Case Study – Methods, Examples and Guide

Table of Contents

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

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

Types of Case Study

Types and Methods of Case Study are as follows:

Single-Case Study

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

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

Multiple-Case Study

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

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

Exploratory Case Study

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

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

Descriptive Case Study

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

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

Instrumental Case Study

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

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

Case Study Data Collection Methods

Here are some common data collection methods for case studies:

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

Observations

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

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

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

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

How to conduct Case Study Research

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

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

Examples of Case Study

Here are some examples of case study research:

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

Application of Case Study

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

Business and Management

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

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

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

Social Sciences

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

Law and Ethics

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

Purpose of Case Study

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

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

Case studies can also serve other purposes, including:

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

Advantages of Case Study Research

There are several advantages of case study research, including:

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

Limitations of Case Study Research

There are several limitations of case study research, including:

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

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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

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

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

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

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

Definitions of qualitative case study research

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

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

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

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

Current methodological issues in qualitative case study research

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

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

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

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

Assessment of rigour

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

Framework for assessing quality in qualitative case study research.

Adapted from Stake ( 1995 , p. 131).

Study design

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

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

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

Search strategy

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

Outcomes of search of qualitative methods journals.

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

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

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

Case study methodology or method

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

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

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

Case study of something particular and case selection

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

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

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

Contextually bound case study

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

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

Article synopsis of case study research using Stake's tradition

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

Article synopsis of case study research using Yin's tradition

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

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

Researcher and case interactions and triangulation

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

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

Study design inconsistent with methodology

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

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

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

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

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

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

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

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

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

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

Limitations of the review

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

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

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

Conflict of interest and funding

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

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Can Dissertation be a Case Study: Research Example and Format

write Case study as dissertation

Also known as a thesis, a dissertation usually comes at the end of a degree course. Unlike essays and other standard research papers, a dissertation is a large project that requires a deeper depth of research.

The research can take up to the final six months of your degree course. The significance of this type of research is to test the ability of a student to do independent research. A student comes up with his or her own idea, does a thorough research then structures the content to make a final research paper.

In essence, this stage of your degree course teaches you how to manage your time and sharpen your individual working skills.

A student usually works with the department supervisor to make dissertation writing easier. The supervisor can help in planning the writing of the dissertation. The purpose of the supervisor is to provide guidance, feedback and advice as you progress from stage one of writing to the end.

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Can Dissertation be a Case Study?

There are very few instances when a dissertation is used as a case study because of the differences.

If you opt to use your dissertation as a case study, ensure that you do not focus on providing solution to the problem.

If it is an already written dissertation, it requires a lot of editing. In a dissertation, you provide the solution to a problem, but in case studies, only analysis of events is enough to complete the project.

How to Incorporate Case Study into Your Dissertation

A good qualitative case study can form the perfect basis of your dissertation and save you a lot of time.

To start with, a case study gives you the avenue to deeply analyze a situation. Precisely so, it will be easier for you to exhibit the academic survey level that your degree requires.

A good case study can be used in your dissertation in a practical sense.

In the final stages of your degree, time constraints are tight and a case study will take you a relatively short period to complete unlike a dissertation. Therefore, it is an appropriate form of research that saves time taken to navigate multiple research sites.

However, to incorporate a case study into your dissertation, pay attention to the potential drawbacks and limitations involved.

To avoid lowering the value and quality of your research, the following are some of the considerations to observe when selecting a proper case study for your dissertation:

a) The case study ought to be clear and in uniformity with the research purpose .

b) The particular case you choose, should be justified.

c) There has to be a clear explanation concerning the basis of the overviews made from your research results.

d) The case study should have a comparison between the chosen cases and others .

To date, there are many students who use case studies as an obvious option for research projects. 

All in all, be careful how you implement the study into your research as many professors may view dissertation as one that lacks rigor and consistency. Despite this skepticism, case studies can offer more exhaustive insights that an ordinary research cannot achieve.

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How to Write Case Study Only as Your Dissertation

A case study and a dissertation share a lot of similarities but they are not the same.

In case studies, there is a full introduction of a topic. But, the opinion of the writer and other similar works do not need citation. Equally, a dissertation requires the citing of a writer’s view as well as that of other similar works. 

A student who is about to graduate is supposed to know instances when case studies can be used as dissertation and when they cannot.

If you are worried about writing a great dissertation that will excite your lecturer, you can opt for the case study method.

Here are important steps to follow in writing a case study only as your dissertation:

• Start by defining the particular question you are going to address in the paper. It will be easier if you create specific questions that will answer the main parts of the situation. Develop your focus of research to get all the information about the topic.
• Design the process of the case study. Come up with a clear roadmap of the selected real life cases and ensure you know the reason why you have chosen them. Also, do not forget to enlighten more information about the research methods you intend to adopt for the purposes of data collection and analysis.
• A case study written only as a dissertation needs a huge amount of data. Needless to say, a writer should develop a clear plan for data collection.
• With your plan ready, proceed to the field and collect data. At this stage, do not make any interpretation of results until the research process is complete.
• Having done that, present the data by reporting in a flowing manner.  Use a simple language for readers to understand your interpretations effortlessly.

Formatting the Case Study        

Following the right format guarantees a good case study paper that you can use to impress the professor as a dissertation. 

Start with an introduction or an exclusive summary so as to inform the reader about the findings and analysis of the case study.

Secondly, provide background information by writing clear facts and pinpointing the topic issues to your audience.

The next part is to embark on the methods and findings.

This is a discussion that entails verdicts of the case you have chosen and should be divided into separate sections for easier understanding. 

Afterwards, come to the section where you will provide the recommendations and how to implement them. Here, a writer should discuss the solution chosen, give clear reasons why it is the right one and how to put it into practice.

Good solutions usually focus on realistic means of improving the situation or solving it.

You can give evidence as a backup for the solutions you have proposed.  The final part is to write a conclusion that summarizes all the important points from the evaluations and solutions of the case study.

3 Examples of Case Study Topics to Write as Dissertations

To arrive at a good case topic idea, hunt for the ultimate topic that inspires you. From the possible list of selection you have, narrow down to topics that reflect the main idea you want.

After arriving at the topic of choice, select the right methodology for researching. Below are good topics you can select for your case study:

1. Why start-up businesses are on a steady rise.

2. Research study case on patients with Omicron corona virus and the latest nursing methods for the virus.

3. Case study on the rise and rise of Tiktok.

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Regardless of the course you have selected or your academic objectives, a college student needs a good case study. The quality of this study will depend on the topic you select.

Therefore, if you select a topic correctly, your ideas will be well organized and you can use available research methodologies to write an interesting case study.

There are different categories of ideas you can base your study on depending on the subject you want. You can focus on titles ranging from information technology to psychology, education and environmental science.

There are also good topic ideas you can derive from applied physics, marketing, management, human right case studies or even nursing.

When not handling complex essays and academic writing tasks, Josh is busy advising students on how to pass assignments. In spare time, he loves playing football or walking with his dog around the park.

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• How it works

Research Methods for Dissertation – Types with Comparison

Published by Carmen Troy at August 13th, 2021 , Revised On June 14, 2023

Introduction

“Research methods for a dissertation refer to the specific approaches, procedures, and techniques employed by researchers to investigate and gather data for their dissertation projects.”

These methods provide a systematic and structured framework for conducting research, ensuring the reliability, validity, and rigour of the study.

What are the different research methods for the dissertation, and which one should I use?

Choosing the right research method for a dissertation is a grinding and perplexing aspect of the dissertation research process. A well-defined  research methodology  helps you conduct your research in the right direction, validates the  results  of your research, and makes sure that the study you’re conducting answers the set  research questions .

The research  title,  research questions,  hypothesis , objectives, and study area generally determine the best research method in the dissertation.

This post’s primary purpose is to highlight what these different  types of research  methods involve and how you should decide which type of research fits the bill. As you read through this article, think about which one of these research methods will be the most appropriate for your research.

The practical, personal, and academic reasons for choosing any particular method of research are also analysed. You will find our explanation of experimental , descriptive , historical , quantitative , qualitative , and mixed research methods useful regardless of your field of study.

While choosing the right method of research for your own research, you need to:

• Understand the difference between research methods and  methodology .
• Think about your research topic, research questions, and research objectives to make an intelligent decision.
• Know about various types of research methods so that you can choose the most suitable and convenient method as per your research requirements.

Research Methodology Vs. Research Methods

A well-defined  research methodology  helps you conduct your research in the right direction, validates the  results  of your research, and makes sure that the study you are conducting answers the set  research questions .

Research methods are the techniques and procedures used for conducting research. Choosing the right research method for your writing is an important aspect of the  research process .

You need to either collect data or talk to the people while conducting any research. The research methods can be classified based on this distinction.

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Types of Research Methods

Research methods are broadly divided into six main categories.

Experimental Research Methods

Descriptive research methods, historical research methods, quantitative research methods, qualitative research methods, mixed methods of research.

Experimental research  includes the experiments conducted in the laboratory or observation under controlled conditions. Researchers try to study human behavior by performing various experiments. Experiments can vary from personal and informal natural comparisons. It includes three  types of variables;

• Independent variable
• Dependent variable
• Controlled variable

Types of Experimental Methods

Laboratory experiments

The experiments were conducted in the laboratory. Researchers have control over the variables of the experiment.

Field experiment

The experiments were conducted in the open field and environment of the participants by incorporating a few artificial changes. Researchers do not have control over variables under measurement. Participants know that they are taking part in the experiment.

Natural experiments

The experiment is conducted in the natural environment of the participants. The participants are generally not informed about the experiment being conducted on them.

Example : Estimating the health condition of the population.

Quasi-experiments

A quasi-experiment is an experiment that takes advantage of natural occurrences. Researchers cannot assign random participants to groups.

Example: Comparing the academic performance of the two schools.

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Descriptive research aims at collecting the information to answer the current affairs. It follows the Ex post facto research, which predicts the possible reasons behind the situation that has already occurred. It aims to answer questions like how, what, when, where, and what rather than ‘why.’

In  historical research , an investigator collects, analyses the information to understand, describe, and explain the events that occurred in the past. Researchers try to find out what happened exactly during a certain period of time as accurately and as closely as possible. It does not allow any manipulation or control of variables.

Quantitative research  is associated with numerical data or data that can be measured. It is used to study a large group of population. The information is gathered by performing statistical, mathematical, or computational techniques.

Quantitative research isn’t simply based on  statistical analysis or quantitative techniques but rather uses a certain approach to theory to address research hypotheses or research questions, establish an appropriate research methodology, and draw findings &  conclusions .

Some most commonly employed quantitative research strategies include data-driven dissertations, theory-driven studies, and reflection-driven research. Regardless of the chosen approach, there are some common quantitative research features as listed below.

• Quantitative research is based on testing or building on existing theories proposed by other researchers whilst taking a reflective or extensive route.
• Quantitative research aims to test the research hypothesis or answer established research questions.
• It is primarily justified by positivist or post-positivist research paradigms.
• The  research design can be relationship-based, quasi-experimental, experimental, or descriptive.
• It draws on a small sample to make generalisations to a wider population using probability sampling techniques.
• Quantitative data is gathered according to the established research questions and using research vehicles such as structured observation, structured interviews, surveys, questionnaires, and laboratory results.
• The researcher uses  statistical analysis  tools and techniques to measure variables and gather inferential or descriptive data. In some cases, your tutor or members of the dissertation committee might find it easier to verify your study results with numbers and statistical analysis.
• The accuracy of the study results is based on external and internal validity and the authenticity of the data used.
• Quantitative research answers research questions or tests the hypothesis using charts, graphs, tables, data, and statements.
• It underpins  research questions  or hypotheses and findings to make conclusions.
• The researcher can provide recommendations for future research and expand or test existing theories.

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It is a type of scientific research where a researcher collects evidence to seek answers to a  question . It is associated with studying human behaviour from an informative perspective. It aims at obtaining in-depth details of the problem.

As the term suggests,  qualitative research  is based on qualitative research methods, including participants’ observations, focus groups, and unstructured interviews.

Qualitative research is very different in nature when compared to quantitative research. It takes an established path towards the  research process , how  research questions  are set up, how existing theories are built upon, what research methods are employed, and how the  findings  are unveiled to the readers.

You may adopt conventional methods, including phenomenological research, narrative-based research, grounded theory research,  ethnographies ,  case studies , and auto-ethnographies.

Again, regardless of the chosen approach to qualitative research, your dissertation will have unique key features as listed below.

• The research questions that you aim to answer will expand or even change as the  dissertation writing process continues. This aspect of the research is typically known as an emergent design where the research objectives evolve with time.
• Qualitative research may use existing theories to cultivate new theoretical understandings or fall back on existing theories to support the research process. However, the original goal of testing a certain theoretical understanding remains the same.
• It can be based on various research models, such as critical theory, constructivism, and interpretivism.
• The chosen research design largely influences the analysis and discussion of results and the choices you make. Research design depends on the adopted research path: phenomenological research, narrative-based research, grounded theory-based research, ethnography, case study-based research, or auto-ethnography.
• Qualitative research answers research questions with theoretical sampling, where data gathered from an organisation or people are studied.
• It involves various research methods to gather qualitative data from participants belonging to the field of study. As indicated previously, some of the most notable qualitative research methods include participant observation, focus groups, and unstructured  interviews .
• It incorporates an  inductive process where the researcher analyses and understands the data through his own eyes and judgments to identify concepts and themes that comprehensively depict the researched material.
• The key quality characteristics of qualitative research are transferability, conformity, confirmability, and reliability.
• Results and discussions are largely based on narratives, case study and personal experiences, which help detect inconsistencies, observations, processes, and ideas.s
• Qualitative research discusses theoretical concepts obtained from the results whilst taking research questions and/or hypotheses  to draw general  conclusions .

Now that you know the unique differences between quantitative and qualitative research methods, you may want to learn a bit about primary and secondary research methods.

Here is an article that will help you  distinguish between primary and secondary research and decide whether you need to use quantitative and/or qualitative primary research methods in your dissertation.

Alternatively, you can base your dissertation on secondary research, which is descriptive and explanatory in essence.

Types of Qualitative Research Methods

Action research

Action research  aims at finding an immediate solution to a problem. The researchers can also act as the participants of the research. It is used in the educational field.

A  case study  includes data collection from multiple sources over time. It is widely used in social sciences to study the underlying information, organisation, community, or event. It does not provide any solution to the problem. Researchers cannot act as the participants of the research.

Ethnography

In  this type of research, the researcher examines the people in their natural environment. Ethnographers spend time with people to study people and their culture closely. They can consult the literature before conducting the study.

When you combine quantitative and qualitative methods of research, the resulting approach becomes mixed methods of research.

Over the last few decades, much of the research in academia has been conducted using mixed methods because of the greater legitimacy this particular technique has gained for several reasons including the feeling that combining the two types of research can provide holistic and more dependable results.

Here is what mixed methods of research involve:

• Interpreting and investigating the information gathered through quantitative and qualitative techniques.
• There could be more than one stage of research. Depending on the research topic, occasionally it would be more appropriate to perform qualitative research in the first stage to figure out and investigate a problem to unveil key themes; and conduct quantitative research in stage two of the process for measuring relationships between the themes.

Note: However, this method has one prominent limitation, which is, as previously mentioned, combining qualitative and quantitative research can be difficult because they both are different in terms of design and approach. In many ways, they are contrasting styles of research, and so care must be exercised when basing your dissertation on mixed methods of research.

When choosing a research method for your own dissertation, it would make sense to carefully think about your  research topic ,  research questions , and research objectives to make an intelligent decision in terms of the philosophy of  research design .

Dissertations based on mixed methods of research can be the hardest to tackle even for PhD students.

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Please Find Below an Example of Research Methods Section in a Dissertation or Thesis.

Background and Problem

Diversity management became prominent in the late twentieth century, with foundations in America. Historically homogeneous or nondiverse nations, such as Finland, have not yet experienced the issues associated with rising cultural and ethnic diversity in the workforce. Regardless of the environment, workforce diversity garners greater attention and is characterised by its expanding relevance due to globalised and international companies, global and national worker mobility, demographic shifts, or enhancing productivity.

As a result, challenges of diversity management have been handled through legal, financial, and moral pressures (Hayes et al., 2020). The evolving structure of the working population in terms of language, ethnic background, maturity level, faith, or ethnocultural history is said to pose a challenge to human resource management (HRM) in utilising diversity: the understanding, abilities, and expertise prospects of the entire workforce to deal with possible developments.

The European approach to diversity management is regarded as growing. However, it is found to emphasise the relationship to business and lack competence in diversity management problems. Mass immigration concentrates variety, sometimes treated as cultural minority issues, implying the normalisation of anti-discrimination actions (Yadav and Lenka, 2020).

These causes, in turn, have provided the basis of comprehensive diversity research, which has generated different theories, frameworks, concepts, and guidelines from interdisciplinary viewpoints, such as industrial and organisational psychology and behaviour (OB), cultural studies, anthropology, migration, economics, postcolonialism, and so on. And in the form of international, social and cultural, organisational, group, and individual scale diversity analysis. This dissertation focuses on diversity concerns from impression management, specifically from HRM as an executive-level phenomenon (Seliverstova, 2021).

As conceptual frameworks, organisational structures concentrating on the production of diversity and social psychology, notably social identity theory with diverse ‘identities’ of persons or intergroup connections, are primarily employed. The study’s primary goal in the workplace is to discover inequities or examine the effects of diversity on workplace outcomes.

Individual study interests include behaviours, emotions, intelligence, intercultural skills or competencies, while group research interests include group dynamics, intergroup interactions, effectiveness, and cooperation or collaboration. Organisational studies address themes such as workforce composition, workplace equality, and diversity challenges and how they may be managed accordingly. Domestic diversity, omitting national distinctions, or global diversity, about diverse country cultures, might be studied further (AYDIN and ÖZEREN, 2018).

Diversity is a context-dependent, particular, comparative, complicated, plural phrase or idea with varying interpretations in different organisations and cultures and no unified definition. As a result, in addition to many internal and external elements, diversity may be managed, individuals taught, and organisations have grown in various ways. This dissertation considers diversity in an organisational environment as a construct of ‘differences’ to be handled (Cummings, 2018).

Various management systems have grown in stages, bringing diverse diversity management concepts. Equality/equal opportunities (EO) legislation and diversity management are the two conventional approaches and primary streams with differing theoretical foundations for managing and dealing with workforce diversity challenges (DM).

These approaches relate to whether diversity is handled by increasing sameness by legal pressures or by voluntarily respecting people’s differences, which shows an organisation’s responsiveness and proactivity toward managing diversity. But most of the literature in this area has avoided the impression management theories (Coad and Guenther, 2014). Therefore, this study will add a new dimension in this area by introducing impression management analysis.

Research Aim and Objectives

This research aims to analyse the impact of organisational structure on human resources diversification from the viewpoint of impression managerial theory. It has the following objectives:

• It will examine the existing impression management literature to draw insights into the relationship under consideration.
• It will identify various factors such as competency, social inclusion, etc., affecting the management’s decision to recruit diverse human resources.
• It will recommend appropriate organisational structures and HR policies to improve diversification of HR by reviewing impression management theories.

Research Questions

This research will answer the following questions:

• How does organisational structure affect human resources diversification from the viewpoint of impression managerial theory?
• What factors such as competency, social inclusion, etc., affect the management decision to recruit diverse human resources?
• What are appropriate organisational structures and HR policies to improve diversification of HR by reviewing impression management theories?

Research Hypothesis

The organisational structure significantly impacts the recruitment of diverse human resources.

Literature Review

According to Staniec and Zakrzewska-Bielawska (2010), considering strategy-oriented activities and organisational components are the critical foundation in the organisational structure required to align structure strategy. Each company’s internal organisation is somewhat distinctive, resulting from various corporate initiatives and historical conditions.

Furthermore, each design is based on essential success elements and vital tasks inherent in the firm plan. This article offers empirical research on unique organisational structure elements in Polish firms in the context of concentration and diversification tactics. And companies that adopted concentration techniques mainly used functional organisational structures.

Tasks were primarily classified and categorised based on functions and phases of the technical process, with coordination based on hierarchy. Jobs were also highly centralised and formalised. Organisational structures of an active type were also prevalent in many firms. Only a handful of the evaluated organisations possessed flexible contemporary divisional or matrix structures appropriate to differentiation. However, it appears that even such organisations should adjust their organisational solutions to perform successfully in an immensely complex and chaotic environment.

Similarly, according to Yang and Konrad (2011), diversity management techniques are the institutionalised methods created and applied by organisations to manage diversity among all organisational shareholders. They examined the existing research on the causes and significance of diversity management approaches.

They construct a research model indicating many potential routes for future study using institutional and resource-based theories. They also offer prospective avenues for study on diversity management techniques to further the two theoretical viewpoints. The findings indicate that research on diverse management practises might provide perceptions into the two ideologies. Diversity management provides a method for reconciling the agency vs structure issue for institutional concept.

Furthermore, diversity management is a suitable framework for studying how institutional pressures are translated into organisational action and the relationship between complying with institutional mandates and attaining high performance. Research on diversity management raises the importance of environmental normative elements in resource-based reasoning.

It allows for exploring essential resource sources and the co-evolution of diversity resources and management capacities, potentially developing dynamic resource-based theory. Furthermore, a review of the existing research on diversity management practices reveals that research in this field has nearly entirely concentrated on employee-related activities.

However, in establishing the idea of diversity management practises, we included the practises that companies put in place to manage diversity across all stakeholder groups on purpose. Management techniques for engaging with consumers, dealers, supervisors, board directors, and community members are critical for meeting institutional theory’s social and normative commitments.

Moreover, according to Sippola (2014), this research looks at diversity management from the standpoint of HRM. The study aims to discover the effects of expanding workforce diversity on HRM inside firms. This goal will be accomplished through four papers examining diversity management’s impacts on HRM from various viewpoints and mostly in longitudinal contexts.

The purpose of the first article, as a pilot survey, is to determine the reasons, advantages, and problems of rising cultural diversity and the consequences for HRM to get a preliminary grasp of the issue in the specific setting. According to the report, diversity is vital for productivity but is not often emphasised in HRM strategy.

The key areas that were changed were acquisition, development, and growth. The second article examines how different diversity management paradigms recognised in businesses affect HRM. It offers an experimentally verified typology that explains reactive or proactive strategic and operational level HRM activities in light of four alternative diversity management perspectives.

The third essay will examine how a ‘working culture bridge group’ strategy fosters and enhances workplace diversity. The research looks into how development goals are defined, what training and development techniques are used, and the consequences and causal factors when an analysis measures the training and development approach.

The primary goal of article four is to establish which components of diversity management design are globally integrated into multinational corporations (MNCs) and which integrating (delivery) methods are employed to facilitate it. Another goal is to identify the institutional problems faced by the Finnish national diversity setting during the integration process.

The findings show that the example organisation achieved more excellent global uniformity at the level of diversification concept through effective use of multiple frameworks but was forced to rely on a more multinational approach to implementing diversification policies and procedures. The difficulties faced emphasised the distinctiveness of Finland’s cognitive and normative institutional setting for diversity.

Furthermore, according to Guillaume et al. (2017), to compensate for the dual-edged character of demographic workplace diversity impacts on social inclusion, competence, and well-being-related factors, research has shifted away from straightforward main effect methods and begun to investigate factors that moderate these effects.

While there is no shortage of primary research on the circumstances that lead to favourable or poor results, it is unknown which contextual elements make it work. Using the Classification framework as a theoretical lens, they examine variables that moderate the impacts of workplace diversity on social integration, performance, and well-being outcomes, emphasising characteristics that organisations and managers can influence.

They suggest future study directions and end with practical applications. They concluded that faultlines, cross-categorisation, and status variations across demographic groupings highlight variety. Cross-categorisation has been proven to reduce intergroup prejudice while promoting social inclusion, competence, and well-being. Whether faultlines and subgroup status inequalities promote negative or good intergroup interactions and hinder social integration, performance, and well-being depends on whether situational factors encourage negative or positive intergroup connections. The impacts were not mitigated by team size or diversity type.

Furthermore, our data demonstrate that task characteristics are essential for workgroup diversity. Any demographic diversity in workgroups can promote creativity, but only when combined with task-relevant expertise improves the performance of teams undertaking complicated tasks. The type of team and the industrial context do not appear to play an effect. It is unclear if these findings apply to relational demography and organisational diversity impacts. There is some evidence that, under some settings, relational demography may increase creativity, and, as previously said, demographic variety may help firms function in growth-oriented strategy contexts.

Likewise, according to Ali, Tawfeq, and Dler (2020), diversity management refers to organisational strategies that strive to increase the integration of people from diverse backgrounds into the framework of corporate goals. Organisations should develop productive ways to implement diversity management (DM) policies to establish a creative enterprise that can enhance their operations, goods, and services.

Furthermore, human resource management HRM is a clever tool for any firm to manage resources within the company. As a result, this article explores the link between DM, HR policies, and workers’ creative work-related behaviours in firms in Kurdistan’s Fayoum city. According to the questionnaire, two hypotheses were tested: the influence of HRM on diversity management, HRM on innovation, and the impact of diversity management on innovation.

The first premise is that workplace diversity changes the nature of working relationships, how supervisors and managers connect, and how workers respond to one another. It also addresses human resource functions such as record-keeping, training, recruiting, and employee competence needs. The last premise on the influence of diversity management on innovation is that workplace diversity assists a business in hiring a diverse range of personnel.

In other words, a vibrant population need individuals of varied personalities. Workplace diversity refers to a company’s workforce consisting of employees of various genders, ages, faiths, races, ethnicities, cultural backgrounds, religions, dialects, training, capabilities, etc. According to the study’s findings, human resource management strategies have a substantial influence on diversity management.

Second, diversity management was found to have a considerable impact on creativity. Finally, human resource management techniques influenced innovation significantly. Based on the findings, it was discovered that diversity management had a more significant influence on creation than human resource management.

Lastly, according to Li et al. (2021), the universal trend of rising workplace age diversity has increased the study focus on the organisational effects of age-diverse workforces. Prior research has mainly concentrated on the statistical association between age diversity and organisational success rather than experimentally examining the probable processes behind this relationship.

They argue that age diversity influences organisational performance through human and social capital using an intellectual capital paradigm. Moreover, they investigate workplace functional diversity and age-inclusive management as two confounding factors affecting the benefits of age diversity on physical and human capital.

Their hypotheses were evaluated using data from the Association for Human Resource Management’s major manager-reported workplace survey. Age diversity was favourably linked with organisational performance via the mediation of higher human and social capital. Furthermore, functional diversity and age-inclusive management exacerbated the favourable benefits of age variety on human and social capital. Their study gives insight into how age-diverse workforces might generate value by nurturing knowledge-based organisational resources.

Research Gap/ Contribution

Although there is a vast body of research in diversity in the human resource management area, many researchers explored various dimensions. But no study explicitly discovers the impact of organisational culture on human resource diversification. Moreover, no researchers examined the scope of impression management in this context.

Therefore, this research will fill this considerable literature gap by finding the direct impact of organisational structure on human resource diversification. Secondly, by introducing a new dimension of impression management theory. It will open new avenues for research in this area, and it will help HR managers to formulate better policies for a more inclusive organisational structure.

Research Methodology

It will be mixed quantitative and qualitative research based on the secondary data collected through different research journals and case studies of various companies. Firstly, the quantitative analysis will be conducted through a regression analysis to show the organisational structure’s impact on human resource diversification.

The dummy variable will be used to show organisational structure, and diversification will be captured through the ethnic backgrounds of the employees. Moreover, different variables will be added to the model, such as competency, social inclusion, etc. It will fulfil the objective of identifying various factors which affect the management decision to recruit diverse human resources. Secondly, a systematic review of the literature will be conducted for qualitative analysis to add the impression management dimension to the research. Google Scholar, JSTOR, Scopus, etc., will be used to search keywords such as human resource diversity, impression management, and organisation structure.

Research Limitation

Although research offers a comprehensive empirical analysis on the relationship under consideration due to lack of resources, the study is limited to secondary data. It would be better if the research would’ve been conducted on the primary data collected through the organisations. That would’ve captured the actual views of the working professionals. It would’ve increased the validity of the research.

Ali, M., Tawfeq, A., & Dler, S. (2020). Relationship between Diversity Management and Human Resource Management: Their Effects on Employee Innovation in the Organizations. Black Sea Journal of Management and Marketing, 1 (2), 36-44.

AYDIN, E., & ÖZEREN, E. (2018). Rethinking workforce diversity research through critical perspectives: emerging patterns and research agenda. Business & Management Studies: An International Journal, 6 (3), 650-670.

Coad, A., & Guenther, C. (2014). Processes of firm growth and diversification: theory and evidence. Small Business Economics, 43 (4), 857-871.

Cummings, V. (2018). Economic Diversification and Empowerment of Local Human Resources: Could Singapore Be a Model for the GCC Countries?. In. Economic Diversification in the Gulf Region, II , 241-260.

Guillaume, Y., Dawson, J., Otaye‐Ebede, L., Woods, S., & West, M. (2017). Harnessing demographic differences in organizations: What moderates the effects of workplace diversity? Journal of Organizational Behavior, 38 (2), 276-303.

Hayes, T., Oltman, K., Kaylor, L., & Belgudri, A. (2020). How leaders can become more committed to diversity management. Consulting Psychology Journal: Practice and Research, 72 (4), 247.

Li, Y., Gong, Y., Burmeister, A., Wang, M., Alterman, V., Alonso, A., & Robinson, S. (2021). Leveraging age diversity for organizational performance: An intellectual capital perspective. Journal of Applied Psychology, 106 (1), 71.

Seliverstova, Y. (2021). Workforce diversity management: a systematic literature review. Strategic Management, 26 (2), 3-11.

Sippola, A. (2014). Essays on human resource management perspectives on diversity management. Vaasan yliopisto.

Staniec, I., & Zakrzewska-Bielawska, A. (2010). Organizational structure in the view of single business concentration and diversification strategies—empirical study results. Recent advances in management, marketing, finances. WSEAS Press, Penang, Malaysia .

Yadav, S., & Lenka, U. (2020). Diversity management: a systematic review. Equality, Diversity and Inclusion: An International Journal .

Yang, Y., & Konrad, A. (2011). Understanding diversity management practices: Implications of institutional theory and resource-based theory. Group & Organization Management, 36 (1), 6-38.

FAQs About Research Methods for Dissertations

What is the difference between research methodology and research methods.

Research methodology helps you conduct your research in the right direction, validates the results of your research and makes sure that the study you are conducting answers the set research questions.

Research methods are the techniques and procedures used for conducting research. Choosing the right research method for your writing is an important aspect of the research process.

What are the types of research methods?

The types of research methods include:

•     Experimental research methods.
•     Descriptive research methods
•     Historical Research methods

What is a quantitative research method?

Quantitative research is associated with numerical data or data that can be measured. It is used to study a large group of population. The information is gathered by performing statistical, mathematical, or computational techniques.

What is a qualitative research method?

It is a type of scientific research where a researcher collects evidence to seek answers to a question . It is associated with studying human behavior from an informative perspective. It aims at obtaining in-depth details of the problem.

What is meant by mixed methods research?

Mixed methods of research involve:

• There could be more than one stage of research. Depending on the research topic, occasionally, it would be more appropriate to perform qualitative research in the first stage to figure out and investigate a problem to unveil key themes; and conduct quantitative research in stage two of the process for measuring relationships between the themes.

You May Also Like

This article presents the key advantages and disadvantages of secondary research so you can select the most appropriate research approach for your study.

Quantitative research is associated with measurable numerical data. Qualitative research is where a researcher collects evidence to seek answers to a question.

In historical research, a researcher collects and analyse the data, and explain the events that occurred in the past to test the truthfulness of observations.

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An Event-B model of an automotive adaptive exterior light system

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• Published: 14 May 2024

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• Amel Mammar 1 ,
• Marc Frappier 2 &
• Régine Laleau 3  

This paper introduces an Event-B formal model of the adaptive exterior light system for cars, a case study proposed in the context of the ABZ2020 conference. The system describes the different provided lights and the conditions under which they are switched on/off in order to improve the visibility of the driver without dazzling the oncoming ones. The system can be viewed as a lights controller that reads different information form the available sensors (key state, exterior luminosity, etc.) and takes the adequate actions by acting on the actuators of the lights in order to ensure a good visibility for the driver according to the information read. Our model is built using stepwise refinement with the Event-B method. We consider all the features of the case study, all proof obligations have been discharged using the Rodin provers. Our model has been validated using ProB by applying the different provided scenarios. This validation has permitted us to point out and correct some mistakes, ambiguities and oversights in the first versions of the case study description document.

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Acknowledgements

The authors would like to thank the case study authors, and Frank Houdek in particular, for his responsiveness and useful feedback during the modeling process when questions were raised or when ambiguities were found. The authors would also like to thank Michael Leuschel for his quick feedback on using ProB for this large case study.

This work was supported in part by the ANR projet DISCCONT and NSERC (Natural Sciences and Engineering Research Council of Canada).

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The effect of preoperative use of anticoagulants on the hemostatic effect of intravenous application of tranexamic acid in PLIF: a case control study

• Shenshen Hao 1 ,
• Binbin Li 2 ,
• Shiying Luo 3 ,
• Shengli Dong 1 ,
• Shuai Liu 1 ,
• Hongke Li 1 &
• Xinhao Cao 4  

Scientific Reports volume  14 , Article number:  10997 ( 2024 ) Cite this article

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• Medical research

Intravenous application of tranexamic acid (TXA) in posterior lumbar interbody fusion (PLIF) can effectively reduce blood loss without affecting coagulation function. However, it has not been reported whether preoperative use of anticoagulants may affect the efficacy of TXA in PLIF. The purpose of this study is to observe the effect of preoperative use of anticoagulants on coagulation indicators and blood loss after PLIF receiving intravenous unit dose TXA. A retrospective analysis was conducted on data from 53 patients with PLIF between 2020.11 and 2022.9, who received intravenous application of a unit dose of TXA (1 g/100 mL) 15 min before the skin incision after general anesthesia. Those who used anticoagulants within one week before surgery were recorded as the observation group, while those who did not use anticoagulants were recorded as the control group. The main observation indicators include surgical time, intraoperative blood loss, postoperative drainage volume, blood transfusion, and red blood cell (RBC), hemoglobin (HB), and hematocrit (HCT) measured on the 1st, 4th, 7th, and last-test postoperative days. Secondary observation indicators included postoperative incision healing, deep vein thrombosis of lower limbs, postoperative hospital stay, and activated partial thrombin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen (FIB), and platelets (PLT) on the 1st and 4th days after surgery. The operation was successfully completed in both groups, the incision healed well after operation, and no lower limb deep vein thrombosis occurred. There was no significant difference in surgical time, intraoperative blood loss, postoperative drainage volume, and blood transfusion between the two groups ( p  > 0.05). There was no significant difference in the RBC, HB, and HCT measured on the 1st, 4th, 7th, and last-test postoperative days between the two groups ( p  > 0.05). There was no statistically significant difference in APTT, PT, TT, FIB and PLT between the two groups on the 1st and 4th postoperative days ( p  > 0.05). There was no significant difference in postoperative hospital stay between the two groups ( p  > 0.05). The use of anticoagulants within one week before surgery does not affect the hemostatic effect of intravenous unit dose TXA in PLIF.

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Introduction.

Posterior lumbar interbody fusion (PLIF) is a common and effective operation for the treatment of lumbar disc herniation (LDH), lumbar spinal stenosis (LSS), lumbar spondylolisthesis (LS) and other lumbar diseases 1 , 2 . However, it faces the challenge of massive perioperative blood loss 3 . Tranexamic acid (TXA) is a synthetic derivative of lysine, a synthetic anti fibrinolytic drug that could reduce surgical bleeding by inhibiting fibrinolysis and stabilizing blood clots 4 . Many studies have shown that intravenous TXA can effectively reduce perioperative blood loss in PLIF 5 , 6 , 7 , 8 . Meanwhile, in our previous studies, we confirmed that preoperative intravenous unit dose TXA in PLIF can safely and effectively reduce intraoperative and postoperative blood loss without affecting postoperative coagulation function indicators 9 , 10 .

However, in clinical practice, we have found such a phenomenon. Some patients who require surgery have a history of using anticoagulants for treatment before hospitalization. Therefore, it is inevitable to use anticoagulants before surgery to maintain treatment. In theory, the use of anticoagulants before surgery may increase perioperative blood loss. However, it is not yet known whether the hemostatic effect of TXA in PLIF may be affected by preoperative anticoagulant drugs. Therefore, this study mainly explores the following two issues. One is the safety of using anticoagulants within one week before surgery in PLIF receiving intravenous unit dose TXA. The other is the effect of using anticoagulants within one week before surgery on the hemostatic effect of TXA in PLIF.

Study design

This study was a retrospective, single center case control study. It was approved by NO.2021004, from the Ethics Committee of the General Hospital of Pingmei Shenma Medical Group. This study had been performed in accordance with the Declaration of Helsinki. The medical records were collected in the hospital, and the time range was 2020.11–2022.9. The inclusion criteria include: a . preoperative diagnosis of LDH, LSS, and LS, receiving standard PLIF treatment, b . general anesthesia, c . surgical segments ranging from 1 to 3, d . age range from 50 to 80 years, e . intravenous application of a unit dose of TXA (1 g/100 mL) (containing 100 mL normal saline and 1 g TXA) 15 min before the skin incision after anesthesia. Exclusion criteria include: a . pre-operative history of blood disease, b . preoperative history of deep vein thrombosis (DVT), c . lumbar surgery history, d . history of diabetes, e . intraoperative cerebrospinal fluid leakage or dural injury. Finally, 53 eligible cases were included. Among them, there are 21 males and 32 females, with an average age of (63.7 ± 8.5) years. The criteria for grouping were based on whether anticoagulants, such as low molecular weight heparin (LMWH) or indoprofen tablets, were used within one week before surgery. 25 cases of preoperative use of anticoagulants were recorded as the observation group, 28 cases were not applied and recorded as the control group. The intraoperative and postoperative measures of PLIF were similar. After surgery, two drainage tubes were placed and removed when the drainage flow rate was less than 50 mL/24 h. Postoperative routine use of antibiotics to prevent infection, corticosteroids to reduce spinal cord stress response, dehydration drugs to reduce edema response, non steroidal drugs to reduce pain, and LMWH drugs or indobufen tablets to prevent DVT.

Outcome indicators

Preoperative patient information was collected as baseline data. They included age, gender, body mass index (BMI), disease type, surgical segment, coexisting hypertension, prothrombin time (PT), activated partial thrombin time (APTT), thrombin time (TT), fibrinogen (FIB), platelets (PLT), hemoglobin (HB), red blood cell (RBC), and hematocrit (HCT).

The main observation indicators include surgical time, intraoperative blood loss, postoperative drainage volume, blood transfusion, and RBC, HB, and HCT measured on the 1st, 4th, 7th, and last-test postoperative days. The trend of changes in HB, RBC, and HCT during the perioperative period, represented by the median, was plotted using an Excel table.

Secondary observation indicators included postoperative incision healing, DVT of lower limbs, postoperative hospital stay, APTT, PT, TT, FIB, and PLT on the 1st and 4th postoperative days. The trend of changes in APTT, PT, TT, FIB, and PLT during the perioperative period was represented by the median, and a column chart was drawn using an Excel table.

Statistical methods

Data analysis was performed via SPSS statistical software (version 22.0). The econometric data which met the criteria was represented by mean ± standard deviation, and t-test was used for inter groups comparison. Non-conformities were represented by M [P25; P75], and comparisons between groups were conducted using Mann–Whitney U non-parametric tests. The counting data was expressed in the number of cases, and the Chi-squared test was used to compare between groups. The comparison of RBC, HB, HCT, APTT, PT, TT, FIB, and PLT between two groups measured on the 1st, 4th, 7th, and last-test postoperative days was conducted using a linear mixed model. P  < 0.05 was considered statistically significant.

Ethics approval and consent to participate

This study was approved by the Ethics Committee of the General Hospital of Pingmei Shenma Medical Group, and the reference number is 2021004. This study had been performed in accordance with the Declaration of Helsinki. All authors confirmed that informed consent was obtained from all subjects.

The comparison results of baseline data between the two groups

There was no significant differences in baseline data, concluding age, gender, BMI, disease type, surgical segment, coexisting hypertension, PT, APTT, TT, FIB, PLT, HB, RBC and HCT, between the two groups ( p  > 0.05), as shown in Table 1 .

The comparison of main observation indicators between the two groups

There was no significant difference in surgical time, intraoperative blood loss, postoperative drainage volume, and blood transfusion between the two groups ( p  > 0.05). There was no significant difference in the RBC, HB, and HCT measured on the 1st, 4th, 7th, and last-test postoperative days between the two groups ( p  > 0.05). The comparison was shown in Tables 2 and 3 , Figs. 1 , 2 and 3 .

The changes of RBC of the two groups, 10 12 /L.

The changes of HB of the two groups, g/L.

The changes of HCT of the two groups, L/L.

The comparison of secondary observation indicators between the two groups

The surgery was successfully completed in both groups of patients, with good postoperative incision healing and no occurrence of DVT. There was no significant difference in APTT, PT, TT, FIB and PLT between the two groups on the 1st and 4th postoperative days ( p  > 0.05). The comparison was shown in Table 4 , Figs. 4 , 5 , 6 , 7 and 8 .

The changes of PT of the two groups, s.

The changes of APTT of the two groups, s.

The changes of FIB of the two groups, g/L.

The changes of TT of the two groups, s.

The changes of PLT of the two groups, 10 9 /L.

The safety and feasible of PLIF have been recognized by spine surgeon and patients. There are four main reasons for bleeding in PLIF 11 . Firstly, the muscles in the surgical area of the lower back are very developed, so it is easy to bleed when peeling off the paraspinal muscles and soft tissues during surgery. Secondly, after decompression through laminectomy, the cancellous bone surface is prone to bleeding. Thirdly, when decompression enters the vertebral canal, it is easy to damage the intervertebral venous plexus and cause bleeding. Fourthly, when removing the intervertebral disc, it is necessary to scratch the upper and lower endplates, which is prone to bleeding. In addition, during surgery, a decrease in the number of coagulation factors and hyperfibrinolysis in patients can lead to significant intraoperative bleeding 12 . On the one hand, spine surgeon should consider the effect of PLIF, and on the other hand, consider how to reduce perioperative blood loss 13 . Many scholars have studied that intravenous TXA can safely and effectively reduce perioperative blood loss in PILF patients 5 , 6 , 7 , 8 . There are various options for using TXA during the perioperative period of spinal surgery, such as oral medication, local medication, intravenous medication, etc. 14 , 15 . However, the most commonly used method is intravenous administration 16 . In terms of medication timing, Yu et al. 17 suggested that during posterior lumbar surgery, intravenous administration of TXA 15 min before skin incision can reduce perioperative bleeding. This is because after about 15 min of intravenous application of TXA, it can reach and accumulate in the surgical area to effectively exert its hemostatic effect 18 . Therefore, in this study, TXA was chosen to be administered intravenously 15 min before PLIF. This usage is also one of the recommended methods in the Chinese Expert Consensus 19 .

In clinical practice, there are cases where some patients use anticoagulants before surgery. Vitamin K antagonists represented by Warfarin and antiplatelet drugs represented by aspirin will increase the risk of intraoperative bleeding, so these drugs are not used during perioperative preventive anticoagulation 20 . Heparins are widely used anticoagulants in clinical practice, mainly including ordinary heparin and LMWH. The relative molecular weight of LMWH is smaller than that of ordinary heparin, and it can only bind to antithrombin factor IIIa and cannot bind to factor IIa, thus possessing anti factor Xa effects 21 . LMWH can inhibit the activation of thrombin, thereby playing an anti-thrombotic role 22 . Meanwhile, compared to ordinary heparin, LMWH has a longer half-life, better bioavailability, better subcutaneous absorption, more stable pharmacokinetics, fewer adverse reactions such as bleeding, allergic reactions, and heparin induced thrombocytopenia, making it widely used in clinical practice 23 . Some studies have proved that the anticoagulant efficacy of factor Xa inhibitor represented by Rivaroxaban is consistent with LMWH, and does not increase the risk of serious bleeding, but it is currently mainly used after hip and knee joint replacement 24 , 25 . Indobufen, as a new generation of antiplatelet drugs, has good anticoagulant effects 26 . It can effectively inhibit the activity of platelet cyclooxygenase 1 , which is similar to the biochemical, functional and clinical effects of standard dose aspirin 27 . Indobufen tablets are oral medications and are more suitable for patients who are unwilling to receive subcutaneous injection of LMWH. Therefore, the anticoagulants used by the patients in this study were LMWH and indobufen tablets. In theory, for such patients, intraoperative and postoperative bleeding may increase.

However, the results of this study found that the intraoperative blood loss, postoperative drainage volume, and blood transfusion rate were similar in both groups. This indicates that for PLIF, TXA has a similar hemostatic effect in patients who use anticoagulants before surgery compared to those who do not. In order to further observe the possible correlation between the two types of drugs, namely synergistic or antagonistic effects. This study continuously observed RBC, HB, and HCT at different stages after surgery, and found no significant difference between the two groups, and both groups remained relatively stable. On the other hand, this suggests that the hemostatic effect of TXA in PLIF is not affected by the use of anticoagulants before surgery. It is worth noting that the PLIF surgical technique is already very mature, and the perioperative treatment measures are also very standardized. Moreover, both groups of patients in this study adopted similar treatment plans. These may be some of the possible reasons why the above indicators are similar. Therefore, further research is needed on the possible interrelationships between anticoagulants and TXA.

At the same time, patients receiving PLIF are mostly elderly people who require bed rest after surgery, and there are high-risk factors for thrombosis 28 . TXA, as an anti fibrotic hemostatic drug, may theoretically increase the risk of DVT 29 , 30 . The use of anticoagulants before surgery may affect postoperative coagulation function and recovery process. It is not yet known whether the simultaneous use of two types of drugs in a short period of time will have an impact on the safety of surgery. As is well known, surgical safety is a prerequisite for PLIF. Therefore, this study investigated the safety of surgery. In this study, not only were the surgeries completed safely in both groups, but there were no adverse events after the surgery, and the postoperative hospital stay was similar. Moreover, postoperative coagulation function indicators (APTT, PT, TT, FIB) and PLT were also similar. These indicate that preoperative use of anticoagulant drugs will not have adverse effects on the perioperative safety and postoperative recovery cycle of PLIF patients who have received intravenous TXA. There are two possible reasons for this phenomenon. Firstly, the fibrinolytic system and coagulation system are two independent systems, and there may be no related interference between anti-fibrinolytic and anticoagulant systems. Secondly, the sample size of this study is small and may have some bias. However, overall, TXA is safe and feasible for PLIF application in preoperative anticoagulant patients.

Through this study, two issues mentioned at the beginning were resolved. Firstly, it is safe and feasible to use anticoagulants within one week before surgery in PLIF with intravenous TXA. Secondly, the use of anticoagulants within one week before surgery did not affect the hemostatic effect of intravenous TXA on PLIF. However, this study is a single center, small sample retrospective medical record control study, and the reliability of its conclusions may inevitably be affected to some extent. Further research is needed to support the application of TXA in preoperative anticoagulation patients.

Data availability

The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.

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Project supported by Hainan Province Clinical Medical Center (No. 0202067). Scientific research project of General Hospital of Pingmei Shenma Medical Group (No. 4104022021180717).

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S. H. wrote the first draft of the article. B. L. critically reviewed drafts. S. L. critically edited drafts. S. D. diagnosed the patients. S. L. and H. L. treated the patient. C. X. has made substantial contributions to the conception and designed of the manuscript. S. D., S. L. and H. L. followed up the patients. All authors read and approved the final manuscript.

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Hao, S., Li, B., Luo, S. et al. The effect of preoperative use of anticoagulants on the hemostatic effect of intravenous application of tranexamic acid in PLIF: a case control study. Sci Rep 14 , 10997 (2024). https://doi.org/10.1038/s41598-024-60440-9

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• Published: 09 May 2024

Evaluation of integrated community case management of the common childhood illness program in Gondar city, northwest Ethiopia: a case study evaluation design

• Mekides Geta 1 ,
• Geta Asrade Alemayehu 2 ,
• Wubshet Debebe Negash 2 ,
• Tadele Biresaw Belachew 2 ,
• Chalie Tadie Tsehay 2 &
• Getachew Teshale 2  

BMC Pediatrics volume  24 , Article number:  310 ( 2024 ) Cite this article

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Integrated Community Case Management (ICCM) of common childhood illness is one of the global initiatives to reduce mortality among under-five children by two-thirds. It is also implemented in Ethiopia to improve community access and coverage of health services. However, as per our best knowledge the implementation status of integrated community case management in the study area is not well evaluated. Therefore, this study aimed to evaluate the implementation status of the integrated community case management program in Gondar City, Northwest Ethiopia.

A single case study design with mixed methods was employed to evaluate the process of integrated community case management for common childhood illness in Gondar town from March 17 to April 17, 2022. The availability, compliance, and acceptability dimensions of the program implementation were evaluated using 49 indicators. In this evaluation, 484 mothers or caregivers participated in exit interviews; 230 records were reviewed, 21 key informants were interviewed; and 42 observations were included. To identify the predictor variables associated with acceptability, we used a multivariable logistic regression analysis. Statistically significant variables were identified based on the adjusted odds ratio (AOR) with a 95% confidence interval (CI) and p-value. The qualitative data was recorded, transcribed, and translated into English, and thematic analysis was carried out.

The overall implementation of integrated community case management was 81.5%, of which availability (84.2%), compliance (83.1%), and acceptability (75.3%) contributed. Some drugs and medical equipment, like Cotrimoxazole, vitamin K, a timer, and a resuscitation bag, were stocked out. Health care providers complained that lack of refreshment training and continuous supportive supervision was the common challenges that led to a skill gap for effective program delivery. Educational status (primary AOR = 0.27, 95% CI:0.11–0.52), secondary AOR = 0.16, 95% CI:0.07–0.39), and college and above AOR = 0.08, 95% CI:0.07–0.39), prescribed drug availability (AOR = 2.17, 95% CI:1.14–4.10), travel time to the to the ICCM site (AOR = 3.8, 95% CI:1.99–7.35), and waiting time (AOR = 2.80, 95% CI:1.16–6.79) were factors associated with the acceptability of the program by caregivers.

Conclusion and recommendation

The overall implementation status of the integrated community case management program was judged as good. However, there were gaps observed in the assessment, classification, and treatment of diseases. Educational status, availability of the prescribed drugs, waiting time and travel time to integrated community case management sites were factors associated with the program acceptability. Continuous supportive supervision for health facilities, refreshment training for HEW’s to maximize compliance, construction clean water sources for HPs, and conducting longitudinal studies for the future are the forwarded recommendation.

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Integrated Community Case Management (ICCM) is a critical public health strategy for expanding the coverage of quality child care services [ 1 , 2 ]. It mainly concentrated on curative care and also on the diagnosis, treatment, and referral of children who are ill with infectious diseases [ 3 , 4 ].

Based on the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) recommendations, Ethiopia adopted and implemented a national policy supporting community-based treatment of common childhood illnesses like pneumonia, Diarrhea, uncomplicated malnutrition, malaria and other febrile illness and Amhara region was one the piloted regions in late 2010 [ 5 ]. The Ethiopian primary healthcare units, established at district levels include primary hospitals, health centers (HCs), and health posts (HPs). The HPs are run by Health Extension Workers (HEWs), and they have function of monitoring health programs and disease occurrence, providing health education, essential primary care services, and timely referrals to HCs [ 6 , 7 ]. The Health Extension Program (HEP) uses task shifting and community ownership to provide essential health services at the first level using the health development army and a network of woman volunteers. These groups are organized to promote health and prevent diseases through community participation and empowerment by identifying the salient local bottlenecks which hinder vital maternal, neonatal, and child health service utilization [ 8 , 9 ].

One of the key steps to enhance the clinical case of health extension staff is to encourage better growth and development among under-five children by health extension. Healthy family and neighborhood practices are also encouraged [ 10 , 11 ]. The program also combines immunization, community-based feeding, vitamin A and de-worming with multiple preventive measures [ 12 , 13 ]. Now a days rapidly scaling up of ICCM approach to efficiently manage the most common causes of morbidity and mortality of children under the age of five in an integrated manner at the community level is required [ 14 , 15 ].

Over 5.3 million children are died at a global level in 2018 and most causes (75%) are preventable or treatable diseases such as pneumonia, malaria and diarrhea [ 16 ]. About 99% of the global burden of mortality and morbidity of under-five children which exists in developing countries are due to common childhood diseases such as pneumonia, diarrhea, malaria and malnutrition [ 17 ].

In 2013, the mortality rate of under-five children in Sub-Saharan Africa decreased to 86 deaths per 1000 live birth and estimated to be 25 per 1000live births by 2030. However, it is a huge figure and the trends are not sufficient to reach the target [ 18 ]. About half of global under-five deaths occurred in sub-Saharan Africa. And from the top 26 nations burdened with 80% of the world’s under-five deaths, 19 are in sub-Saharan Africa [ 19 ].

To alleviate the burden, the Ethiopian government tries to deliver basic child care services at the community level by trained health extension workers. The program improves the health of the children not only in Ethiopia but also in some African nations. Despite its proven benefits, the program implementation had several challenges, in particular, non-adherence to the national guidelines among health care workers [ 20 ]. Addressing those challenges could further improve the program performance. Present treatment levels in sub-Saharan Africa are unacceptably poor; only 39% of children receive proper diarrhea treatment, 13% of children with suspected pneumonia receive antibiotics, 13% of children with fever receive a finger/heel stick to screen for malaria [ 21 ].

To improve the program performance, program gaps should be identified through scientific evaluations and stakeholder involvement. This evaluation not only identify gaps but also forward recommendations for the observed gaps. Furthermore, the implementation status of ICCM of common childhood illnesses has not been evaluated in the study area yet. Therefore, this work aimed to evaluate the implementation status of integrated community case management program implementation in Gondar town, northwest Ethiopia. The findings may be used by policy makers, healthcare providers, funders and researchers.

Method and material

Evaluation design and settings.

A single-case study design with concurrent mixed-methods evaluation was conducted in Gondar city, northwest Ethiopia, from March 17 to April 17, 2022. The evaluability assessment was done from December 15–30, 2021. Both qualitative and quantitative data were collected concurrently, analyzed separately, and integrated at the result interpretation phase.

The evaluation area, Gondar City, is located in northwest Ethiopia, 740 km from Addis Ababa, the capital city of the country. It has six sub-cities and thirty-six kebeles (25 urban and 11 rural). In 2019, the estimated total population of the town was 338,646, and 58,519 (17.3%) were under-five children. In the town there are eight public health centers and 14 health posts serving the population. All health posts provide ICCM service for more than 70,852 populations.

Evaluation approach and dimensions

Program stakeholders.

The evaluation followed a formative participatory approach by engaging the potential stakeholders in the program. Prior to the development of the proposal, an extensive discussion was held with the Gondar City Health Department to identify other key stakeholders in the program. Service providers at each health facility (HCs and HPs), caretakers of sick children, the Gondar City Health Office (GCHO), the Amhara Regional Health Bureau (ARHB), the Minister of Health (MoH), and NGOs (IFHP and Save the Children) were considered key stakeholders. During the Evaluability Assessment (EA), the stakeholders were involved in the development of evaluation questions, objectives, indicators, and judgment criteria of the evaluation.

Evaluation dimensions

The availability and acceptability dimensions from the access framework [ 22 ] and compliance dimension from the fidelity framework [ 23 ] were used to evaluate the implementation of ICCM.

Population and samplings

All under-five children and their caregivers attended at the HPs; program implementers (health extension workers, healthcare providers, healthcare managers, PHCU focal persons, MCH coordinators, and other stakeholders); and ICCM records and registries in the health posts of Gondar city administration were included in the evaluation. For quantitative data, the required sample size was proportionally allocated for each health post based on the number of cases served in the recent one month. But the qualitative sample size was determined by data saturation, and the samples were selected purposefully.

The data sources and sample size for the compliance dimension were all administrative records/reports and ICCM registration books (230 documents) in all health posts registered from December 1, 2021, to February 30, 2022 (three months retrospectively) included in the evaluation. The registries were assessed starting from the most recent registration number until the required sample size was obtained for each health post.

The sample size to measure the mothers’/caregivers’ acceptability towards ICCM was calculated by taking prevalence of caregivers’ satisfaction on ICCM program p  = 74% from previously similar study [ 24 ] and considering standard error 4% at 95% CI and 10% non- responses, which gave 508. Except those who were seriously ill, all caregivers attending the ICCM sites during data collection were selected and interviewed consecutively.

The availability of required supplies, materials and human resources for the program were assessed in all 14HPs. The data collectors observed the health posts and collected required data by using a resources inventory checklist.

A total of 70 non-participatory patient-provider interactions were also observed. The observations were conducted per each health post and for health posts which have more than one health extension workers one of them were selected randomly. The observation findings were used to triangulate the findings obtained through other data collection techniques. Since people may act accordingly to the standards when they know they are observed for their activities, we discarded the first two observations from analysis. It is one of the strategies to minimize the Hawthorne effect of the study. Finally a total of 42 (3 in each HPs) observations were included in the analysis.

Twenty one key informants (14 HEWs, 3 PHCU focal person, 3 health center heads and one MCH coordinator) were interviewed. These key informants were selected since they are assumed to be best teachers in the program. Besides originally developed key informant interview questions, the data collectors probed them to get more detail and clear information.

Variables and measurement

The availability of resources, including trained healthcare workers, was examined using 17 indicators, with weighted score of 35%. Compliance was used to assess HEWs’ adherence to the ICCM treatment guidelines by observing patient-provider interactions and conducting document reviews. We used 18 indicators and a weighted value of 40%.

Mothers’ /caregivers’/ acceptance of ICCM service was examined using 14 indicators and had a weighted score of 25%. The indicators were developed with a five-point Likert scale (1: strongly disagree, 2: disagree, 3: neutral, 4: agree and 5: strongly agree). The cut off point for this categorization was calculated using the demarcation threshold formula: ( \(\frac{\text{t}\text{o}\text{t}\text{a}\text{l}\, \text{h}\text{i}\text{g}\text{h}\text{e}\text{s}\text{t}\, \text{s}\text{c}\text{o}\text{r}\text{e}-\,\text{t}\text{o}\text{t}\text{a}\text{l}\, \text{l}\text{o}\text{w}\text{e}\text{s}\text{t} \,\text{s}\text{c}\text{o}\text{r}\text{e}}{2}) +total lowest score\) ( 25 – 27 ). Those mothers/caregivers/ who scored above cut point (42) were considered as “satisfied”, otherwise “dissatisfied”. The indicators were adapted from the national ICCM and IMNCI implementation guideline and other related evaluations with the participation of stakeholders. Indicator weight was given by the stakeholders during EA. Indicators score was calculated using the formula \(\left(achieved \,in \%=\frac{indicator \,score \,x \,100}{indicator\, weight} \right)\) [ 26 , 28 ].

The independent variables for the acceptability dimension were socio-demographic and economic variables (age, educational status, marital status, occupation of caregiver, family size, income level, and mode of transport), availability of prescribed drugs, waiting time, travel time to ICCM site, home to home visit, consultation time, appointment, and source of information.

The overall implementation of ICCM was measured by using 49 indicators over the three dimensions: availability (17 indicators), compliance (18 indicators) and acceptability (14 indicators).

Program logic model

Based on the constructed program logic model and trained health care providers, mothers/caregivers received health information and counseling on child feeding; children were assessed, classified, and treated for disease, received follow-up; they were checked for vitamin A; and deworming and immunization status were the expected outputs of the program activities. Improved knowledge of HEWs on ICCM, increased health-seeking behavior, improved quality of health services, increased utilization of services, improved data quality and information use, and improved child health conditions are considered outcomes of the program. Reduction of under-five morbidity and mortality and improving quality of life in the society are the distant outcomes or impacts of the program (Fig.  1 ).

Integrated community case management of childhood illness program logic model in Gondar City in 2022

Data collection tools and procedure

Resource inventory and data extraction checklists were adapted from standard ICCM tool and check lists [ 29 ]. A structured interviewer administered questionnaire was adapted by referring different literatures [ 30 , 31 ] to measure the acceptability of ICCM. The key informant interview (KII) guide was also developed to explore the views of KIs. The interview questionnaire and guide were initially developed in English and translated into the local language (Amharic) and finally back to English to ensure consistency. All the interviews were done in the local language, Amharic.

Five trained clinical nurses and one BSC nurse were recruited from Gondar zuria and Wegera district as data collectors and supervisors, respectively. Two days training on the overall purpose of the evaluation and basic data collection procedures were provided prior to data collection. Then, both quantitative and qualitative data were gathered at the same time. The quantitative data were gathered from program documentation, charts of ICCM program visitors and, exit interview. Interviews with 21 KIIs and non-participatory observations of patient-provider interactions were used to acquire qualitative data. Key informant interviews were conducted to investigate the gaps and best practices in the implementation of the ICCM program.

A pretest was conducted to 26 mothers/caregivers/ at Maksegnit health post and appropriate modifications were made based on the pretest results. The data collectors were supervised and principal evaluator examined the completeness and consistency of the data on a daily basis.

Data management and analysis

For analysis, quantitative data were entered into epi-data version 4.6 and exported to Stata 14 software for analysis. Narration and tabular statistics were used to present descriptive statistics. Based on established judgment criteria, the total program implementation was examined and interpreted as a mix of the availability, compliance, and acceptability dimensions. To investigate the factors associated with ICCM acceptance, a binary logistic regression analysis was performed. During bivariable analysis, variables with p-values less than 0.25 were included in multivariable analysis. Finally, variables having a p-value less than 0.05 and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) were judged statistically significant. Qualitative data were collected recorded, transcribed into Amharic, then translated into English and finally coded and thematically analyzed.

Judgment matrix analysis

The weighted values of availability, compliance, and acceptability dimensions were 35, 40, and 25 based on the stakeholder and investigator agreement on each indicator, respectively. The judgment parameters for each dimension and the overall implementation of the program were categorized as poor (< 60%), fair (60–74.9%), good (75-84.9%), and very good (85–100%).

Availability of resources

A total of 26 HEWs were assigned within the fourteen health posts, and 72.7% of them were trained on ICCM to manage common childhood illnesses in under-five children. However, the training was given before four years, and they didn’t get even refreshment training about ICCM. The KII responses also supported that the shortage of HEWs at the HPs was the problem in implementing the program properly.

I am the only HEW in this health post and I have not been trained on ICCM program. So, this may compromise the quality of service and client satisfaction.(25 years old HEW with two years’ experience)

All observed health posts had ICCM registration books, monthly report and referral formats, functional thermometer, weighting scale and MUAC tape meter. However, timer and resuscitation bag was not available in all HPs. Most of the key informant finding showed that, in all HPs there was no shortage of guideline, registration book and recording tool; however, there was no OTP card in some health posts.

“Guideline, ICCM registration book for 2–59 months of age, and other different recording and reporting formats and booklet charts are available since September/2016. However, OTP card is not available in most HPs.”. (A 30 years male health center director)

Only one-fifth (21%) of HPs had a clean water source for drinking and washing of equipment. Most of Key-informant interview findings showed that the availability of infrastructures like water was not available in most HPs. Poor linkage between HPs, HCs, town health department, and local Kebele administer were the reason for unavailability.

Since there is no water for hand washing, or drinking, we obligated to bring water from our home for daily consumptions. This increases the burden for us in our daily activity. (35 years old HEW)

Most medicines, such as anti-malaria drugs with RDT, Quartem, Albendazole, Amoxicillin, vitamin A capsules, ORS, and gloves, were available in all the health posts. Drugs like zinc, paracetamol, TTC eye ointment, and folic acid were available in some HPs. However, cotrimoxazole and vitamin K capsules were stocked-out in all health posts for the last six months. The key informant also revealed that: “Vitamin K was not available starting from the beginning of this program and Cotrimoxazole was not available for the past one year and they told us they would avail it soon but still not availed. Some essential ICCM drugs like anti malaria drugs, De-worming, Amoxicillin, vitamin A capsules, ORS and medical supplies were also not available in HCs regularly.”(28 years’ Female PHCU focal)

The overall availability of resources for ICCM implementation was 84.2% which was good based on our presetting judgment parameter (Table  1 ).

Health extension worker’s compliance

From the 42 patient-provider interactions, we found that 85.7%, 71.4%, 76.2%, and 95.2% of the children were checked for body temperature, weight, general danger signs, and immunization status respectively. Out of total (42) observation, 33(78.6%) of sick children were classified for their nutritional status. During observation time 29 (69.1%) of caregivers were counseled by HEWs on food, fluid and when to return back and 35 (83.3%) of children were appointed for next follow-up visit. Key informant interviews also affirmed that;

“Most of our health extension workers were trained on ICCM program guidelines but still there are problems on assessment classification and treatment of disease based on guidelines and standards this is mainly due to lack refreshment training on the program and lack of continuous supportive supervision from the respective body.” (27years’ Male health center head)

From 10 clients classified as having severe pneumonia cases, all of them were referred to a health center (with pre-referral treatment), and from those 57 pneumonia cases, 50 (87.7%) were treated at the HP with amoxicillin or cotrimoxazole. All children with severe diarrhea, very severe disease, and severe complicated malnutrition cases were referred to health centers with a pre-referral treatment for severe dehydration, very severe febrile disease, and severe complicated malnutrition, respectively. From those with some dehydration and no dehydration cases, (82.4%) and (86.8%) were treated at the HPs for some dehydration (ORS; plan B) and for no dehydration (ORS; plan A), respectively. Moreover, zinc sulfate was prescribed for 63 (90%) of under-five children with some dehydration or no dehydration. From 26 malaria cases and 32 severe uncomplicated malnutrition and moderate acute malnutrition cases, 20 (76.9%) and 25 (78.1%) were treated at the HPs, respectively. Of the total reviewed documents, 56 (93.3%), 66 (94.3%), 38 (84.4%), and 25 (78.1%) of them were given a follow-up date for pneumonia, diarrhea, malaria, and malnutrition, respectively.

Supportive supervision and performance review meetings were conducted only in 10 (71.4%) HPs, but all (100%) HPs sent timely reports to the next supervisory body.

Most of the key informants’ interview findings showed that supportive supervision was not conducted regularly and for all HPs.

I had mentored and supervised by supportive supervision teams who came to our health post at different times from health center, town health office and zonal health department. I received this integrated supervision from town health office irregularly, but every month from catchment health center and last integrated supportive supervision from HC was on January. The problem is the supervision was conducted for all programs.(32 years’ old and nine years experienced female HEW)

Moreover, the result showed that there was poor compliance of HEWs for the program mainly due to weak supportive supervision system of managerial and technical health workers. It was also supported by key informants as:

We conducted supportive supervision and performance review meeting at different time, but still there was not regular and not addressed all HPs. In addition to this the supervision and review meeting was conducted as integration of ICCM program with other services. The other problem is that most of the time we didn’t used checklist during supportive supervision. (Mid 30 years old male HC director)

Based on our observation and ICCM document review, 83.1% of the HEWs were complied with the ICCM guidelines and judged as fair (Table  2 ).

Acceptability of ICCM program

Sociodemographic and obstetric characteristics of participants.

A total of 484 study participants responded to the interviewer-administered questionnaire with a response rate of 95.3%. The mean age of study participants was 30.7 (SD ± 5.5) years. Of the total caregivers, the majority (38.6%) were categorized under the age group of 26–30 years. Among the total respondents, 89.3% were married, and regarding religion, the majorities (84.5%) were Orthodox Christian followers. Regarding educational status, over half of caregivers (52.1%) were illiterate (unable to read or write). Nearly two-thirds of the caregivers (62.6%) were housewives (Table  3 ).

All the caregivers came to the health post on foot, and most of them 418 (86.4%) arrived within one hour. The majority of 452 (93.4%) caregivers responded that the waiting time to get the service was less than 30 min. Caregivers who got the prescribed drugs at the health post were 409 (84.5%). Most of the respondents, 429 (88.6%) and 438 (90.5%), received counseling services on providing extra fluid and feeding for their sick child and were given a follow-up date.

Most 298 (61.6%) of the caregivers were satisfied with the convenience of the working hours of HPs, and more than three-fourths (80.8%) were satisfied with the counseling services they received. Most of the respondents, 366 (75.6%), were satisfied with the appropriateness of waiting time and 431 (89%) with the appropriateness of consultation time. The majority (448 (92.6%) of caregivers were satisfied with the way of communicating with HEWs, and 269 (55.6%) were satisfied with the knowledge and competence of HEWs. Nearly half of the caregivers (240, or 49.6%) were satisfied with the availability of drugs at health posts.

The overall acceptability of the ICCM program was 75.3%, which was judged as good. A low proportion of acceptability was measured on the cleanliness of the health posts, the appropriateness of the waiting area, and the competence and knowledge of the HEWs. On the other hand, high proportion of acceptability was measured on appropriateness of waiting time, way of communication with HEWs, and the availability of drugs (Table  4 ).

Factors associated with acceptability of ICCM program

In the final multivariable logistic regression analysis, educational status of caregivers, availability of prescribed drugs, time to arrive, and waiting time were factors significantly associated with the satisfaction of caregivers with the ICCM program.

Accordingly, the odds of caregivers with primary education, secondary education, and college and above were 73% (AOR = 0.27, 95% CI: 0.11–0.52), 84% (AOR = 0.16, 95% CI: 0.07–0.39), and 92% (AOR = 0.08, 95% CI: 0.07–0.40) less likely to accept the program as compared to mothers or caregivers who were not able to read and write, respectively. The odds of caregivers or mothers who received prescribed drugs were 2.17 times more likely to accept the program as compared to their counters (AOR = 2.17, 95% CI: 1.14–4.10). The odds of caregivers or mothers who waited for services for less than 30 min were 2.8 times more likely to accept the program as compared to those who waited for more than 30 min (AOR = 2.80, 95% CI: 1.16–6.79). Moreover, the odds of caregivers/mothers who traveled an hour or less for service were 3.8 times more likely to accept the ICCM program as compared to their counters (AOR = 3.82, 95% CI:1.99–7.35) (Table  5 ).

Overall ICCM program implementation and judgment

The implementation of the ICCM program in Gondar city administration was measured in terms of availability (84.2%), compliance (83.1%), and acceptability (75.3%) dimensions. In the availability dimension, amoxicillin, antimalarial drugs, albendazole, Vit. A, and ORS were available in all health posts, but only six HPs had Ready-to-Use Therapeutic Feedings, three HPs had ORT Corners, and none of the HPs had functional timers. In all health posts, the health extension workers asked the chief to complain, correctly assessed for pneumonia, diarrhea, malaria, and malnutrition, and sent reports based on the national schedule. However, only 70% of caretakers counseled about food, fluids, and when to return, 66% and 76% of the sick children were checked for anemia and other danger signs, respectively. The acceptability level of the program by caretakers and caretakers’/mothers’ educational status, waiting time to get the service and travel time ICCM sites were the factors affecting its acceptability. The overall ICCM program in Gondar city administration was 81.5% and judged as good (Fig.  2 ).

Overall ICCM program implementation and the evaluation dimensions in Gondar city administration, 2022

The implementation status of ICCM was judged by using three dimensions including availability, compliance and acceptability of the program. The judgment cut of points was determined during evaluability assessment (EA) along with the stakeholders. As a result, we found that the overall implementation status of ICCM program was good as per the presetting judgment parameter. Availability of resources for the program implementation, compliance of HEWs to the treatment guideline and acceptability of the program services by users were also judged as good as per the judgment parameter.

This evaluation showed that most medications, equipment and recording and reporting materials available. This finding was comparable with the standard ICCM treatment guide line [ 10 ]. On the other hand trained health care providers, some medications like Zink, Paracetamol and TTC eye ointment, folic acid and syringes were not found in some HPs. However the finding was higher than the study conducted in SNNPR on selected health posts [ 33 ] and a study conducted in Soro district, southern Ethiopia [ 24 ]. The possible reason might be due to low interruption of drugs at town health office or regional health department stores, regular supplies of essential drugs and good supply management and distribution of drug from health centers to health post.

The result of this evaluation showed that only one fourth of health posts had functional ORT Corner which was lower compared to the study conducted in SNNPR [ 34 ]. This might be due poor coverage of functional pipe water in the kebeles and the installation was not set at the beginning of health post construction as reported from one of ICCM program coordinator.

Compliance of HEWs to the treatment guidelines in this evaluation was higher than the study done in southern Ethiopia (65.6%) [ 24 ]. This might be due to availability of essential drugs educational level of HEWs and good utilization of ICCM guideline and chart booklet by HEWs. The observations showed most of the sick children were assessed for danger sign, weight, and temperature respectively. This finding is lower than the study conducted in Rwanda [ 35 ]. This difference might be due to lack of refreshment training and regular supportive supervision for HEWs. This also higher compared to the study done in three regions of Ethiopia indicates that 88%, 92% and 93% of children classified as per standard for Pneumonia, diarrhea and malaria respectively [ 36 ]. The reason for this difference may be due to the presence of medical equipment and supplies including RDT kit for malaria, and good educational level of HEWs.

Moreover most HPs received supportive supervision and performance review meeting was conducted and all of them send reports timely to next level. The finding of this evaluation was lower than the study conducted on implementation evaluation of ICCM program southern Ethiopia [ 24 ] and study done in three regions of Ethiopia (Amhara, Tigray and SNNPR) [ 37 ]. This difference might be due sample size variation.

The overall acceptability of the ICCM program was less than the presetting judgment parameter but slightly higher compared to the study in southern Ethiopia [ 24 ]. This might be due to presence of essential drugs for treating children, reasonable waiting and counseling time provided by HEWs, and smooth communication between HEWs and caregivers. In contrast, this was lower than similar studies conducted in Wakiso district, Uganda [ 38 ]. The reason for this might be due to contextual difference between the two countries, inappropriate waiting area to receive the service and poor cleanness of the HPs in our study area. Low acceptability of caregivers to ICCM service was observed in the appropriateness of waiting area, availability of drugs, cleanness of health post, and competence of HEWs while high level of caregiver’s acceptability was consultation time, counseling service they received, communication with HEWs, treatment given for their sick children and interest to return back for ICCM service.

Caregivers who achieved primary, secondary, and college and above were more likely accept the program services than those who were illiterate. This may more educated mothers know about their child health condition and expect quality service from healthcare providers which is more likely reduce the acceptability of the service. The finding is congruent with a study done on implementation evaluation of ICCM program in southern Ethiopia [ 24 ]. However, inconsistent with a study conducted in wakiso district in Uganda [ 38 ]. The possible reason for this might be due to contextual differences between the two countries. The ICCM program acceptability was high in caregivers who received all prescribed drugs than those did not. Caregivers those waited less than 30 min for service were more accepted ICCM services compared to those more than 30 minutes’ waiting time. This finding is similar compared with the study conducted on implementation evaluation of ICCM program in southern Ethiopia [ 24 ]. In contrary, the result was incongruent with a survey result conducted by Ethiopian public health institute in all regions and two administrative cities of Ethiopia [ 39 ]. This variation might be due to smaller sample size in our study the previous one. Moreover, caregivers who traveled to HPs less than 60 min were more likely accepted the program than who traveled more and the finding was similar with the study finding in Jimma zone [ 40 ].

Strengths and limitations

This evaluation used three evaluation dimensions, mixed method and different data sources that would enhance the reliability and credibility of the findings. However, the study might have limitations like social desirability bias, recall bias and Hawthorne effect.

The implementation of the ICCM program in Gondar city administration was measured in terms of availability (84.2%), compliance (83.1%), and acceptability (75.3%) dimensions. In the availability dimension, amoxicillin, antimalarial drugs, albendazole, Vit. A, and ORS were available in all health posts, but only six HPs had Ready-to-Use Therapeutic Feedings, three HPs had ORT Corners, and none of the HPs had functional timers.

This evaluation assessed the implementation status of the ICCM program, focusing mainly on availability, compliance, and acceptability dimensions. The overall implementation status of the program was judged as good. The availability dimension is compromised due to stock-outs of chloroquine syrup, cotrimoxazole, and vitamin K and the inaccessibility of clean water supply in some health posts. Educational statuses of caregivers, availability of prescribed drugs at the HPs, time to arrive to HPs, and waiting time to receive the service were the factors associated with the acceptability of the ICCM program.

Therefore, continuous supportive supervision for health facilities, and refreshment training for HEW’s to maximize compliance are recommended. Materials and supplies shall be delivered directly to the health centers or health posts to solve the transportation problem. HEWs shall document the assessment findings and the services provided using the registration format to identify their gaps, limitations, and better performances. The health facilities and local administrations should construct clean water sources for health facilities. Furthermore, we recommend for future researchers and program evaluators to conduct longitudinal studies to know the causal relationship of the program interventions and the outcomes.

Data availability

Data will be available upon reasonable request from the corresponding author.

Abbreviations

Ethiopian Demographic and Health Survey

Health Center/Health Facility

Health Extension Program

Health Extension Workers

Health Post

Health Sector Development Plan

Integrated Community Case Management of Common Childhood Illnesses

Information Communication and Education

Integrated Family Health Program

Integrated Management of Neonatal and Childhood Illness

Integrated Supportive Supervision

Maternal and Child Health

Mid Upper Arm Circumference

Non-Government Organization

Oral Rehydration Salts

Outpatient Therapeutic program

Primary health care unit

Rapid Diagnostics Test

Ready to Use Therapeutic Foods

Sever Acute Malnutrition

South Nation Nationalities People Region

United Nations International Child Emergency Fund

World Health Organization

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Acknowledgements

We are very grateful to University of Gondar and Gondar town health office for its welcoming approaches. We would also like to thank all of the study participants of this evaluation for their information and commitment. Our appreciation also goes to the data collectors and supervisors for their unreserved contribution.

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Mekides Geta

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Geta Asrade Alemayehu, Wubshet Debebe Negash, Tadele Biresaw Belachew, Chalie Tadie Tsehay & Getachew Teshale

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All authors contributed to the preparation of the manuscript. M.G. conceived and designed the evaluation and performed the analysis then T.B.B., W.D.N., G.A.A., C.T.T. and G.T. revised the analysis. G.T. prepared the manuscript and all the authors revised and approved the final manuscript.

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Geta, M., Alemayehu, G.A., Negash, W.D. et al. Evaluation of integrated community case management of the common childhood illness program in Gondar city, northwest Ethiopia: a case study evaluation design. BMC Pediatr 24 , 310 (2024). https://doi.org/10.1186/s12887-024-04785-0

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Received : 20 February 2024

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DOI : https://doi.org/10.1186/s12887-024-04785-0

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