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The Value of Case Studies in Family History

“Could I have an example, please?” This is one of the most common questions we all have, about almost any subject, whether or not we ask it out loud. Good examples help us connect the dots in our learning. They help us see relationships between pieces of information, how cause and effect works, and how we can apply principles in a variety of ways.

On the other hand, an example that’s unfocused or unclear might be confusing and worse than no example at all.

It’s much the same in family history. We can find some great tools or pieces of information, but how do we apply them in our own research? That’s where a good case study can be really valuable. It not only walks us through solving a research problem, but it also does the following:

Highlights the principles that were used
Explains why they were effective
Offers suggestions on how you might use them in your research

what is the importance of family case study

As you might expect, not all case studies are created equal. Sometimes you have to dig a bit to identify the principles and how you can use them. Be prepared to use “intelligent filters”—skip past any parts that are repetitious or wandering, and read between the lines to find nuggets of information you might need. In some ways, it’s like mining a historical record for insights. The tips and trick you learn will prove valuable as you search for clues in your own ancestors’ stories.

In this newspaper case study, the author helps us find research clues by using the following elements:

Background : This sets the stage for the person we are following.
Comparisons : The primary account of the story is compared with accounts from other newspapers. This shows the value of working with multiple sources in research.
Next Steps : The author suggests additional approaches and record searches. This is good for a brief case study, while more extensive ones will provide details of what was found in the extra research.
Takeaway : This is the main point learned from the case study. You can add your own takeaways, from your analysis of what you have read.

Case Studies in The Family History Guide

There are plenty of links to research case studies in The Family History Guide, from basic record finds, to tracing immigrant ancestors, to breaking through walls with DNA results, and more. Many of them are included in the Country and Ethnic pages, plus more in the Vault.

Here are a few of the case studies to get you started, in video and article formats (videos noted with their timings):

ExploreGenealogy: Overcoming a Family History Roadblock
Family Locket: Hooking Teens on Research with Land Patents
Family Locket: Putting Your Ancestors in their Place
BYU FHL: Case Studies in Migration for Genealogists —67:54
FamilySearch: Using English Records— 16:00
FamilySearch: A French Case Study: Church Records —5:54
Ancestry DNA: Genealogy Brick Wall Case Study —21:26
The Root: Who Were My Kin Born During Slavery?

New: The Family History Guide Q&A Center

Sneak Peek: The Stars Project

Finding Your Ancestors Using Employment Records

Try a New Source – NUMIDENT

Researching with Photographs

TreeFind: A Versatile Tool for FamilySearch Family Tree

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Article contents

Family, culture, and communication.

V. Santiago Arias V. Santiago Arias College of Media and Communication, Texas Tech University
and Narissra Maria Punyanunt-Carter Narissra Maria Punyanunt-Carter College of Media and Communication, Texas Tech University
https://doi.org/10.1093/acrefore/9780190228613.013.504
Published online: 22 August 2017

Through the years, the concept of family has been studied by family therapists, psychology scholars, and sociologists with a diverse theoretical framework, such as family communication patterns (FCP) theory, dyadic power theory, conflict, and family systems theory. Among these theories, there are two main commonalities throughout its findings: the interparental relationship is the core interaction in the familial system because the quality of their communication or coparenting significantly affects the enactment of the caregiver role while managing conflicts, which are not the exception in the familial setting. Coparenting is understood in its broader sense to avoid an extensive discussion of all type of families in our society. Second, while including the main goal of parenting, which is the socialization of values, this process intrinsically suggests cultural assimilation as the main cultural approach rather than intergroup theory, because intercultural marriages need to decide which values are considered the best to be socialized. In order to do so, examples from the Thai culture and Hispanic and Latino cultures served to show cultural assimilation as an important mediator of coparenting communication patterns, which subsequently affect other subsystems that influence individuals’ identity and self-esteem development in the long run. Finally, future directions suggest that the need for incorporating a nonhegemonic one-way definition of cultural assimilation allows immigration status to be brought into the discussion of family communication issues in the context of one of the most diverse countries in the world.

parental communication
dyadic power
family communication systems
cultural assimilation

Introduction

Family is the fundamental structure of every society because, among other functions, this social institution provides individuals, from birth until adulthood, membership and sense of belonging, economic support, nurturance, education, and socialization (Canary & Canary, 2013 ). As a consequence, the strut of its social role consists of operating as a system in a manner that would benefit all members of a family while achieving what is considered best, where decisions tend to be coherent, at least according to the norms and roles assumed by family members within the system (Galvin, Bylund, & Brommel, 2004 ). Notwithstanding, the concept of family can be interpreted differently by individual perceptions to an array of cultural backgrounds, and cultures vary in their values, behaviors, and ideas.

The difficulty of conceptualizing this social institution suggests that family is a culture-bound phenomenon (Bales & Parsons, 2014 ). In essence, culture represents how people view themselves as part of a unique social collective and the ensuing communication interactions (Olaniran & Roach, 1994 ); subsequently, culture provides norms for behavior having a tremendous impact on those family members’ roles and power dynamics mirrored in its communication interactions (Johnson, Radesky, & Zuckerman, 2013 ). Thus, culture serves as one of the main macroframeworks for individuals to interpret and enact those prescriptions, such as inheritance; descent rules (e.g., bilateral, as in the United States, or patrilineal); marriage customs, such as ideal monogamy and divorce; and beliefs about sexuality, gender, and patterns of household formation, such as structure of authority and power (Weisner, 2014 ). For these reasons, “every family is both a unique microcosm and a product of a larger cultural context” (Johnson et al., 2013 , p. 632), and the analysis of family communication must include culture in order to elucidate effective communication strategies to solve familial conflicts.

In addition, to analyze familial communication patterns, it is important to address the most influential interaction with regard to power dynamics that determine the overall quality of family functioning. In this sense, within the range of family theories, parenting function is the core relationship in terms of power dynamics. Parenting refers to all efforts and decisions made by parents individually to guide their children’s behavior. This is a pivotal function, but the quality of communication among people who perform parenting is fundamental because their internal communication patterns will either support or undermine each caregiver’s parenting attempts, individually having a substantial influence on all members’ psychological and physical well-being (Schrodt & Shimkowski, 2013 ). Subsequently, parenting goes along with communication because to execute all parenting efforts, there must be a mutual agreement among at least two individuals to conjointly take care of the child’s fostering (Van Egeren & Hawkins, 2004 ). Consequently, coparenting serves as a crucial predictor of the overall family atmosphere and interactions, and it deserves special attention while analyzing family communication issues.

Through the years, family has been studied by family therapists, psychology scholars, and sociologists, but interaction behaviors define the interpersonal relationship, roles, and power within the family as a system (Rogers, 2006 ). Consequently, family scholarship relies on a wide range of theories developed within the communication field and in areas of the social sciences (Galvin, Braithwaite, & Bylund, 2015 ) because analysis of communication patterns in the familial context offers more ecological validity that individuals’ self-report measures. As many types of interactions may happen within a family, there are many relevant venues (i.e., theories) for scholarly analysis on this subject, which will be discussed later in this article in the “ Family: Theoretical Perspectives ” section. To avoid the risk of cultural relativeness while defining family, this article characterizes family as “a long-term group of two or more people related through biological, legal, or equivalent ties and who enact those ties through ongoing interactions providing instrumental and/or emotional support” (Canary & Canary, 2013 , p. 5).

Therefore, the purpose of this article is to provide an overview of the most relevant theories in family communication to identify frustrations and limitations with internal communication. Second, as a case in point, the United States welcomes more than 50 million noncitizens as temporary visitors and admits approximately 1 million immigrants to live as lawful residents yearly (Fullerton, 2014 ), this demographic pattern means that nearly one-third of the population (102 million) comes from different cultural backgrounds, and therefore, the present review will incorporate culture as an important mediator for coparenting, so that future research can be performed to find specific techniques and training practices that are more suitable for cross-cultural contexts.

Family: Theoretical Perspectives

Even though the concept of family can be interpreted individually and differently in different cultures, there are also some commonalities, along with communication processes, specific roles within families, and acceptable habits of interactions with specific family members disregarding cultural differences. This section will provide a brief overview of the conceptualization of family through the family communication patterns (FCP) theory, dyadic power theory, conflict, and family systems theory, with a special focus on the interparental relationship.

Family Communication Patterns Theory

One of the most relevant approaches to address the myriad of communication issues within families is the family communication patterns (FCP) theory. Originally developed by McLeod and Chaffee ( 1973 ), this theory aims to understand families’ tendencies to create stable and predictable communication patterns in terms of both relational cognition and interpersonal behavior (Braithwaite & Baxter, 2005 ). Specifically, this theory focuses on the unique and amalgamated associations derived from interparental communication and its impact on parenting quality to determine FCPs and the remaining interactions (Young & Schrodt, 2016 ).

To illustrate FCP’s focus on parental communication, Schrodt, Witt, and Shimkowski ( 2014 ) conducted a meta-analysis of 74 studies (N = 14,255) to examine the associations between the demand/withdraw family communication patterns of interaction, and the subsequent individual, relational, and communicative outcomes. The cumulative evidence suggests that wife demand/husband withdraw and husband demand/wife withdraw show similar moderate correlations with communicative and psychological well-being outcomes, and even higher when both patterns are taken together (at the relational level). This is important because one of the main tenets of FCP is that familial relationships are drawn on the pursuit of coorientation among members. Coorientation refers to the cognitive process of two or more individuals focusing on and assessing the same object in the same material and social context, which leads to a number of cognitions as the number of people involved, which results in different levels of agreement, accuracy, and congruence (for a review, see Fitzpatrick & Koerner, 2005 ); for example, in dyads that are aware of their shared focus, two different cognitions of the same issue will result.

Hereafter, the way in which these cognitions are socialized through power dynamics determined socially and culturally by roles constitutes specific interdependent communication patterns among family members. For example, Koerner and Fitzpatrick ( 2006 ) provide a taxonomy of family types on the basis of coorientation and its impact on communication pattern in terms of the degree of conformity in those conversational tendencies. To wit, consensual families mostly agree for the sake of the hierarchy within a given family and to explore new points of view; pluralistic families allow members to participate equally in conversations and there is no pressure to control or make children’s decisions; protective families maintain the hierarchy by making decisions for the sake of achieving common family goals; and laissez-faire families, which are low in conversation and conformity orientation, allow family members to not get deeply involved in the family.

The analysis of family communication patterns is quintessential for family communication scholarly work because it influences forming an individual’s self concept in the long run. As a case in point, Young and Schrodt ( 2016 ) surveyed 181 young adults from intact families, where conditional and interaction effects between communication patterns and conformity orientation were observed as the main predictors of future romantic partners. Moreover, this study concluded that FCPs and interparental confirmation are substantial indicators of self-to-partner confirmation, after controlling for reciprocity of confirmation within the romantic relationship. As a consequence, FCP influences children’s and young adults’ perceptions of romantic behavior (e.g., Fowler, Pearson, & Beck, 2010 ); the quality of communication behavior, such as the degree of acceptation of verbal aggression in romantic dyads (e.g., Aloia & Solomon, 2013 ); gender roles; and conflict styles (e.g., Taylor & Segrin, 2010 ), and parental modeling (e.g., Young & Schrodt, 2016 ).

This suggests three important observations. First, family is a very complex interpersonal context, in which communication processes, specific roles within families, and acceptable habits of interactions with specific family members interact as subsystems (see Galvin et al., 2004 ; Schrodt & Shimkowski, 2013 ). Second, among those subsystems, the core interaction is the individuals who hold parenting roles (i.e., intact and post divorced families); the couple (disregarding particular sexual orientations), and, parenting roles have a reciprocal relationship over time (Le, McDaniel, Leavitt, & Feinberg, 2016 ). Communication between parenting partners is crucial for the development of their entire family; for example, Schrodt and Shimkowski ( 2013 ) conducted a survey with 493 young adult children from intact (N = 364) and divorced families (N = 129) about perceptions of interparental conflict that involves triangulation (the impression of being in the “middle” and feeling forced to display loyalty to one of the parents). Results suggest that supportive coparental communication positively predicts relational satisfaction with mothers and fathers, as well as mental health; on the other hand, antagonist and hostile coparental communication predicted negative marital satisfaction.

Consequently, “partners’ communication with one another will have a positive effect on their overall view of their marriage, . . . and directly result[ing in] their views of marital satisfaction” (Knapp & Daly, 2002 , p. 643). Le et al. ( 2016 ) conducted a longitudinal study to evaluate the reciprocal relationship between marital interaction and coparenting from the perspective of both parents in terms of support or undermining across the transition to parenthood from a dyadic perspective; 164 cohabiting heterosexual couples expecting their first child were analyzed from pregnancy until 36 months after birth. Both parents’ interdependence was examined in terms of three variables: gender difference analysis, stability over time in marriage and coparenting, and reciprocal associations between relationship quality and coparenting support or undermining. The findings suggest a long-term reciprocal association between relationship quality and coparenting support or undermining in heterosexual families; the quality of marriage relationship during prenatal stage is highly influential in coparenting after birth for both men and women; but, coparenting is connected to romantic relationship quality only for women.

Moreover, the positive association between coparenting and the parents’ relationship relates to the spillover hypothesis, which posits that the positive or negative factors in the parental subsystem are significantly associated with higher or lower marital satisfaction in the spousal subsystem, respectively. Ergo, overall parenting performance is substantially affected by the quality of marital communication patterns.

Dyadic Power

In addition, after analyzing the impact of marital interaction quality in families on marital satisfaction and future parental modeling, it is worth noting that marital satisfaction and coparenting are importantly mediated by power dynamics within the couple (Halstead, De Santis, & Williams, 2016 ), and even mediates marital commitment (e.g., Lennon, Stewart, & Ledermann, 2013 ). If the quality of interpersonal relationship between those individuals who hold parenting roles determines coparenting quality as well, then the reason for this association lies on the fact that virtually all intimate relationships are substantially characterized by power dynamics; when partners perceive more rewards than costs in the relationship, they will be more satisfied and significantly more committed to the relationship (Lennon et al., 2013 ). As a result, the inclusion of power dynamics in the analysis of family issues becomes quintessential.

For the theory of dyadic power, power in its basic sense includes dominance, control, and influence over others, as well as a means to meet survival needs. When power is integrated into dyadic intimate relationships, it generates asymmetries in terms of interdependence between partners due to the quality of alternatives provided by individual characteristics such as socioeconomic status and cultural characteristics such as gender roles. This virtually gives more power to men than women. Power refers to “the feeling derived from the ability to dominate, or control, the behavior, affect, and cognitions of another person[;] in consequence, this concept within the interparental relationship is enacted when one partner who controls resources and limiting the behavioral options of the other partner” (Lennon et al., 2013 , p. 97). Ergo, this theory examines power in terms of interdependence between members of the relationship: the partner who is more dependent on the other has less power in the relationship, which, of course, directly impact parenting decisions.

As a case in point, Worley and Samp ( 2016 ) examined the balance of decision-making power in the relationship, complaint avoidance, and complaint-related appraisals in 175 heterosexual couples. Findings suggest that decision-making power has a curvilinear association, in which individuals engaged in the least complaint avoidance when they were relatively equal to their partners in terms of power. In other words, perceptions of one another’s power potentially encourage communication efficacy in the interparental couple.

The analysis of power in intimate relationships, and, to be specific, between parents is crucial because it not only relates to marital satisfaction and commitment, but it also it affects parents’ dyadic coping for children. In fact, Zemp, Bodenmann, Backes, Sutter-Stickel, and Revenson ( 2016 ) investigated parents’ dyadic coping as a predictor of children’s internalizing symptoms, externalizing symptoms, and prosocial behavior in three independent studies. When there is a positive relationship among all three factors, the results indicated that the strongest correlation was the first one. Again, the quality of the marital and parental relationships has the strongest influence on children’s coping skills and future well-being.

From the overview of the two previous theories on family, it is worth addressing two important aspects. First, parenting requires an intensive great deal of hands-on physical care, attention to safety (Mooney-Doyle, Deatrick, & Horowitz, 2014 ), and interpretation of cues, and this is why parenting, from conception to when children enter adulthood, is a tremendous social, cultural, and legally prescribed role directed toward caregiving and endlessly attending to individuals’ social, physical, psychological, emotional, and cognitive development (Johnson et al., 2013 ). And while parents are making decisions about what they consider is best for all family members, power dynamics play a crucial role in marital satisfaction, commitment, parental modeling, and overall interparental communication efficacy in the case of postdivorce families. Therefore, the likelihood of conflict is latent within familial interactions while making decisions; indeed, situations in which family members agree on norms as a consensus is rare (Ritchie & Fitzpatrick, 1990 ).

In addition to the interparental and marital power dynamics that delineates family communication patterns, the familial interaction is distinctive from other types of social relationships in the unequaled role of emotions and communication of affection while family members interact and make decisions for the sake of all members. For example, Ritchie and Fitzpatrick ( 1990 ) provided evidence that fathers tended to perceive that all other family members agree with his decisions or ideas. Even when mothers confronted and disagreed with the fathers about the fathers’ decisions or ideas, the men were more likely to believe that their children agreed with him. When the children were interviewed without their parents, however, the majority of children agreed with the mothers rather than the fathers (Ritchie & Fitzpatrick, 1990 ). Subsequently, conflict is highly present in families; however, in general, the presence of conflict is not problematic per se. Rather, it is the ability to manage and recover from it and that could be problematic (Floyd, 2014 ).

One of the reasons for the role of emotions in interpersonal conflicts is explained by the Emotion-in-Relationships Model (ERM). This model states that feelings of bliss, satisfaction, and relaxation often go unnoticed due to the nature of the emotions, whereas “hot” emotions, such as anger and contempt, come to the forefront when directed at a member of an interpersonal relationship (Fletcher & Clark, 2002 ). This type of psychophysical response usually happens perhaps due to the different biophysical reactive response of the body compared to its reaction to positive ones (Floyd, 2014 ). There are two dimensions that define conflict. Conflict leads to the elicitation of emotions, but sometimes the opposite occurs: emotions lead to conflict. The misunderstanding or misinterpretation of emotions among members of a family can be a source of conflict, as well as a number of other issues, including personality differences, past history, substance abuse, mental or physical health problems, monetary issues, children, intimate partner violence, domestic rape, or maybe just general frustration due to recent events (Sabourin, Infante, & Rudd, 1990 ). In order to have a common understanding of this concept for the familial context in particular, conflict refers to as “any incompatibility that can be expressed by people related through biological, legal, or equivalent ties” (Canary & Canary, 2013 , p. 6). Thus, the concept of conflict goes hand in hand with coparenting.

There is a myriad of everyday family activities in which parents need to decide the best way to do them: sometimes they are minor, such as eating, watching TV, or sleeping schedules; others are more complicated, such as schooling. Certainly, while socializing and making these decisions, parents may agree or not, and these everyday situations may lead to conflict. Whether or not parents live together, it has been shown that “the extent to which children experience their parents as partners or opponents in parenting is related to children’s adjustment and well-being” (Gable & Sharp, 2016 , p. 1), because the ontology of parenting is materialized through socialization of values about every aspect and duty among all family members, especially children, to perpetuate a given society.

As the findings provided in this article show, the study of family communication issues is pivotal because the way in which those issues are solved within families will be copied by children as their values. Values are abstract ideas that delineate behavior toward the evaluation of people and events and vary in terms of importance across individuals, but also among cultures. In other words, their future parenting (i.e., parenting modeling) of children will replicate those same strategies for conflict solving for good or bad, depending on whether parents were supportive between each other. Thus, socialization defines the size and scope of coparenting.

The familial socialization of values encompasses the distinction between parents’ personal execution of those social appraisals and the values that parents want their children to adopt, and both are different things; nonetheless, familial socialization does not take place in only one direction, from parents to children. Benish-Weisman, Levy, and Knafo ( 2013 ) investigated the differentiation process—or, in other words, the distinction between parents’ own personal values and their socialization values and the contribution of children’s values to their parents’ socialization values. In this study, in which 603 Israeli adolescents and their parents participated, the findings suggest that parents differentiate between their personal values and their socialization values, and adolescents’ values have a specific contribution to their parents’ socialization values. As a result, socialization is not a unidirectional process affected by parents alone, it is an outcome of the reciprocal interaction between parents and their adolescent children, and the given importance of a given value is mediated by parents and their culture individually (Johnson et al., 2013 ). However, taking power dynamics into account does not mean that adolescents share the same level of decision-making power in the family; thus, socialization take place in both directions, but mostly from parents to children. Finally, it is worth noticing that the socialization of values in coparenting falls under the cultural umbrella. The next section pays a special attention to the role of culture in family communication.

The Role of Culture in Parenting Socialization of Values

There are many individual perceived realities and behaviors in the familial setting that may lead to conflict among members, but all of them achieve a common interpretation through culture; indeed, “all family conflict processes by broad cultural factors” (Canary & Canary, 2013 , p. 46). Subsequently, the goal of this section is to provide an overview of the perceived realities and behaviors that exist in family relationships with different cultural backgrounds. How should one approach the array of cultural values influencing parental communication patterns?

An interesting way of immersing on the role of culture in family communication patterns and its further socialization of values is explored by Schwartz ( 1992 ). The author developed a value system composed of 10 values operationalized as motivational goals for modern society: (a) self-direction (independence of thought and action); (b) stimulation (excitement, challenge, and novelty); (c) hedonism (pleasure or sensuous gratification); (d) achievement (personal success according to social standards); (e) power (social status, dominance over people and resources); (f) conformity (restraint of actions that may harm others or violate social expectations); (g) tradition (respect and commitment to cultural or religious customs and ideas); (h) benevolence (preserving and enhancing the welfare of people to whom one is close); (i) universalism (understanding, tolerance, and concern for the welfare of all people and nature); and (j) security (safety and stability of society, relationships, and self).

Later, Schwartz and Rubel ( 2005 ) applied this value structure, finding it to be commonly shared among over 65 countries. Nevertheless, these values are enacted in different ways by societies and genders about the extent to which men attribute more relevance to values of power, stimulation, hedonism, achievement, and self-direction, and the opposite was found for benevolence and universalism and less consistently for security. Also, it was found that all sex differences were culturally moderated, suggesting that cultural background needs to be considered in the analysis of coparental communication when socializing those values.

Even though Schwartz’s work was more focused on individuals and societies, it is a powerful model for the analysis of the role of culture on family communication and parenting scholarships. Indeed, Schwartz et al. ( 2013 ) conducted a longitudinal study with a sample of 266 Hispanic adolescents (14 years old) and their parents that looked at measures of acculturation, family functioning, and adolescent conduct problems, substance use, and sexual behavior at five time points. Results suggest that higher levels of acculturation in adolescents were linked to poorer family functioning; however, overall assimilation negatively predicted adolescent cigarette smoking, sexual activity, and unprotected sex. The authors emphasize the role of culture, and acculturation patterns in particular, in understanding the mediating role of family functioning and culture.

Ergo, it is crucial to address the ways in which culture affects family functioning. On top of this idea, Johnson et al. ( 2013 ) observed that Western cultures such as in the United States and European countries are oriented toward autonomy, favoring individual achievement, self-reliance, and self-assertiveness. Thus, coparenting in more autonomous countries will socialize to children the idea that achievement in life is an outcome of independence, resulting in coparenting communication behaviors that favor verbal praise and feedback over physical contact. As opposed to autonomy-oriented cultures, other societies, such as Asian, African, and Latin American countries, emphasize interdependence over autonomy; thus, parenting in these cultures promotes collective achievement, sharing, and collaboration as the core values.

These cultural orientations can be observed in parents’ definitions of school readiness and educational success; for Western parents, examples include skills such as counting, recognizing letters, or independently completing tasks such as coloring pictures, whereas for more interdependent cultures, the development of obedience, respect for authority, and appropriate social skills are the skills that parents are expecting their children to develop to evaluate school readiness. As a matter of fact, Callaghan et al. ( 2011 ) conducted a series of eight studies to evaluate the impact of culture on the social-cognitive skills of one- to three-year-old children in three diverse cultural settings such as Canada, Peru, and India. The results showed that children’s acquisition of specific cognitive skills is moderated by specific learning experiences in a specific context: while Canadian children were understanding the performance of both pretense and pictorial symbols skillfully between 2.5 and 3.0 years of age, on average, Peruvian and Indian children mastered those skills more than a year later. Notwithstanding, this finding does not suggest any kind of cultural superiority; language barriers and limitations derived from translation itself may influence meanings, affecting the results (Sotomayor-Peterson, De Baca, Figueredo, & Smith-Castro, 2013 ). Therefore, in line with the findings of Schutz ( 1970 ), Geertz ( 1973 ), Grusec ( 2002 ), Sotomayor-Peterson et al. ( 2013 ), and Johnson et al. ( 2013 ), cultural values provide important leverage for understanding family functioning in terms of parental decision-making and conflict, which also has a substantial impact on children’s cognitive development.

Subsequently, cultural sensitivity to the analysis of the familial system in this country needs to be specially included because cultural differences are part of the array of familial conflicts that may arise, and children experience real consequences from the quality of these interactions. Therefore, parenting, which is already arduous in itself, and overall family functioning significantly become troublesome when parents with different cultural backgrounds aim to socialize values and perform parenting tasks. The following section provides an account of these cross-cultural families.

Intercultural Families: Adding Cultural Differences to Interparental Communication

For a country such as the United States, with 102 million people from many different cultural backgrounds, the presence of cross-cultural families is on the rise, as is the likelihood of intermarriage between immigrants and natives. With this cultural diversity, the two most prominent groups are Hispanics and Asians, particular cases of which will be discussed next. Besides the fact that parenting itself is a very complex and difficult task, certainly the biggest conflict consists of making decisions about the best way to raise children in terms of their values with regard to which ethnic identity better enacts the values that parents believe their children should embrace. As a result, interracial couples might confront many conflicts and challenges due to cultural differences affecting marital satisfaction and coparenting.

Assimilation , the degree to which a person from a different cultural background has adapted to the culture of the hostage society, is an important phenomenon in intermarriage. Assimilationists observe that children from families in which one of the parents is from the majority group and the other one from the minority do not automatically follow the parent from the majority group (Cohen, 1988 ). Indeed, they follow their mothers more, whichever group she belongs to, because of mothers are more prevalent among people with higher socioeconomic status (Gordon, 1964 ; Portes, 1984 ; Schwartz et al., 2013 ).

In an interracial marriage, the structural and interpersonal barriers inhibiting the interaction between two parents will be reduced significantly if parents develop a noncompeting way to communicate and solve conflicts, which means that both of them might give up part of their culture or ethnic identity to reach consensus. Otherwise, the ethnic identity of children who come from interracial marriages will become more and more obscure (Saenz, Hwang, Aguirre, & Anderson, 1995 ). Surely, parents’ noncompeting cultural communication patterns are fundamental for children’s development of ethnic identity. Biracial children develop feelings of being outsiders, and then parenting becomes crucial to developing their strong self-esteem (Ward, 2006 ). Indeed, Gordon ( 1964 ) found that children from cross-racial or cross-ethnic marriages are at risk of developing psychological problems. In another example, Jognson and Nagoshi ( 1986 ) studied children who come from mixed marriages in Hawaii and found that the problems of cultural identification, conflicting demands in the family, and of being marginal in either culture still exist (Mann & Waldron, 1977 ). It is hard for those mixed-racial children to completely develop the ethnic identity of either the majority group or the minority group.

The question of how children could maintain their minority ethnic identity is essential to the development of ethnic identity as a whole. For children from interracial marriage, the challenge to maintain their minority ethnic identity will be greater than for the majority ethnic identity (Waters, 1990 ; Schwartz et al., 2013 ) because the minority-group spouse is more likely to have greater ethnic consciousness than the majority-group spouse (Ellman, 1987 ). Usually, the majority group is more influential than the minority group on a child’s ethnic identity, but if the minority parent’s ethnicity does not significantly decline, the child’s ethnic identity could still reflect some characteristics of the minority parent. If parents want their children to maintain the minority group’s identity, letting the children learn the language of the minority group might be a good way to achieve this. By learning the language, children form a better understanding of that culture and perhaps are more likely to accept the ethnic identity that the language represents (Xin & Sandel, 2015 ).

In addition to language socialization as a way to contribute to children’s identity in biracial families, Jane and Bochner ( 2009 ) indicated that family rituals and stories could be important in performing and transforming identity. Families create and re-create their identities through various kinds of narrative, in which family stories and rituals are significant. Festivals and rituals are different from culture to culture, and each culture has its own. Therefore, exposing children to the language, rituals, and festivals of another culture also could be helpful to form their ethnic identity, in order to counter problems of self-esteem derived from the feeling of being an outsider.

To conclude this section, the parenting dilemma in intercultural marriages consists of deciding which culture they want their children to be exposed to and what kind of heritage they want to pass to children. The following section will provide two examples of intercultural marriages in the context of American society without implying that there are no other insightful cultures that deserve analysis, but the focus on Asian-American and Hispanics families reflects the available literature (Canary & Canary, 2013 ) and its demographic representativeness in this particular context. In addition, in order to acknowledge that minorities within this larger cultural background deserve more attention due to overemphasis on larger cultures in scholarship, such as Chinese or Japanese cultures, the Thai family will provide insights into understanding the role of culture in parenting and its impact on the remaining familial interaction, putting all theories already discussed in context. Moreover, the Hispanic family will also be taken in account because of its internal pan-ethnicity variety.

An Example of Intercultural Parenting: The Thai Family

The Thai family, also known as Krob Krua, may consist of parents, children, paternal and maternal grandparents, aunts, uncles, grandchildren, in-laws, and any others who share the same home. Thai marriages usually are traditional, in which the male is the authority figure and breadwinner and the wife is in charge of domestic items and the homemaker. It has been noted that Thai mothers tend to be the major caregivers and caretakers in the family rather than fathers (Tulananda, Young, & Roopnarine, 1994 ). On the other hand, it has been shown that Thai mothers also tend to spoil their children with such things as food and comfort; Tulananda et al. ( 1994 ) studied the differences between American and Thai fathers’ involvement with their preschool children and found that American fathers reported being significantly more involved with their children than Thai fathers. Specifically, the fathers differed in the amount of socialization and childcare; Thai fathers reported that they obtained more external support from other family members than American fathers; also, Thai fathers were more likely to obtain support for assisting with daughters than sons.

Furthermore, with regard to the family context, Tulananda and Roopnarine ( 2001 ) noted that over the years, some attention has been focused on the cultural differences among parent-child behaviors and interactions; hereafter, the authors believed that it is important to look at cultural parent-child interactions because that can help others understand children’s capacity to socialize and deal with life’s challenges. As a matter of fact, the authors also noted that Thai families tend to raise their children in accordance with Buddhist beliefs. It is customary for young Thai married couples to live with either the wife’s parents (uxorilocal) or the husband’s parents (virilocal) before living on their own (Tulananda & Roopnarine, 2001 ). The process of developing ethnicity could be complicated. Many factors might influence the process, such as which parent is from the minority culture and the cultural community, as explained in the previous section of this article.

This suggests that there is a difference in the way that Thai and American fathers communicate with their daughters. As a case in point, Punyanunt-Carter ( 2016 ) examined the relationship maintenance behaviors within father-daughter relationships in Thailand and the United States. Participants included 134 American father-daughter dyads and 154 Thai father-daughter dyads. The findings suggest that when quality of communication was included in this relationship, both types of families benefit from this family communication pattern, resulting in better conflict management and advice relationship maintenance behaviors. However, differences were found: American fathers are more likely than American daughters to employ relationship maintenance behaviors; in addition, American fathers are more likely than Thai fathers to use relationship maintenance strategies.

As a consequence, knowing the process of ethnic identity development could provide parents with different ways to form children’s ethnic identity. More specifically, McCann, Ota, Giles, and Caraker ( 2003 ), and Canary and Canary ( 2013 ) noted that Southeast Asian cultures have been overlooked in communication studies research; these countries differ in their religious, political, and philosophical thoughts, with a variety of collectivistic views and religious ideals (e.g., Buddhism, Taoism, Islam), whereas the United States is mainly Christian and consists of individualistic values.

The Case of Hispanic/Latino Families in the United States

There is a need for including Hispanic/Latino families in the United States because of the demographic representativeness and trends of the ethnicity: in 2016 , Hispanics represent nearly 17% of the total U.S. population, becoming the largest minority group. There are more than 53 million Hispanics and Latinos in the United States; in addition, over 93% of young Hispanics and Latinos under the age of 18 hold U.S. citizenship, and more than 73,000 of these people turn 18 every month (Barreto & Segura, 2014 ). Furthermore, the current Hispanic and Latino population is spread evenly between foreign-born and U.S.-born individuals, but the foreign-born population is now growing faster than the number of Hispanic children born in the country (Arias & Hellmueller, 2016 ). This demographic trend is projected to reach one-third of the U.S. total population by 2060 ; therefore, with the growth of other minority populations in the country, the phenomenon of multiracial marriage and biracial children is increasing as well.

Therefore, family communication scholarship has an increasing necessity to include cultural particularities in the analysis of the familial system; in addition to the cultural aspects already explained in this article, this section addresses the influence of familism in Hispanic and Latino familial interactions, as well as how immigration status moderates the internal interactions, reflected in levels of acculturation, that affect these families negatively.

With the higher marriage and birth rates among Hispanics and Latinos living in the United States compared to non-Latino Whites and African American populations, the Hispanic familial system is perhaps the most stereotyped as being familistic (Glick & Van Hook, 2008 ). This family trait consists of the fact that Hispanics place a very high value on marriage and childbearing, on the basis of a profound commitment to give support to members of the extended family as well. This can be evinced in the prevalence of extended-kind shared households in Hispanic and Latino families, and Hispanic children are more likely to live in extended-family households than non-Latino Whites or blacks (Glick & Van Hook, 2008 ). Living in extended-family households, most likely with grandparents, may have positive influences on Hispanic and Latino children, such as greater attention and interaction with loving through consistent caregiving; grandparents may help by engaging with children in academic-oriented activities, which then affects positively cognitive educational outcomes.

However, familism is not the panacea for all familial issues for several reasons. First, living in an extended-family household requires living arrangements that consider adults’ needs more than children’s. Second, the configuration of Hispanic and Latino households is moderated by any immigration issues with all members of the extended family, and this may cause problems for children (Menjívar, 2000 ). The immigration status of each individual member may produce a constant state of flux, whereas circumstances change to adjust to economic opportunities, which in turn are limited by immigration laws, and it gets even worse when one of the parents isn’t even present in the children’s home, but rather live in their home country (Van Hook & Glick, 2006 ). Although Hispanic and Latino children are more likely to live with married parents and extended relatives, familism is highly affected by the immigration status of each member.

On the other hand, there has been research to address the paramount role of communication disregarding the mediating factor of cultural diversity. For example, Sotomayor-Peterson et al. ( 2013 ) performed a cross-cultural comparison of the association between coparenting or shared parental effort and family climate among families from Mexico, the United States, and Costa Rica. The overall findings suggest what was explained earlier in this article: more shared parenting predicts better marital interaction and family climate overall.

In addition, parenting quality has been found to have a positive relationship with children’s developmental outcomes. In fact, Sotomayor-Peterson, Figueredo, Christensen, and Taylor ( 2012 ) conducted a study with 61 low-income Mexican American couples, with at least one child between three and four years of age, recruited from a home-based Head Start program. The main goal of this study was to observe the extent that shared parenting incorporates cultural values and income predicts family climate. The findings suggest that the role of cultural values such as familism, in which family solidarity and avoidance of confrontation are paramount, delineate shared parenting by Mexican American couples.

Cultural adaptation also has a substantial impact on marital satisfaction and children’s cognitive stimulation. Indeed, Sotomayor-Peterson, Wilhelm, and Card ( 2011 ) investigated the relationship between marital relationship quality and subsequent cognitive stimulation practices toward their infants in terms of the actor and partner effects of White and Hispanic parents. The results indicate an interesting relationship between the level of acculturation and marital relationship quality and a positive cognitive stimulation of infants; specifically, marital happiness is associated with increased cognitive stimulation by White and high-acculturated Hispanic fathers. Nevertheless, a major limitation of Hispanic acculturation literature has been seen, reflecting a reliance on cross-sectional studies where acculturation was scholarly operationalized more as an individual difference variable than as a longitudinal adaptation over time (Schwartz et al., 2013 ).

Culture and Family Communication: the “so what?” Question

This article has presented an entangled overview of family communication patterns, dyadic power, family systems, and conflict theories to establish that coparenting quality plays a paramount role. The main commonality among those theories pays special attention to interparental interaction quality, regardless of the type of family (i.e., intact, postdivorce, same-sex, etc.) and cultural background. After reviewing these theories, it was observed that the interparental relationship is the core interaction in the familial context because it affects children from their earlier cognitive development to subsequent parental modeling in terms of gender roles. Thus, in keeping with Canary and Canary ( 2013 ), no matter what approach may be taken to the analysis of family communication issues, the hypothesis that a positive emotional climate within the family is fostered only when couples practice a sufficient level of shared parenting and quality of communication is supported.

Nevertheless, this argument does not suggest that the role of culture in the familial interactions should be undersold. While including the main goal of parenting, which is the socialization of values, in the second section of this article, the text also provides specific values of different countries that are enacted and socialized differently across cultural contexts to address the role of acculturation in the familial atmosphere, the quality of interactions, and individual outcomes. As a case in point, Johnson et al. ( 2013 ) provided an interesting way of seeing how cultures differ in their ways of enacting parenting, clarifying that the role of culture in parenting is not a superficial or relativistic element.

In addition, by acknowledging the perhaps excessive attention to larger Asian cultural backgrounds (such as Chinese or Japanese cultures) by other scholars (i.e., Canary & Canary, 2013 ), an insightful analysis of the Thai American family within the father-daughter relationship was provided to exemplify, through the work of Punyanunt-Carter ( 2016 ), how specific family communication patterns, such as maintenance relationship communication behaviors, affect the quality of familial relationships. Moreover, a second, special focus was put on Hispanic families because of the demographic trends of the United States, and it was found that familism constitutes a distinctive aspect of these families.

In other words, the third section of this article provided these two examples of intercultural families to observe specific ways that culture mediates the familial system. Because one of the main goals of the present article was to demonstrate the mediating role of culture as an important consideration for family communication issues in the United States, the assimilationist approach was taken into account; thus, the two intercultural family examples discussed here correspond to an assimilationist nature rather than using an intergroup approach.

This decision was made without intending to diminish the value of other cultures or ethnic groups in the country, but an extensive revision of all types of intercultural families is beyond the scope of this article. Second, the assimilationist approach forces one to consider cultures that are in the process of adapting to a new hosting culture, and the Thai and Hispanic families in the United States comply with this theoretical requisite. For example, Whites recognize African Americans as being as American as Whites (i.e., Dovidio, Gluszek, John, Ditlmann, & Lagunes, 2010 ), whereas they associate Hispanics and Latinos with illegal immigration in the United States (Stewart et al., 2011 ), which has been enhanced by the U.S. media repeatedly since 1994 (Valentino et al., 2013 ), and it is still happening (Dixon, 2015 ). In this scenario, “ask yourself what would happen to your own personality if you heard it said over and over again that you were lazy, a simple child of nature, expected to steal, and had inferior blood? . . . One’s reputation, whether false or true, cannot be hammered, hammered, hammered, into one’s head without doing something to one’s character” (Allport, 1979 , p. 142, cited in Arias & Hellmueller, 2016 ).

As a consequence, on this cultural canvas, it should not be surprising that Lichter, Carmalt, and Qian ( 2011 ) found that second-generation Hispanics are increasingly likely to marry foreign-born Hispanics and less likely to marry third-generation or later coethnics or Whites. In addition, this study suggests that third-generation Hispanics and later were more likely than in the past to marry non-Hispanic Whites; thus, the authors concluded that there has been a new retreat from intermarriage among the largest immigrant groups in the United States—Hispanics and Asians—in the last 20 years.

If we subscribe to the idea that cultural assimilation goes in only one direction—from the hegemonic culture to the minority culture—then the results of Lichter, Carmalt, and Qian ( 2011 ) should not be of scholarly concern; however, if we believe that cultural assimilation happens in both directions and intercultural families can benefit both the host and immigrant cultures (for a review, see Schwartz et al., 2013 ), then this is important to address in a country that just elected a president, Donald Trump, who featured statements racially lambasting and segregating minorities, denigrating women, and criticizing immigration as some of the main tenets of his campaign. Therefore, we hope that it is clear why special attention was given to the Thai and Hispanic families in this article, considering the impact of culture on the familial system, marital satisfaction, parental communication, and children’s well-being. Even though individuals with Hispanic ancentry were in the United States even before it became a nation, Hispanic and Latino families are still trying to convince Americans of their right to be accepted in American culture and society.

With regard to the “So what?” question, assimilation is important to consider while analyzing the role of culture in family communication patterns, power dynamics, conflict, or the functioning of the overall family system in the context of the United States. This is because this country is among the most popular in the world in terms of immigration requests, and its demographics show that one out of three citizens comes from an ethnic background other than the hegemonic White culture. In sum, cultural awareness has become pivotal in the analysis of family communication issues in the United States. Furthermore, the present overview of family, communication, and culture ends up supporting the idea of positive associations being derived from the pivotal role of marriage relationship quality, such that coparenting and communication practices vary substantially within intercultural marriages moderated by gender roles.

Culture is a pivotal moderator of these associations, but this analysis needs to be tethered to societal structural level, in which cultural differences, family members’ immigration status, media content, and level of acculturation must be included in family research. This is because in intercultural marriages, in addition to the tremendous parenting role, they have to deal with cultural assimilation and discrimination, and this becomes important if we care about children’s cognitive development and the overall well-being of those who are not considered White. As this article shows, the quality of familial interactions has direct consequences on children’s developmental outcomes (for a review, see Callaghan et al., 2011 ).

Therefore, the structure and functioning of family has an important impact on public health at both physiological and psychological levels (Gage, Everett, & Bullock, 2006 ). At the physiological level, the familial interaction instigates expression and reception of strong feelings affecting tremendously on individuals’ physical health because it activates neuroendocrine responses that aid stress regulation, acting as a stress buffer and accelerating physiological recovery from elevated stress (Floyd & Afifi, 2012 ; Floyd, 2014 ). Robles, Shaffer, Malarkey, and Kiecolt-Glaser ( 2006 ) found that a combination of supportive communication, humor, and problem-solving behavior in husbands predicts their wives’ cortisol and adrenocorticotropic hormone (ACTH)—both physiological factors are considered as stress markers (see 2006 ). On the other hand, the psychology of individuals, the quality of family relationships has major repercussions on cognitive development, as reflected in educational attainment (Sohr-Preston et al., 2013 ), and highly mediated by cultural assimilation (Schwartz et al., 2013 ), which affects individuals through parenting modeling and socialization of values (Mooney-Doyle, Deatrick, & Horowitz, 2014 ).

What Is a Case Study?

Weighing the pros and cons of this method of research

Verywell / Colleen Tighe

Pros and Cons

What Types of Case Studies Are Out There?

Where do you find data for a case study, how do i write a psychology case study.

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

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

While case studies focus on a single individual or group, they follow a format similar to other types of psychology writing. If you are writing a case study, we got you—here are some rules of APA format to reference.

At a Glance

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

What Are the Benefits and Limitations of Case Studies?

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

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

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

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

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

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

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

Case Study Examples

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

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

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

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

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

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

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

The type of case study that psychology researchers use depends on the unique characteristics of the situation and the case itself.

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

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

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

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

Section 1: A Case History

This section will have the following structure and content:

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

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

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

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

Section 2: Treatment Plan

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

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

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

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

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

Need More Tips?

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

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

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

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

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

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

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

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Knowledge Base

Methodology

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

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

Published on May 8, 2019 by Shona McCombes . Revised on November 20, 2023.

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

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

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

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

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

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

Case study examples
Research question	Case study
What are the ecological effects of wolf reintroduction?	Case study of wolf reintroduction in Yellowstone National Park
How do populist politicians use narratives about history to gain support?	Case studies of Hungarian prime minister Viktor Orbán and US president Donald Trump
How can teachers implement active learning strategies in mixed-level classrooms?	Case study of a local school that promotes active learning
What are the main advantages and disadvantages of wind farms for rural communities?	Case studies of three rural wind farm development projects in different parts of the country
How are viral marketing strategies changing the relationship between companies and consumers?	Case study of the iPhone X marketing campaign
How do experiences of work in the gig economy differ by gender, race and age?	Case studies of Deliveroo and Uber drivers in London

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Research bias

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

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The pressing problem on poverty have led the Philippine government to initiate program on poverty alleviation, and one of these programs is the Pantawid Pamilyang Pilipino Program (4Ps). Review of related studies revealed that there is a need to investigate the impact of this program. In this context, this case study was conducted to determine the impact of the 4Ps in terms of poverty reduction, social development, financial management, and livelihood empowerment. Through the use of an aide-mémoire, six (6) beneficiaries and their families were interviewed. Results of thematic analysis of the interview transcripts revealed that 4Ps program provides the families’ basic needs, promotes the families’ well-being, promotes their socioeconomic status, and provides capital for their livelihood. Clearly, the program had positive impact on the lives of the beneficiaries which characterizes the Ilokano phrase ‘Rang-ay Babaen ti 4Ps’ which means the improvement of the quality and status of the...

Bukal Life Journal

Robert H Munson , Bukal Life

Publication of Bukal Life Care & Counseling Center, Baguio City, Philippines. Bukal Life Journal publishes papers and shorter works that relate to Pastoral Care, Pastoral Counseling, and Pastoral Theology

Linnri Castro

Isaiah Carlo S . Cabañero

The House of Families (HoF) at the CAMELEON Family Development Center aims to empower its partner families to foster, care for, and nurture their children. Empowering these families is vital. Through helping parents develop their capabilities in performing their roles and responsibilities towards their children, the intervention helps strengthen relationships and build support systems between and among family members. The HoF generally welcomes all families, regardless of the educational attainment, religious beliefs, or economic status of their members. It targets to involve at least 200 families who may come from the barangays of San Enrique, Passi City, and Bingawan in Iloilo Province. These families belong to poor families in rural areas. Many of them are economically disadvantaged, with fathers working either as farmers or farm laborers in the field for six (6) days a week, for 8 hours per day, while mothers often stay at home to take care of domestic work and in raising their children.

Jonathan Yambao

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Roberta Heale 1 ,
Alison Twycross 2
1 School of Nursing , Laurentian University , Sudbury , Ontario , Canada
2 School of Health and Social Care , London South Bank University , London , UK
Correspondence to Dr Roberta Heale, School of Nursing, Laurentian University, Sudbury, ON P3E2C6, Canada; rheale{at}laurentian.ca

https://doi.org/10.1136/eb-2017-102845

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What is it?

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

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

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

Benefits and limitations of case studies

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

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

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

Examples of case studies

Example 1: nurses’ paediatric pain management practices.

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

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

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

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

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

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

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

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

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

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

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

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

Gustafsson J
Calanzaro M
Sandelowski M

Competing interests None declared.

Provenance and peer review Commissioned; internally peer reviewed.

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http://orcid.org/0000-0003-1141-7613 Sergi Fàbregues 1 and
Michael D Fetters 2
1 Department of Psychology and Education , Universitat Oberta de Catalunya , Barcelona , Spain
2 Department of Family Medicine , University of Michigan , Ann Arbor , Michigan , USA
Correspondence to Dr Sergi Fàbregues, Department of Psychology and Education, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, 08018, Barcelona, Spain; sfabreguesf{at}uoc.edu

The aim of this article is to introduce family medicine researchers to case study research, a rigorous research methodology commonly used in the social and health sciences and only distantly related to clinical case reports. The article begins with an overview of case study in the social and health sciences, including its definition, potential applications, historical background and core features. This is followed by a 10-step description of the process of conducting a case study project illustrated using a case study conducted about a teaching programme executed to teach international family medicine resident learners sensitive examination skills. Steps for conducting a case study include (1) conducting a literature review; (2) formulating the research questions; (3) ensuring that a case study is appropriate; (4) determining the type of case study design; (5) defining boundaries of the case(s) and selecting the case(s); (6) preparing for data collection; (7) collecting and organising the data; (8) analysing the data; (9) writing the case study report; and (10) appraising the quality. Case study research is a highly flexible and powerful research tool available to family medicine researchers for a variety of applications.

Case study research
research design
mixed methods
family practice
primary care
general practice

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

https://doi.org/10.1136/fmch-2018-000074

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Significance statement

Given their potential for answering ‘how’ and ‘why’ questions about complex issues in their natural setting, case study designs are being increasingly used in the health sciences. Conducting a case study can, however, be a complex task because of the possibility of combining multiple methods and the need to choose between different types of case study designs. In order to introduce family medicine and community health researchers to the fundamentals of case study research, this article reviews its definition, potential applications, historical background and main characteristics. It follows on with a practical, step-by-step description of the case study process that will be useful to researchers interested in implementing this research design in their own practice.

Introduction

This article provides family medicine and community health researchers a concise resource to conduct case study research. The article opens with an overview of case study in the social and health sciences, including its definition, potential applications, historical background and core features. This is followed by a 10-step description of the process of conducting a case study project, as described in the literature. These steps are illustrated using a case study about a teaching programme executed to teach international medical learners sensitive examination skills. The article ends with recommendations of useful articles and textbooks on case study research.

Origins of case study research

Case study is a research design that involves an intensive and holistic examination of a contemporary phenomenon in a real-life setting. 1–3 It uses a variety of methods and multiple data sources to explore, describe or explain a single case bounded in time and place (ie, an event, individual, group, organisation or programme). A distinctive feature of case study is its focus on the particular characteristics of the case being studied and the contextual aspects, relationships and processes influencing it. 4 Here we do not include clinical case reports as these are beyond the scope of this article. While distantly related to clinical case reports commonly used to report unusual clinical case presentations or findings, case study is a research approach that is frequently used in the social sciences and health sciences. In contrast to other research designs, such as surveys or experiments, a key strength of case study is that it allows the researcher to adopt a holistic approach—rather than an isolated approach—to the study of social phenomena. As argued by Yin, 3 case studies are particularly suitable for answering ‘how’ research questions (ie, how a treatment was received) as well as ‘why’ research questions (ie, why the treatment produced the observed outcomes).

Given its potential for understanding complex processes as they occur in their natural setting, case study increasingly is used in a wide range of health-related disciplines and fields, including medicine, 5 nursing, 6 health services research 1 and health communication. 7 With regard to clinical practice and research, a number of authors 1 5 8 have highlighted how insights gained from case study designs can be used to describe patients’ experiences regarding care, explore health professionals’ perceptions regarding a policy change, and understand why medical treatments and complex interventions succeed or fail.

In anthropology and sociology, case study as a research design was introduced as a response to the prevailing view of quantitative research as the primary way of undertaking research. 9 From its beginnings, social scientists saw case study as a method to obtain comprehensive accounts of social phenomena from participants. In addition, it could complement the findings of survey research. Between the 1920s and 1960s, case study became the predominant research approach among the members of the Department of Sociology of the University of Chicago, widely known as ‘The Chicago School’. 10 11 During this period, prominent sociologists, such as Florian Znaniecki, William Thomas, Everett C Hughes and Howard S Becker, undertook a series of innovative case studies (including classical works such as The Polish peasant in Europe and America or Boys in White ), which laid the foundations of case study designs as implemented today.

In the 1970s, case study increasingly was adopted in the USA and UK in applied disciplines and fields, such as education, programme evaluation and public policy research. 12 As a response to the limitations of quasi-experimental designs for undertaking comprehensive programme evaluations, researchers in these disciplines saw in case studies—either alone or in combination with experimental designs—an opportunity to gain additional insights into the outcomes of programme implementation. In the mid-1980s and early 1990s, the case study approach became recognised as having its own ‘logic of design’ (p46). 13 This period coincides with the publication of a considerable number of influential articles 14–16 and textbooks 4 17 18 on case study research.

These publications were instrumental in shaping contemporary case study practice, yet they reflected divergent views about the nature of case study, including how it should be defined, designed and implemented (see Yazan 19 for a comparison of the perspectives of Yin, Merriam and Stake, three leading case study methodologists). What these publications have in common is that case study revolves around four key features.

First, case study examines a specific phenomenon in detail by performing an indepth and intensive analysis of the selected case. The rationale for case study designs, rather than more expansive designs such as surveys, is that the researcher is interested in investigating the particularity of a case, that is, the unique attributes that define an event, individual, group, organisation or programme. 2 Second, case study is conducted in natural settings where people meet, interact and change their perceptions over time. The use of the case study design is a choice in favour of ‘maintaining the naturalness of the research situation and the natural course of events’ (p177). 20

Third, case study assumes that a case under investigation is entangled with the context in which it is embedded. This context entails a number of interconnected processes that cannot be disassociated from the case, but rather are part of the study. The case study researcher is interested in understanding how and why such processes take place and, consequently, uncovering the interactions between a case and its context. Research questions concerning how and why phenomena occur are particularly appropriate in case study research. 3

Fourth, case study encourages the researcher to use a variety of methods and data types in a single study. 20 21 These can be solely qualitative, solely quantitative or a mixture of both. The latter option allows the researcher to gain a more comprehensive understanding of the case and improve the accuracy of the findings. The four above-mentioned key features of case study are shown in table 1 , using the example of a mixed methods case study evaluation. 22

View inline

Key features of case study as presented by Shultz et al 22

There are many potential applications for case study research. While often misconstrued as having only an exploratory role, case study research can be used for descriptive and explanatory research (p7–9). 3 Family medicine and community health researchers can use case study research for evaluating a variety of educational programmes, clinical programmes or community programmes.

Case study illustration from family medicine

In the featured study, Japanese family medicine residents received standardised patient instructor-based training in female breast, pelvic, male genital and prostate examinations as part of an international training collaboration to launch a new family medicine residency programme. 22 From family medicine residents, trainers and staff, the authors collected and analysed data from post-training feedback, semistructured interviews and a web-based questionnaire. While the programme was perceived favourably, they noted barriers to reinforcement in their home training programme, and taboos regarding gender-specific healthcare appear as barriers to implementing a similar programme in the home institution.

A step-by-step description of the process of carrying out a case study

As shown in table 2 and illustrated using the article by Shultz et al , 22 case study research generally includes 10 steps. While commonly conducted in this order, the steps do not always occur linearly as data collection and analysis may occur over several iterations or implemented with a slightly different order.

Ten steps for conducting a case study

Examples of published studies using the four types of case study designs suggested by Yin 3

Step 1. Conduct a literature review

During the literature review, researchers systematically search for publications, select those most relevant to the study’s purpose, critically appraise them and summarise the major themes. The literature review helps researchers ascertain what is and is not known about the phenomenon under study, delineate the scope and research questions of the study, and develop an academic or practical justification for the study. 23

Step 2. Formulate the research questions

Research questions critically define in operational terms what will be researched and how. They focus the study and play a key role in guiding design decisions. Key decisions include the case selection and choice of a case study design most suitable for the study. According to Fraenkel et al , 24 the key attributes of good research questions are (1) feasibility, (2) clarity, (3) significance, (4) connection to previous research identified in the literature and (5) compliance with ethical research standards.

Step 3. Ensure that a case study is appropriate

Before commencing the study, researchers should ensure that case study design embodies the most appropriate strategy for answering the study questions. The above-noted four key features—in depth examination of phenomena, naturalness, a focus on context and the use of a combination of methods—should be reflected in the research questions as well as subsequent design decisions.

Step 4. Determine the type of case study design

Researchers need to choose a specific case study design. Sometimes, researchers may define the case first (step 5), for example, in a programme evaluation, and the case may need to be defined before determining the type. Yin’s 3 typology is based on two dimensions, whether the study will examine a single case or multiple cases, and whether the study will focus on a single or multiple units of analysis. Figure 1 illustrates these four types of design using a hypothetical example of a programme evaluation. Table 3 shows an example of each type from the literature.

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Types of case study designs. 3 21

In type 1 holistic single case design , researchers examine a single programme as the sole unit of analysis. In type 2 embedded single case design , the interest is not exclusively in the programme, but also in its different subunits, including sites, staff and participants. These subunits constitute the range of units of analysis. In type 3 holistic multiple case design , researchers conduct a within and cross-case comparison of two or more programmes, each of which constitutes a single unit of analysis. A major strength of multiple case designs is that they enable researchers to develop an in depth description of each case and to identify patterns of variation and similarity between the cases. Multiple case designs are likely to have stronger internal validity and generate more insightful findings than single case designs. They do this by allowing ‘examination of processes and outcomes across many cases, identification of how individual cases might be affected by different environments, and the specific conditions under which a finding may occur’ (p583). 25 In type 4 embedded multiple case design , a variant of the holistic multiple case design, researchers perform a detailed examination of the subunits of each programme, rather than just examining each case as a whole.

Step 5. Define the boundaries of the case(s) and select the case(s)

Miles et al 26 define a case as ‘a phenomenon of some sort occurring in a bounded context’ (p28). What is and is not the case and how the case fits within its broader context should be explicitly defined. As noted in step 4, this step may occur before choice of the case study type, and the process may actually occur in a back-and-forth fashion. A case can entail an individual, a group, an organisation, an institution or a programme. In this step, researchers delineate the spatial and temporal boundaries of the case, that is, ‘when and where it occurred, and when and what was of interest’ (p390). 9 Aside from ensuring the coherence and consistency of the study, bounding the case ensures that the planned research project is feasible in terms of time and resources. Having access to the case and ensuring ethical research practice are two central considerations in case selection. 1

Step 6. Prepare to collect data

Before beginning the data collection, researchers need a study protocol that describes in detail the methods of data collection. The protocol should emphasise the coherence between the data collection methods and the research questions. According to Yin, 3 a case study protocol should include (1) an overview of the case study, (2) data collection procedures, (3) data collection questions and (4) a guide for the case study report. The protocol should be sufficiently flexible to allow researchers to make changes depending on the context and specific circumstances surrounding each data collection method.

Step 7. Collect and organise the data

While case study is often portrayed as a qualitative approach to research (eg, interviews, focus groups or observations), case study designs frequently rely on multiple data sources, including quantitative data (eg, surveys or statistical databases). A growing number of authors highlight the ways in which the use of mixed methods within case study designs might contribute to developing ‘a more complete understanding of the case’ (p902), 21 shedding light on ‘the complexity of a case’ (p118) 27 or increasing ‘the internal validity of a study’ (p6). 1 Guetterman and Fetters 21 explain how a qualitative case study can also be nested within a mixed methods design (ie, be considered the qualitative component of the design). An interesting strategy for organising multiple data sources is suggested by Yin. 3 He recommends using a case study database in which different data sources (eg, audio files, notes, documents or photographs) are stored for later retrieval or inspection. See guidance from Creswell and Hirose 28 for conducting a survey and qualitative data collection in mixed methods and DeJonckheere 29 on semistructured interviewing.

Step 8. Analyse the data

Bernard and Ryan 30 define data analysis as ‘the search for patterns in data and for ideas that help explain why these patterns are there in the first place’ (p109). Depending on the case study design, analysis of the qualitative and quantitative data can be done concurrently or sequentially. For the qualitative data, the first step of the analysis involves segmenting the data into coding units, ascribing codes to data segments and organising the codes in a coding scheme. 31 Depending on the role of theory in the study, an inductive, data-driven approach can be used where meaning is found in the data, or a deductive, concept-driven approach can be adopted where predefined concepts derived from the literature, or previous research, are used to code the data. 32 The second step involves searching for patterns across codes and subsets of respondents, so major themes are identified to describe, explain or predict the phenomenon under study. Babchuk 33 provides a step-by-step guidance for qualitative analysis in this issue. When conducting a single case study, the within-case analysis yields an in depth, thick description of the case. When the study involves multiple cases, the cross-comparison analysis elicits a description of similarities and divergence between cases and may generate explanations and theoretical predictions regarding other cases. 26

For the quantitative part of the case study, data are entered in statistical software packages for conducting descriptive or inferential analysis. Guetterman 34 provides a step-by-step guidance on basic statistics. In case study designs where both data strands are analysed simultaneously, analytical techniques include pattern matching, explanation building, time-series analysis and creating logic models (p142–167). 3

Step 9. Write the case study report

The case study report should have the following three characteristics. First, the description of the case and its context should be sufficiently comprehensive to allow the reader to understand the complexity of the phenomena under study. 35 Second, the data should be presented in a concise and transparent manner to enable the reader to question, or to re-examine, the findings. 36 Third, the report should be adapted to the interests and needs of its primary audience or audiences (eg, academics, practitioners, policy-makers or funders of research). Yin 3 suggests six formats for organising case study reports, namely linear-analytic, comparative, chronological, theory building, suspense and unsequenced structures. To facilitate case transferability and applicability to other similar contexts, the case study report must include a detailed description of the case.

Step 10. Appraise quality

Although presented as the final step of the case study process, quality appraisal should be considered throughout the study. Multiple criteria and frameworks for appraising the quality of case study research have been suggested in the literature. Yin 3 suggests the following four criteria: construct validity (ie, the extent to which a study accurately measures the concepts that it claims to investigate), internal validity (ie, the strength of the relationship between variables and findings), external validity (ie, the extent to which the findings can be generalised) and reliability (ie, the extent to which the findings can be replicated by other researchers conducting the same study). Yin 37 also suggests using two separate sets of guidelines for conducting case study research and for appraising the quality of case study proposals. Stake 4 presents a 20-item checklist for critiquing case study reports, and Creswell and Poth 38 and Denscombe 39 outline a number of questions to consider. Since these quality frameworks have evolved from different disciplinary and philosophical backgrounds, the researcher’s approach should be coherent with the epistemology of the study. Figure 2 provides a quality appraisal checklist adapted from Creswell and Poth 38 and Denscombe. 39

Checklist for evaluating the quality of a case study. 38 39

The challenges to conducting case study research include rationalising the literature based on literature review, writing the research questions, determining how to bound the case, and choosing among various case study purposes and designs. Factors held in common with other methods include analysing and presenting the findings, particularly with multiple data sources.

Other resources

Resources with more in depth guidance on case study research include Merriam, 17 Stake 4 and Yin. 3 While each reflects a different perspective on case study research, they all provide useful guidance for designing and conducting case studies. Other resources include Creswell and Poth, 38 Swanborn 2 and Tight. 40 For mixed methods case study designs, Creswell and Clark, 27 Guetterman and Fetters, 21 Luck et al , 6 and Plano Clark et al 41 provide guidance. Byrne and Ragin’s 42 The SAGE Handbook of Case-Based Methods and Mills et al ’s 43 Encyclopedia of case study research provide guidance for experienced case study researchers.

Conclusions

Family medicine and community health researchers engage in a wide variety of clinical, educational, research and administrative programmes. Case study research provides a highly flexible and powerful research tool to evaluate rigorously many of these endeavours and disseminate this information.

Acknowledgments

The authors would like to acknowledge the help of Dick Edelstein and Marie-Hélène Paré in editing the final manuscript.

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Contributors SF and MDF conceived and drafted the manuscript, and approved the final version of the manuscript.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Patient consent for publication Not required.

Provenance and peer review Not commissioned; internally peer reviewed.

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Defining Family: A Case Study Activity

Emily Ruehs-Navarro
Sarah Friedman

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Learning Goals and Assessments

Learning Goal(s):

Goal 1: Students will be able to challenge normative definitions of the family.
Goal 2: Identify the various institutions and social groups that define families currently and evaluate how family groups are impacted by these definitions.
Goal 3: Reflect on the importance of defining families and the barriers faced by social groups who do not meet societal definitions of family

Goal Assessment(s):

Assessment 1: Through discussion of case studies, students will identify social groups that consider themselves family, yet do not fall into many definitions..
Assessment 2: Students will create a list of scenarios in which the definition of family is important. They will then identify which institutions have the power to create the definition in each scenario.
Assessment 3: Through small group and class conversations, students will identify how social groups in the case study do or do not have access to resources based on normative definitions of families.

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5 Benefits of Learning Through the Case Study Method

Harvard Business School MBA students learning through the case study method

28 Nov 2023

While several factors make HBS Online unique —including a global Community and real-world outcomes —active learning through the case study method rises to the top.

In a 2023 City Square Associates survey, 74 percent of HBS Online learners who also took a course from another provider said HBS Online’s case method and real-world examples were better by comparison.

Here’s a primer on the case method, five benefits you could gain, and how to experience it for yourself.

Access your free e-book today.

What Is the Harvard Business School Case Study Method?

The case study method , or case method , is a learning technique in which you’re presented with a real-world business challenge and asked how you’d solve it. After working through it yourself and with peers, you’re told how the scenario played out.

HBS pioneered the case method in 1922. Shortly before, in 1921, the first case was written.

“How do you go into an ambiguous situation and get to the bottom of it?” says HBS Professor Jan Rivkin, former senior associate dean and chair of HBS's master of business administration (MBA) program, in a video about the case method . “That skill—the skill of figuring out a course of inquiry to choose a course of action—that skill is as relevant today as it was in 1921.”

Originally developed for the in-person MBA classroom, HBS Online adapted the case method into an engaging, interactive online learning experience in 2014.

In HBS Online courses , you learn about each case from the business professional who experienced it. After reviewing their videos, you’re prompted to take their perspective and explain how you’d handle their situation.

You then get to read peers’ responses, “star” them, and comment to further the discussion. Afterward, you learn how the professional handled it and their key takeaways.

HBS Online’s adaptation of the case method incorporates the famed HBS “cold call,” in which you’re called on at random to make a decision without time to prepare.

“Learning came to life!” said Sheneka Balogun , chief administration officer and chief of staff at LeMoyne-Owen College, of her experience taking the Credential of Readiness (CORe) program . “The videos from the professors, the interactive cold calls where you were randomly selected to participate, and the case studies that enhanced and often captured the essence of objectives and learning goals were all embedded in each module. This made learning fun, engaging, and student-friendly.”

If you’re considering taking a course that leverages the case study method, here are five benefits you could experience.

5 Benefits of Learning Through Case Studies

1. take new perspectives.

The case method prompts you to consider a scenario from another person’s perspective. To work through the situation and come up with a solution, you must consider their circumstances, limitations, risk tolerance, stakeholders, resources, and potential consequences to assess how to respond.

Taking on new perspectives not only can help you navigate your own challenges but also others’. Putting yourself in someone else’s situation to understand their motivations and needs can go a long way when collaborating with stakeholders.

2. Hone Your Decision-Making Skills

Another skill you can build is the ability to make decisions effectively . The case study method forces you to use limited information to decide how to handle a problem—just like in the real world.

Throughout your career, you’ll need to make difficult decisions with incomplete or imperfect information—and sometimes, you won’t feel qualified to do so. Learning through the case method allows you to practice this skill in a low-stakes environment. When facing a real challenge, you’ll be better prepared to think quickly, collaborate with others, and present and defend your solution.

3. Become More Open-Minded

As you collaborate with peers on responses, it becomes clear that not everyone solves problems the same way. Exposing yourself to various approaches and perspectives can help you become a more open-minded professional.

When you’re part of a diverse group of learners from around the world, your experiences, cultures, and backgrounds contribute to a range of opinions on each case.

On the HBS Online course platform, you’re prompted to view and comment on others’ responses, and discussion is encouraged. This practice of considering others’ perspectives can make you more receptive in your career.

“You’d be surprised at how much you can learn from your peers,” said Ratnaditya Jonnalagadda , a software engineer who took CORe.

In addition to interacting with peers in the course platform, Jonnalagadda was part of the HBS Online Community , where he networked with other professionals and continued discussions sparked by course content.

“You get to understand your peers better, and students share examples of businesses implementing a concept from a module you just learned,” Jonnalagadda said. “It’s a very good way to cement the concepts in one's mind.”

4. Enhance Your Curiosity

One byproduct of taking on different perspectives is that it enables you to picture yourself in various roles, industries, and business functions.

“Each case offers an opportunity for students to see what resonates with them, what excites them, what bores them, which role they could imagine inhabiting in their careers,” says former HBS Dean Nitin Nohria in the Harvard Business Review . “Cases stimulate curiosity about the range of opportunities in the world and the many ways that students can make a difference as leaders.”

Through the case method, you can “try on” roles you may not have considered and feel more prepared to change or advance your career .

5. Build Your Self-Confidence

Finally, learning through the case study method can build your confidence. Each time you assume a business leader’s perspective, aim to solve a new challenge, and express and defend your opinions and decisions to peers, you prepare to do the same in your career.

According to a 2022 City Square Associates survey , 84 percent of HBS Online learners report feeling more confident making business decisions after taking a course.

“Self-confidence is difficult to teach or coach, but the case study method seems to instill it in people,” Nohria says in the Harvard Business Review . “There may well be other ways of learning these meta-skills, such as the repeated experience gained through practice or guidance from a gifted coach. However, under the direction of a masterful teacher, the case method can engage students and help them develop powerful meta-skills like no other form of teaching.”

Your Guide to Online Learning Success | Download Your Free E-Book

How to Experience the Case Study Method

If the case method seems like a good fit for your learning style, experience it for yourself by taking an HBS Online course. Offerings span seven subject areas, including:

Business essentials
Leadership and management
Entrepreneurship and innovation
Finance and accounting
Business in society

No matter which course or credential program you choose, you’ll examine case studies from real business professionals, work through their challenges alongside peers, and gain valuable insights to apply to your career.

Are you interested in discovering how HBS Online can help advance your career? Explore our course catalog and download our free guide —complete with interactive workbook sections—to determine if online learning is right for you and which course to take.

About the Author

Where Harris stands on Israel, abortion, climate change, education and the economy

[Editor's note: An earlier version of this story misstated Harris' proposed 2019 climate plan investment levels. The correct estimate is nearly seven times more than Biden's current proposal.]

Vice President Kamala Harris has emerged as the Democratic party’s presidential frontrunner after Joe Biden dropped his reelection bid Sunday.

Most Democrats have backed Harris, who announced her 2024 campaign for president shortly after Biden penned a letter explaining his decision to exit the 2024 race. Depending on who you ask, Harris is viewed as a moderate or a progressive reformer.

A former prosecutor, Harris was elected San Francisco’s district attorney with a “tough on crime” message in 2003 and worked in that role for seven years. She became the state’s attorney general in 2011 and served until 2017, when she was elected to represent California in the U.S. Senate.

Text with USA TODAY: Sign-up now and get answers to all your election questions.

More: Election 2024 live updates: Endorsements rush in for Harris; Trump attacks begin

Harris launched her own unsuccessful presidential campaign at a rally in her hometown of Oakland, California in 2019. She dropped her bid for the White House and joined President Joe Biden’s ticket in August the following year. In 2021, she was sworn in as vice president.

Decades in the public spotlight and on the public record, here is what we know about where Harris stands on key issues:

Foreign Policy

As Biden’s second-in-command, Harris has largely stood behind his foreign policy positions, but there are signs she could be tougher on Israel over the war in Gaza than the president.

Harris has not given reason to believe she will deviate much from Biden on issues relating to China , for example. She is also unlikely to sway from supporting Ukraine. Harris said earlier this year that Russia has committed “crimes against humanity” in Ukraine over the last two years.

Harris has not directly opposed Biden’s staunch support for Israel, but has expressed sympathy for the more than 38,000 Palestinian lives lost during the conflict. She was one of the first high-profile members of his administration to call for an immediate temporary cease-fire in March. She acknowledged the “immense scale of suffering” in Gaza and said the Israel-Hamas war is a “humanitarian catastrophe” for innocent civilians.

Harris’ support for women’s access to abortions has been a focal point of her tenure as the country’s first female vice president. She embarked on a nationwide Reproductive Freedoms Tour earlier this year to draw attention to attacks on abortion access following the Dobbs decision . She attended her first stop in Wisconsin on Jan. 22, the 51st anniversary of Roe v. Wade .

Harris proposed federal protections that would limit state abortion restrictions during her first presidential campaign. Under her proposal, states would need to clear laws regulating abortion with the Department of Justice, which would need to confirm they are constitutional before taking effect, she explained in 2019 .

“How dare these elected leaders believe they are in a better position to tell women what they need, to tell women what is in their best interest?” Harris asked during a visit to a Minnesota Planned Parenthood clinic in March. “We have to be a nation that trusts women.”

Harris has traveled on an Economic Opportunity Tour this summer to defend the Biden administration’s economic policy and attack former President Donald Trump’s economic agenda.

While on tour, she touted legislation passed during Biden’s time in office, including the American Rescue Plan and Inflation Reduction Act . Harris has tried to emphasize that wage increases have outpaced inflation since the pandemic and made the case that Trump has plans to give more tax cuts to the rich.

“Donald Trump gave tax cuts to billionaires,” she said in a June social media post . “President Joe Biden and I are investing in the middle class and making sure billionaires and big corporations pay their fair share.”

The vice president has made clear that climate change is a key issue a Harris administration would seek to address.

While running for president in 2019, she proposed a climate plan with a $10 trillion price tag — nearly seven times more than the $1.6 trillion Biden has invested in addressing the issue. She also called for a ban on fracking.

As a senator, she co-sponsored the Green New Deal , which called for a dramatic increase in the production of renewable fuels, including wind, solar, and hydropower sources. The 10-year mobilization plan pushed for a transition to energy systems less reliant on generating greenhouse gases, which are the primary contributors to climate change.

Harris has been an advocate inside the Biden administration pushing for the president to forgive student loan debt , which became a staple of his domestic policy agenda.

As a senator, she co-sponsored Vermont Sen. Bernie Sanders’ legislation to make two-year college free for all students and waive tuition for middle-class students attending four-year public universities.

At a Pride Month event last year, she criticized Florida’s 2022 “Don’t Say Gay” law banning educators from discussing sexual orientation and gender identity in elementary and middle school classrooms. Shortly after she announced her presidential campaign Sunday, the American Federation of Teachers endorsed Harris.

Rachel Barber is a 2024 election fellow at USA TODAY, focusing on politics and education. Follow her on X, formerly Twitter, at @rachelbarber_

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BMC Med Res Methodol

The case study approach

Sarah crowe.

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

Kathrin Cresswell

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

Ann Robertson

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

Anthony Avery

Aziz sheikh.

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

Introduction

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

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

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

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

Minority ethnic people experience considerably greater morbidity from asthma than the White majority population. Research has shown however that these minority ethnic populations are likely to be under-represented in research undertaken in the UK; there is comparatively less marginalisation in the US.

To investigate approaches to bolster recruitment of South Asians into UK asthma studies through qualitative research with US and UK researchers, and UK community leaders.

Single intrinsic case study

Centred on the issue of recruitment of South Asian people with asthma.

In-depth interviews were conducted with asthma researchers from the UK and US. A supplementary questionnaire was also provided to researchers.

Framework approach.

Barriers to ethnic minority recruitment were found to centre around:

1. The attitudes of the researchers' towards inclusion: The majority of UK researchers interviewed were generally supportive of the idea of recruiting ethnically diverse participants but expressed major concerns about the practicalities of achieving this; in contrast, the US researchers appeared much more committed to the policy of inclusion.

2. Stereotypes and prejudices: We found that some of the UK researchers' perceptions of ethnic minorities may have influenced their decisions on whether to approach individuals from particular ethnic groups. These stereotypes centred on issues to do with, amongst others, language barriers and lack of altruism.

3. Demographic, political and socioeconomic contexts of the two countries: Researchers suggested that the demographic profile of ethnic minorities, their political engagement and the different configuration of the health services in the UK and the US may have contributed to differential rates.

4. Above all, however, it appeared that the overriding importance of the US National Institute of Health's policy to mandate the inclusion of minority ethnic people (and women) had a major impact on shaping the attitudes and in turn the experiences of US researchers'; the absence of any similar mandate in the UK meant that UK-based researchers had not been forced to challenge their existing practices and they were hence unable to overcome any stereotypical/prejudicial attitudes through experiential learning.

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

Health work forces globally are needing to reorganise and reconfigure in order to meet the challenges posed by the increased numbers of people living with long-term conditions in an efficient and sustainable manner. Through studying the introduction of General Practitioners with a Special Interest in respiratory disorders, this study aimed to provide insights into this important issue by focusing on community respiratory service development.

To understand and compare the process of workforce change in respiratory services and the impact on patient experience (specifically in relation to the role of general practitioners with special interests) in a theoretically selected sample of Primary Care Organisations (PCOs), in order to derive models of good practice in planning and the implementation of a broad range of workforce issues.

Multiple-case design of respiratory services in health regions in England and Wales.

Four PCOs.

Face-to-face and telephone interviews, e-mail discussions, local documents, patient diaries, news items identified from local and national websites, national workshop.

Reading, coding and comparison progressed iteratively.

1. In the screening phase of this study (which involved semi-structured telephone interviews with the person responsible for driving the reconfiguration of respiratory services in 30 PCOs), the barriers of financial deficit, organisational uncertainty, disengaged clinicians and contradictory policies proved insurmountable for many PCOs to developing sustainable services. A key rationale for PCO re-organisation in 2006 was to strengthen their commissioning function and those of clinicians through Practice-Based Commissioning. However, the turbulence, which surrounded reorganisation was found to have the opposite desired effect.

2. Implementing workforce reconfiguration was strongly influenced by the negotiation and contest among local clinicians and managers about "ownership" of work and income.

3. Despite the intention to make the commissioning system more transparent, personal relationships based on common professional interests, past work history, friendships and collegiality, remained as key drivers for sustainable innovation in service development.

It was only possible to undertake in-depth work in a selective number of PCOs and, even within these selected PCOs, it was not possible to interview all informants of potential interest and/or obtain all relevant documents. This work was conducted in the early stages of a major NHS reorganisation in England and Wales and thus, events are likely to have continued to evolve beyond the study period; we therefore cannot claim to have seen any of the stories through to their conclusion.

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

Healthcare systems globally are moving from paper-based record systems to electronic health record systems. In 2002, the NHS in England embarked on the most ambitious and expensive IT-based transformation in healthcare in history seeking to introduce electronic health records into all hospitals in England by 2010.

To describe and evaluate the implementation and adoption of detailed electronic health records in secondary care in England and thereby provide formative feedback for local and national rollout of the NHS Care Records Service.

A mixed methods, longitudinal, multi-site, socio-technical collective case study.

Five NHS acute hospital and mental health Trusts that have been the focus of early implementation efforts.

Semi-structured interviews, documentary data and field notes, observations and quantitative data.

Qualitative data were analysed thematically using a socio-technical coding matrix, combined with additional themes that emerged from the data.

1. Hospital electronic health record systems have developed and been implemented far more slowly than was originally envisioned.

2. The top-down, government-led standardised approach needed to evolve to admit more variation and greater local choice for hospitals in order to support local service delivery.

3. A range of adverse consequences were associated with the centrally negotiated contracts, which excluded the hospitals in question.

4. The unrealistic, politically driven, timeline (implementation over 10 years) was found to be a major source of frustration for developers, implementers and healthcare managers and professionals alike.

We were unable to access details of the contracts between government departments and the Local Service Providers responsible for delivering and implementing the software systems. This, in turn, made it difficult to develop a holistic understanding of some key issues impacting on the overall slow roll-out of the NHS Care Record Service. Early adopters may also have differed in important ways from NHS hospitals that planned to join the National Programme for Information Technology and implement the NHS Care Records Service at a later point in time.

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

There is a need to reduce the disease burden associated with iatrogenic harm and considering that healthcare education represents perhaps the most sustained patient safety initiative ever undertaken, it is important to develop a better appreciation of the ways in which undergraduate and newly qualified professionals receive and make sense of the education they receive.
To investigate the formal and informal ways pre-registration students from a range of healthcare professions (medicine, nursing, physiotherapy and pharmacy) learn about patient safety in order to become safe practitioners.
Multi-site, mixed method collective case study.
: Eight case studies (two for each professional group) were carried out in educational provider sites considering different programmes, practice environments and models of teaching and learning.
Structured in phases relevant to the three knowledge contexts:
	Documentary evidence (including undergraduate curricula, handbooks and module outlines), complemented with a range of views (from course leads, tutors and students) and observations in a range of academic settings.

	Policy and management views of patient safety and influences on patient safety education and practice. NHS policies included, for example, implementation of the National Patient Safety Agency's , which encourages organisations to develop an organisational safety culture in which staff members feel comfortable identifying dangers and reporting hazards.

	The cultures to which students are exposed i.e. patient safety in relation to day-to-day working. NHS initiatives included, for example, a hand washing initiative or introduction of infection control measures.


1. Practical, informal, learning opportunities were valued by students. On the whole, however, students were not exposed to nor engaged with important NHS initiatives such as risk management activities and incident reporting schemes.
2. NHS policy appeared to have been taken seriously by course leaders. Patient safety materials were incorporated into both formal and informal curricula, albeit largely implicit rather than explicit.
3. Resource issues and peer pressure were found to influence safe practice. Variations were also found to exist in students' experiences and the quality of the supervision available.
The curriculum and organisational documents collected differed between sites, which possibly reflected gatekeeper influences at each site. The recruitment of participants for focus group discussions proved difficult, so interviews or paired discussions were used as a substitute.

What is a case study?

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

Definitions of a case study

Author	Definition
Stake[ ]	(p.237)
Yin[ , , ]	(Yin 1999 p. 1211, Yin 1994 p. 13)

	•
	• (Yin 2009 p18)
Miles and Huberman[ ]	(p. 25)
Green and Thorogood[ ]	(p. 284)
George and Bennett[ ]	(p. 17)"

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

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

What are case studies used for?

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

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

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

Characteristics	Criticisms	Key references
Involves questioning one's own assumptions taking into account the wider political and social environment.	It can possibly neglect other factors by focussing only on power relationships and may give the researcher a position that is too privileged.	Howcroft and Trauth[ ] Blakie[ ] Doolin[ , ]
Interprets the limiting conditions in relation to power and control that are thought to influence behaviour.		Bloomfield and Best[ ]
Involves understanding meanings/contexts and processes as perceived from different perspectives, trying to understand individual and shared social meanings. Focus is on theory building.	Often difficult to explain unintended consequences and for neglecting surrounding historical contexts	Stake[ ] Doolin[ ]
Involves establishing which variables one wishes to study in advance and seeing whether they fit in with the findings. Focus is often on testing and refining theory on the basis of case study findings.	It does not take into account the role of the researcher in influencing findings.	Yin[ , , ] Shanks and Parr[ ]

How are case studies conducted?

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

Defining the case

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

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

	Clarity: Does the proposal read well?
	Integrity: Do its pieces fit together?
	Attractiveness: Does it pique the reader's interest?
	The case: Is the case adequately defined?
	The issues: Are major research questions identified?
	Data Resource: Are sufficient data sources identified?
	Case Selection: Is the selection plan reasonable?
	Data Gathering: Are data-gathering activities outlined?
	Validation: Is the need and opportunity for triangulation indicated?
	Access: Are arrangements for start-up anticipated?
	Confidentiality: Is there sensitivity to the protection of people?
	Cost: Are time and resource estimates reasonable?

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

Selecting the case(s)

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

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

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

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

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

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

Collecting the data

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

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

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

Analysing, interpreting and reporting case studies

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

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

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

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

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

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

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

Potential pitfalls and mitigating actions when undertaking case study research

Potential pitfall	Mitigating action
Selecting/conceptualising the wrong case(s) resulting in lack of theoretical generalisations	Developing in-depth knowledge of theoretical and empirical literature, justifying choices made
Collecting large volumes of data that are not relevant to the case or too little to be of any value	Focus data collection in line with research questions, whilst being flexible and allowing different paths to be explored
Defining/bounding the case	Focus on related components (either by time and/or space), be clear what is outside the scope of the case
Lack of rigour	Triangulation, respondent validation, the use of theoretical sampling, transparency throughout the research process
Ethical issues	Anonymise appropriately as cases are often easily identifiable to insiders, informed consent of participants
Integration with theoretical framework	Allow for unexpected issues to emerge and do not force fit, test out preliminary explanations, be clear about epistemological positions in advance

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

1. Is this report easy to read?

2. Does it fit together, each sentence contributing to the whole?

3. Does this report have a conceptual structure (i.e. themes or issues)?

4. Are its issues developed in a series and scholarly way?

5. Is the case adequately defined?

6. Is there a sense of story to the presentation?

7. Is the reader provided some vicarious experience?

8. Have quotations been used effectively?

9. Are headings, figures, artefacts, appendices, indexes effectively used?

10. Was it edited well, then again with a last minute polish?

11. Has the writer made sound assertions, neither over- or under-interpreting?

12. Has adequate attention been paid to various contexts?

13. Were sufficient raw data presented?

14. Were data sources well chosen and in sufficient number?

15. Do observations and interpretations appear to have been triangulated?

16. Is the role and point of view of the researcher nicely apparent?

17. Is the nature of the intended audience apparent?

18. Is empathy shown for all sides?

19. Are personal intentions examined?

20. Does it appear individuals were put at risk?

Conclusions

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

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

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

Pre-publication history

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

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

Acknowledgements

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

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Introduction

Origins of case study research

Case study illustration from family medicine

A step-by-step description of the process of carrying out a case study

Step 1. Conduct a literature review

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Step 3. Ensure that a case study is appropriate

Step 4. Determine the type of case study design

Step 5. Define the boundaries of the case(s) and select the case(s)

Step 6. Prepare to collect data

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