Volume 18, No. 1, Art. 19 – January 2017
Case Study Research: Foundations and Methodological Orientations
Helena Harrison, Melanie Birks, Richard Franklin & Jane Mills
Abstract: Over the last forty years, case study research has undergone substantial methodological development. This evolution has resulted in a pragmatic, flexible research approach, capable of providing comprehensive in-depth understanding of a diverse range of issues across a number of disciplines. Change and progress have stemmed from parallel influences of historical transformations in approaches to research and individual researcher's preferences, perspectives, and interpretations of this design. Researchers who have contributed to the development of case study research come from diverse disciplines with different philosophical perspectives, resulting in a variety of definitions and approaches. For the researcher new to using case study, such variety can create a confusing platform for its application. In this article, we explore the evolution of case study research, discuss methodological variations, and summarize key elements with the aim of providing guidance on the available options for researchers wanting to use case study in their work.
Key words: case study; method; methodology; nursing research; qualitative; research design; research
Table of Contents
2. History and Evolution
3. Foundational Concepts
3.1 Definitions and descriptions
3.2 Methodology or method
3.3 Philosophical orientation
3.4 Philosophical variation
3.4.1 YIN: Realist—postpositivist
3.4.2 MERRIAM: Pragmatic constructivist
3.4.3 STAKE: Relativist—constructivist/interpretivist
4. Common Characteristics of Case Study Research
Case study research has grown in reputation as an effective methodology to investigate and understand complex issues in real world settings. Case study designs have been used across a number of disciplines, particularly the social sciences, education, business, law, and health, to address a wide range of research questions. Consequently, over the last 40 years, through the application of a variety of methodological approaches, case study research has undergone substantial development. Change and progress have stemmed from parallel influences from historical approaches to research and individual researcher's preferences, perspectives on, and interpretations of case study research. Central to these variations is the underpinning ontological and epistemological orientations of those involved in the evolution of case study research. Researchers who have contributed to the development of case study research come from diverse disciplines and their philosophical underpinnings have created variety and diversity in approaches used. Consequently, various designs have been proposed for preparing, planning, and conducting case study research with advice on key considerations for achieving success. As a result, while case study research has evolved to be a pragmatic, flexible research approach, the variation in definition, application, validity, and purposefulness can create a confusing platform for its use. 
In this article, we examine each of these issues in turn, with the aim of improving our understanding of case study research and clarifying the requisite tenets to consider when designing a case study. We begin with an overview of the history and evolution of case study research, followed by a discussion of the methodological and philosophical variations found within case study designs. We end with a summary of the common characteristics of case study research and a table that brings together the fundamental elements that we found common in all case study approaches to research. 
2. History and Evolution
Case study research as a strategy for methodological exploration, according to FLYVBJERG (2011) "has been around as long as recorded history" (p.302). Contemporary case study research is said to have its origins in qualitative approaches to research in the disciplines of anthropology, history, psychology, and sociology (MERRIAM, 1998; SIMONS, 2009; STEWART, 2014). Historical examples of case study stem as far back as the early nineteenth century with the biography of Charles DARWIN (STEWART, 2014). Most attribute the origins of case study research to studies undertaken in anthropology and social sciences in the early twentieth century when lengthy, detailed ethnographic studies of individuals and cultures were conducted using this design (JOHANSSON, 2003, MERRIAM, 2009; SIMONS, 2009; STEWART, 2014). Sociologists and anthropologists investigated people's lives, experiences, and how they understood the social and cultural context of their world, with the aim of gaining insight into how individuals interpreted and attributed meaning to their experiences and constructed their worlds (JOHANSSON, 2003; SIMONS, 2009). Such investigations were conducted in the natural setting of those experiences with results presented descriptively or as a narrative (MERRIAM, 2009). The most notable case studies include THOMAS and ZNANIECKI's (1958 [1918-1920]) study of Polish peasants in Europe and America and, the ethnographic work by MALINOWSKI (1913) in the Trobriand Islands in Melanesia that spanned over several years (CRESWELL, HANSON, PLANO CLARK & MORALES, 2007; JOHANSSON, 2003; STEWART, 2014). 
With the emergence and dominance of positivism in science in the late 1940s and 1950s, quantitative methods became a popular focus for the social sciences. As a result, surveys, experiments, and statistical methods anchored in quantitative approaches were favored and considered more rigorous than qualitative designs (JOHANSSON, 2003). The dominance of research using experimental designs continued through the 1960s and 1970s with quantitative empirical results considered to be gold standard evidence. Case studies continued to be used during this time, however usually as a method within quantitative studies or referred to as descriptive research to study a specific phenomenon (MERRIAM, 2009). At the same time, case study research was often criticized for its inability to support generalizability and thus considered to provide limited validity and value as a research design (JOHANSSON, 2003; MERRIAM, 2009; STEWART, 2014). This context led to a philosophical division in research approaches: those supporting positivism and quantitative approaches and those aligned with qualitative methods embedded in constructivist and interpretivist paradigms. 
Antecedents of modern day case study research are most often cited as being conducted in the Chicago School of Sociology between the 1920-1950s (STEWART, 2014). Here, anthropologists practiced their methods on university cultures or by conducting lengthy case studies involving field-based observations of groups with the aim of understanding their social and cultural lives (CRESWELL et al., 2007; JOHANSSON, 2003; STEWART, 2014). Parallel to the use of case studies in anthropology, medicine and disciplines in the social sciences such as sociology, education and political science also embraced case study as a form of inquiry (ANTHONY & JACK, 2009; BROWN, 2008; CRESWELL et al., 2007; GEORGE & BENNETT, 2005; GERRING, 2004; SIMONS, 2009; YIN, 2014). 
A second generation of case study researchers emerged with the advent of grounded theory methodology (GLASER & STRAUSS, 1967). Grounded theory "merged qualitative field study methods from the Chicago School of Sociology with quantitative methods of data analysis" (JOHANSSON, 2003, p.8), resulting in an inductive methodology that used detailed systematic procedures to analyze data. This renewed interest in qualitative methodology led to a revival in the use of case study in a number of disciplines (ANTHONY & JACK, 2009; GEORGE & BENNETT, 2005; JOHANSSON, 2003; MERRIAM, 2009; STAKE, 1995). According to JOHANSSON (2003), Robert YIN followed this progress, and drawing on scientific approaches to research gained from his background in the social sciences, applied experimental logic to naturalistic inquiry, and blended this with qualitative methods, further bridging the methodological gap and strengthening the methodological quality of case study research. He presented a structured process for undertaking case study research where formal propositions or theories guide the research process and are tested as part of the outcome, highlighting his realist approach to qualitative case study research. While still qualitative and inductive, it was deterministic in nature with an emphasis on cause and effect, testing theories, and an apprehension of the truth (BROWN, 2008; YIN, 2014). 
Similarly, the uptake of case study research in the political sciences, particularly during the 1980's and 1990’s, led to a more integrated methodological approach with the aim of theoretical development and testing (GEORGE & BENNETT, 2005). The integration of formal, statistical, and narrative methods in a single study, combined with the use of empirical methods for case selection and causal inference, demonstrated the versatility of case study design and made a significant contribution to its methodological evolution (ibid.). Similarly, case studies in international relations integrated rigorous, standardized methods with statistical and formal methods, including qualitative comparative analysis and process tracing to improve understanding of world politics (BENNETT & ELMAN, 2007; GERRING, 2004; LEVY, 2007). According to GEORGE and BENNETT (2005) "scholars have formalized case study methods more completely and linked them to underlying arguments in the philosophy of science" (p.6). The continued use of case study to understand the complexities of institutions, practices, processes, and relations in politics, has demonstrated the utility of case study for researching complex issues, and testing causal mechanisms that can be applied across varied disciplines. 
Corresponding with these developments, in the 1970's, educational research embraced case study as a way to evaluate curriculum design and innovation (MERRIAM, 2009; SIMONS, 2009; STAKE, 1995). Methods were required that could be used to explore factors such as participants' perspectives and the influence of socio-political contexts on curriculum successes and failures (SIMONS, 2009). Development of case study research in education, focused on the need to determine the impact of educational programs and provide relevant evidence for policy and practice decisions that supported social and educational change in the United Kingdom and the United States (ibid.). The most significant contributors to this field were STAKE (1995, 2006) and MERRIAM (1998, 2009). STAKE (1995), an educational psychologist with an interest in developing program evaluation methods, used a constructivist orientation to case study. This resulted in placing more emphasis on inductive exploration, discovery, and holistic analysis that was presented in thick descriptions of the case. Similarly, MERRIAM (1998, 2009) used case study research to explore and evaluate educational programs. MERRIAM's approach emphasized defining and understanding the case through the products of inquiry and drew on the work of both YIN and STAKE. MERRIAM (2009) described case study research by its characteristics: particularistic, descriptive and heuristic, highlighting the purpose and qualitative nature of case study research, the focus on a specific entity and, the motivation to understand and describe the findings. Similar to STAKE (1995, 2006), MERRIAM (1998, 2009) was not as structured in her approach as YIN (2014), but promoted the use of a theoretical framework or research questions to guide the case study and organized, systematic data collection to manage the process of inquiry. 
Simple in theory yet complex in nature, the planning, preparation and execution of case study research has developed to a point where the continued application of case study research across a number of professions particularly education, health, and social sciences, has provided a unique platform for credible research endeavors. Case study research has grown in sophistication and is viewed as a valid form of inquiry to explore a broad scope of complex issues, particularly when human behavior and social interactions are central to understanding topics of interest (ANTHONY & JACK, 2009; FLYVBJERG, 2011; GEORGE & BENNETT, 2005; LUCK, JACKSON & USHER, 2006; MERRIAM, 2009; STAKE, 2006; YIN, 2014). 
In Figure 1, developed by JOHANSSON (2003) and adapted for this discussion, a summary of the evolution of case study across a timeline dating back to 1600 is displayed. Key contributors to case study research and major contextual influences on its evolution are included. As the figure highlights, early case studies were conducted in the social sciences. With the dominance of logical positivism from the 1940's through to the 1960's and 1970's case study methodology was viewed with skepticism and criticism. The development of grounded theory in the 1960's led to a resurgence in case study research, with its application in the social sciences, education, and the humanities. Over the last 50 years, case study has been re-established as a credible, valid research design that facilitates the exploration of complex issues.
Figure 1: The history and evolution of case study research (JOHANSSON, 2003, p.7) 
3. Foundational Concepts
While over time the contributions of researchers from varied disciplines have helped to develop and strengthen case study research, the variety of disciplinary backgrounds has also added complexity, particularly around how case study research is defined, described, and applied in practice. In the sections that follow, the nature of this complexity in explored. 
3.1 Definitions and descriptions
There are a number of definitions and descriptions presented across the literature, which can create confusion when attempting to understand case study research. The most common definitions come from the work of YIN (2014), STAKE (1995), and MERRIAM (2009). YIN's two-part definition (2014) focuses on the scope, process, and methodological characteristics of case study research, emphasizing the nature of inquiry as being empirical, and the importance of context to the case. On the other hand, STAKE (1995) takes a more flexible stance and while concerned with rigor in the processes, maintains a focus on what is studied (the case) rather than how it is studied (the method). For STAKE case study research is "the study of the particularity and complexity of a single case, coming to understand its activity within important circumstances" (p.xi). MERRIAM (2009) includes what is studied and the products of the research when defining case study as: "... an in depth description and analysis of a bounded system" (p.40). Like STAKE, MERRIAM emphasizes the defining feature of case study research as being the object of the study (the bounded system; i.e., the case) adding that case study research focuses on a particular thing and that the product of an investigation should be descriptive and heuristic in nature. In discussing the proliferation of definitions (and subsequent confusion), FLYVBJERG (2011) contends that using a simple definition might be a more useful approach, citing the MERRIAM-WEBSTER DICTIONARY's (2009) definition, as an example that captures the key requisites in the context of research: "an intensive analysis of an individual unit (as a person or community) stressing developmental factors in relation to environment" (p.103). These varied definitions stem from the researchers' differing approaches to developing case study methodology and often reflect the elements they emphasize as central to their designs. The diversity of approaches subsequently adds diversity to definition and description. 
3.2 Methodology or method
A further challenge to understanding case study research relates to it being referred to and used as both a methodology and a method. MILLS (2014) distinguishes methods as procedures and techniques employed in the study, while methodology is the lens through which the researcher views and makes decisions about the study. Given the variation in definitions and descriptions, referring to case study research as a methodology and/or a single method can be perplexing, misleading, and at times counterproductive (ANTHONY & JACK, 2009; BOBLIN, IRELAND, KIRKPATRICK & ROBERTSON, 2013; FLYVBJERG, 2011). Furthermore, advocates of case study encourage the use of both quantitative and qualitative methods within their designs adding further obscurity to the question of methodology (MERRIAM, 1998; STAKE, 1995; STEWART, 2014; YIN, 2014). 
The ambiguity about case study being either or both a methodology and method, is compounded by the terminology used in discussions about case study. Across the literature, case study is referred to as a methodology and a method, an approach, research and research design, research strategy, and/or a form of inquiry (ANTHONY & JACK, 2009; BROWN, 2008; CRESWELL, 2014; GERRING, 2004; MERRIAM, 2009; SIMONS, 2009, STAKE, 1995, 2006; STEWART, 2014; YIN, 2014). Often these terms are used interchangeably without definitional clarity. For example, YIN (2014) discusses case study research and in the context of presenting case study, refers to it as a research method while emphasizing the procedures used. He does not use the terms methodology or strategy. CRESWELL (2014) refers to case studies as a qualitative design, while others use the term case study (FLYVBJERG, 2011; STAKE, 1995, 2006; STEWART, 2014), qualitative case study (MERRIAM, 2009), or describe case study as an approach (SIMONS, 2009). This mixed use of terminology is confusing given the definitional separations between methodology and methods and the varied application of case study in research endeavors. 
Prominent case study researchers do however emphasize that an overarching methodology shapes a case study design and that multiple sources of data and methods can be used (MERRIAM, 2009; STAKE, 2006; YIN, 2014), thus providing the distinction between the two. This distinction accentuates the need for researchers to describe the particular underpinning methodology adopted and to clarify the alignment of chosen methods used with their philosophical assumptions and their chosen approach. Exploring the philosophical orientation of case study research and variations in different case study approaches can help to clarify these differences, and promote a better understanding of how to apply these principles in practice. 
3.3 Philosophical orientation
Many methodologies are aligned with specific philosophical positions that guide the research process. Case study, however, has a practical versatility in its agnostic approach whereby "it is not assigned to a fixed ontological, epistemological or methodological position" (ROSENBERG & YATES, 2007, p.447). Philosophically, case study research can be orientated from a realist or positivist perspective where the researcher holds the view that there is one single reality, which is independent of the individual and can be apprehended, studied and measured, through to a relativist or interpretivist perspective. A relativist or interpretivist perspective adopts the premises that multiple realities and meanings exist, which depend on and are co-created by the researcher (LINCOLN, LYNHAM & GUBA, 2011; YIN, 2014). This philosophical versatility provides the researcher with the opportunity to decide the methodological orientation used in the conduct of the case study (STEWART, 2014; YIN, 2014). Examples of this choice are discussed later where the philosophical variations of MERRIAM (2009), STAKE (1995), and YIN (2014) are explicated. 
In the context of healthcare research and specifically nursing, LUCK et al. (2006) describe case study research as "a bridge across paradigms" (p.103). As a result, some case study approaches are either quantitatively or qualitatively orientated while others encompass both qualitative and quantitative aims and methods (MERRIAM, 2009; MILES, HUBERMAN & SALDANA, 2014; YIN, 2014). DENZIN and LINCOLN (2011) emphasize the qualitative essence of case study, while acknowledging its evolution and fluidity with regard to accommodating varied ontologies, epistemologies, methodologies, and methods. This ability to accommodate a range of philosophical positions is seen as an advantage whereby case study enables the opportunity to design research that can be specifically tailored to the inherent complexity of the research problem (ANTHONY & JACK, 2009; CASEY & HOUGHTON, 2010; FLYVBJERG, 2011; FARQUHAR, 2012; LUCK et al., 2006; MERRIAM, 2009; STAKE, 2006; YIN, 2014). 
Case study research is most often described as qualitative inquiry (CRESWELL, 2014; DENZIN & LINCOLN, 2011; MERRIAM, 2009; MILES et al., 2014; STAKE, 2006). Qualitative paradigms are broad and can encompass exploratory, explanatory, interpretive, or descriptive aims. Examples include narrative research, phenomenology, grounded theory, and ethnography (DENZIN & LINCOLN, 2011). Each methodology is unique in approach depending on the ontological and epistemological stance, however all stem from the motivation to explore, seek understanding, and establish the meaning of experiences from the perspective of those involved (ibid.; see also MERRIAM, 2009). For this purpose, qualitative researchers can employ a broad scope of methods and interpretative practices in any one study, although they typically include observations, interviews, and analysis of participants' words (DENZIN & LINCOLN, 2011; MERRIAM, 2009). DENZIN and LINCOLN (2011, pp. 8-10) summarize the characteristics of qualitative research into five key attributes:
reducing the use of positivist or post positivist perspectives;
accepting postmodern sensibilities;
capturing the individual's point of view;
examining the constraints of everyday life;
securing rich descriptions. 
These attributes are commonly exemplified in case study research. The fundamental goal of case study research is to conduct an in-depth analysis of an issue, within its context with a view to understand the issue from the perspective of participants (MERRIAM, 2009; SIMONS, 2009; STAKE, 2006, YIN, 2014). Like other forms of qualitative research, the researcher will seek to explore, understand and present the participants' perspectives and get close to them in their natural setting (CRESWELL, 2013). Interaction between participants and the researcher is required to generate data, which is an indication of the researcher's level of connection to and being immersed in the field. Because of this, constructivism and interpretivism commonly permeate the implementation of this research design. Methods used in case study to facilitate achieving the aim of co-constructing data most often include observations, interviews, focus groups, document and artifact analysis (MERRIAM, 2009; SIMONS, 2009; STAKE, 1995; 2006; STEWART, 2014; YIN, 2014). The researcher's perceptions and interpretations become part of the research and as a result, a subjective and interpretive orientation flows throughout the inquiry (CRESWELL, 2014). Subjectivity is openly acknowledged and to manage this, the researcher embraces a reflexive stance within the study, adopting methods such as memoing and journaling that support this position (DENZIN & LINCOLN, 2011; MILES et al., 2014, STAKE, 2006; YIN, 2014). 
3.4 Philosophical variation
In choosing a methodological position, careful consideration of the different case study approaches is required to determine the design that best addresses the aim of the study, and that aligns with the researcher's worldview. The goal of this alignment is to engender coherence between the researcher's philosophical position, their research question, design, and methods to be used in the study (FARQUHAR, 2012; LUCK et al., 2006; STEWART, 2014; YIN, 2014). To assist in understanding and achieving this alignment, the qualitative case study approaches developed by YIN (2014), STAKE (1995) and MERRIAM (1998, 2009) are explored in the following sections. Examples are provided of how these researchers' philosophical orientation influences the application of case study in practice. 
3.4.1 YIN: Realist—postpositivist
YIN (2014) conceptualizes case study research as a form of social science. Post-positivism is evident in how he defines "case study as a form of empirical inquiry" (p.16). YIN himself describes his approach to case study as using a "realist perspective" (p.17) and focuses on maintaining objectivity in the methodological processes within the design. 
Postpositivist qualitative researchers conduct research that embraces the ideals of objectivity and the generalizability of results (ELLINGSON, 2011). The goal of a postpositivist researcher is to use science as a way to apprehend the nature of reality while understanding that all measurement is imperfect. Therefore, emphasis is placed on using multiple methods with triangulation to circumvent errors and understand what is happening in reality as close as possible to the "truth" (LINCOLN et al., 2011). The researcher will often categorize qualitative data to create quantitative data that can then be analyzed using statistical methods. Validity of research results are verified through the scrutiny of others and, as such, adherence to mechanisms that ensure rigor in data collection and analysis is vital. Furthermore, postpositivists accept that everyone is inherently biased in worldviews, which ultimately influence how the methods used are deployed. Interaction with research subjects therefore needs to be minimized and subjectivity managed to avoid biasing the results (ibid.). 
Embedded within YIN's (2014) case study design are the hallmarks of a postpositivist approach to research: seeking rival explanations and falsifying hypotheses, the capability for replication with a multiple case study design, the pursuit of generalizations (if required), minimizing levels of subjectivity, and the use of multiple methods of qualitative and quantitative data collection and analysis. While objectivity is a goal, YIN also recognizes the descriptive and interpretive elements of case study. According to YIN what makes case study research distinct from experimental studies is the case study is investigated in context, examined in its "real world setting" (p.16). Selection of cases is based on the purpose of the research and related to the theoretical propositions about the topic of interest. YIN suggests careful screening in the selection of cases to ensure specific relevance to the issues of interest and the use of replication logic: cases are chosen to produce anticipated contrasting findings (theoretical replication) or similar findings (literal replication). Precision, process, and practicality are core attributes of YIN's approach to case study. Design features are sequentially structured and motivated by empirical application. This positioning reflects the axiology of postpositivism where maintaining intellectual honesty, managing bias, and acknowledging limitations, coupled with meticulous data collection and accurate reporting are critical elements in the conduct of research (KILLAM, 2013; YIN, 2014). 
3.4.2 MERRIAM: Pragmatic constructivist
MERRIAM (1998) maintains a constructivist approach to case study research, whereby the researcher assumes that reality is constructed intersubjectively through meanings and understandings developed socially and experientially. Like YIN (2014), MERRIAM (1998, 2009) asserts that when information is plentiful and concepts abstract, it is important to utilize processes that help interpret, sort, and manage information and that adapt findings to convey clarity and applicability to the results. In this way, MERRIAM's perspective brings forth a pragmatic approach to constructivist inquiry. MERRIAM (2009) acknowledges case study research can use both quantitative and qualitative methods; however, when working on qualitative case studies, methods aimed at generating inductive reasoning and interpretation rather than testing hypothesis take priority. Cases are selected based on the research purpose and question, and for what they could reveal about the phenomenon or topic of interest. The aim is to provide a rich holistic description that illuminates one's understanding of the phenomena (MERRIAM, 1998). Interviews are the most common form of qualitative data collection, although MERRIAM does not stipulate prioritizing a particular method for data collection or analysis, she does emphasize the importance of rigorous procedures to frame the research process. Advocating for careful planning, development, and execution of case study research, MERRIAM (1998, 2009) discusses the pragmatic structures that ensure case study research is manageable, rigorous, credible, and applicable. Processes such as descriptive, thematic and content analysis, and triangulation are significant in ensuring the quality of a study, therefore, methods of data collection and analysis need to be organized and systematized with a detailed chain of evidence (MERRIAM, 2009). Theoretical frameworks or research questions are used and drawn from the literature or discipline (MERRIAM, 1998). According to BROWN (2008), Merriam's style brings forth a practical application of pluralistic strategies that guide pragmatic constructivist research to derive knowledge about an area of inquiry. 
3.4.3 STAKE: Relativist—constructivist/interpretivist
STAKE (1995, 2006) has an approach to case study research that is qualitative and closely aligned with a constructivist and interpretivist orientation. While having a disciplined approach to the process and acknowledging that case study can use quantitative methods, STAKE's approach is underpinned by a strong motivation for discovering meaning and understanding of experiences in context. The role of the researcher in producing this knowledge is critical, and STAKE emphasizes the researcher's interpretive role as essential in the process. An interpretative position views reality as multiple and subjective, based on meanings and understanding. Knowledge generated from the research process is relative to the time and context of the study and the researcher is interactive and participates in the study. In terms of epistemology, STAKE argues that situation shapes activity, experience, and one's interpretation of the case. For STAKE (2006), to understand the case "requires experiencing the activity of the case as it occurs in its context and in its particular situation" (p.2). The researcher attempts to capture her or his interpreted reality of the case, while studying the case situationally enables an examination of the integrated system in which the case unfolds. Similar to YIN (2014) and MERRIAM (2009), a case or cases are selected for what they can reveal about topic of interest and depend on the aim and conditions of the study. A case is selected because it is interesting in itself or can facilitate the understanding of something else; it is instrumental in providing insight on an issue (STAKE, 2006). 
For STAKE, multiple sources and methods of data collection and analysis can be used, however, interviews and observations are the preferred and dominant data collection method. In seeking understanding and meaning, the researcher is positioned with participants as a partner in the discovery and generation of knowledge, where both direct interpretations, and categorical or thematic grouping of findings are used. STAKE (1995) recommends vignettes—episodes of storytelling—to illustrate aspects of the case and thick descriptions to convey findings, a further illustration of his constructivist and interpretivist approach to case study research. 
BROWN (2007) suggests the three approaches used by these seminal researchers rest along a quantitative-qualitative continuum where the postpositivist methodology of YIN (2014) sits at one end, STAKE's interpretivist design (1995, 2006) sits at the other end and MERRIAM (1998, 2009) who as a pragmatic constructivist draws on the elements of both, rests toward the center. BROWN (2008) sums up the influences of each, saying that "case study research is supported by the pragmatic approach of Merriam, informed by the rigour of Yin and enriched by the creative interpretation described by Stake" (p.9). While some may argue that mixing qualitative and quantitative methods could threaten the veracity of the research (BOBLIN et al., 2013; SANDELOWSKI, 2011), MERRIAM's approach demonstrates that when the integrity of the design is robust, methodological flexibility can be accommodated. 
4. Common Characteristics of Case Study Research
Despite variation in the approaches of the different exponents of case study, there are characteristics common to all of them. Case study research is consistently described as a versatile form of qualitative inquiry most suitable for a comprehensive, holistic, and in-depth investigation of a complex issue (phenomena, event, situation, organization, program individual or group) in context, where the boundary between the context and issue is unclear and contains many variables (CRESWELL, 2014; FLYVBJERG, 2011; MERRIAM, 2009; SIMONS, 2009; STAKE, 2006; YIN, 2014). Case study research can be used to study a range of topics and purposes (SIMONS, 2009; STAKE, 2006; STEWART, 2014) however, the essential requisite for employing case study stems from one's motivation to illuminate understanding of complex phenomena (MERRIAM, 2009; STAKE, 2006; YIN, 2014). Primarily exploratory and explanatory in nature, case study is used to gain an understanding of the issue in real life settings and recommended to answer how andwhy or less frequently what research questions (FLYVBJERG, 2011; MERRIAM, 2009; SIMONS, 2009; STAKE, 2006; STEWART, 2014; YIN 2014). 
Defining the case (unit of analysis or object of the study) and bounding the case can be difficult as many points of interest and variables intersect and overlap in case study research. Developing research questions and/or propositions to select the case, identify the focus, and refine the boundaries is recommended to effectively establish these elements in the research design (MERRIAM, 2009; STAKE, 2006; YIN, 2014). Bounding the case is essential to focusing, framing, and managing data collection and analysis. This involves being selective and specific in identifying the parameters of the case including the participant/s, location and/or process to be explored, and establishing the timeframe for investigating the case (MERRIAM, 2009; STAKE, 2006; YIN, 2014). 
The use of multiple methods to collect and analyze data are encouraged and found to be mutually informative in case study research where together they provide a more synergistic and comprehensive view of the issue being studied (FLYVBJERG, 2011; MERRIAM, 2009; STAKE, 2006; YIN, 2014). How the methods are used will vary and depend on the research purpose and design, which is often a variation of a single or multiple case study research design. Interviews and focus groups, observations, and exploring artifacts are most commonly employed to collect and generate data with triangulation of methods and data, however, this is not exclusive. 
The fundamental elements of case study research (Table 1) are evident in the approaches of MERRIAM (2009), STAKE (1995, 2006), and YIN (2014) as well as other case study researchers who have contributed to the development and discussion of case study research (CRESWELL, 2013, 2014; FLYVBJERG, 2011; GEORGE & BENNETT, 2007; MILES et al., 2014; SIMONS, 2009). These elements delineate case study from other forms of research and inform the critical aspects of the research design and execution.
Object of the case study identified as the entity of interest or unit of analysis
Program, individual, group, social situation, organization, event, phenomena, or process
A bounded system
Bounded by time, space, and activity
Encompasses a system of connections
Bounding applies frames to manage contextual variables
Boundaries between the case and context can be blurred
Studied in context
Studied in its real life setting or natural environment
Context is significant to understanding the case
Contextual variables include political, economic, social, cultural, historical, and/or organizational factors
Chosen for intensive analysis of an issue
Fieldwork is intrinsic to the process of the inquiry
Subjectivity a consistent thread—varies in depth and engagement depending on the philosophical orientation of the research, purpose, and methods
Reflexive techniques pivotal to credibility and research process
Selecting the case
Based on the purpose and conditions of the study
Involves decisions about people, settings, events, phenomena, social processes
Scope: single, within case and multiple case sampling
Broad: capture ordinary, unique, varied and/or accessible aspects
Methods: specified criteria, methodical and purposive; replication logic: theoretical or literal replication (YIN, 2014)
Multiple sources of evidence
Multiple sources of evidence for comprehensive depth and breadth of inquiry
Methods of data collection: interviews, observations, focus groups, artifact and document review, questionnaires and/or surveys
Methods of analysis: vary and depend on data collection methods and cases; need to be systematic and rigorous
Triangulation highly valued and commonly employed
Case study design
Descriptive, exploratory, explanatory, illustrative, evaluative
Single or multiple cases
Embedded or holistic (YIN, 2014)
Particularistic, heuristic, descriptive (MERRIAM, 1998, 2009)
Intrinsic, instrumental, and collective (STAKE, 1995, 2006)
Table 1: Case study elements and descriptors 
A final, critical point when conducting case study research is the importance of careful preparation and planning, coupled with the development of a systematic implementation structure (FLYVBJERG, 2011; MERRIAM, 2009; STAKE, 2006; STEWART, 2014; YIN, 2014). As discussed earlier, ensuring the alignment of philosophy and methodology with the research purpose and methods employed underpins a rigorous research process (STEWART, 2014). Clarity in this alignment is fundamental to ensuring the veracity of the research and depends on the design developed. During this process, researchers are encouraged to "logically justify their philosophical position, research design and include a coherent argument for inclusion of varying research methods" (LUCK et al., 2006, p.107). Study propositions, theory, research or issue questions work as a conceptual framework and need to align with the case to guide the design and determine methods of data collection and analysis (STAKE, 2006; STEWART, 2014; YIN, 2014). Maintaining meticulous records and a systematic chain of evidence over the duration of the study is critical; as is being able to access, present and explain procedures supports the ethical integrity and rigor of the research and findings (MERRIAM, 2009; STEWART, 2014; YIN, 2014). Collective alignment of these elements articulates a justifiable framework for the research study and cultivates trustworthiness and the validity, reliability and credibility of the research findings. 
Considering these fundamental elements and common approaches to case study research, the definition from CRESWELL et al. (2007) seems to best capture the full depth and breadth of case study concepts and descriptions. The authors describe case study as "a methodology, a type of design in qualitative research, an object of study and a product of the inquiry" (p.245). They conclude with a definition that collates the hallmarks of key approaches and represents the core features of a case study:
"Case study research is a qualitative approach in which the investigator explores a bounded system (a case) or multiple bounded systems (cases) over time through detailed, in-depth data collection involving multiple sources of information (e.g., observations, interviews, audiovisual material, and documents and reports) and reports a case description and case-based themes" (ibid.). 
Since the 1980's a broad scope of case study approaches have developed. This range accentuates the flexibility of case study research as a distinct form of inquiry that enables comprehensive and in-depth insight into a diverse range of issues across a number of disciplines. While differences exist in some areas, commonalities are evident that can guide the application of a case study research design. Key contributors to the development of case study agree that the focus of a case study is the detailed inquiry of a unit of analysis as a bounded system (the case), over time, within its context. The versatility of case study research to accommodate the researcher's philosophical position presents a unique platform for a range of studies that can generate greater insights into areas of inquiry. With the capacity to tailor approaches, case study designs can address a wide range of questions that ask why, what, and how of an issue and assist researchers to explore, explain, describe, evaluate, and theorize about complex issues in context. Outcomes can lead to an in-depth understanding of behaviors, processes, practices, and relationships in context. Professions including the social sciences, education, health, law, management, business, and urban planning have embraced case study research, demonstrating these outcomes. Ongoing application of and sound debate about the value, validity, and capability of case study research have strengthened the efficacy of case study approaches as powerful forms of qualitative research. 
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Helena HARRISON, MN(Ed) is a PhD candidate in the College of Healthcare Sciences, Division of Tropical Health and Medicine, James Cook University, Australia. Her research interests include undergraduate and postgraduate nurse education with her current study focusing on the practice readiness of new graduate registered nurses in Australia.
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Melanie Birks, PhD is professor and Head of Nursing, Midwifery and Nutrition at James Cook University, Australia. Her research interests are in the areas of accessibility, innovation, relevance and quality in nursing education.
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Richard Franklin, Ph.D. is an associate professor at the College of Public Health, Medical & Veterinary Sciences at James Cook University. Richard's public health projects have explored injury prevention and safety promotion and focused areas of farm safety, rural safety, occupational health and safety, falls, disasters, health promotion, and alcohol and aquatic safety. Richard's research interests include translating evidence into practice, epidemiological, program and product evaluation, surveillance and using mixed methods research for solving real world problems.
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Harrison, Helena; Birks, Melanie; Franklin, Richard & Mills, Jane (2017). Case Study Research: Foundations and Methodological Orientations [34 paragraphs]. Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, 18(1), Art. 19,
Methodology or method? A critical review of qualitative case study reports
Nerida Hyett, PhD Candidate,*Amanda Kenny, Dr, and Virginia Dickson-Swift, Dr
Faculty of Health Sciences, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
*Correspondence: N. Hyett, La Trobe Rural Health School, La Trobe University, P.O. Box 199, Bendigo, Victoria 3550, Australia. E-mail: ua.ude.ebortaL@tteyH.N
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Accepted 2014 Apr 7.
Copyright © 2014 N. Hyett et al.
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Int J Qual Stud Health Well-being. 2014; 9: 10.3402/qhw.v9.23606.
Published online 2014 May 7. doi: 10.3402/qhw.v9.23606
This article has been cited by other articles in PMC.
Despite on-going debate about credibility, and reported limitations in comparison to other approaches, case study is an increasingly popular approach among qualitative researchers. We critically analysed the methodological descriptions of published case studies. Three high-impact qualitative methods journals were searched to locate case studies published in the past 5 years; 34 were selected for analysis. Articles were categorized as health and health services (n=12), social sciences and anthropology (n=7), or methods (n=15) case studies. The articles were reviewed using an adapted version of established criteria to determine whether adequate methodological justification was present, and if study aims, methods, and reported findings were consistent with a qualitative case study approach. Findings were grouped into five themes outlining key methodological issues: case study methodology or method, case of something particular and case selection, contextually bound case study, researcher and case interactions and triangulation, and study design inconsistent with methodology reported. Improved reporting of case studies by qualitative researchers will advance the methodology for the benefit of researchers and practitioners.
Keywords: Case studies, health research, research design, interdisciplinary research, qualitative research, literature review
Case study research is an increasingly popular approach among qualitative researchers (Thomas, 2011). Several prominent authors have contributed to methodological developments, which has increased the popularity of case study approaches across disciplines (Creswell, 2013b; Denzin & Lincoln, 2011b; Merriam, 2009; Ragin & Becker, 1992; Stake, 1995; Yin, 2009). Current qualitative case study approaches are shaped by paradigm, study design, and selection of methods, and, as a result, case studies in the published literature vary. Differences between published case studies can make it difficult for researchers to define and understand case study as a methodology.
Experienced qualitative researchers have identified case study research as a stand-alone qualitative approach (Denzin & Lincoln, 2011b). Case study research has a level of flexibility that is not readily offered by other qualitative approaches such as grounded theory or phenomenology. Case studies are designed to suit the case and research question and published case studies demonstrate wide diversity in study design. There are two popular case study approaches in qualitative research. The first, proposed by Stake (1995) and Merriam (2009), is situated in a social constructivist paradigm, whereas the second, by Yin (2012), Flyvbjerg (2011), and Eisenhardt (1989), approaches case study from a post-positivist viewpoint. Scholarship from both schools of inquiry has contributed to the popularity of case study and development of theoretical frameworks and principles that characterize the methodology.
The diversity of case studies reported in the published literature, and on-going debates about credibility and the use of case study in qualitative research practice, suggests that differences in perspectives on case study methodology may prevent researchers from developing a mutual understanding of practice and rigour. In addition, discussion about case study limitations has led some authors to query whether case study is indeed a methodology (Luck, Jackson, & Usher, 2006; Meyer, 2001; Thomas, 2010; Tight, 2010). Methodological discussion of qualitative case study research is timely, and a review is required to analyse and understand how this methodology is applied in the qualitative research literature. The aims of this study were to review methodological descriptions of published qualitative case studies, to review how the case study methodological approach was applied, and to identify issues that need to be addressed by researchers, editors, and reviewers. An outline of the current definitions of case study and an overview of the issues proposed in the qualitative methodological literature are provided to set the scene for the review.
Definitions of qualitative case study research
Case study research is an investigation and analysis of a single or collective case, intended to capture the complexity of the object of study (Stake, 1995). Qualitative case study research, as described by Stake (1995), draws together “naturalistic, holistic, ethnographic, phenomenological, and biographic research methods” in a bricoleur design, or in his words, “a palette of methods” (Stake, 1995, pp. xi–xii). Case study methodology maintains deep connections to core values and intentions and is “particularistic, descriptive and heuristic” (Merriam, 2009, p. 46).
As a study design, case study is defined by interest in individual cases rather than the methods of inquiry used. The selection of methods is informed by researcher and case intuition and makes use of naturally occurring sources of knowledge, such as people or observations of interactions that occur in the physical space (Stake, 1998). Thomas (2011) suggested that “analytical eclecticism” is a defining factor (p. 512). Multiple data collection and analysis methods are adopted to further develop and understand the case, shaped by context and emergent data (Stake, 1995). This qualitative approach “explores a real-life, contemporary bounded system (a case) or multiple bounded systems (cases) over time, through detailed, in-depth data collection involving multiple sources of information … and reports a case descriptionandcase themes” (Creswell, 2013b, p. 97). Case study research has been defined by the unit of analysis, the process of study, and the outcome or end product, all essentially the case (Merriam, 2009).
The case is an object to be studied for an identified reason that is peculiar or particular. Classification of the case and case selection procedures informs development of the study design and clarifies the research question. Stake (1995) proposed three types of cases and study design frameworks. These include the intrinsic case, the instrumental case, and the collective instrumental case. The intrinsic case is used to understand the particulars of a single case, rather than what it represents. An instrumental case study provides insight on an issue or is used to refine theory. The case is selected to advance understanding of the object of interest. A collective refers to an instrumental case which is studied as multiple, nested cases, observed in unison, parallel, or sequential order. More than one case can be simultaneously studied; however, each case study is a concentrated, single inquiry, studied holistically in its own entirety (Stake, 1995, 1998).
Researchers who use case study are urged to seek out what is common and what is particular about the case. This involves careful and in-depth consideration of the nature of the case, historical background, physical setting, and other institutional and political contextual factors (Stake, 1998). An interpretive or social constructivist approach to qualitative case study research supports a transactional method of inquiry, where the researcher has a personal interaction with the case. The case is developed in a relationship between the researcher and informants, and presented to engage the reader, inviting them to join in this interaction and in case discovery (Stake, 1995). A postpositivist approach to case study involves developing a clear case study protocol with careful consideration of validity and potential bias, which might involve an exploratory or pilot phase, and ensures that all elements of the case are measured and adequately described (Yin, 2009, 2012).
Current methodological issues in qualitative case study research
The future of qualitative research will be influenced and constructed by the way research is conducted, and by what is reviewed and published in academic journals (Morse, 2011). If case study research is to further develop as a principal qualitative methodological approach, and make a valued contribution to the field of qualitative inquiry, issues related to methodological credibility must be considered. Researchers are required to demonstrate rigour through adequate descriptions of methodological foundations. Case studies published without sufficient detail for the reader to understand the study design, and without rationale for key methodological decisions, may lead to research being interpreted as lacking in quality or credibility (Hallberg, 2013; Morse, 2011).
There is a level of artistic license that is embraced by qualitative researchers and distinguishes practice, which nurtures creativity, innovation, and reflexivity (Denzin & Lincoln, 2011b; Morse, 2009). Qualitative research is “inherently multimethod” (Denzin & Lincoln, 2011a, p. 5); however, with this creative freedom, it is important for researchers to provide adequate description for methodological justification (Meyer, 2001). This includes paradigm and theoretical perspectives that have influenced study design. Without adequate description, study design might not be understood by the reader, and can appear to be dishonest or inaccurate. Reviewers and readers might be confused by the inconsistent or inappropriate terms used to describe case study research approach and methods, and be distracted from important study findings (Sandelowski, 2000). This issue extends beyond case study research, and others have noted inconsistencies in reporting of methodology and method by qualitative researchers. Sandelowski (2000, 2010) argued for accurate identification of qualitative description as a research approach. She recommended that the selected methodology should be harmonious with the study design, and be reflected in methods and analysis techniques. Similarly, Webb and Kevern (2000) uncovered inconsistencies in qualitative nursing research with focus group methods, recommending that methodological procedures must cite seminal authors and be applied with respect to the selected theoretical framework. Incorrect labelling using case study might stem from the flexibility in case study design and non-directional character relative to other approaches (Rosenberg & Yates, 2007). Methodological integrity is required in design of qualitative studies, including case study, to ensure study rigour and to enhance credibility of the field (Morse, 2011).
Case study has been unnecessarily devalued by comparisons with statistical methods (Eisenhardt, 1989; Flyvbjerg, 2006, 2011; Jensen & Rodgers, 2001; Piekkari, Welch, & Paavilainen, 2009; Tight, 2010; Yin, 1999). It is reputed to be the “the weak sibling” in comparison to other, more rigorous, approaches (Yin, 2009, p. xiii). Case study is not an inherently comparative approach to research. The objective is not statistical research, and the aim is not to produce outcomes that are generalizable to all populations (Thomas, 2011). Comparisons between case study and statistical research do little to advance this qualitative approach, and fail to recognize its inherent value, which can be better understood from the interpretive or social constructionist viewpoint of other authors (Merriam, 2009; Stake, 1995). Building on discussions relating to “fuzzy” (Bassey, 2001), or naturalistic generalizations (Stake, 1978), or transference of concepts and theories (Ayres, Kavanaugh, & Knafl, 2003; Morse et al., 2011) would have more relevance.
Case study research has been used as a catch-all design to justify or add weight to fundamental qualitative descriptive studies that do not fit with other traditional frameworks (Merriam, 2009). A case study has been a “convenient label for our research—when we ‘can't think of anything ‘better”—in an attempt to give it [qualitative methodology] some added respectability” (Tight, 2010, p. 337). Qualitative case study research is a pliable approach (Merriam, 2009; Meyer, 2001; Stake, 1995), and has been likened to a “curious methodological limbo” (Gerring, 2004, p. 341) or “paradigmatic bridge” (Luck et al., 2006, p. 104), that is on the borderline between postpositivist and constructionist interpretations. This has resulted in inconsistency in application, which indicates that flexibility comes with limitations (Meyer, 2001), and the open nature of case study research might be off-putting to novice researchers (Thomas, 2011). The development of a well-(in)formed theoretical framework to guide a case study should improve consistency, rigour, and trust in studies published in qualitative research journals (Meyer, 2001).
Assessment of rigour
The purpose of this study was to analyse the methodological descriptions of case studies published in qualitative methods journals. To do this we needed to develop a suitable framework, which used existing, established criteria for appraising qualitative case study research rigour (Creswell, 2013b; Merriam, 2009; Stake, 1995). A number of qualitative authors have developed concepts and criteria that are used to determine whether a study is rigorous (Denzin & Lincoln, 2011b; Lincoln, 1995; Sandelowski & Barroso, 2002). The criteria proposed by Stake (1995) provide a framework for readers and reviewers to make judgements regarding case study quality, and identify key characteristics essential for good methodological rigour. Although each of the factors listed in Stake's criteria could enhance the quality of a qualitative research report, in Table I we present an adapted criteria used in this study, which integrates more recent work by Merriam (2009) and Creswell (2013b). Stake's (1995) original criteria were separated into two categories. The first list of general criteria is “relevant for all qualitative research.” The second list, “high relevance to qualitative case study research,” was the criteria that we decided had higher relevance to case study research. This second list was the main criteria used to assess the methodological descriptions of the case studies reviewed. The complete table has been preserved so that the reader can determine how the original criteria were adapted.
Framework for assessing quality in qualitative case study research.
The critical review method described by Grant and Booth (2009) was used, which is appropriate for the assessment of research quality, and is used for literature analysis to inform research and practice. This type of review goes beyond the mapping and description of scoping or rapid reviews, to include “analysis and conceptual innovation” (Grant & Booth, 2009, p. 93). A critical review is used to develop existing, or produce new, hypotheses or models. This is different to systematic reviews that answer clinical questions. It is used to evaluate existing research and competing ideas, to provide a “launch pad” for conceptual development and “subsequent testing” (Grant & Booth, 2009, p. 93).
Qualitative methods journals were located by a search of the 2011 ISI Journal Citation Reports in Social Science, via the database Web of Knowledge (see m.webofknowledge.com). No “qualitative research methods” category existed in the citation reports; therefore, a search of all categories was performed using the term “qualitative.” In Table II, we present the qualitative methods journals located, ranked by impact factor. The highest ranked journals were selected for searching. We acknowledge that the impact factor ranking system might not be the best measure of journal quality (Cheek, Garnham, & Quan, 2006); however, this was the most appropriate and accessible method available.
International Journal of Qualitative Studies on Health and Well-being.
In March 2013, searches of the journals, Qualitative Health Research, Qualitative Research, and Qualitative Inquiry were completed to retrieve studies with “case study” in the abstract field. The search was limited to the past 5 years (1 January 2008 to 1 March 2013). The objective was to locate published qualitative case studies suitable for assessment using the adapted criterion. Viewpoints, commentaries, and other article types were excluded from review. Title and abstracts of the 45 retrieved articles were read by the first author, who identified 34 empirical case studies for review. All authors reviewed the 34 studies to confirm selection and categorization. In Table III, we present the 34 case studies grouped by journal, and categorized by research topic, including health sciences, social sciences and anthropology, and methods research. There was a discrepancy in categorization of one article on pedagogy and a new teaching method published in Qualitative Inquiry (Jorrín-Abellán, Rubia-Avi, Anguita-Martínez, Gómez-Sánchez, & Martínez-Mones, 2008). Consensus was to allocate to the methods category.
Outcomes of search of qualitative methods journals.
In Table III, the number of studies located, and final numbers selected for review have been reported. Qualitative Health Research published the most empirical case studies (n=16). In the health category, there were 12 case studies of health conditions, health services, and health policy issues, all published in Qualitative Health Research. Seven case studies were categorized as social sciences and anthropology research, which combined case study with biography and ethnography methodologies. All three journals published case studies on methods research to illustrate a data collection or analysis technique, methodological procedure, or related issue.
The methodological descriptions of 34 case studies were critically reviewed using the adapted criteria. All articles reviewed contained a description of study methods; however, the length, amount of detail, and position of the description in the article varied. Few studies provided an accurate description and rationale for using a qualitative case study approach. In the 34 case studies reviewed, three described a theoretical framework informed by Stake (1995), two by Yin (2009), and three provided a mixed framework informed by various authors, which might have included both Yin and Stake. Few studies described their case study design, or included a rationale that explained why they excluded or added further procedures, and whether this was to enhance the study design, or to better suit the research question. In 26 of the studies no reference was provided to principal case study authors. From reviewing the description of methods, few authors provided a description or justification of case study methodology that demonstrated how their study was informed by the methodological literature that exists on this approach.
The methodological descriptions of each study were reviewed using the adapted criteria, and the following issues were identified: case study methodology or method; case of something particular and case selection; contextually bound case study; researcher and case interactions and triangulation; and, study design inconsistent with methodology. An outline of how the issues were developed from the critical review is provided, followed by a discussion of how these relate to the current methodological literature.
Case study methodology or method
A third of the case studies reviewed appeared to use a case report method, not case study methodology as described by principal authors (Creswell, 2013b; Merriam, 2009; Stake, 1995; Yin, 2009). Case studies were identified as a case report because of missing methodological detail and by review of the study aims and purpose. These reports presented data for small samples of no more than three people, places or phenomenon. Four studies, or “case reports” were single cases selected retrospectively from larger studies (Bronken, Kirkevold, Martinsen, & Kvigne, 2012; Coltart & Henwood, 2012; Hooghe, Neimeyer, & Rober, 2012; Roscigno et al., 2012). Case reports were not a case of something, instead were a case demonstration or an example presented in a report. These reports presented outcomes, and reported on how the case could be generalized. Descriptions focussed on the phenomena, rather than the case itself, and did not appear to study the case in its entirety.
Case reports had minimal in-text references to case study methodology, and were informed by other qualitative traditions or secondary sources (Adamson & Holloway, 2012; Buzzanell & D'Enbeau, 2009; Nagar-Ron & Motzafi-Haller, 2011). This does not suggest that case study methodology cannot be multimethod, however, methodology should be consistent in design, be clearly described (Meyer, 2001; Stake, 1995), and maintain focus on the case (Creswell, 2013b).
To demonstrate how case reports were identified, three examples are provided. The first, Yeh (2013) described their study as, “the examination of the emergence of vegetarianism in Victorian England serves as a case study to reveal the relationships between boundaries and entities” (p. 306). The findings were a historical case report, which resulted from an ethnographic study of vegetarianism. Cunsolo Willox, Harper, Edge, ‘My Word’: Storytelling and Digital Media Lab, and Rigolet Inuit Community Government (2013) used “a case study that illustrates the usage of digital storytelling within an Inuit community” (p. 130). This case study reported how digital storytelling can be used with indigenous communities as a participatory method to illuminate the benefits of this method for other studies. This “case study was conducted in the Inuit community” but did not include the Inuit community in case analysis (Cunsolo Willox et al., 2013, p. 130). Bronken et al. (2012) provided a single case report to demonstrate issues observed in a larger clinical study of aphasia and stroke, without adequate case description or analysis.
Case study of something particular and case selection
Case selection is a precursor to case analysis, which needs to be presented as a convincing argument (Merriam, 2009). Descriptions of the case were often not adequate to ascertain why the case was selected, or whether it was a particular exemplar or outlier (Thomas, 2011). In a number of case studies in the health and social science categories, it was not explicit whether the case was of something particular, or peculiar to their discipline or field (Adamson & Holloway, 2012; Bronken et al., 2012; Colón-Emeric et al., 2010; Jackson, Botelho, Welch, Joseph, & Tennstedt, 2012; Mawn et al., 2010; Snyder-Young, 2011). There were exceptions in the methods category (Table III), where cases were selected by researchers to report on a new or innovative method. The cases emerged through heuristic study, and were reported to be particular, relative to the existing methods literature (Ajodhia-Andrews & Berman, 2009; Buckley & Waring, 2013; Cunsolo Willox et al., 2013; De Haene, Grietens, & Verschueren, 2010; Gratton & O'Donnell, 2011; Sumsion, 2013; Wimpenny & Savin-Baden, 2012).
Case selection processes were sometimes insufficient to understand why the case was selected from the global population of cases, or what study of this case would contribute to knowledge as compared with other possible cases (Adamson & Holloway, 2012; Bronken et al., 2012; Colón-Emeric et al., 2010; Jackson et al., 2012; Mawn et al., 2010). In two studies, local cases were selected (Barone, 2010; Fourie & Theron, 2012) because the researcher was familiar with and had access to the case. Possible limitations of a convenience sample were not acknowledged. Purposeful sampling was used to recruit participants within the case of one study, but not of the case itself (Gallagher et al., 2013). Random sampling was completed for case selection in two studies (Colón-Emeric et al., 2010; Jackson et al., 2012), which has limited meaning in interpretive qualitative research.
To demonstrate how researchers provided a good justification for the selection of case study approaches, four examples are provided. The first, cases of residential care homes, were selected because of reported occurrences of mistreatment, which included residents being locked in rooms at night (Rytterström, Unosson, & Arman, 2013). Roscigno et al. (2012) selected cases of parents who were admitted for early hospitalization in neonatal intensive care with a threatened preterm delivery before 26 weeks. Hooghe et al. (2012) used random sampling to select 20 couples that had experienced the death of a child; however, the case study was of one couple and a particular metaphor described only by them. The final example, Coltart and Henwood (2012), provided a detailed account of how they selected two cases from a sample of 46 fathers based on personal characteristics and beliefs. They described how the analysis of the two cases would contribute to their larger study on first time fathers and parenting.
Contextually bound case study
The limits or boundaries of the case are a defining factor of case study methodology (Merriam, 2009; Ragin & Becker, 1992; Stake, 1995; Yin, 2009). Adequate contextual description is required to understand the setting or context in which the case is revealed. In the health category, case studies were used to illustrate a clinical phenomenon or issue such as compliance and health behaviour (Colón-Emeric et al., 2010; D'Enbeau, Buzzanell, & Duckworth, 2010; Gallagher et al., 2013; Hooghe et al., 2012; Jackson et al., 2012; Roscigno et al., 2012). In these case studies, contextual boundaries, such as physical and institutional descriptions, were not sufficient to understand the case as a holistic system, for example, the general practitioner (GP) clinic in Gallagher et al. (2013), or the nursing home in Colón-Emeric et al. (2010). Similarly, in the social science and methods categories, attention was paid to some components of the case context, but not others, missing important information required to understand the case as a holistic system (Alexander, Moreira, & Kumar, 2012; Buzzanell & D'Enbeau, 2009; Nairn & Panelli, 2009; Wimpenny & Savin-Baden, 2012).
In two studies, vicarious experience or vignettes (Nairn & Panelli, 2009) and images (Jorrín-Abellán et al., 2008) were effective to support description of context, and might have been a useful addition for other case studies. Missing contextual boundaries suggests that the case might not be adequately defined. Additional information, such as the physical, institutional, political, and community context, would improve understanding of the case (Stake, 1998). In Boxes 1 and 2, we present brief synopses of two studies that were reviewed, which demonstrated a well bounded case. In Box 1, Ledderer (2011) used a qualitative case study design informed by Stake's tradition. In Box 2, Gillard, Witt, and Watts (2011) were informed by Yin's tradition. By providing a brief outline of the case studies in Boxes 1 and 2, we demonstrate how effective case boundaries can be constructed and reported, which may be of particular interest to prospective case study researchers.
Article synopsis of case study research using Stake's tradition
Ledderer (2011) used a qualitative case study research design, informed by modern ethnography. The study is bounded to 10 general practice clinics in Denmark, who had received federal funding to implement preventative care services based on a Motivational Interviewing intervention. The researcher question focussed on “why is it so difficult to create change in medical practice?” (Ledderer, 2011, p. 27). The study context was adequately described, providing detail on the general practitioner (GP) clinics and relevant political and economic influences. Methodological decisions are described in first person narrative, providing insight on researcher perspectives and interaction with the case. Forty-four interviews were conducted, which focussed on how GPs conducted consultations, and the form, nature and content, rather than asking their opinion or experience (Ledderer, 2011, p. 30). The duration and intensity of researcher immersion in the case enhanced depth of description and trustworthiness of study findings. Analysis was consistent with Stake's tradition, and the researcher provided examples of inquiry techniques used to challenge assumptions about emerging themes. Several other seminal qualitative works were cited. The themes and typology constructed are rich in narrative data and storytelling by clinic staff, demonstrating individual clinic experiences as well as shared meanings and understandings about changing from a biomedical to psychological approach to preventative health intervention. Conclusions make note of social and cultural meanings and lessons learned, which might not have been uncovered using a different methodology.
Article synopsis of case study research using Yin's tradition
Gillard et al. (2011) study of camps for adolescents living with HIV/AIDs provided a good example of Yin's interpretive case study approach. The context of the case is bounded by the three summer camps of which the researchers had prior professional involvement. A case study protocol was developed that used multiple methods to gather information at three data collection points coinciding with three youth camps (Teen Forum, Discover Camp, and Camp Strong). Gillard and colleagues followed Yin's (2009) principles, using a consistent data protocol that enhanced cross-case analysis. Data described the young people, the camp physical environment, camp schedule, objectives and outcomes, and the staff of three youth camps. The findings provided a detailed description of the context, with less detail of individual participants, including insight into researcher's interpretations and methodological decisions throughout the data collection and analysis process. Findings provided the reader with a sense of “being there,” and are discovered through constant comparison of the case with the research issues; the case is the unit of analysis. There is evidence of researcher immersion in the case, and Gillard reports spending significant time in the field in a naturalistic and integrated youth mentor role.
This case study is not intended to have a significant impact on broader health policy, although does have implications for health professionals working with adolescents. Study conclusions will inform future camps for young people with chronic disease, and practitioners are able to compare similarities between this case and their own practice (for knowledge translation). No limitations of this article were reported. Limitations related to publication of this case study were that it was 20 pages long and used three tables to provide sufficient description of the camp and program components, and relationships with the research issue.
Researcher and case interactions and triangulation
Researcher and case interactions and transactions are a defining feature of case study methodology (Stake, 1995). Narrative stories, vignettes, and thick description are used to provoke vicarious experience and a sense of being there with the researcher in their interaction with the case. Few of the case studies reviewed provided details of the researcher's relationship with the case, researcher–case interactions, and how these influenced the development of the case study (Buzzanell & D'Enbeau, 2009; D'Enbeau et al., 2010; Gallagher et al., 2013; Gillard et al., 2011; Ledderer, 2011; Nagar-Ron & Motzafi-Haller, 2011). The role and position of the researcher needed to be self-examined and understood by readers, to understand how this influenced interactions with participants, and to determine what triangulation is needed (Merriam, 2009; Stake, 1995).
Gillard et al. (2011) provided a good example of triangulation, comparing data sources in a table (p. 1513). Triangulation of sources was used to reveal as much depth as possible in the study by Nagar-Ron and Motzafi-Haller (2011), while also enhancing confirmation validity. There were several case studies that would have benefited from improved range and use of data sources, and descriptions of researcher–case interactions (Ajodhia-Andrews & Berman, 2009; Bronken et al., 2012; Fincham, Scourfield, & Langer, 2008; Fourie & Theron, 2012; Hooghe et al., 2012; Snyder-Young, 2011; Yeh, 2013).
Study design inconsistent with methodology
Good, rigorous case studies require a strong methodological justification (Meyer, 2001) and a logical and coherent argument that defines paradigm, methodological position, and selection of study methods (Denzin & Lincoln, 2011b). Methodological justification was insufficient in several of the studies reviewed (Barone, 2010; Bronken et al., 2012; Hooghe et al., 2012; Mawn et al., 2010; Roscigno et al., 2012; Yeh, 2013). This was judged by the absence, or inadequate or inconsistent reference to case study methodology in-text.
In six studies, the methodological justification provided did not relate to case study. There were common issues identified. Secondary sources were used as primary methodological references indicating that study design might not have been theoretically sound (Colón-Emeric et al., 2010; Coltart & Henwood, 2012; Roscigno et al., 2012; Snyder-Young, 2011). Authors and sources cited in methodological descriptions were inconsistent with the actual study design and practices used (Fourie & Theron, 2012; Hooghe et al., 2012; Jorrín-Abellán et al., 2008; Mawn et al., 2010; Rytterström et al., 2013; Wimpenny & Savin-Baden, 2012). This occurred when researchers cited Stake or Yin, or both (Mawn et al., 2010; Rytterström et al., 2013), although did not follow their paradigmatic or methodological approach. In 26 studies there were no citations for a case study methodological approach.
The findings of this study have highlighted a number of issues for researchers. A considerable number of case studies reviewed were missing key elements that define qualitative case study methodology and the tradition cited. A significant number of studies did not provide a clear methodological description or justification relevant to case study. Case studies in health and social sciences did not provide sufficient information for the reader to understand case selection, and why this case was chosen above others. The context of the cases were not described in adequate detail to understand all relevant elements of the case context, which indicated that cases may have not been contextually bounded. There were inconsistencies between reported methodology, study design, and paradigmatic approach in case studies reviewed, which made it difficult to understand the study methodology and theoretical foundations. These issues have implications for methodological integrity and honesty when reporting study design, which are values of the qualitative research tradition and are ethical requirements (Wager & Kleinert, 2010a). Poorly described methodological descriptions may lead the reader to misinterpret or discredit study findings, which limits the impact of the study, and, as a collective, hinders advancements in the broader qualitative research field.
The issues highlighted in our review build on current debates in the case study literature, and queries about the value of this methodology. Case study research can be situated within different paradigms or designed with an array of methods. In order to maintain the creativity and flexibility that is valued in this methodology, clearer descriptions of paradigm and theoretical position and methods should be provided so that study findings are not undervalued or discredited. Case study research is an interdisciplinary practice, which means that clear methodological descriptions might be more important for this approach than other methodologies that are predominantly driven by fewer disciplines (Creswell, 2013b).
Authors frequently omit elements of methodologies and include others to strengthen study design, and we do not propose a rigid or purist ideology in this paper. On the contrary, we encourage new ideas about using case study, together with adequate reporting, which will advance the value and practice of case study. The implications of unclear methodological descriptions in the studies reviewed were that study design appeared to be inconsistent with reported methodology, and key elements required for making judgements of rigour were missing. It was not clear whether the deviations from methodological tradition were made by researchers to strengthen the study design, or because of misinterpretations. Morse (2011) recommended that innovations and deviations from practice are best made by experienced researchers, and that a novice might be unaware of the issues involved with making these changes. To perpetuate the tradition of case study research, applications in the published literature should have consistencies with traditional methodological constructions, and deviations should be described with a rationale that is inherent in study conduct and findings. Providing methodological descriptions that demonstrate a strong theoretical foundation and coherent study design will add credibility to the study, while ensuring the intrinsic meaning of case study is maintained.
The value of this review is that it contributes to discussion of whether case study is a methodology or method. We propose possible reasons why researchers might make this misinterpretation. Researchers may interchange the terms methods and methodology, and conduct research without adequate attention to epistemology and historical tradition (Carter & Little, 2007; Sandelowski, 2010). If the rich meaning that naming a qualitative methodology brings to the study is not recognized, a case study might appear to be inconsistent with the traditional approaches described by principal authors (Creswell, 2013a; Merriam, 2009; Stake, 1995; Yin, 2009). If case studies are not methodologically and theoretically situated, then they might appear to be a case report.
Case reports are promoted by university and medical journals as a method of reporting on medical or scientific cases; guidelines for case reports are publicly available on websites (http://www.hopkinsmedicine.org/institutional_review_board/guidelines_policies/guidelines/case_report.html). The various case report guidelines provide a general criteria for case reports, which describes that this form of report does not meet the criteria of research, is used for retrospective analysis of up to three clinical cases, and is primarily illustrative and for educational purposes. Case reports can be published in academic journals, but do not require approval from a human research ethics committee. Traditionally, case reports describe a single case, to explain how and what occurred in a selected setting, for example, to illustrate a new phenomenon that has emerged from a larger study. A case report is not necessarily particular or the study of a case in its entirety, and the larger study would usually be guided by a different research methodology.
This description of a case report is similar to what was provided in some studies reviewed. This form of report lacks methodological grounding and qualities of research rigour. The case report has publication value in demonstrating an example and for dissemination of knowledge (Flanagan, 1999). However, case reports have different meaning and purpose to case study, which needs to be distinguished. Findings of our review suggest that the medical understanding of a case report has been confused with qualitative case study approaches.
In this review, a number of case studies did not have methodological descriptions that included key characteristics of case study listed in the adapted criteria, and several issues have been discussed. There have been calls for improvements in publication quality of qualitative research (Morse, 2011), and for improvements in peer review of submitted manuscripts (Carter & Little, 2007; Jasper, Vaismoradi, Bondas, & Turunen, 2013). The challenging nature of editor and reviewers responsibilities are acknowledged in the literature (Hames, 2013; Wager & Kleinert, 2010b); however, review of case study methodology should be prioritized because of disputes on methodological value.
Authors using case study approaches are recommended to describe their theoretical framework and methods clearly, and to seek and follow specialist methodological advice when needed (Wager & Kleinert, 2010a). Adequate page space for case study description would contribute to better publications (Gillard et al., 2011). Capitalizing on the ability to publish complementary resources should be considered.
Limitations of the review
There is a level of subjectivity involved in this type of review and this should be considered when interpreting study findings. Qualitative methods journals were selected because the aims and scope of these journals are to publish studies that contribute to methodological discussion and development of qualitative research. Generalist health and social science journals were excluded that might have contained good quality case studies. Journals in business or education were also excluded, although a review of case studies in international business journals has been published elsewhere (Piekkari et al., 2009).
The criteria used to assess the quality of the case studies were a set of qualitative indicators. A numerical or ranking system might have resulted in different results. Stake's (1995) criteria have been referenced elsewhere, and was deemed the best available (Creswell, 2013b; Crowe et al., 2011). Not all qualitative studies are reported in a consistent way and some authors choose to report findings in a narrative form in comparison to a typical biomedical report style (Sandelowski & Barroso, 2002), if misinterpretations were made this may have affected the review.
Case study research is an increasingly popular approach among qualitative researchers, which provides methodological flexibility through the incorporation of different paradigmatic positions, study designs, and methods. However, whereas flexibility can be an advantage, a myriad of different interpretations has resulted in critics questioning the use of case study as a methodology. Using an adaptation of established criteria, we aimed to identify and assess the methodological descriptions of case studies in high impact, qualitative methods journals. Few articles were identified that applied qualitative case study approaches as described by experts in case study design. There were inconsistencies in methodology and study design, which indicated that researchers were confused whether case study was a methodology or a method. Commonly, there appeared to be confusion between case studies and case reports. Without clear understanding and application of the principles and key elements of case study methodology, there is a risk that the flexibility of the approach will result in haphazard reporting, and will limit its global application as a valuable, theoretically supported methodology that can be rigorously applied across disciplines and fields.
Conflict of interest and funding
The authors have not received any funding or benefits from industry or elsewhere to conduct this study.
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