case study method and

The Ultimate Guide to Qualitative Research - Part 1: The Basics

• Introduction and overview
• What is qualitative research?
• What is qualitative data?
• Examples of qualitative data
• Qualitative vs. quantitative research
• Mixed methods
• Qualitative research preparation
• Theoretical perspective
• Theoretical framework
• Literature reviews

Research question

• Conceptual framework
• Conceptual vs. theoretical framework

Data collection

• Qualitative research methods
• Focus groups
• Observational research

What is a case study?

Applications for case study research, what is a good case study, process of case study design, benefits and limitations of case studies.

• Ethnographical research
• Ethical considerations
• Confidentiality and privacy
• Power dynamics
• Reflexivity

Case studies

Case studies are essential to qualitative research , offering a lens through which researchers can investigate complex phenomena within their real-life contexts. This chapter explores the concept, purpose, applications, examples, and types of case studies and provides guidance on how to conduct case study research effectively.

Whereas quantitative methods look at phenomena at scale, case study research looks at a concept or phenomenon in considerable detail. While analyzing a single case can help understand one perspective regarding the object of research inquiry, analyzing multiple cases can help obtain a more holistic sense of the topic or issue. Let's provide a basic definition of a case study, then explore its characteristics and role in the qualitative research process.

Definition of a case study

A case study in qualitative research is a strategy of inquiry that involves an in-depth investigation of a phenomenon within its real-world context. It provides researchers with the opportunity to acquire an in-depth understanding of intricate details that might not be as apparent or accessible through other methods of research. The specific case or cases being studied can be a single person, group, or organization – demarcating what constitutes a relevant case worth studying depends on the researcher and their research question .

Among qualitative research methods , a case study relies on multiple sources of evidence, such as documents, artifacts, interviews , or observations , to present a complete and nuanced understanding of the phenomenon under investigation. The objective is to illuminate the readers' understanding of the phenomenon beyond its abstract statistical or theoretical explanations.

Characteristics of case studies

Case studies typically possess a number of distinct characteristics that set them apart from other research methods. These characteristics include a focus on holistic description and explanation, flexibility in the design and data collection methods, reliance on multiple sources of evidence, and emphasis on the context in which the phenomenon occurs.

Furthermore, case studies can often involve a longitudinal examination of the case, meaning they study the case over a period of time. These characteristics allow case studies to yield comprehensive, in-depth, and richly contextualized insights about the phenomenon of interest.

The role of case studies in research

Case studies hold a unique position in the broader landscape of research methods aimed at theory development. They are instrumental when the primary research interest is to gain an intensive, detailed understanding of a phenomenon in its real-life context.

In addition, case studies can serve different purposes within research - they can be used for exploratory, descriptive, or explanatory purposes, depending on the research question and objectives. This flexibility and depth make case studies a valuable tool in the toolkit of qualitative researchers.

Remember, a well-conducted case study can offer a rich, insightful contribution to both academic and practical knowledge through theory development or theory verification, thus enhancing our understanding of complex phenomena in their real-world contexts.

What is the purpose of a case study?

Case study research aims for a more comprehensive understanding of phenomena, requiring various research methods to gather information for qualitative analysis . Ultimately, a case study can allow the researcher to gain insight into a particular object of inquiry and develop a theoretical framework relevant to the research inquiry.

Why use case studies in qualitative research?

Using case studies as a research strategy depends mainly on the nature of the research question and the researcher's access to the data.

Conducting case study research provides a level of detail and contextual richness that other research methods might not offer. They are beneficial when there's a need to understand complex social phenomena within their natural contexts.

The explanatory, exploratory, and descriptive roles of case studies

Case studies can take on various roles depending on the research objectives. They can be exploratory when the research aims to discover new phenomena or define new research questions; they are descriptive when the objective is to depict a phenomenon within its context in a detailed manner; and they can be explanatory if the goal is to understand specific relationships within the studied context. Thus, the versatility of case studies allows researchers to approach their topic from different angles, offering multiple ways to uncover and interpret the data .

The impact of case studies on knowledge development

Case studies play a significant role in knowledge development across various disciplines. Analysis of cases provides an avenue for researchers to explore phenomena within their context based on the collected data.

This can result in the production of rich, practical insights that can be instrumental in both theory-building and practice. Case studies allow researchers to delve into the intricacies and complexities of real-life situations, uncovering insights that might otherwise remain hidden.

Types of case studies

In qualitative research , a case study is not a one-size-fits-all approach. Depending on the nature of the research question and the specific objectives of the study, researchers might choose to use different types of case studies. These types differ in their focus, methodology, and the level of detail they provide about the phenomenon under investigation.

Understanding these types is crucial for selecting the most appropriate approach for your research project and effectively achieving your research goals. Let's briefly look at the main types of case studies.

Exploratory case studies

Exploratory case studies are typically conducted to develop a theory or framework around an understudied phenomenon. They can also serve as a precursor to a larger-scale research project. Exploratory case studies are useful when a researcher wants to identify the key issues or questions which can spur more extensive study or be used to develop propositions for further research. These case studies are characterized by flexibility, allowing researchers to explore various aspects of a phenomenon as they emerge, which can also form the foundation for subsequent studies.

Descriptive case studies

Descriptive case studies aim to provide a complete and accurate representation of a phenomenon or event within its context. These case studies are often based on an established theoretical framework, which guides how data is collected and analyzed. The researcher is concerned with describing the phenomenon in detail, as it occurs naturally, without trying to influence or manipulate it.

Explanatory case studies

Explanatory case studies are focused on explanation - they seek to clarify how or why certain phenomena occur. Often used in complex, real-life situations, they can be particularly valuable in clarifying causal relationships among concepts and understanding the interplay between different factors within a specific context.

Intrinsic, instrumental, and collective case studies

These three categories of case studies focus on the nature and purpose of the study. An intrinsic case study is conducted when a researcher has an inherent interest in the case itself. Instrumental case studies are employed when the case is used to provide insight into a particular issue or phenomenon. A collective case study, on the other hand, involves studying multiple cases simultaneously to investigate some general phenomena.

Each type of case study serves a different purpose and has its own strengths and challenges. The selection of the type should be guided by the research question and objectives, as well as the context and constraints of the research.

The flexibility, depth, and contextual richness offered by case studies make this approach an excellent research method for various fields of study. They enable researchers to investigate real-world phenomena within their specific contexts, capturing nuances that other research methods might miss. Across numerous fields, case studies provide valuable insights into complex issues.

Critical information systems research

Case studies provide a detailed understanding of the role and impact of information systems in different contexts. They offer a platform to explore how information systems are designed, implemented, and used and how they interact with various social, economic, and political factors. Case studies in this field often focus on examining the intricate relationship between technology, organizational processes, and user behavior, helping to uncover insights that can inform better system design and implementation.

Health research

Health research is another field where case studies are highly valuable. They offer a way to explore patient experiences, healthcare delivery processes, and the impact of various interventions in a real-world context.

Case studies can provide a deep understanding of a patient's journey, giving insights into the intricacies of disease progression, treatment effects, and the psychosocial aspects of health and illness.

Asthma research studies

Specifically within medical research, studies on asthma often employ case studies to explore the individual and environmental factors that influence asthma development, management, and outcomes. A case study can provide rich, detailed data about individual patients' experiences, from the triggers and symptoms they experience to the effectiveness of various management strategies. This can be crucial for developing patient-centered asthma care approaches.

Other fields

Apart from the fields mentioned, case studies are also extensively used in business and management research, education research, and political sciences, among many others. They provide an opportunity to delve into the intricacies of real-world situations, allowing for a comprehensive understanding of various phenomena.

Case studies, with their depth and contextual focus, offer unique insights across these varied fields. They allow researchers to illuminate the complexities of real-life situations, contributing to both theory and practice.

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Understanding the key elements of case study design is crucial for conducting rigorous and impactful case study research. A well-structured design guides the researcher through the process, ensuring that the study is methodologically sound and its findings are reliable and valid. The main elements of case study design include the research question , propositions, units of analysis, and the logic linking the data to the propositions.

The research question is the foundation of any research study. A good research question guides the direction of the study and informs the selection of the case, the methods of collecting data, and the analysis techniques. A well-formulated research question in case study research is typically clear, focused, and complex enough to merit further detailed examination of the relevant case(s).

Propositions

Propositions, though not necessary in every case study, provide a direction by stating what we might expect to find in the data collected. They guide how data is collected and analyzed by helping researchers focus on specific aspects of the case. They are particularly important in explanatory case studies, which seek to understand the relationships among concepts within the studied phenomenon.

Units of analysis

The unit of analysis refers to the case, or the main entity or entities that are being analyzed in the study. In case study research, the unit of analysis can be an individual, a group, an organization, a decision, an event, or even a time period. It's crucial to clearly define the unit of analysis, as it shapes the qualitative data analysis process by allowing the researcher to analyze a particular case and synthesize analysis across multiple case studies to draw conclusions.

Argumentation

This refers to the inferential model that allows researchers to draw conclusions from the data. The researcher needs to ensure that there is a clear link between the data, the propositions (if any), and the conclusions drawn. This argumentation is what enables the researcher to make valid and credible inferences about the phenomenon under study.

Understanding and carefully considering these elements in the design phase of a case study can significantly enhance the quality of the research. It can help ensure that the study is methodologically sound and its findings contribute meaningful insights about the case.

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Conducting a case study involves several steps, from defining the research question and selecting the case to collecting and analyzing data . This section outlines these key stages, providing a practical guide on how to conduct case study research.

Defining the research question

The first step in case study research is defining a clear, focused research question. This question should guide the entire research process, from case selection to analysis. It's crucial to ensure that the research question is suitable for a case study approach. Typically, such questions are exploratory or descriptive in nature and focus on understanding a phenomenon within its real-life context.

Selecting and defining the case

The selection of the case should be based on the research question and the objectives of the study. It involves choosing a unique example or a set of examples that provide rich, in-depth data about the phenomenon under investigation. After selecting the case, it's crucial to define it clearly, setting the boundaries of the case, including the time period and the specific context.

Previous research can help guide the case study design. When considering a case study, an example of a case could be taken from previous case study research and used to define cases in a new research inquiry. Considering recently published examples can help understand how to select and define cases effectively.

Developing a detailed case study protocol

A case study protocol outlines the procedures and general rules to be followed during the case study. This includes the data collection methods to be used, the sources of data, and the procedures for analysis. Having a detailed case study protocol ensures consistency and reliability in the study.

The protocol should also consider how to work with the people involved in the research context to grant the research team access to collecting data. As mentioned in previous sections of this guide, establishing rapport is an essential component of qualitative research as it shapes the overall potential for collecting and analyzing data.

Collecting data

Gathering data in case study research often involves multiple sources of evidence, including documents, archival records, interviews, observations, and physical artifacts. This allows for a comprehensive understanding of the case. The process for gathering data should be systematic and carefully documented to ensure the reliability and validity of the study.

Analyzing and interpreting data

The next step is analyzing the data. This involves organizing the data , categorizing it into themes or patterns , and interpreting these patterns to answer the research question. The analysis might also involve comparing the findings with prior research or theoretical propositions.

Writing the case study report

The final step is writing the case study report . This should provide a detailed description of the case, the data, the analysis process, and the findings. The report should be clear, organized, and carefully written to ensure that the reader can understand the case and the conclusions drawn from it.

Each of these steps is crucial in ensuring that the case study research is rigorous, reliable, and provides valuable insights about the case.

The type, depth, and quality of data in your study can significantly influence the validity and utility of the study. In case study research, data is usually collected from multiple sources to provide a comprehensive and nuanced understanding of the case. This section will outline the various methods of collecting data used in case study research and discuss considerations for ensuring the quality of the data.

Interviews are a common method of gathering data in case study research. They can provide rich, in-depth data about the perspectives, experiences, and interpretations of the individuals involved in the case. Interviews can be structured , semi-structured , or unstructured , depending on the research question and the degree of flexibility needed.

Observations

Observations involve the researcher observing the case in its natural setting, providing first-hand information about the case and its context. Observations can provide data that might not be revealed in interviews or documents, such as non-verbal cues or contextual information.

Documents and artifacts

Documents and archival records provide a valuable source of data in case study research. They can include reports, letters, memos, meeting minutes, email correspondence, and various public and private documents related to the case.

These records can provide historical context, corroborate evidence from other sources, and offer insights into the case that might not be apparent from interviews or observations.

Physical artifacts refer to any physical evidence related to the case, such as tools, products, or physical environments. These artifacts can provide tangible insights into the case, complementing the data gathered from other sources.

Ensuring the quality of data collection

Determining the quality of data in case study research requires careful planning and execution. It's crucial to ensure that the data is reliable, accurate, and relevant to the research question. This involves selecting appropriate methods of collecting data, properly training interviewers or observers, and systematically recording and storing the data. It also includes considering ethical issues related to collecting and handling data, such as obtaining informed consent and ensuring the privacy and confidentiality of the participants.

Data analysis

Analyzing case study research involves making sense of the rich, detailed data to answer the research question. This process can be challenging due to the volume and complexity of case study data. However, a systematic and rigorous approach to analysis can ensure that the findings are credible and meaningful. This section outlines the main steps and considerations in analyzing data in case study research.

Organizing the data

The first step in the analysis is organizing the data. This involves sorting the data into manageable sections, often according to the data source or the theme. This step can also involve transcribing interviews, digitizing physical artifacts, or organizing observational data.

Categorizing and coding the data

Once the data is organized, the next step is to categorize or code the data. This involves identifying common themes, patterns, or concepts in the data and assigning codes to relevant data segments. Coding can be done manually or with the help of software tools, and in either case, qualitative analysis software can greatly facilitate the entire coding process. Coding helps to reduce the data to a set of themes or categories that can be more easily analyzed.

Identifying patterns and themes

After coding the data, the researcher looks for patterns or themes in the coded data. This involves comparing and contrasting the codes and looking for relationships or patterns among them. The identified patterns and themes should help answer the research question.

Interpreting the data

Once patterns and themes have been identified, the next step is to interpret these findings. This involves explaining what the patterns or themes mean in the context of the research question and the case. This interpretation should be grounded in the data, but it can also involve drawing on theoretical concepts or prior research.

Verification of the data

The last step in the analysis is verification. This involves checking the accuracy and consistency of the analysis process and confirming that the findings are supported by the data. This can involve re-checking the original data, checking the consistency of codes, or seeking feedback from research participants or peers.

Like any research method , case study research has its strengths and limitations. Researchers must be aware of these, as they can influence the design, conduct, and interpretation of the study.

Understanding the strengths and limitations of case study research can also guide researchers in deciding whether this approach is suitable for their research question . This section outlines some of the key strengths and limitations of case study research.

Benefits include the following:

• Rich, detailed data: One of the main strengths of case study research is that it can generate rich, detailed data about the case. This can provide a deep understanding of the case and its context, which can be valuable in exploring complex phenomena.
• Flexibility: Case study research is flexible in terms of design , data collection , and analysis . A sufficient degree of flexibility allows the researcher to adapt the study according to the case and the emerging findings.
• Real-world context: Case study research involves studying the case in its real-world context, which can provide valuable insights into the interplay between the case and its context.
• Multiple sources of evidence: Case study research often involves collecting data from multiple sources , which can enhance the robustness and validity of the findings.

On the other hand, researchers should consider the following limitations:

• Generalizability: A common criticism of case study research is that its findings might not be generalizable to other cases due to the specificity and uniqueness of each case.
• Time and resource intensive: Case study research can be time and resource intensive due to the depth of the investigation and the amount of collected data.
• Complexity of analysis: The rich, detailed data generated in case study research can make analyzing the data challenging.
• Subjectivity: Given the nature of case study research, there may be a higher degree of subjectivity in interpreting the data , so researchers need to reflect on this and transparently convey to audiences how the research was conducted.

Being aware of these strengths and limitations can help researchers design and conduct case study research effectively and interpret and report the findings appropriately.

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Case Study – Methods, Examples and Guide

Table of Contents

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

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

Types of Case Study

Types and Methods of Case Study are as follows:

Single-Case Study

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

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

Multiple-Case Study

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

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

Exploratory Case Study

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

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

Descriptive Case Study

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

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

Instrumental Case Study

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

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

Case Study Data Collection Methods

Here are some common data collection methods for case studies:

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

Observations

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

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

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

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

How to conduct Case Study Research

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

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

Examples of Case Study

Here are some examples of case study research:

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

Application of Case Study

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

Business and Management

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

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

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

Social Sciences

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

Law and Ethics

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

Purpose of Case Study

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

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

Case studies can also serve other purposes, including:

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

Advantages of Case Study Research

There are several advantages of case study research, including:

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

Limitations of Case Study Research

There are several limitations of case study research, including:

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

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Muhammad Hassan

Researcher, Academic Writer, Web developer

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

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

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

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

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

Table of contents

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Prevent plagiarism. Run a free check.

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

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

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

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

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

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

Research bias

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

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What the Case Study Method Really Teaches

• Nitin Nohria

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

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

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

• Nitin Nohria is the George F. Baker Jr. and Distinguished Service University Professor. He served as the 10th dean of Harvard Business School, from 2010 to 2020.

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What Is a Case Study?

Weighing the pros and cons of this method of research

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

Cara Lustik is a fact-checker and copywriter.

Verywell / Colleen Tighe

• Pros and Cons

What Types of Case Studies Are Out There?

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

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

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

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

At a Glance

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

What Are the Benefits and Limitations of Case Studies?

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

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

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

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

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

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

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

Case Study Examples

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

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

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

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

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

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

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

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

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

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

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

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

Section 1: A Case History

This section will have the following structure and content:

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

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

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

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

Section 2: Treatment Plan

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

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

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

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

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

Need More Tips?

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

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

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

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

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

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

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

Case Study Research Method in Psychology

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

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

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

Learn about our Editorial Process

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

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

On This Page:

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

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

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

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

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

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

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

 Famous Case Studies

• Anna O – One of the most famous case studies, documenting psychoanalyst Josef Breuer’s treatment of “Anna O” (real name Bertha Pappenheim) for hysteria in the late 1800s using early psychoanalytic theory.
• Little Hans – A child psychoanalysis case study published by Sigmund Freud in 1909 analyzing his five-year-old patient Herbert Graf’s house phobia as related to the Oedipus complex.
• Bruce/Brenda – Gender identity case of the boy (Bruce) whose botched circumcision led psychologist John Money to advise gender reassignment and raise him as a girl (Brenda) in the 1960s.
• Genie Wiley – Linguistics/psychological development case of the victim of extreme isolation abuse who was studied in 1970s California for effects of early language deprivation on acquiring speech later in life.
• Phineas Gage – One of the most famous neuropsychology case studies analyzes personality changes in railroad worker Phineas Gage after an 1848 brain injury involving a tamping iron piercing his skull.

Clinical Case Studies

• Studying the effectiveness of psychotherapy approaches with an individual patient
• Assessing and treating mental illnesses like depression, anxiety disorders, PTSD
• Neuropsychological cases investigating brain injuries or disorders

Child Psychology Case Studies

• Studying psychological development from birth through adolescence
• Cases of learning disabilities, autism spectrum disorders, ADHD
• Effects of trauma, abuse, deprivation on development

Types of Case Studies

• Explanatory case studies : Used to explore causation in order to find underlying principles. Helpful for doing qualitative analysis to explain presumed causal links.
• Exploratory case studies : Used to explore situations where an intervention being evaluated has no clear set of outcomes. It helps define questions and hypotheses for future research.
• Descriptive case studies : Describe an intervention or phenomenon and the real-life context in which it occurred. It is helpful for illustrating certain topics within an evaluation.
• Multiple-case studies : Used to explore differences between cases and replicate findings across cases. Helpful for comparing and contrasting specific cases.
• Intrinsic : Used to gain a better understanding of a particular case. Helpful for capturing the complexity of a single case.
• Collective : Used to explore a general phenomenon using multiple case studies. Helpful for jointly studying a group of cases in order to inquire into the phenomenon.

Where Do You Find Data for a Case Study?

There are several places to find data for a case study. The key is to gather data from multiple sources to get a complete picture of the case and corroborate facts or findings through triangulation of evidence. Most of this information is likely qualitative (i.e., verbal description rather than measurement), but the psychologist might also collect numerical data.

1. Primary sources

• Interviews – Interviewing key people related to the case to get their perspectives and insights. The interview is an extremely effective procedure for obtaining information about an individual, and it may be used to collect comments from the person’s friends, parents, employer, workmates, and others who have a good knowledge of the person, as well as to obtain facts from the person him or herself.
• Observations – Observing behaviors, interactions, processes, etc., related to the case as they unfold in real-time.
• Documents & Records – Reviewing private documents, diaries, public records, correspondence, meeting minutes, etc., relevant to the case.

2. Secondary sources

• News/Media – News coverage of events related to the case study.
• Academic articles – Journal articles, dissertations etc. that discuss the case.
• Government reports – Official data and records related to the case context.
• Books/films – Books, documentaries or films discussing the case.

3. Archival records

Searching historical archives, museum collections and databases to find relevant documents, visual/audio records related to the case history and context.

Public archives like newspapers, organizational records, photographic collections could all include potentially relevant pieces of information to shed light on attitudes, cultural perspectives, common practices and historical contexts related to psychology.

4. Organizational records

Organizational records offer the advantage of often having large datasets collected over time that can reveal or confirm psychological insights.

Of course, privacy and ethical concerns regarding confidential data must be navigated carefully.

However, with proper protocols, organizational records can provide invaluable context and empirical depth to qualitative case studies exploring the intersection of psychology and organizations.

• Organizational/industrial psychology research : Organizational records like employee surveys, turnover/retention data, policies, incident reports etc. may provide insight into topics like job satisfaction, workplace culture and dynamics, leadership issues, employee behaviors etc.
• Clinical psychology : Therapists/hospitals may grant access to anonymized medical records to study aspects like assessments, diagnoses, treatment plans etc. This could shed light on clinical practices.
• School psychology : Studies could utilize anonymized student records like test scores, grades, disciplinary issues, and counseling referrals to study child development, learning barriers, effectiveness of support programs, and more.

How do I Write a Case Study in Psychology?

Follow specified case study guidelines provided by a journal or your psychology tutor. General components of clinical case studies include: background, symptoms, assessments, diagnosis, treatment, and outcomes. Interpreting the information means the researcher decides what to include or leave out. A good case study should always clarify which information is the factual description and which is an inference or the researcher’s opinion.

1. Introduction

• Provide background on the case context and why it is of interest, presenting background information like demographics, relevant history, and presenting problem.
• Compare briefly to similar published cases if applicable. Clearly state the focus/importance of the case.

2. Case Presentation

• Describe the presenting problem in detail, including symptoms, duration,and impact on daily life.
• Include client demographics like age and gender, information about social relationships, and mental health history.
• Describe all physical, emotional, and/or sensory symptoms reported by the client.
• Use patient quotes to describe the initial complaint verbatim. Follow with full-sentence summaries of relevant history details gathered, including key components that led to a working diagnosis.
• Summarize clinical exam results, namely orthopedic/neurological tests, imaging, lab tests, etc. Note actual results rather than subjective conclusions. Provide images if clearly reproducible/anonymized.
• Clearly state the working diagnosis or clinical impression before transitioning to management.

3. Management and Outcome

• Indicate the total duration of care and number of treatments given over what timeframe. Use specific names/descriptions for any therapies/interventions applied.
• Present the results of the intervention,including any quantitative or qualitative data collected.
• For outcomes, utilize visual analog scales for pain, medication usage logs, etc., if possible. Include patient self-reports of improvement/worsening of symptoms. Note the reason for discharge/end of care.

4. Discussion

• Analyze the case, exploring contributing factors, limitations of the study, and connections to existing research.
• Analyze the effectiveness of the intervention,considering factors like participant adherence, limitations of the study, and potential alternative explanations for the results.
• Identify any questions raised in the case analysis and relate insights to established theories and current research if applicable. Avoid definitive claims about physiological explanations.
• Offer clinical implications, and suggest future research directions.

5. Additional Items

• Thank specific assistants for writing support only. No patient acknowledgments.
• References should directly support any key claims or quotes included.
• Use tables/figures/images only if substantially informative. Include permissions and legends/explanatory notes.
• Provides detailed (rich qualitative) information.
• Provides insight for further research.
• Permitting investigation of otherwise impractical (or unethical) situations.

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

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

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

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

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

Limitations

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

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

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

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

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

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

Breuer, J., & Freud, S. (1895).  Studies on hysteria . Standard Edition 2: London.

Curtiss, S. (1981). Genie: The case of a modern wild child .

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

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

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

Harlow J. M. (1848). Passage of an iron rod through the head.  Boston Medical and Surgical Journal, 39 , 389–393.

Harlow, J. M. (1868).  Recovery from the Passage of an Iron Bar through the Head .  Publications of the Massachusetts Medical Society. 2  (3), 327-347.

Money, J., & Ehrhardt, A. A. (1972).  Man & Woman, Boy & Girl : The Differentiation and Dimorphism of Gender Identity from Conception to Maturity. Baltimore, Maryland: Johns Hopkins University Press.

Money, J., & Tucker, P. (1975). Sexual signatures: On being a man or a woman.

Further Information

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

Related Articles

Research Methodology

Mixed Methods Research

Conversation Analysis

Discourse Analysis

Phenomenology In Qualitative Research

Ethnography In Qualitative Research

Narrative Analysis In Qualitative Research

What is the Case Study Method?

Overview Dropdown up

Overview dropdown down, celebrating 100 years of the case method at hbs.

The 2021-2022 academic year marks the 100-year anniversary of the introduction of the case method at Harvard Business School. Today, the HBS case method is employed in the HBS MBA program, in Executive Education programs, and in dozens of other business schools around the world. As Dean Srikant Datar's says, the case method has withstood the test of time.

Case Discussion Preparation Details Expand All Collapse All

In self-reflection in self-reflection dropdown down, in a small group setting in a small group setting dropdown down, in the classroom in the classroom dropdown down, beyond the classroom beyond the classroom dropdown down, how the case method creates value dropdown up, how the case method creates value dropdown down, in self-reflection, in a small group setting, in the classroom, beyond the classroom.

How Cases Unfold In the Classroom

How cases unfold in the classroom dropdown up, how cases unfold in the classroom dropdown down, preparation guidelines expand all collapse all, read the professor's assignment or discussion questions read the professor's assignment or discussion questions dropdown down, read the first few paragraphs and then skim the case read the first few paragraphs and then skim the case dropdown down, reread the case, underline text, and make margin notes reread the case, underline text, and make margin notes dropdown down, note the key problems on a pad of paper and go through the case again note the key problems on a pad of paper and go through the case again dropdown down, how to prepare for case discussions dropdown up, how to prepare for case discussions dropdown down, read the professor's assignment or discussion questions, read the first few paragraphs and then skim the case, reread the case, underline text, and make margin notes, note the key problems on a pad of paper and go through the case again, case study best practices expand all collapse all, prepare prepare dropdown down, discuss discuss dropdown down, participate participate dropdown down, relate relate dropdown down, apply apply dropdown down, note note dropdown down, understand understand dropdown down, case study best practices dropdown up, case study best practices dropdown down, participate, what can i expect on the first day dropdown down.

Most programs begin with registration, followed by an opening session and a dinner. If your travel plans necessitate late arrival, please be sure to notify us so that alternate registration arrangements can be made for you. Please note the following about registration:

HBS campus programs – Registration takes place in the Chao Center.

India programs – Registration takes place outside the classroom.

Other off-campus programs – Registration takes place in the designated facility.

What happens in class if nobody talks? Dropdown down

Professors are here to push everyone to learn, but not to embarrass anyone. If the class is quiet, they'll often ask a participant with experience in the industry in which the case is set to speak first. This is done well in advance so that person can come to class prepared to share. Trust the process. The more open you are, the more willing you’ll be to engage, and the more alive the classroom will become.

Does everyone take part in "role-playing"? Dropdown down

Professors often encourage participants to take opposing sides and then debate the issues, often taking the perspective of the case protagonists or key decision makers in the case.

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22 Case Study Research: In-Depth Understanding in Context

Helen Simons, School of Education, University of Southampton

• Published: 01 July 2014
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This chapter explores case study as a major approach to research and evaluation. After first noting various contexts in which case studies are commonly used, the chapter focuses on case study research directly Strengths and potential problematic issues are outlined and then key phases of the process. The chapter emphasizes how important it is to design the case, to collect and interpret data in ways that highlight the qualitative, to have an ethical practice that values multiple perspectives and political interests, and to report creatively to facilitate use in policy making and practice. Finally, it explores how to generalize from the single case. Concluding questions center on the need to think more imaginatively about design and the range of methods and forms of reporting requiredto persuade audiences to value qualitative ways of knowing in case study research.

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The Case Study as Research Method: A Practical Handbook

Qualitative Research in Accounting & Management

ISSN : 1176-6093

Article publication date: 21 June 2011

Scapens, R.W. (2011), "The Case Study as Research Method: A Practical Handbook", Qualitative Research in Accounting & Management , Vol. 8 No. 2, pp. 201-204. https://doi.org/10.1108/11766091111137582

Emerald Group Publishing Limited

Copyright © 2011, Emerald Group Publishing Limited

This book aims to provide case‐study researchers with a step‐by‐step practical guide to “help them conduct the study with the required degree of rigour” (p. xi).

It seeks to “demonstrate that the case study is indeed a scientific method” (p. 104) and to show “the usefulness of the case method as one tool in the researcher's methodological arsenal” (p. 105). The individual chapters cover the various stages in conducting case‐study research, and each chapter sets out a number of practical steps which have to be taken by the researcher. The following are the eight stages/chapters and, in brackets, the number of steps in each stages:

Assessing appropriateness and usefulness (4).

Ensuring accuracy of results (21).

Preparation (6).

Selecting cases (4).

Collecting data (7).

Analyzing data (4).

Interpreting data (3).

Reporting results (4).

It is particularly noticeable that ensuring accuracy of results has by far the largest number of number of steps – 21 steps compared to seven or fewer steps in the other stages. This reflects Gagnon's concern to demonstrate the scientific rigour of case‐study research. In the forward, he explains that the book draws on his experience in conducting his own PhD research, which was closely supervised by three professors, one of whom was inclined towards quantitative research. Consequently, his research was underpinned by the principles and philosophy of quantitative research. This is clearly reflected in the approach taken in this book, which seeks to show that case‐study research is just as rigorous and scientific as quantitative research, and it can produce an objective and accurate representation of the observed reality.

There is no discussion of the methodological issues relating to the use of case‐study research methods. This is acknowledged in the forward, although Gagnon refers to them as philosophical or epistemological issues (p. xii), as he tends to use the terms methodology and method interchangeably – as is common in quantitative research. Although he starts (step 1.1) by trying to distance case and other qualitative research from the work of positivists, arguing that society is socially constructed, he nevertheless sees social reality as objective and independent of the researcher. So for Gagnon, the aim of case research is to accurately reflect that reality. At various points in the book the notion of interpretation is used – evidence is interpreted and the (objective) case findings have to be interpreted.

So although there is a distancing from positivist research (p. 1), the approach taken in this book retains an objective view of the social reality which is being researched; a view which is rather different to the subjective view of reality taken by many interpretive case researchers. This distinction between an objective and a subjective view of the social reality being researched – and especially its use in contrasting positivist and interpretive research – has its origins the taxonomy of Burrell and Morgan (1979) . Although there have been various developments in the so‐called “objective‐subjective debate”, and recently some discussion in relation to management accounting research ( Kakkuri‐Knuuttila et al. , 2008 ; Ahrens, 2008 ), this debate is not mentioned in the book. Nevertheless, it is clear that Gagnon is firmly in the objective camp. In a recent paper, Johnson et al. (2006, p. 138) provide a more contemporary classification of the different types of qualitative research. In their terms, the approach taken in this book could be described as neo‐empiricist – an approach which they characterise as “qualitative positivists”.

The approach taken in this handbook leaves case studies open to the criticisms that they are a small sample, and consequently difficult to generalise, and to arguments that case studies are most appropriate for exploratory research which can subsequently be generalised though quantitative research. Gagnon explains that this was the approach he used after completing his thesis (p. xi). The handbook only seems to recognise two types of case studies, namely exploratory and raw empirical case studies – the latter being used where “the researcher is interested in a subject without having formed any preconceived ideas about it” (p. 15) – which has echoes of Glaser and Strauss (1967) . However, limiting case studies to these two types ignores other potential types; in particular, explanatory case studies which are where interpretive case‐study research can make important contributions ( Ryan et al. , 2002 ).

This limited approach to case studies comes through in the practical steps which are recommended in the handbook, and especially in the discussion of reliability and validity. The suggested steps seem to be designed to keep very close to the notions of reliability and validity used in quantitative research. There is no mention of the recent discussion of “validity” in interpretive accounting research, which emphasises the importance of authenticity and credibility and their implications for writing up qualitative and case‐study research ( Lukka and Modell, 2010 ). Although the final stage of Gagnon's handbook makes some very general comments about reporting the results, it does not mention, for example, Baxter and Chua's (2008) paper in QRAM which discusses the importance of demonstrating authenticity, credibility and transferability in writing qualitative research.

Despite Gagnon's emphasis on traditional notions of reliability and validity the handbook provides some useful practical advice for all case‐study researchers. For example, case‐study research needs a very good research design; case‐study researchers must work hard to gain access to and acceptance in the research settings; a clear strategy is needed for data collection; the case researcher should create field notes (in a field notebook, or otherwise) to record all the thoughts, ideas, observations, etc. that would not otherwise be collected; and the vast amount of data that case‐study research can generate needs to be carefully managed. Furthermore, because of what Gagnon calls the “risk of mortality” (p. 54) (i.e. the risk that access to a research site may be lost – for instance, if the organisation goes bankrupt) it is crucial for some additional site(s) to be selected at the outset to ensure that the planned research can be completed. This is what I call “insurance cases” when talking to my own PhD students. Interestingly, Gagnon recognises the ethical issues involved in doing case studies – something which is not always mentioned by the more objectivist type of case‐study researchers. He emphasises that it is crucial to honour confidentiality agreements, to ensure data are stored securely and that commitments are met and promises kept.

There is an interesting discussion of the advantages and disadvantages of using computer methods in analysing data (in stage 6). However, the discussion of coding appears to be heavily influenced by grounded theory, and is clearly concerned with producing an accurate reflection of an objective reality. In addition, Gagnon's depiction of case analysis is overly focussed on content analysis – possibly because it is a quantitative type of technique. There is no reference to the other approaches available to qualitative researchers. For example, there is no mention of the various visualisation techniques set out in Miles and Huberman (1994) .

To summarise, Gagnon's book is particularly useful for case‐study researchers who see the reality they are researching as objective and researcher independent. However, this is a sub‐set of case‐study researchers. Although some of the practical guidance offered is relevant for other types of case‐study researchers, those who see multiple realities in the social actors and/or recognise the subjectivity of the research process might have difficulty with some of the steps in this handbook. Gagnon's aim to show that the case study is a scientific method, gives the handbook a focus on traditional (quantitatively inspired) notions rigour and validity, and a tendency to ignore (or at least marginalise) other types of case study research. For example, the focus on exploratory cases, which need to be supplemented by broad based quantitative research, overlooks the real potential of case study research which lies in explanatory cases. Furthermore, Gagnon is rather worried about participant research, as the researcher may play a role which is “not consistent with scientific method” (p. 42), and which may introduce researcher bias and thereby damage “the impartiality of the study” (p. 53). Leaving aside the philosophical question about whether any social science research, including quantitative research, can be impartial, this stance could severely limit the potential of case‐study research and it would rule out both the early work on the sociology of mass production and the recent calls for interventionist research. Clearly, there could be a problem where a researcher is trying to sell consulting services, but there is a long tradition of social researchers working within organisations that they are studying. Furthermore, if interpretive research is to be relevant for practice, researchers may have to work with organisations to introduce new ideas and new ways of analysing problems. Gagnon would seem to want to avoid all such research – as it would not be “impartial”.

Consequently, although there is some good practical advice for case study researchers in this handbook, some of the recommendations have to be treated cautiously, as it is a book which sees case‐study research in a very specific way. As mentioned earlier, in the Forward Gagnon explicitly recognises that the book does not take a position on the methodological debates surrounding the use of case studies as a research method, and he says that “The reader should therefore use and judge this handbook with these considerations in mind” (p. xii). This is very good advice – caveat emptor .

Ahrens , T. ( 2008 ), “ A comment on Marja‐Liisa Kakkuri‐Knuuttila ”, Accounting, Organizations and Society , Vol. 33 Nos 2/3 , pp. 291 ‐ 7 , Kari Lukka and Jaakko Kuorikoski.

Baxter , J. and Chua , W.F. ( 2008 ), “ The field researcher as author‐writer ”, Qualitative Research in Accounting & Management , Vol. 5 No. 2 , pp. 101 ‐ 21 .

Burrell , G. and Morgan , G. ( 1979 ), Sociological Paradigms and Organizational Analysis , Heinneman , London .

Glaser , B.G. and Strauss , A.L. ( 1967 ), The Discovery of Grounded Theory: Strategies for Qualitative Research , Aldine , New York, NY .

Johnson , P. , Buehring , A. , Cassell , C. and Symon , G. ( 2006 ), “ Evaluating qualitative management research: towards a contingent critieriology ”, International Journal of Management Reviews , Vol. 8 No. 3 , pp. 131 ‐ 56 .

Kakkuri‐Knuuttila , M.‐L. , Lukka , K. and Kuorikoski , J. ( 2008 ), “ Straddling between paradigms: a naturalistic philosophical case study on interpretive research in management accounting ”, Accounting, Organizations and Society , Vol. 33 Nos 2/3 , pp. 267 ‐ 91 .

Lukka , K. and Modell , S. ( 2010 ), “ Validation in interpretive management accounting research ”, Accounting, Organizations and Society , Vol. 35 , pp. 462 ‐ 77 .

Miles , M.B. and Huberman , A.M. ( 1994 ), Qualitative Data Analysis: A Source Book of New Methods , 2nd ed. , Sage , London .

Ryan , R.J. , Scapens , R.W. and Theobald , M. ( 2002 ), Research Methods and Methodology in Finance and Accounting , 2nd ed. , Thomson Learning , London .

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• Case Study | Definition, Examples & Methods

Case Study | Definition, Examples & Methods

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

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

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

Table of contents

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Definitions of qualitative case study research

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

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

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

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

Current methodological issues in qualitative case study research

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

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

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

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

Assessment of rigour

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

Framework for assessing quality in qualitative case study research.

Adapted from Stake ( 1995 , p. 131).

Study design

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

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

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

Search strategy

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

Outcomes of search of qualitative methods journals.

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

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

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

Case study methodology or method

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

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

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

Case study of something particular and case selection

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

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

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

Contextually bound case study

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

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

Article synopsis of case study research using Stake's tradition

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

Article synopsis of case study research using Yin's tradition

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

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

Researcher and case interactions and triangulation

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

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

Study design inconsistent with methodology

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

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

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

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

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

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

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

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

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

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

Limitations of the review

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

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

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

Conflict of interest and funding

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

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Blog Beginner Guides 6 Types of Case Studies to Inspire Your Research and Analysis

6 Types of Case Studies to Inspire Your Research and Analysis

Written by: Ronita Mohan Sep 20, 2021

Case studies have become powerful business tools. But what is a case study? What are the benefits of creating one? Are there limitations to the format?

If you’ve asked yourself these questions, our helpful guide will clear things up. Learn how to use a case study for business. Find out how cases analysis works in psychology and research.

We’ve also got examples of case studies to inspire you.

Haven’t made a case study before? You can easily  create a case study  with Venngage’s customizable case study templates .

Click to jump ahead:

What is a case study?

6 types of case studies, what is a business case study, what is a case study in research, what is a case study in psychology, what is the case study method, benefits of case studies, limitations of case studies, faqs about case studies.

A case study is a research process aimed at learning about a subject, an event or an organization. Case studies are use in business, the social sciences and healthcare.

A case study may focus on one observation or many. It can also examine a series of events or a single case. An effective case study tells a story and provides a conclusion.

Healthcare industries write reports on patients and diagnoses. Marketing case study examples , like the one below, highlight the benefits of a business product.

Now that you know what a case study is, let’s look at the six different types of case studies next.

There are six common types of case reports. Depending on your industry, you might use one of these types.

Descriptive case studies

Explanatory case studies, exploratory case reports, intrinsic case studies, instrumental case studies, collective case reports.

We go into more detail about each type of study in the guide below.

Related:  15+ Professional Case Study Examples [Design Tips + Templates]

When you have an existing hypothesis, you can design a descriptive study. This type of report starts with a description. The aim is to find connections between the subject being studied and a theory.

Once these connections are found, the study can conclude. The results of this type of study will usually suggest how to develop a theory further.

A study like the one below has concrete results. A descriptive report would use the quantitative data as a suggestion for researching the subject deeply.

When an incident occurs in a field, an explanation is required. An explanatory report investigates the cause of the event. It will include explanations for that cause.

The study will also share details about the impact of the event. In most cases, this report will use evidence to predict future occurrences. The results of explanatory reports are definitive.

Note that there is no room for interpretation here. The results are absolute.

The study below is a good example. It explains how one brand used the services of another. It concludes by showing definitive proof that the collaboration was successful.

Another example of this study would be in the automotive industry. If a vehicle fails a test, an explanatory study will examine why. The results could show that the failure was because of a particular part.

Related: How to Write a Case Study [+ Design Tips]

An explanatory report is a self-contained document. An exploratory one is only the beginning of an investigation.

Exploratory cases act as the starting point of studies. This is usually conducted as a precursor to large-scale investigations. The research is used to suggest why further investigations are needed.

An exploratory study can also be used to suggest methods for further examination.

For example, the below analysis could have found inconclusive results. In that situation, it would be the basis for an in-depth study.

Intrinsic studies are more common in the field of psychology. These reports can also be conducted in healthcare or social work.

These types of studies focus on a unique subject, such as a patient. They can sometimes study groups close to the researcher.

The aim of such studies is to understand the subject better. This requires learning their history. The researcher will also examine how they interact with their environment.

For instance, if the case study below was about a unique brand, it could be an intrinsic study.

Once the study is complete, the researcher will have developed a better understanding of a phenomenon. This phenomenon will likely not have been studied or theorized about before.

Examples of intrinsic case analysis can be found across psychology. For example, Jean Piaget’s theories on cognitive development. He established the theory from intrinsic studies into his own children.

Related: What Disney Villains Can Tell Us About Color Psychology [Infographic]

This is another type of study seen in medical and psychology fields. Instrumental reports are created to examine more than just the primary subject.

When research is conducted for an instrumental study, it is to provide the basis for a larger phenomenon. The subject matter is usually the best example of the phenomenon. This is why it is being studied.

Take the example of the fictional brand below.

Assume it’s examining lead generation strategies. It may want to show that visual marketing is the definitive lead generation tool. The brand can conduct an instrumental case study to examine this phenomenon.

Collective studies are based on instrumental case reports. These types of studies examine multiple reports.

There are a number of reasons why collective reports are created:

• To provide evidence for starting a new study
• To find pattens between multiple instrumental reports
• To find differences in similar types of cases
• Gain a deeper understanding of a complex phenomenon
• Understand a phenomenon from diverse contexts

A researcher could use multiple reports, like the one below, to build a collective case report.

Related: 10+ Case Study Infographic Templates That Convert

A business or marketing case study aims at showcasing a successful partnership. This can be between a brand and a client. Or the case study can examine a brand’s project.

There is a perception that case studies are used to advertise a brand. But effective reports, like the one below, can show clients how a brand can support them.

Hubspot created a case study on a customer that successfully scaled its business. The report outlines the various Hubspot tools used to achieve these results.

Hubspot also added a video with testimonials from the client company’s employees.

So, what is the purpose of a case study for businesses? There is a lot of competition in the corporate world. Companies are run by people. They can be on the fence about which brand to work with.

Business reports  stand out aesthetically, as well. They use  brand colors  and brand fonts . Usually, a combination of the client’s and the brand’s.

With the Venngage  My Brand Kit  feature, businesses can automatically apply their brand to designs.

A business case study, like the one below, acts as social proof. This helps customers decide between your brand and your competitors.

Don’t know how to design a report? You can learn  how to write a case study  with Venngage’s guide. We also share design tips and examples that will help you convert.

Related: 55+ Annual Report Design Templates, Inspirational Examples & Tips [Updated]

Research is a necessary part of every case study. But specific research fields are required to create studies. These fields include user research, healthcare, education, or social work.

For example, this UX Design  report examined the public perception of a client. The brand researched and implemented new visuals to improve it. The study breaks down this research through lessons learned.

Clinical reports are a necessity in the medical field. These documents are used to share knowledge with other professionals. They also help examine new or unusual diseases or symptoms.

The pandemic has led to a significant increase in research. For example,  Spectrum Health  studied the value of health systems in the pandemic. They created the study by examining community outreach.

The pandemic has significantly impacted the field of education. This has led to numerous examinations on remote studying. There have also been studies on how students react to decreased peer communication.

Social work case reports often have a community focus. They can also examine public health responses. In certain regions, social workers study disaster responses.

You now know what case studies in various fields are. In the next step of our guide, we explain the case study method.

In the field of psychology, case studies focus on a particular subject. Psychology case histories also examine human behaviors.

Case reports search for commonalities between humans. They are also used to prescribe further research. Or these studies can elaborate on a solution for a behavioral ailment.

The American Psychology Association  has a number of case studies on real-life clients. Note how the reports are more text-heavy than a business case study.

Famous psychologists such as Sigmund Freud and Anna O popularised the use of case studies in the field. They did so by regularly interviewing subjects. Their detailed observations build the field of psychology.

It is important to note that psychological studies must be conducted by professionals. Psychologists, psychiatrists and therapists should be the researchers in these cases.

Related: What Netflix’s Top 50 Shows Can Teach Us About Font Psychology [Infographic]

The case study method, or case method, is a learning technique where you’re presented with a real-world business challenge and asked how you’d solve it.

After working through it independently and with peers, you learn how the actual scenario unfolded. This approach helps develop problem-solving skills and practical knowledge.

This method often uses various data sources like interviews, observations, and documents to provide comprehensive insights. The below example would have been created after numerous interviews.

Case studies are largely qualitative. They analyze and describe phenomena. While some data is included, a case analysis is not quantitative.

There are a few steps in the case method. You have to start by identifying the subject of your study. Then determine what kind of research is required.

In natural sciences, case studies can take years to complete. Business reports, like this one, don’t take that long. A few weeks of interviews should be enough.

The case method will vary depending on the industry. Reports will also look different once produced.

As you will have seen, business reports are more colorful. The design is also more accessible . Healthcare and psychology reports are more text-heavy.

Designing case reports takes time and energy. So, is it worth taking the time to write them? Here are the benefits of creating case studies.

• Collects large amounts of information
• Helps formulate hypotheses
• Builds the case for further research
• Discovers new insights into a subject
• Builds brand trust and loyalty
• Engages customers through stories

For example, the business study below creates a story around a brand partnership. It makes for engaging reading. The study also shows evidence backing up the information.

We’ve shared the benefits of why studies are needed. We will also look at the limitations of creating them.

Related: How to Present a Case Study like a Pro (With Examples)

There are a few disadvantages to conducting a case analysis. The limitations will vary according to the industry.

• Responses from interviews are subjective
• Subjects may tailor responses to the researcher
• Studies can’t always be replicated
• In certain industries, analyses can take time and be expensive
• Risk of generalizing the results among a larger population

These are some of the common weaknesses of creating case reports. If you’re on the fence, look at the competition in your industry.

Other brands or professionals are building reports, like this example. In that case, you may want to do the same.

What makes a case study a case study?

A case study has a very particular research methodology. They are an in-depth study of a person or a group of individuals. They can also study a community or an organization. Case reports examine real-world phenomena within a set context.

How long should a case study be?

The length of studies depends on the industry. It also depends on the story you’re telling. Most case studies should be at least 500-1500 words long. But you can increase the length if you have more details to share.

What should you ask in a case study?

The one thing you shouldn’t ask is ‘yes’ or ‘no’ questions. Case studies are qualitative. These questions won’t give you the information you need.

Ask your client about the problems they faced. Ask them about solutions they found. Or what they think is the ideal solution. Leave room to ask them follow-up questions. This will help build out the study.

How to present a case study?

When you’re ready to present a case study, begin by providing a summary of the problem or challenge you were addressing. Follow this with an outline of the solution you implemented, and support this with the results you achieved, backed by relevant data. Incorporate visual aids like slides, graphs, and images to make your case study presentation more engaging and impactful.

Now you know what a case study means, you can begin creating one. These reports are a great tool for analyzing brands. They are also useful in a variety of other fields.

Use a visual communication platform like Venngage to design case studies. With Venngage’s templates, you can design easily. Create branded, engaging reports, all without design experience.

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5 Benefits of 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.”

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.

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Case study definition

Case study, a term which some of you may know from the "Case Study of Vanitas" anime and manga, is a thorough examination of a particular subject, such as a person, group, location, occasion, establishment, phenomena, etc. They are most frequently utilized in research of business, medicine, education and social behaviour. There are a different types of case studies that researchers might use:

• Collective case studies

• Descriptive case studies

• Explanatory case studies

• Exploratory case studies

• Instrumental case studies

• Intrinsic case studies

Case studies are usually much more sophisticated and professional than regular essays and courseworks, as they require a lot of verified data, are research-oriented and not necessarily designed to be read by the general public.

How to write a case study?

It very much depends on the topic of your case study, as a medical case study and a coffee business case study have completely different sources, outlines, target demographics, etc. But just for this example, let's outline a coffee roaster case study. Firstly, it's likely going to be a problem-solving case study, like most in the business and economics field are. Here are some tips for these types of case studies:

• Your case scenario should be precisely defined in terms of your unique assessment criteria.

• Determine the primary issues by analyzing the scenario. Think about how they connect to the main ideas and theories in your piece.

• Find and investigate any theories or methods that might be relevant to your case.

• Keep your audience in mind. Exactly who are your stakeholder(s)? If writing a case study on coffee roasters, it's probably gonna be suppliers, landlords, investors, customers, etc.

• Indicate the best solution(s) and how they should be implemented. Make sure your suggestions are grounded in pertinent theories and useful resources, as well as being realistic, practical, and attainable.

• Carefully proofread your case study. Keep in mind these four principles when editing: clarity, honesty, reality and relevance.

Are there any online services that could write a case study for me?

Luckily, there are!

We completely understand and have been ourselves in a position, where we couldn't wrap our head around how to write an effective and useful case study, but don't fear - our service is here.

We are a group that specializes in writing all kinds of case studies and other projects for academic customers and business clients who require assistance with its creation. We require our writers to have a degree in your topic and carefully interview them before they can join our team, as we try to ensure quality above all. We cover a great range of topics, offer perfect quality work, always deliver on time and aim to leave our customers completely satisfied with what they ordered.

The ordering process is fully online, and it goes as follows:

• Select the topic and the deadline of your case study.

• Provide us with any details, requirements, statements that should be emphasized or particular parts of the writing process you struggle with.

• Leave the email address, where your completed order will be sent to.

• Select your payment type, sit back and relax!

With lots of experience on the market, professionally degreed writers, online 24/7 customer support and incredibly low prices, you won't find a service offering a better deal than ours.

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• The case for cases: We need a new approach
• What are case studies?
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• Whole class discussion: the classical method
• Small group methods: an overview
• Problem-based learning
• Interrupted case method
• Intimate debate method
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• How not to teach with case studies
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Calculation of the minimum clinically important difference (MCID) using different methodologies: case study and practical guide

• Original Article
• Open access
• Published: 28 June 2024

Cite this article

You have full access to this open access article

• Anita M. Klukowska 1 , 2 ,
• W. Peter Vandertop 1 ,
• Marc L. Schröder 3 &
• Victor E. Staartjes   ORCID: orcid.org/0000-0003-1039-2098 4  

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Introduction

Establishing thresholds of change that are actually meaningful for the patient in an outcome measurement instrument is paramount. This concept is called the minimum clinically important difference (MCID). We summarize available MCID calculation methods relevant to spine surgery, and outline key considerations, followed by a step-by-step working example of how MCID can be calculated, using publicly available data, to enable the readers to follow the calculations themselves.

Thirteen MCID calculations methods were summarized, including anchor-based methods, distribution-based methods, Reliable Change Index, 30% Reduction from Baseline, Social Comparison Approach and the Delphi method. All methods, except the latter two, were used to calculate MCID for improvement of Zurich Claudication Questionnaire (ZCQ) Symptom Severity of patients with lumbar spinal stenosis. Numeric Rating Scale for Leg Pain and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire Walking Ability domain were used as anchors.

The MCID for improvement of ZCQ Symptom Severity ranged from 0.8 to 5.1. On average, distribution-based methods yielded lower MCID values, than anchor-based methods. The percentage of patients who achieved the calculated MCID threshold ranged from 9.5% to 61.9%.

Conclusions

MCID calculations are encouraged in spinal research to evaluate treatment success. Anchor-based methods, relying on scales assessing patient preferences, continue to be the “gold-standard” with receiver operating characteristic curve approach being optimal. In their absence, the minimum detectable change approach is acceptable. The provided explanation and step-by-step example of MCID calculations with statistical code and publicly available data can act as guidance in planning future MCID calculation studies.

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The anchor design of anchor-based method to determine the minimal clinically important difference: a systematic review

Values derived from patient reported outcomes in spine surgery: a systematic review of the minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state

Avoid common mistakes on your manuscript.

The notion of minimum clinically important difference (MCID) was introduced to establish thresholds of change in an outcome measurement instrument that are actually meaningful for the patient. Jaeschke et al . originally defined it “as the smallest difference in score in the domain of interest which the patient perceives as beneficial and which would mandate, in the absence of troublesome side-effects and excessive cost, a change in the patient’s management” [ 1 ].

In many clinical trials statistical analyses only focuses on intergroup comparisons of raw outcome scores using parametric/non-parametric tests and deriving conclusions based on the p -value. Using the classical threshold of p- value < 0.05 only suggests that the observed effect is unlikely to have occurred by chance, but it does not equate to a change that is clinically meaningful for the patient [ 2 ]. Calculating MCID scores, and using them as thresholds for “treatment success”, ensures that patients’ needs and preferences are considered and allows for comparison of proportion of patients experiencing a clinically relevant improvement among different groups [ 3 ]. Through MCID, clinicians can better understand the impact of an intervention on their patients’ lives, sample size calculations can become more robust and health policy makers may decide which treatments deserve reimbursement [ 4 , 5 , 6 ].

The MCID can be determined from the patient’s perspective, where it is the patient who decides whether a change in their health was meaningful [ 4 , 7 , 8 , 9 ]. This is the most common “gold-standard” approach and one that we will focus on. Occasionally, the clinician’s perspective can also be used to determine MCID. However, MCID for a clinician may not necessarily mean an increase in a patient’s functionality, but rather a change in disease survival or treatment planning [ 10 ]. MCID can also be defined at a societal level, as e.g. improvement in a patient’s functionality significant enough to aid their return to work [ 11 ].

MCID thresholds are intended to assess an individual’s clinical improvement and ought not to be applied to mean scores of entire groups post-intervention, as doing so may falsely over-estimate treatment effectiveness. It is also noteworthy to mention that obtained MCID values are not treatment-specific but broadly disease category-specific. They rely on a patient’s perception of clinical benefit, which is influenced by their diagnosis and subsequent symptoms, not just treatment modality.

In this study, we summarize available MCID calculation methods and outline key considerations when designing a MCID study, followed by a step-by-step working example of how MCID can be calculated.

Navigating the case study

To illustrate the MCID methods and to enable the reader to follow the practical calculation guide of different MCID values, based on the described methods along the way, a previously published data set of 84 patients, as described in Minetama et al ., was used based on CC0.10 license [ 12 ]. Data can be downloaded at https://data.mendeley.com/datasets/vm8rg6rvsw/1 . The statistical R code can be found in Supplementry content  1 including instructions on formatting the data set for MCID calculations The title of different MCID methods in the paper (listed below) and their number correspond to the same title and respective number in the R code. All analyses in this case study were carried out using R version 2023.12 + 402 (The R Foundation for Statistical Computing, Vienna Austria) [ 13 ].

The aim of Minetama et al . was to assess the effectiveness of supervised physical therapy (PT) with unsupervised at-home-exercises (HE) in patients with lumbar spinal stenosis (LSS). The main inclusion criteria were presence of neurogenic intermittent claudication and pain/or numbness in the lower extremities with or without back pain and > 50 years of age; diagnosis of LSS confirmed on MRI and a history of ineffective response to therapy for ≥ 3 months. Patients were then randomized into a 6-week PT or HE programme [ 12 ]. All data was pooled, as a clinically significant benefit for patients is independent of group allocation and because MCID is disease-specific. Therefore, the derived MCID will be applicable to most patients with lumbar spinal stenosis, irrespective of treatment modality. Change scores were calculated by subtracting baseline scores from follow-up scores.

MCID calculation methods

There are multiple approaches to calculate MCID, mainly divided into anchor-based and distribution-based methods (Fig.  1 ) [ 4 , 10 , 14 , 15 , 16 , 17 ]. Before deciding on the method, it needs to be defined whether the calculated MCID will be for improvement or deterioration [ 18 ]. Most commonly, MCID is used to measure improvement (as per Jaeschke et al . definition) [ 1 , 4 , 7 , 14 , 15 , 16 , 19 , 20 ]. The value of MCID for improvement should not be directly applied in reverse to determine whether a decrease in patients' scores signifies a clinically meaningful deterioration – those are two separate concepts [ 18 ]. In addition, the actual MCID value ought to be applied to post-intervention score of an individual patient (not the overall score for the whole group), to determine whether, at follow-up, he or she experienced a change equating to MCID or more, compared to their baseline score. Such patient is then classified as “responders”.

Flow diagram presenting range of Minimum clinically important difference calculation methods stratified into anchor, distribution-based and “other” described in the study. MCID, Minimum Clinically Important Difference; MIC, Minimal Important Change

According to the Consensus-based Standards for the selection of health measurement instruments (COSMIN) guidelines, the “anchor-based” approach is regarded as the “gold-standard” [ 21 , 22 , 23 ]. In this approach, we determine the MCID of a chosen outcome measurement, based on whether a pre-defined MCID (usually derived from another published study) was achieved by an external criterion, known as the anchor, usually another patient-reported outcome measure (PROM) or an objective test of functionality [ 4 , 7 , 8 , 15 , 16 , 17 , 18 , 20 ]. It is best to use scales which allow the patient to rate the specific aspect of their health related to the disease of interest post-intervention compared to baseline on a Likert-type scale. This scale may range, for example, from “much worse”, “somewhat worse”, “about the same”, “somewhat better”, to “much better”, such as the established Global Assessment Rating tool [ 7 , 8 , 24 , 25 ]. Depending on the scale, some studies determine MCID by calculating change scores for patients who only ranked themselves as “somewhat better”, and some only consider patients who ranked themselves as “much better” [ 7 , 25 , 26 , 27 , 28 , 29 ]. This discrepancy is likely an explanation for a range of MCID for a single outcome measure dependent on the methodology. There appears to be no singular “correct” approach. One of the alternatives to the Global assessment rating is the use of the health transition item (HTI) from the SF-36 questionnaire, where patients are asked about their overall health compared to one year ago [ 7 , 30 , 31 ]. Although quick and easy to conduct, the patient’s response may be influenced by comorbid health issues other than those targeted by intervention. Nevertheless, any anchor where the patient is the one to decide what change is clinically meaningful, captures the true essence of the MCID. One should however, be mindful of the not easily addressed recall bias with such anchors – patients at times do not reliably remember their baseline health status [ 32 ]. Moreover, what the above anchors do not consider is, whether the patient would still choose the intervention for the same condition despite experiencing side-effects or cost. That can be addressed through implementing anchors such as the Satisfaction with Results scale described in Copay et al ., who found that MCID values based on the Satisfaction with Results scale were slightly higher than those derived from HTI-SF-36 [ 7 , 33 ].

Other commonly used outcome scales, such as Oswestry Disability Index (ODI), Roland–Morris Disability Questionnaire (RMDQ), Visual Analogue Scale (VAS), or EQ5D-3L Health-Related Quality of Life, can also act as anchors [ 7 , 14 , 16 , 34 , 35 ]. In such instances, patients complete the “anchor” questionnaire at baseline and post-intervention and the MCID of that anchor is derived from a previous publication [ 12 , 16 , 35 ]. Before deciding on the MCID, full understanding of how it was derived in that previous publication is crucial. Ideally, this should be done for a population similar to our study cohort, with comparable follow-up periods [ 18 , 20 ]. Correlations between the anchor instrument and the investigated outcome measurement instrument must be recorded, and ought to be at least moderate (> 0.05), as that is the best indicator of construct validity (whether both the anchor instrument and outcome instrument represent a similar construct of patient health) [ 18 , 36 ]. If such correlation is not available, the anchor-based MCID credibility instrument is available to aid in assessing construct proximity between the two [ 36 , 37 ].

Once the process for selecting an anchor and classifying “responders” and “non-responders” is established, the MCID can be calculated. The outcome instrument of interest will be defined as an outcome for which we want to calculate the MCID. The first anchor-based method (within-patient change) focuses on the average improvement seen among clear responders in the anchor. The between-patient change anchor-based method additionally subtracts the average improvement seen among non-responders (unchanged and/or worsened) and consequently ends up with a smaller MCID value. Finally, an anchor-based method based on Receiver Operating Characteristic (ROC) curve analysis–that can be considered the current “gold standard”- also exists, which effectively looks at the MCID calculation as a sort of diagnostic instrument and aims to improve the discriminatory performance of our MCID threshold. In the following paragraphs, the three anchor-based methods are described in more detail. The R code (Supplementry Content  1 ) enables the reader to follow the text and to calculate MCID for the Zurich Claudication Questionnaire (ZCQ) Symptom Severity domain, based on a publicly available dataset [ 12 ].

Choice of outcome measurement instruments for MCID calculation case study

The chosen outcome measurement instrument in this case study for which MCID for improvement will be calculated is ZCQ Symptom Severity domain [ 12 ]. The ZCQ is composed of three subscales: symptom severity (7 questions, score per question ranging from 1 to 5 points); physical function (5 questions, score per question ranging from 1 to 4 points) and patient satisfaction with treatment scale (6 questions, score per question ranging from to 4 points). Higher scores indicate greater disability/worse satisfaction [ 38 ]. To visualize different MCID values, Numeric Rating Scale (NRS) for Leg Pain (score from 0 “no pain” to 10 “worse possible pain) and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) Walking Ability domain are chosen, as they showed high responsiveness in patients with LSS post-operatively [ 39 ].Through 25 questions, the JOABPEQ assesses five distinctive domains: pain-related symptoms, lumbar spine dysfunction, walking ability, impairment in social functioning and psychological disturbances. The score for each domain ranges from 0 to 100 points (higher score indicating better health status) [ 40 ]. The correlation of ZCQ symptom severity with NRS Leg Pain and JOABPEQ Walking Ability domain, is 0.56 and − 0.51, respectively [ 39 ]. For a patient to be classified as a “responder”, using the NRS for Leg pain or JOABPEQ walking ability, the score at 6-week follow-up must have improved by 1.6 points or 20 points, respectively [ 7 , 40 , 41 ].

This publicly available dataset does not report patient satisfaction or any kind of global assessment rating.

To enable calculation of global assessment rating-based MCID methods for educational purposes, despite very limited availability of studies providing MCID for deterioration of JOABPEQ, we decided to stratify patients in this dataset into the three following groups, based on the JOABPEQ Walking Ability as an anchor: likely improved (change score above 20 points according to Kasai et al . ), no significant change (− 20– + 20 points change score), and likely deteriorated (lower than − 20 points change score) [ 41 ]. As obtained MCID values were expected to be negative, all values, for clarity of presentation, were multiplied by − 1, except in Method (IX), where graphical data distribution was shown.

The different methods in detail

Method (i) calculating mcid using “within-patient” score change.

The first method focuses on calculating the change between baseline and post-intervention score of our outcome instrument, for each patient classified as a “responder”. A “responder” is a patient who, at follow-up, has achieved the pre-defined MCID of the anchor (or ranks themselves high enough on Global assessment rating type scale based on our methodology). The MCID is then defined as the mean change in the outcome instrument of interest of those classified as “responders” [ 4 , 7 , 16 , 31 ].

The corresponding R-Code formula is described in Step 5a of Supplementry Content  1 . Calculated within-patient MCID of ZCQ Symptom Severity based on NRS Leg Pain and JOABPEQ Walking Ability domain was 4.4 and 4.2, respectively.

Method (II) calculating MCID using “between-patient” score change

In this approach, the mean change in our outcome instrument is calculated for not only “responders” but also for “non-responders”. “Non-responders” are patients who did not achieve the pre-defined MCID of our anchor or who did not rank themselves high enough (unchanged, or sometimes: unchanged + worsened) on Global Assessment Rating type scale according to our methodology. The minimum clinically important difference of our outcome instrument is then defined as the difference between the mean change scores of “responders” and “non-responders” [ 4 , 7 , 16 , 19 ].

The corresponding R-Code formula is described in Step 5b of Supplementry content  1 . Calculated between-patient MCID of ZCQ Symptom Severity based on NRS Leg Pain and JOABPEQ Walking Ability domain was 3.5 and 2.8, respectively.

Method (III) calculating MCID using the ROC analysis

Here the MCID is derived through ROC analysis to identify the “threshold” score of our outcome instrument that best discriminates between “responders” and “non-responders” of the anchor [ 4 , 7 , 16 , 19 , 27 ]. To understand ROC, one must familiarize oneself with the concept of sensitivity and specificity. In ROC analysis, sensitivity is defined as the ability of the test to correctly detect “true positives”, which in this context refers to patients who have achieved a clinically meaningful change.

“False negative” would be a patient, who was classified as “non-responder” but is really a “responder”. Specificity is defined as the ability of a test to correctly detect a “true negative” result- a patient who did not achieve a clinically meaningful change – a “non-responder” [ 25 ].

A “false positive” would be a patient, who was classified as a “responder” but who was a “non-responder”. Values for sensitivity and specificity range from 0 to 1. Sensitivity of 1 means that the test can detect 100% of “true positives”’ (“responders”), while specificity of 1 reflects the ability to detect 100% of “true negatives” (“non-responders”). It is unclear what the minimum sensitivity and specificity should be for a “gold-standard” MCID, which is why the most established approach is to opt for a MCID threshold that maximizes both sensitivity and specificity at the same time, which can be done using ROC analysis [ 4 , 7 , 25 , 31 , 42 ]. During ROC analysis, the “closest-to-(0,1)-criterion” (the top left most point of the curve) or the Youden index are the two methods to automatically determine the optimal threshold point [ 43 ].

When conducting the ROC analysis, the Area under the curve (AUC) is also determined–a measure of how well the MCID threshold discriminates responders and non-responders in general. Values in AUC can range 0–1. An AUC of 0.5 signifies that the score discriminates no better than random chance, whereas a value of 1 means that the score perfectly discriminates between responders and non-responders. In the literature, an AUC of 0.7 and 0.8 is deemed fair (acceptable), while ≥ 0.8 to < 0.9 is considered good and values ≥ 0.9 are considered excellent [ 44 ]. Calculating the AUC provides a rough estimate of how well the chosen MCID threshold performs. The corresponding R-Code formula is described in Step 5c of Supplementry content  1 . Statistical package pROC was used. The calculated MCID of ZCQ symptom severity based on NRS Leg Pain and JOABPEQ Walking Ability domain was for both 1.5.

Calculation of MCID through distribution-based methods

Calculation of MCID using the distribution-based approach focuses on statistical properties of the dataset [ 7 , 14 , 16 , 27 , 45 ]. Those methods are objective, easy to calculate, and in some cases, yield values close to anchor-based MCID. The advantage of this approach is that it does not rely on any external criterion or require additional studies on previously established MCIDs or other validated “gold standard” questionnaires for the specific disease in each clinical setting. However, it fails to include the patient’s perspective of a clinically meaningful change, which will be discussed later in this study. In this sense, distribution-based methods focus on finding MCID thresholds that enable mathematical distinction of what is considered a changed vs. unchanged score, whereas anchor-based methods focus on finding MCID thresholds which represent a patient-centered, meaningful improvement.

Method (IV) calculating MCID through Standard Error of Measurement (SEM)

The standard error of measurement conceptualizes the reliability of the outcome measure, by determining how repeated measurements of an outcome may differ from the “true score”. Greater SEM equates to lower reliability, which is suggestive of meaningful inconsistencies in the values produced by the outcome instrument despite similar measuring conditions. Hence, it has been theorized that 1 SEM is equal to MCID, because a change score ≥ 1 SEM, is unlikely to be due to measurement error and therefore is also more likely to be clinically meaningful [ 46 , 47 ]. The following formula is used: [ 1 , 7 , 35 , 46 , 48 ].

The ICC, also called reliability coefficient, signifies level of agreement or consistency between measurements taken on different occasions or by different raters [ 49 ]. There are various ways of calculating the ICC depending on the used model with values < 0.5, 0.5– 0.75, 0.75–0.9 and > 0.90 indicating poor, moderate, good and excellent reliability, respectively [ 49 ]. While a value of 1 × SEM is probably the most established way to calculate MCID, in the literature, a range of multiplication factors for SEM-based MCID have been used, including 1.96 SEM or even 2.77 SEM to identify a more specific threshold for improvement [ 48 , 50 ]. The corresponding R-Code formula is described in Step 6a of Supplementry Content  1 . The chosen ZCQ Symptom Severity ICC was 0.81 [ 51 ]. The SEM-based MCID was 1.9.

Method (V) calculating MCID through Effect Size (ES)

Effect size (ES) is a standardized measure of the strength of the relationship or difference between two variables [ 52 ]. It is described by Cohen et al . as “degree to which the null hypothesis (there is no difference between the two groups) is false”. It allows for direct comparison of different instruments with different units between studies. There are multiple forms to calculate ES, but for the purpose of MCID calculations, the ES represents the number of SDs by which the post-intervention score has changed from baseline score. It is calculated based on the following formula incorporating the average change score divided by the SD of the baseline score: [ 52 ].

According to Cohen et al . 0.2 is considered small ES, 0.5 is moderate ES and 0.8 or more is large ES [ 53 ]. Most commonly, a change score with an ES of 0.2 is considered equivalent to MCID [ 7 , 16 , 31 , 54 , 55 , 56 ]. Using this method, we are basically identifying the mean change score (in this case reflecting the MCID) that equates to an ES of 0.2: [ 7 , 55 ].

Practically, if a patient experienced small improvement in an outcome measure post intervention, the ES will be smaller than for a patient who experienced a large improvement in outcomes measure. The corresponding R-Code formula is described in Step 6b of Supplementry Content  1 . The ES-based MCID was 0.9.

Method (VI) calculating MCID through Standardized Response Mean (SRM)

The Standardized Response Mean (SRM) aims to gauge the responsiveness of an outcome similarly to ES. Initially described by Cohen et al . as a derivative of ES assessing differences of paired observations in a single sample, later renamed as SRM, it is also considered an “index of responsiveness” [ 38 , 53 ]. However, the denominator is SD of the change scores–not the SD of the baseline scores–while the numerator remains the average change score from baseline to follow-up: [ 10 , 45 , 57 , 58 , 59 ].

Similarly, to Cohen’s rule of interpreting ES, it has been theorized that responsiveness can be considered low if SRM is 0.2–0.5, moderate if > 0.5–0.8 and large if > 0.8 [ 58 , 59 , 60 ]. Again, a change score equating to SRM of 0.2 (although SRM of 1/3 or 0.5 were also proposed) can be considered MCID, although studies have used the overall SRM as MCID as well [ 45 , 54 , 56 , 61 ]. However, since SRM is a standardized index, similarly to ES, the aim of the SRM-based method ought to be to identify a change score that indicates responsiveness of 0.2: [ 61 ].

Similar to the ES-based method, the SRM-based approach for calculating the MCID is not commonly used in in spine surgery studies [ 14 ]. It is a measure of responsiveness, which is the ability to detect change over time in a construct to be measured by the instrument, and ought to be therefore calculated for the study-specific change score rather than extrapolated as a “universal” MCID threshold to other studies. The corresponding R-Code formula is described in Step 6c of Supplementry Content  1 . The SRM-based MCID was 0.8.

The limitation of using Method (V) and (VI) in MCID calculations will be later described in Discussion.

Method (VII) calculating MCID through SD

Standard Deviation represents the average spread of individual data points around the mean value of the outcome measure. Norman et al . found in their review of studies using MCID in health-related quality of life instruments that most studies had an average ES of 0.5, which equated to clinically meaningful change score of 0.5 × SD of baseline score [ 7 , 16 ,  30 ].

The corresponding R-Code formula is described in Step 6d of Supplementry content  1 . The SD-based MCID was 2.1.

Method (VIII) calculating MCID through 95% Minimum Detectable Change (MDC)

The MDC is defined as the minimal change below which there is a 95% chance that it is due to measurement error of the outcome measurement instrument: [ 7 , 61 ].

Usually, value corresponding to z is the desired level of confidence, which for 95% confidence level is 1.96. Although MDC–like all distribution-based methods–does not consider whether a change is clinically meaningful, the calculated MCID should be at least the same or greater than MDC to enable distinguishing true mathematical change from measurement noise. The 95% MDC calculation, is the most common distribution-based approach in spinal surgery, and it appears to most closely resemble anchor-derived MCID values, as demonstrated by Copay et al . [ 7 , 14 , 62 ]. The corresponding R-Code formula is described in Step 6e of Supplementry Content  1 . The 95% MDC was 5.1.

Method (IX) calculating MCID through Reliable Change Index

Another less frequently applied method through which “responders and “non-responders” can be classified but which does not rely on an external criterion is the Reliable Change Index (RCI), also called the Jacobson–Truax index [ 63 , 64 ]. It indicates whether an individual change score is statistically significantly greater than a change in score that could have occurred due to random measurement error alone [ 63 ].

In theory, a patient can be considered to experience a statistically reliably identifiable improvement ( p  < 0.05), if the individual RCI is > 1.96. Again, it does not reflect whether the change is clinically meaningful for the patient but rather that the change should not be attributed to measurement error alone and likely has a component of true score change. Therefore, this method is discouraged in MCID calculations as it relies on statistical properties of the sample and not patient preferences–as all distribution-based methods do [ 65 ]. In the example of Bolton et al . who focused on the Bournemouth Questionnaire in patients with neck pain, RCI was subsequently used to discriminate between “responders” and “non-responders”. The ROC analysis approach was then used to determine the MCID [ 64 ]. The corresponding R-Code formula is described in Step 6f of Supplementry Content  1 . Again, pROC package was used. The ROC-derived MCID was 2.5.

Other methods

Method (x) calculating mcid through anchor-based minimal important change (mic) distribution model.

In theory, combining anchor- and distribution-based methods could yield superior results. Some suggestions include averaging the values of various methods, simply combining two different methods (i.e. both an anchor-based criterion such as ROC-based MCID from patient satisfaction and 95% MDC-based MCID have to both be met to consider a patient as having achieved MCID) [ 25 ]. In 2007, de Vet et al . introduced a new visual method of MCID calculations that does not only combine but also integrates both anchor- and distribution-based calculations [ 25 ]. In addition, their method allows the calculation of both MCID for improvement and for deterioration, as these can differ.

In short form, using an anchor, patients were divided into three “importantly improved”, “not importantly changed” and “importantly deteriorated” groups (Fig.  2 ) . Then distribution expressed in percentiles of patients who “importantly improved”, “importantly deteriorated” and “not importantly changed” were plotted on a graph. This is the anchor-based part of the approach, ensuring that MCID thresholds chosen have clinical value.

Distribution of the Zurich Claudication Questionnaire Symptom Severity change scores for patients categorized as experiencing “important improvement”, “no important change” or “important deterioration” in JOABPEQ walking ability as an anchor (Method (X)). For ZCQ Symptom Severity score to improve, the actual value must decrease explaining the negative values in the model. ROC , Receiver Operating Characteristic; ZCQ , Zurich Claudication Questionnaire; JOABPEQ , Japanese Orthopaedic Association Back Pain Evaluation Questionnaire

The second part of the approach is then entirely focused on the group of patients determined by the anchor to be “unchanged”, and can be either distribution- or anchor-based:

In the first and more anchor-based method, the ROC-based method described in Method (III) is applied to find the threshold for improvement (by finding the ROC-based threshold point that optimizes sensitivity and specificity of identifying improved vs unchanged patients) or for deterioration (by finding the ROC-based threshold point that optimizes sensitivity and specificity of identifying deteriorated vs unchanged patients). For example, the threshold for improvement is found by combining the improved and unchanged groups, and then testing out different thresholds for discriminating those two groups from each other. The optimal point on the resulting ROC curve based on the closest-to-(0,1)-criterion is then found.

In the second method, which is distribution-based, the upper 95% (for improvement) and lower 95% (for deterioration) limits are found based solely on the group of patients determined to be unchanged. The following formula is used (instead, subtracting instead of adding the 1.645 × SD for deterioration or improvement, respectively): [ 25 ]

The corresponding R-Code formula can be found under Step 7a in Supplementry Content  1 . The model is presented in Fig.  2 . The 95% upper limit and 95% lower limit was 4.1 and − 7.2 respectively. The ROC-derived MCID using RCI was − 2.5 (important improvement vs unchanged) and − 0.5 (important deterioration vs unchanged). For the purpose of the model, MCID values were not multiplied by − 1 but remained in original form.

Method (XI) calculating MCID as 30% Reduction from Baseline

In recent years, a simple 30% reduction from baseline values has been introduced as an alternative to MCID calculations [ 66 ]. It has been speculated that absolute-point changes are difficult to interpret and have limited value in context of “ceiling” and “floor” effects (i.e. values that are on the extreme spectra of the measurement scale) [ 4 ]. To overcome this, Khan et al . found that 30% reduction in PROMs has similar effectiveness as traditional anchored or distribution-based methods in detecting patients with clinically meaningful differences post lumbar spine surgery [ 15 ]. The corresponding R-Code formula can be found under Step 7b in Supplementry Content  1 .

Method (XII) Calculating MCID through Delphi method

The Delphi Method is a systemic approach using the collective opinion of experts to establish a consensus regarding a medical issue [ 67 ]. It has mostly been used to develop best practice guidelines [ 68 ]. However, it can also be used to aid MCID determination [ 69 ]. The method focuses on distributing questionnaires or surveys to panel of members. The anonymized answers are grouped together and shared again with the expert panel in subsequent rounds. This allows the experts to reflect on their opinions and consider strengths and weaknesses of the others response. The process is repeated until consensus is reached. Ensuring anonymity, this prevents any potential bias linked to a specific participant’s concern about their own opinion being viewed or influenced by other personal factors [ 67 ].

Method (XIII) calculating MCID through Social Comparison Approach

The final approach is asking patients to compare themselves to other patients, which requires time and resources [ 70 ]. In a study by Redelmeier et al . patients with chronic obstructive pulmonary disease in a rehabilitation program were organized into small groups and observed each other at multiple occasions [ 70 ]. Additionally, each patient was paired with another participant and had a one-to-one interview with them discussing different aspects of their health. Finally, each patient anonymously rated themselves against their partner on a scale “much better”, “somewhat better”, “a little bit better”, “about the same”, “a little bit worse” “somewhat worse” and “much worse”. MCID was then calculated based on the mean change score of patients who graded themselves as “a little bit better” (MCID for improvement) or a “little bit worse” (MCID for deterioration), like in the within-patient change and between-patient change method described in Method (I) and (II) [ 70 ].

Substantial Clinical Benefit

Over the years, it has been noted that MCID calculations based either purely on distribution-based method or only group of patients rating themselves as “somewhat better” or “slightly better” does not necessarily constitute a change that patients would consider beneficial enough “to mandate, in the absence of troublesome side effects and excessive cost, to undergo the treatment again” [ 3 , 24 ]. Therefore, the concept of substantial clinical benefit (SCB) has been introduced as a way of identifying a threshold of clinical success of intervention rather than a “floor” value for improvement- that is MCID [ 24 ]. For example, in Carreon et al ., ROC derived SCB “thresholds” were defined as a change score with equal sensitivity and specificity to distinguish “much better” from “somewhat better” patients post cervical spinal fusion [ 71 ]. Glassman et al . on the other hand used ROC derived SCB thresholds to discriminate between “much better” and “about the same” patients following lumbar spinal fusion. The authors stress that SCB and MCID are indeed separate entities, and one should not be used to derive the other [ 24 ]. Thus, while the methods to derive SCB and MCID thresholds can be carried out similarly based on anchors, the ultimate goal of applying SCB versus MCID is different.

Using the various methods explained above, overall, MCID for improvement for ZCQ Symptoms Severity domain ranged from 0.8 to 5.1 (Table  1 ). Here, the readers obtained results can be checked for correctness. On average distribution-based MCID values were lower than anchor-based MCID values. Within distribution-based approach, method (VIII) “Minimum detectable change” resulted in MCID of 5.1, which exceeded the MCID’s derived using the “gold-standard” anchor-based approaches. The average MCID based on anchor of NRS Leg pain and JOABPEQ walking ability was 3.1 and 2.8, respectively. Dependent on methods used, percentage of responders to HE and PT intervention fell within range of 9.5% for “30% Reduction from Baseline” method to 61.9% using ES- and SRM-based method (Table  2 ). Method (X) is graphically presented in Fig.  2 .

As demonstrated above, the MCID is dependent upon the methodology and the chosen anchor, highlighting the necessity for careful preparation in MCID calculations. The lowest MCID of 0.8 was calculated for Method (VI) being SRM. Logically, if a patient on average had a baseline ZCQ Symptom Severity score of 23.2, an improvement of 0.8 is unlikely to be clinically meaningful, even if rounded up. It rather informs on the measurement error property of our instrument as explained by COSMIN. Additionally, the distribution-based methods rely on statistical properties of the sample, which varies from cohort to cohort making it only generalizable to patient groups with similar SD but not applicable to others with a different spread of data [ 52 ]. Not surprisingly, anchor-based methods considering patient preferences yielded on average higher MCID values than distribution-based methods, which again varied from anchor to anchor. The mean MCID for improvement calculated for NPRS Leg Pain was 3.1, while for JOABPEQ Walking Ability it was 2.8—such similar values prove the importance of selecting responsive anchors with at least moderate correlations. Despite assessing different aspects of LSS disease, the MCID remained comparable in this specific case.

Interestingly, Method (VIII) MDC yielded the highest value of 5.1, exceeding the “gold-standard” ROC-derived MCID. This suggests that, in this example, using this ROC-derived MCID in clinical practice would be illogical, as the value falls within the measurement error determined by MDC. Here it would be appropriate to choose MDC approach as the MCID. Interestingly, ROC-derived MCID values based on Global Assessment Rating like stratification of patients based on their JOABPEQ Walking Ability (Method X) yielded higher MCID, than in Method (III). This may be attributed to a more a balanced distribution of “responders” and “non-responders” (only unchanged patients) in Method (X), unlike in the latter (Method III) where patients were strictly categorized into “responders” and “non-responders” (including both deteriorated and unchanged). This further highlights the importance of using global assessment rating type scales in determining the extent of clinical benefit.

Although ES-based (Method (V)) and SRM-based (Method (VI)) MCID calculations have been described in the literature, ES and SRM were originally created to quantify the strength of relationship between scores of two samples (in case of ES) and change score of paired observations in one sample (in case of SRM) [ 53 , 58 , 59 ]. They do offer an alternative to MCID calculations. However, verification with other MCID calculation methods, ideally anchor-based, is strongly recommended. As seen in this case study and other MCID’s derived similarly, they often result small estimates [ 7 , 55 ]. There is also no consensus regarding the choice of SD of Change Score vs. SD of Baseline Score as denominator. Additionally, whether the calculated MCID (mean change score) should represent value, such as the ES is 0.2 indicating small effect, or value should be 0.5 suggesting moderate effect is currently arbitrary and often relies on the researcher’s preference [ 53 , 55 , 59 ]. Both ES and SRM can be used to assess whether the overall change score observed in single study is suggestive of a clinically meaningful benefit in that specific cohort or in case of SRM, whether the outcome measure is responsive. However, it is our perspective that extending such value as “MCID” from one study to another is not recommended.

One can argue whether there is even a place for distribution-based methods in MCID calculations. They ultimately fail to provide an MCID value that meets the original definition of Jaeschke et al . “of smallest change in the outcome that the patient would identify as important”. At no point are patients asked about what constitutes a meaningful change for them, and the value is derived from statistical properties of the sample solely [ 1 ]. Nevertheless, conduction of studies on MCID implementing scales such as Global Assessment Rating is time-consuming and performing studies for each patient outcome and each disease is likely not feasible. Distribution-based methods still have some merit in that they–like the 95% MDC method—can help distinguish measurement noise and inaccuracy from true change. Even if anchor-based methods should probably be used to define MCID thresholds, they ought to be supported by a calculation of MDC so that it can be decided whether the chosen threshold makes sense mathematically (i.e., can reliably be distinguished from measurement inaccuracies) as seen in our case study.

Calculating MCID for different diagnoses

Previously, MCID thresholds for outcome measurement instruments were calculated for generic populations, such as patients suffering from low back pain. More recently, MCID values for commonly used PROMs in spine surgery, such as ODI, RMDQ or NRS have been calculated for more narrowly defined diagnoses, such as lumbar disc herniation (LDH) or LSS. The question arises as to whether a separate MCID is needed for all the different spinal conditions. In general, establishing an MCID specific to these patient groups is only recommended if these patient’s perception of meaningful change is different from that of low back pain in general. Importantly, again, the MCID should not be treatment-specific, but rather broadly disease specific. Therefore, it is advisable to use MCID based on patients who had the most similar disease characteristics to our cohort. For example, an MCID for NRS Back Pain based on study group composed of different types of lumbar degenerative disease, may in some cases, be applied to study cohort composed solely of patients with LDH. However, no such extrapolation should be performed for populations with back pain secondary to malignancy, due to a totally different pathogenesis and associated symptoms that may influence the ability to detect a clinically meaningful change in the above NRS Back Pain such as fatigue or anorexia.

Study cohort characteristics that influence MCID

Regardless of robust methodology, it can be expected that it is impossible to obtain the same MCID on different occasions even in the same population due to the inherent subjectivity of what is perceived as “clinically beneficial” and day-to-day symptom fluctuation. However, it was found that patients who have worse baseline scores, reflecting e.g., more advanced disease, require greater overall change at follow-up to report it as clinically meaningful [ 72 ]. One should also be mindful of “regression to the mean” where extremely high or low-scoring patients then subsequently score closer to baseline at second measurement [ 73 ]. Therefore, adequate cohort characteristics need to be presented, for the readers to judge how generalizable the MCID may be to their study cohort. If a patient pre-operatively experiences NRS Leg Pain of 1, and the MCID is 1.6, they cannot achieve MCID at all, as the maximum possible change score is smaller than the MCID threshold (“floor effect”). A similar situation can occur with patients closer to the higher end of the scale (“ceiling effect”). The general rule is, that if at least 15% of the study cohort has the highest or lowest possible score for a given outcome instrument, one can expect significant “ceiling/floor effects” [ 50 ]. One way to overcome this, is through transferring absolute MCID scores to percentage change scores [ 4 , 45 ]. However, percentage change scores only account for high baseline scores, if high baseline scores indicate larger disability (as seen with ODI) and have a possibility of larger change. If a high score in an instruments reflects better health status (as seen in in SF-36), than percentage change scores will increase the association with baseline score [ 4 ]. In general, it is important to consider which patient to exclude from certain analyses when applying MCID: For example, patients without relevant disease preoperatively (for example, those exhibiting so-called “patient-accepted symptom states”, PASS) should probably be excluded altogether when reporting the percentage of patients achieving MCID [ 74 ].

Establishing reliable thresholds for MCID is key in clinical research and forms the basis of patient-centered treatment evaluations when using patient-reported outcome measures or objective functional tests. Calculation of MCID thresholds can be achieved using a variety of different methods, each yielding completely different results, as is demonstrated in this practical guide. Generally, anchor-based methods relying on scales assessing patient preferences/satisfaction or global assessment ratings continue to be the “gold-standard” approach- the most common being ROC analysis. In the absence of appropriate anchors, the distribution-based MCID based on the 95% MDC approach is acceptable, as it appears to yield the most similar results compared to anchor-based approaches. Moreover, we recommend using it as a supplement to any anchor-based MCID thresholds to check if they can reliably distinguish true change from measurement inaccuracies. The explanation provided in this practical guide with step-by-step examples along with public data and statistical code can add as guidance for future studies calculating MCID thresholds.

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Klukowska, A.M., Vandertop, W.P., Schröder, M.L. et al. Calculation of the minimum clinically important difference (MCID) using different methodologies: case study and practical guide. Eur Spine J (2024). https://doi.org/10.1007/s00586-024-08369-5

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