case study related to article 18

University of Birmingham

The importance of freedom of religious or belief (FoRB) protections, as expressed in Article 18 of the Universal Declaration of Human Rights (UDHR) is not widely understood outside academic and legal circles. There are a sizeable number of organisations endeavouring to change this, but for Article 18  to be fully understood, it must be reinterpreted and reaffirmed in every generation across all societies.

The Universal Declaration, with its Article 18 provision for FoRB, goes back to the document’s drafting in 1948, as a strong statement for FoRB in the post-Holocaust and post-World War II world.  Article 18 states:

Everyone has the right to freedom of thought, conscience and religion ; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship and observance.

This commitment to FoRB, while not uncontroversial at the time of the UDHR, laid the foundation for FoRB rights in international law in the latter half of the twentieth century.

Language nearly identical to Article 18 of the UDHR was adopted as the first portion of a more elaborate guarantee of FoRB, reaffirmed in 1966 in Article 18 of the International Covenant on Civil on Civil and Political Rights (ICCPR), which stated:

• Everyone shall have the right to freedom of thought, conscience and religion . This right shall include freedom to have or to adopt a religion or belief of his choice, and freedom, either individually or in community with others and in public or private, to manifest his religion or belief in worship, observance, practice and teaching.
• No one shall be subject to coercion which would impair his freedom to have or to adopt a religion or belief of his choice.
• Freedom to manifest one's religion or beliefs may be subject only to such limitations as are prescribed by law and are necessary to protect public safety, order, health, or morals or the fundamental rights and freedoms of others.
• The States Parties to the present Covenant undertake to have respect for the liberty of parents and, when applicable, legal guardians to ensure the religious and moral education of their children in conformity with their own convictions.

To the original freedoms to have and to manifest FoRB contained in UDHR Article 18, the ICCPR Article 18 thus added protections from coercion, the possibility of limitations in instances where FoRB might conflict with the rights of others, and a provision on the liberty of parents to educate their children in religious matters.

Article 18, in both the UDHR and ICCPR formulations, affords wide-ranging protections to ‘freedom of thought, conscience, and religion’. They thus protect not only religion, but a range of other beliefs, as well as the right not to subscribe to religious beliefs at all. Article 18 includes not only private belief, worship and practice, but also the public expression of belief in civil society and the public sphere. This public dimension of Article 18 inextricably links FoRB rights to related rights of speech, expression, assembly, association and education. These many dimensions of FoRB received further expression in the U.N. General Assembly’s 1981 Declaration on the Elimination of All Forms of Intolerance and of Discrimination Based on Religion or Belief . This ‘Religion Declaration’ is the highest-level U.N. statement specifically on FoRB. Article 18 is increasingly seen as not only a right of individuals, but also a collective right of religious communities and religious groups, particularly since the General Assembly’s 1992 Declaration on the Rights of Persons Belonging to National or Ethnic, Religious and Linguistic Minorities, which has come to be seen as a strong statement of rights on the basis of group identity, alongside the many guarantees of individual human rights in international law.

When understood as ‘religious freedom’ or ‘freedom of religion’, FoRB can give the impression of being about ‘religious rights’ or ‘rights for the religious’. Article 18 has been broadly conceived as including a range of religious and non-religious beliefs. It is, indeed, the case in religiously pluralistic societies that differing beliefs can lead to conflict, discrimination and even outright religious persecution by and among religious groups. But the world’s religions are not only powerful sources of human rights in and of themselves, they also bring resources for transforming conflict and securing peace and social development.

Different societies, at times, may be at different places when it comes to freedom of religion or belief. Nowadays, international human rights doctrine affords what is known as a ‘margin of appreciation’- deference to national context and other factors - when it comes to recognising the efforts that nations make toward human rights realisation.  This can vary from society to society. Societies may also differ in their understanding of the relation between FoRB and other rights to speech, expression, and relations between social groups in pluralistic societies. We will be addressing some of these interrelations in subsequent posts.

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10 Proving Bad Faith in International Law: Lessons from the Article 18 Case Law of the European Court of Human Rights

• Published: November 2022
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The aim of this chapter is to analyze the European Court of Human Rights’ (ECtHR) evolving bad faith jurisprudence against the backdrop of the difficulties associated with proving bad faith violations in international law. By way of a close reading of the case law of the ECtHR between 2004, when it found its first bad faith violation until 2020, the chapter investigates how the Court has come to treat good faith as a rebuttable presumption, how the secondary rules of evidence concerning bad faith violations have developed in the case law of the Court over time, and the consequences of these developments for the primary rule provided in article 18 of the European Convention on Human Rights (ECHR). The chapter argues that the development of secondary rules of evidence to prove bad faith violations of the ECHR are closely interrelated with the recent developments in the interpretation of primary rules of the ECHR under article 18. The ECtHR’s bad faith case law has, over time, evolved away from a direct and subjective evidence paradigm to a circumstantial and indirect evidence paradigm. At the same time, the substantive interpretation of article 18 of the ECHR , too evolved, to signal that the use of domestic laws and judicial proceedings in the service of anti rule of law and antidemocratic agendas constitutes a violation of the ECHR. These developments make the ECtHR an avant-garde adjudicatory body in developing secondary rules of evidence for deciding whether states violate their international law obligations in bad faith.

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• Constitution of India

Article 18 of the Indian Constitution

This article is written by Shraddha Jain , a student of the Institute of Law, Nirma University, Ahmedabad. The author discusses Article 18 of the Indian Constitution. The main discussion of the Article is on the abolition of titles, the purpose of this abolition in the country, and some landmark judgments on this issue. 

This article has been published by Sneha Ma h awar .

Table of Contents

Introduction 

Article 18 of the Indian Constitution talks about the abolition of titles. This Article prohibited title recognition and conferment in our country. In 1948, a draft version of Article 12 was created, and later on, this version was edited and presented as Article 18 of the Indian Constitution. This article only applies to those titles that may have an influence on social equality and create unfairness among members of the community.

This provision does not restrict the award and its usage to Indian nationals for their outstanding work in various fields. Even though it is mentioned in Part III of the Indian Constitution, the purpose of this Article is not to protect the fundamental rights of Indian citizens, but it seeks to limit legislative and executive action.

Provisions of Article 18 of the Indian Constitution

Article 18 consists of 4 clauses, which are as follows:

Article 18(1) : The first clause is  for the state’s responsibility. Article 18 (1) prohibits all titles. It prevents the government from bestowing titles on anyone, whether a citizen or a non-citizen, apart from the titles in the fields of military and academic, for example, Paramveer, Doctor, etc. As a result, a university might bestow a title or honour on a deserving individual.

Article 18(2) : The second clause and subsequent provisions are for nationals. It forbids an Indian national from taking any title from a foreign nation.

Article 18(3) : It prevents an individual who is not an Indian citizen, but holds any office of profit or trust post under the Government of India, from taking any title from any foreign nation without the President’s assent.

Article 18(4) : It states that no individual, whether citizen or non-citizen, possessing any office of profit or charity post under the government of India, should receive any gifts, emoluments, or office of any type from or under any foreign nation without the President’s assent.

Clauses (3) and (4) were inserted to guarantee that a non-citizen remains faithful to the government, i.e., does not violate the confidence placed in him.

Nevertheless, the modern bestowment of titles such as ‘Bharat Ratna’, ‘Padma Vibhushan’, ‘Padma Bhushan’, and ‘Padma Shri’, which were established in 1954, is claimed to be permissible under Article 18 because they just reflect the state’s appreciation of exemplary work by people in diverse spheres of activity. It should be kept in mind that Article 18 does not safeguard any fundamental rights, but rather limits executive and legislative jurisdiction.

Constitutional debate on Article 18 of the Indian Constitution

Today’s Article 18 was initially Article 12 of the drafted Indian Constitution.

Article 12 of the Draft Constitution , 1948 was as follows:

1) The state shall not bestow any titles.

(2) No Indian citizen shall receive any title from a foreign nation.

(3) No individual possessing any office of profit or trust post under the Government of India will take any gift, remuneration, rank, or office of any form from or under any foreign nation without the President’s assent.

On December 1, 1948, draft Article 12 (present Article 18) was discussed. It prohibited title recognition and conferment to any individual.

A Drafting Committee member suggested a modification to the article to specify that titles of military and academic excellence would be given exemption from the ambit of Draft Article 12. The Assembly adopted this modification without controversy.

Another participant of the assembly proposed to modify sub-section (2) to clearly indicate that the government will not acknowledge any titles bestowed by a foreign nation. He contended that, in its current form, Draft Article 12 only prevents an Indian national from taking a title and does not prevent the State from acknowledging it; furthermore, no punishment or penalties were specified for doing the same.

One of the members said that anyone who accepts such a title must be considered to have surrendered their citizenship of India. The Drafting Committee Chairman stated that the government might exercise its residuary authorities to impose a punishment for this action. The Assembly rejected the amendment.

On December 1, 1948, the amended Draft Article 12 was accepted.

What is meant by the term “titles”

A ‘title’ is anything that is attached to one’s identity as a prefix or suffix, such as Sir, Nawab, Maharaja, and so on. Titles and titular achievements must not be granted in a democratic country. It will be counterproductive to the development of social justice.

Titles refer to any inherited designations (such as Rai Bahadur, Khan Bahadur, Sawai, Rai Sahab, Zamindar, Taluqdar, and so on) used by people during the colonial period, and the objective of this Article 18 in our Constitution is to maintain fairness among everyone.

It excludes military and scholarly professionals, as well as civilian honours such as Padma Shri, Padma Bhushan, Padma Vibhushan, and Bharat Ratna, with the limitation that no one will ever use them as a suffix or prefix to their names.

What was the need for introducing Article 18 of the Indian Constitution

• Titles are used to differentiate an individual’s rank by pinning inferiority complexes upon other people. As a result, the constituent assembly agreed to eliminate such inequality and drafted this article, which has four provisions.
• It would endanger the current societal harmony and unity. The nationalists decided unanimously to eliminate titles in order to protect the aim of a democratic republic.
• Honours and titular achievements should not be established in democratic government. This is in the development of a nation that aims to achieve political, cultural, and economic justice and aspires to become really democratic. There is really no place for a handful of people to possess titles, which might establish artificial disparities among the members of an equal community.
• If people have been given titles, they will create concerns that will prevent the establishment of good interpersonal relationships.

Punishment under Article 18 of the Indian Constitution

• Accepting a title is a breach of a regulation, but it is not an offence.
• By using Article 226 , an individual may impose a restriction on the state through the writ of Mandamus.
• The recourse is only applicable for the enforcement of constitutionally protected rights.

Landmark judgments under Article 18 of the Indian Constitution

In the judgement of Balaji Raghavan v. Union of India (1995) , the petitioners questioned the legitimacy of national awards like the Bharat Ratna, Padma Vibhushan, Padma Bhushan, and Padma Shri, and asked the Court to prohibit the Indian government from bestowing these honours. They have argued that the National Awards come under the purview of titles under Article 18 of the Constitution of India and hence contravene Article 18(1).

The petitioners are of the belief that the term ‘title’ must be granted the broadest possible interpretation and range in order to give effect to the statutory interpretation, provided that the only exceptions to this rule are military and technical excellence. It was also asserted that these honours are being excessively misappropriated, that the reason for which they were given has been undermined, and that they’re being given to people who are not eligible for them.

Balaji Raghavan brought a writ of mandamus in the High Court of Madras under Article 226 of the Indian Constitution to prohibit the Government of India from bestowing any of the major awards.

The issue that went to the Hon’ble Supreme Court was— “Whether the honours such as Bharat Ratna, Padma Vibhushan, Padma Bhushan, and Padma Shri come under the purview of “titles” within the definition of Article 18(1) of the Indian Constitution? “

The Supreme Court ruled that the notion of equality doesn’t really require that excellence be denied and also that people who have done great service to the nation be denied awards. Article 51A(j) of the Indian Constitution exhorts every individual “ to aspire for expertise in all fields of collective and individual interaction, so that the nation continually increases to higher levels of undertaking and accomplishment “. 

National Awards such as the Bharat Ratna, Padma Bhushan, and Padma Shri do not violate the concept of equality protected by the provisions of the Indian Constitution. These National Honours are not ‘titles’ in the spirit of Article 18 and hence do not violate Article 18 of the Indian Constitution. To prevent abuse of this power, the Court advised that the Prime Minister should appoint a high-level commission, in agreement with the President, to guarantee that only meritorious individuals receive the honours.                       

In the case of Indira Jaising v. Supreme Court of India (2017) , a complaint was lodged in this matter questioning the usage of the term ‘senior advocate’ before the names of the advocates. The Supreme Court ruled that this is not the title, but rather a demarcation, and therefore does not violate Article 18 of the Indian Constitution.

Section 16 of the Advocates Act 1961 establishes the foundation for such a division. Section 16(2) of the Advocates Act of 1961 states that an advocate could be classified as a senior advocate if the Supreme Court or the High Court feels he possesses the necessary skill, expertise, and understanding of the law. The Court granted orders in all of these instances and established a regular body called the ‘Committee for Senior Advocate Designation’.

Position in other Nations

United State of America : Article I Section 9 Clause 8 of the U.S. Constitution contains a similar prohibition that forbids anyone from holding positions of profit or trust after accepting gifts of any kind from a foreign government without the consent of Congress. The American Constitution, on the other hand, follows the tradition of periodically granting civil honours, such as the Presidential Medal of Freedom.

Canada : The Order of Canada was created by the Canadian government in the year 1967 and is given for a broad range of achievements such as farming, ballet, science, philanthropy, and so on. There are three different levels of membership in the Order of Canada: Companions, Officers, and Members.

France : The Order of Academic Palms , Order of Agricultural Merit , and Order of Arts and Letters were adopted by France to give honour for excellence in education, writing, technology, rendering service in agricultural activities, artistic and other creative activities. 

Conclusion 

The bestowal of awards generates inequality between recipients and ordinary people, but this also promotes undesirable rivalry among winners. It is important to recognise people for their contributions to empower them. Article 18(1) was enacted to stop the corrupt and immoral conduct of citizens, which makes them go about currying favours with power in order to get certain differentiation. Awards not only honour accomplishment, but also many other traits such as skill, difficulty, and effort. Giving awards to citizens is constitutionally legitimate and does not violate Article 14 of the Indian Constitution. If an honour is misused, the defaulter’s reward will be revoked, and some penalty may be imposed. The government should determine the legality of titles on a regular basis. The purpose of awarding titles should be clarified.

Frequently Asked Questions (FAQs) 

What is the distinction between titles and awards.

At the time of British administration, the titles were given to people who pleased Britishers with their administrative abilities. Individuals are honoured for their services to the advancement of art, literature, and technology, as well as for exceptional public service. While rewards are given solely on the basis of a person’s performance without regard to religion, class, gender, or colour, British rulers conferred titles on certain groups.

Why is it necessary to give an award to someone?

Individuals would be motivated to work more for the betterment of the nation if they were rewarded. As a result, a system of honours and decorations has been established to recognise excellence in the execution of certain responsibilities.

What are the criteria for selecting people for ‘Padma awards’?

The Union Government established a ‘High Level Review Committee,’ led by the Vice-President, to look into current regulations and determine the method for choosing people for “Padma awards” in order to increase respect for such honours. This Commission proposed the formation of State-level Committees to provide suggestions to the Union. The proposed names will be considered by the Union government and a commission composed of the Cabinet Secretary, the Home Ministry, and the Secretary to the President of India. Following that, the completed names must be presented to the Prime Minister’s office and then to the President. There are no rules governing ‘Bharat Ratna’ awards.

 References 

• https://www.constitutionofindia.net/constitution_of_india/18/articles/Article%2018
• MP Jain’s Indian Constitutional Law
• https://www.mea.gov.in/Images/pdf1/Part3.pdf
• (2)%20An%20advocate%20may%2C,is%20deserving%20of%20such%20distinction .
• https://www.constitutionofindia.net/constitution_of_india/fundamental_rights/articles/Article%2014
• https://www.eure-et-loir.gouv.fr/Demarches-administratives/Distinctions-honorifiques-et-Medailles/Les-ordres-ministeriels/Ordre-des-Palmes-academiques
• https://archive.gg.ca/honours/nat-ord/oc/oc-con_e.asp
• https://constitution.congress.gov/browse/article-1/section-9/clause-8/#:~:text=No%20Title%20of%20Nobility%20shall,%2C%20Prince%2C%20or%20foreign%20State .
• (1970) 2 SCC (Jour) 5

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Right to Equality (Article 14 to 18): Meaning, Provisions & Significance

The Right to Equality , enshrined as a fundamental right in the Indian Constitution, plays a crucial role in building a just and equitable society. The provisions under this right collectively form the bedrock upon which the edifice of Indian democracy is built. This article of NEXT IAS delves into the nuances of provisions related to the Right to Equality, their meaning, significance, exceptions, and more.

Meaning of Right to Equality

The Right to Equality in the Indian Constitution is a fundamental human right that signifies that all people should be treated equally and without discrimination. This principle is foundational to human rights law and is enshrined in various international treaties and national constitutions around the world. The essence of this right is to ensure that no individual or group is denied societal opportunities or privileges that are available to others based on arbitrary criteria such as race, gender, age, sexual orientation, nationality, religion, or any other status.

Right to Equality in India

The Right to Equality is a Fundamental Right enshrined in the Constitution of India. The detailed provisions related to the Right to Equality contained in Articles 14 to 18 of the Constitution form the cornerstone of justice and fairness in society. Together they ensure that everyone is treated equally before the law, given equal opportunities in certain matters, and is not discriminated against on grounds such as religion, race, caste, sex, or place of birth, etc.

Right to Equality: Provisions Under the Indian Constitution

Equality before law and equal protection of laws (article 14).

• This provision mandates that the State shall not deny to any person Equality before the Law or the Equal Protection of the Laws within the territory of India.
• This right is extended to citizens, foreigners as well as legal persons such as companies.

Equality before Law

• the absence of any special privileges in favor of any person,
• the equal subjection of all persons to the ordinary law of the land,
• no person is above the law.

Equal Protection of Laws

• equality of treatment under equal circumstances, both in the privileges conferred and liabilities imposed by the laws,
• the similar application of the same laws to all persons who are similarly situated,
• the like should be treated alike without any discrimination.
• A simple comparison of the concepts of ‘Equality before Law’ and ‘Equal Protection of Laws’ tells that the former is a negative concept , while the latter is a positive concept. However, they both align in their common aim to establish equality of legal status, opportunity, and justice.

Rule of Law

• Absence of arbitrary power i.e. no man can be punished except for a breach of law.
• Equality before law i.e. equal subjection of all citizens to the laws of the land.
• The primacy of the rights of the individual i.e. constitution is the result of the rights of the individual as defined and enforced by the courts of law, rather than the constitution being the source of the individual rights.
• The concept of ‘ Equality before Law ’ is an element of the concept of ‘Rule of Law’.
• In the case of the Indian system, only the 1st and 2nd elements of the ‘Rule of Law’ are applicable, and not the 3rd one. This is because, in India, the constitution is the source of the individual rights.
• The Supreme Court has ruled that the ‘Rule of Law’ as embodied in Article 14 is a ‘basic feature’ of the constitution , and hence cannot be destroyed by a constitutional amendment.

Exceptions to Equality

The rule of equality before the law has certain exceptions. These exceptions are mentioned below:

• As ruled by the Supreme Court, while Article 14 forbids class legislation, it permits the reasonable classification of persons, objects, and transactions by law. However, the classification should not be arbitrary, artificial, or evasive.
• As per Article 361 , the President of India and the Governor of States enjoy certain immunities.
• As per Article 361-A , no person shall be liable for any proceedings in any court for publication of a true report of any proceedings of Parliament or State Legislature.
• Article 105 provides that no member of Parliament shall be liable to any proceedings in any court in respect of anything said or any vote given in Parliament or any committee thereof. Article 194 makes a similar provision for members of the State Legislature.
• Article 31-C provides that laws made by the state for implementing DPSPs contained in Article 39 (b) and (c) cannot be challenged on the grounds of being violative of Article 14.
• Immunity to foreign sovereigns, ambassadors, and diplomats from criminal and civil proceedings.
• UNO and its agencies also enjoy diplomatic immunity from certain proceedings.

Prohibition of Discrimination on Certain Grounds (Article 15)

• The state shall not discriminate against any citizen on grounds only of religion, race, caste, sex, or place of birth.
• No citizen shall be subjected to any disability, liability, restriction, or condition on grounds only of religion, race, case, sex, or place of birth w.r.t. access to public places.
• The first provision prohibits discrimination only by the state , while the second provision prohibits discrimination both by the state and private individuals.
• The crucial term here is ‘only’, which connotes that discrimination on grounds other than those mentioned in the provisions is not prohibited.
• The state is authorized to enact special provisions for the benefit of women and children, such as reserving seats in local bodies or providing free education for children.
• The state is empowered to enact special measures for the advancement of socially and educationally backward classes, as well as scheduled castes and scheduled tribes such as seat reservations or fee concessions in public educational institutions.
• The state has the authority to enact special measures for the advancement of socially and educationally backward classes, scheduled castes, or scheduled tribes in matters of admission to educational institutions, including private ones, whether aided or unaided by the state, excluding minority educational institutions.
• The state is empowered to enact special measures for the advancement of economically weaker sections of society. Additionally, the state may reserve up to 10% of seats for such sections in educational institutions, excluding minority educational institutions. A. This reservation is in addition to existing reservations and is determined based on family income and other indicators of economic disadvantage, as notified by the state.

Equality of Opportunity in Public Employment (Article 16)

• This provision provides for equality of opportunity for all citizens in matters of employment or appointment to any office under the State.
• The citizens cannot be discriminated against or be ineligible for any employment or office under the State only on the grounds of religion, race, caste, sex, descent, place of birth, or residence.
• Parliament may prescribe residence as a condition for certain employment positions under the State, Union Territory, Local Authority, or other authority.
• The State can provide for the reservation of appointments or posts in favor of the backward classes that are inadequately represented in the state services.
• A law can provide that certain religious institutions or denominations may require officeholders to belong to a particular religion or denomination.
• The state can reserve up to 10% of appointments for economically weaker sections, in addition to existing reservations, based on criteria such as family income or other indicators of economic disadvantage. A. This reservation has been added by the 103rd Amendment Act of 2019.

Abolition of Untouchability (Article 17)

• This provision has abolished ‘untouchability’ and forbids its practice in any form.
• Any act enforcing disability based on untouchability shall be deemed as an offense punishable by law.
• Untouchability refers to social disabilities imposed on certain classes of persons because of their birth in certain castes. Hence, it does not cover the social boycott of a few individuals or their exclusions from religious services, etc.
• However, the term ‘untouchability’ has not been defined in the Constitution or the Protection of Civil Rights Act of 1955 (the act enacted to enforce this provision).

Abolition of Titles ( Article 18)

• It prohibits the state from granting any title, except for military or academic distinctions, to any individual, whether a citizen or a foreigner.
• It prohibits Indian citizens from accepting titles from any foreign state.
• A foreigner holding any office of profit or trust under the state cannot accept titles from any foreign state without the President’s consent.
• Neither citizens nor foreigners holding any office of profit or trust under the State are allowed to accept any gift, salary, or position from or under any foreign state without the President’s consent.
• Hereditary titles of nobility e.g. Maharaja, Deewan, etc which were conferred by colonial states are banned by this Article.
• National Awards e.g. Bharat Ratna, Padma Vibhushan, Padma Bhushan, and Padma Sri are not banned by this Article. However, they should not be used as suffixes or prefixes to the names of awardees. Otherwise, they should forfeit the awards.

Significance of Right to Equality

The right to equality holds immense significance as it serves as the foundation for a just and inclusive society. Its importance lies in several key aspects:

• Fairness and Justice – It ensures that all individuals are treated equally under the law, irrespective of their background, race, religion, caste, gender, or economic status. This fosters a sense of fairness and justice in society.
• Non-Discrimination – This right prohibits discrimination in all spheres of life, including employment, education, housing, and public services. It creates a level playing field for everyone, regardless of their differences.
• Inclusivity – This right promotes inclusivity by recognizing the dignity and worth of every individual. It encourages respect for diversity and the participation of all members of society in civic and political life.
• Social Cohesion – This right helps in building social cohesion by reducing social tensions and disparities. When individuals feel that they are treated fairly and have equal opportunities, it fosters a sense of belonging and unity within society.
• Human Rights – This is a fundamental human right enshrined in various international and national legal instruments. Protecting this right is essential for upholding the broader framework of human rights and dignity.

In conclusion, equality lies at the heart of the Indian Constitution, serving as the cornerstone of justice, fairness, and social cohesion. This principle of equality ensures that all individuals are treated fairly before the law, without any unreasonable discrimination. By upholding this fundamental right, India strives to build a society where every citizen has equal opportunities and rights, fostering inclusivity and empowering each individual to contribute to the nation’s progress and prosperity.

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

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

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

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

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

Table of contents

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Article 18 | Constitution of India | Fundamental Rights | Landmark Case

• Post published: June 7, 2021
• Post category: Videos
• Reading time: 2 mins read

Article 18- Abolition of Titles

(1) No title, not being a military or academic distinction, shall be conferred by the State.

(2) No citizen of India shall accept any title from any foreign State.

(3) No person who is not a citizen of India shall, while he holds any office of profit or trust under the State, accept without the consent of the President any title from any foreign State.

(4) No person holding any office of profit or trust under the State shall, without the consent of the President, accept any present, emolument, or office of any kind from or under any foreign State.

For further details and explanation with case law please visit the link below :

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

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

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What is it?

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

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

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

Benefits and limitations of case studies

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

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

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

Examples of case studies

Example 1: nurses’ paediatric pain management practices.

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

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

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

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

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

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

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

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

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

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

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

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

• Gustafsson J
• Calanzaro M
• Sandelowski M

Competing interests None declared.

Provenance and peer review Commissioned; internally peer reviewed.

Read the full text or download the PDF:

Organizing Your Social Sciences Research Assignments

• Annotated Bibliography
• Analyzing a Scholarly Journal Article
• Group Presentations
• Dealing with Nervousness
• Using Visual Aids
• Grading Someone Else's Paper
• Types of Structured Group Activities
• Group Project Survival Skills
• Leading a Class Discussion
• Multiple Book Review Essay
• Reviewing Collected Works
• Writing a Case Analysis Paper
• Writing a Case Study
• About Informed Consent
• Writing Field Notes
• Writing a Policy Memo
• Writing a Reflective Paper
• Writing a Research Proposal
• Generative AI and Writing
• Acknowledgments

A case study research paper examines a person, place, event, condition, phenomenon, or other type of subject of analysis in order to extrapolate  key themes and results that help predict future trends, illuminate previously hidden issues that can be applied to practice, and/or provide a means for understanding an important research problem with greater clarity. A case study research paper usually examines a single subject of analysis, but case study papers can also be designed as a comparative investigation that shows relationships between two or more subjects. The methods used to study a case can rest within a quantitative, qualitative, or mixed-method investigative paradigm.

Case Studies. Writing@CSU. Colorado State University; Mills, Albert J. , Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010 ; “What is a Case Study?” In Swanborn, Peter G. Case Study Research: What, Why and How? London: SAGE, 2010.

How to Approach Writing a Case Study Research Paper

General information about how to choose a topic to investigate can be found under the " Choosing a Research Problem " tab in the Organizing Your Social Sciences Research Paper writing guide. Review this page because it may help you identify a subject of analysis that can be investigated using a case study design.

However, identifying a case to investigate involves more than choosing the research problem . A case study encompasses a problem contextualized around the application of in-depth analysis, interpretation, and discussion, often resulting in specific recommendations for action or for improving existing conditions. As Seawright and Gerring note, practical considerations such as time and access to information can influence case selection, but these issues should not be the sole factors used in describing the methodological justification for identifying a particular case to study. Given this, selecting a case includes considering the following:

• The case represents an unusual or atypical example of a research problem that requires more in-depth analysis? Cases often represent a topic that rests on the fringes of prior investigations because the case may provide new ways of understanding the research problem. For example, if the research problem is to identify strategies to improve policies that support girl's access to secondary education in predominantly Muslim nations, you could consider using Azerbaijan as a case study rather than selecting a more obvious nation in the Middle East. Doing so may reveal important new insights into recommending how governments in other predominantly Muslim nations can formulate policies that support improved access to education for girls.
• The case provides important insight or illuminate a previously hidden problem? In-depth analysis of a case can be based on the hypothesis that the case study will reveal trends or issues that have not been exposed in prior research or will reveal new and important implications for practice. For example, anecdotal evidence may suggest drug use among homeless veterans is related to their patterns of travel throughout the day. Assuming prior studies have not looked at individual travel choices as a way to study access to illicit drug use, a case study that observes a homeless veteran could reveal how issues of personal mobility choices facilitate regular access to illicit drugs. Note that it is important to conduct a thorough literature review to ensure that your assumption about the need to reveal new insights or previously hidden problems is valid and evidence-based.
• The case challenges and offers a counter-point to prevailing assumptions? Over time, research on any given topic can fall into a trap of developing assumptions based on outdated studies that are still applied to new or changing conditions or the idea that something should simply be accepted as "common sense," even though the issue has not been thoroughly tested in current practice. A case study analysis may offer an opportunity to gather evidence that challenges prevailing assumptions about a research problem and provide a new set of recommendations applied to practice that have not been tested previously. For example, perhaps there has been a long practice among scholars to apply a particular theory in explaining the relationship between two subjects of analysis. Your case could challenge this assumption by applying an innovative theoretical framework [perhaps borrowed from another discipline] to explore whether this approach offers new ways of understanding the research problem. Taking a contrarian stance is one of the most important ways that new knowledge and understanding develops from existing literature.
• The case provides an opportunity to pursue action leading to the resolution of a problem? Another way to think about choosing a case to study is to consider how the results from investigating a particular case may result in findings that reveal ways in which to resolve an existing or emerging problem. For example, studying the case of an unforeseen incident, such as a fatal accident at a railroad crossing, can reveal hidden issues that could be applied to preventative measures that contribute to reducing the chance of accidents in the future. In this example, a case study investigating the accident could lead to a better understanding of where to strategically locate additional signals at other railroad crossings so as to better warn drivers of an approaching train, particularly when visibility is hindered by heavy rain, fog, or at night.
• The case offers a new direction in future research? A case study can be used as a tool for an exploratory investigation that highlights the need for further research about the problem. A case can be used when there are few studies that help predict an outcome or that establish a clear understanding about how best to proceed in addressing a problem. For example, after conducting a thorough literature review [very important!], you discover that little research exists showing the ways in which women contribute to promoting water conservation in rural communities of east central Africa. A case study of how women contribute to saving water in a rural village of Uganda can lay the foundation for understanding the need for more thorough research that documents how women in their roles as cooks and family caregivers think about water as a valuable resource within their community. This example of a case study could also point to the need for scholars to build new theoretical frameworks around the topic [e.g., applying feminist theories of work and family to the issue of water conservation].

Eisenhardt, Kathleen M. “Building Theories from Case Study Research.” Academy of Management Review 14 (October 1989): 532-550; Emmel, Nick. Sampling and Choosing Cases in Qualitative Research: A Realist Approach . Thousand Oaks, CA: SAGE Publications, 2013; Gerring, John. “What Is a Case Study and What Is It Good for?” American Political Science Review 98 (May 2004): 341-354; Mills, Albert J. , Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010; Seawright, Jason and John Gerring. "Case Selection Techniques in Case Study Research." Political Research Quarterly 61 (June 2008): 294-308.

Structure and Writing Style

The purpose of a paper in the social sciences designed around a case study is to thoroughly investigate a subject of analysis in order to reveal a new understanding about the research problem and, in so doing, contributing new knowledge to what is already known from previous studies. In applied social sciences disciplines [e.g., education, social work, public administration, etc.], case studies may also be used to reveal best practices, highlight key programs, or investigate interesting aspects of professional work.

In general, the structure of a case study research paper is not all that different from a standard college-level research paper. However, there are subtle differences you should be aware of. Here are the key elements to organizing and writing a case study research paper.

I.  Introduction

As with any research paper, your introduction should serve as a roadmap for your readers to ascertain the scope and purpose of your study . The introduction to a case study research paper, however, should not only describe the research problem and its significance, but you should also succinctly describe why the case is being used and how it relates to addressing the problem. The two elements should be linked. With this in mind, a good introduction answers these four questions:

• What is being studied? Describe the research problem and describe the subject of analysis [the case] you have chosen to address the problem. Explain how they are linked and what elements of the case will help to expand knowledge and understanding about the problem.
• Why is this topic important to investigate? Describe the significance of the research problem and state why a case study design and the subject of analysis that the paper is designed around is appropriate in addressing the problem.
• What did we know about this topic before I did this study? Provide background that helps lead the reader into the more in-depth literature review to follow. If applicable, summarize prior case study research applied to the research problem and why it fails to adequately address the problem. Describe why your case will be useful. If no prior case studies have been used to address the research problem, explain why you have selected this subject of analysis.
• How will this study advance new knowledge or new ways of understanding? Explain why your case study will be suitable in helping to expand knowledge and understanding about the research problem.

Each of these questions should be addressed in no more than a few paragraphs. Exceptions to this can be when you are addressing a complex research problem or subject of analysis that requires more in-depth background information.

II.  Literature Review

The literature review for a case study research paper is generally structured the same as it is for any college-level research paper. The difference, however, is that the literature review is focused on providing background information and  enabling historical interpretation of the subject of analysis in relation to the research problem the case is intended to address . This includes synthesizing studies that help to:

• Place relevant works in the context of their contribution to understanding the case study being investigated . This would involve summarizing studies that have used a similar subject of analysis to investigate the research problem. If there is literature using the same or a very similar case to study, you need to explain why duplicating past research is important [e.g., conditions have changed; prior studies were conducted long ago, etc.].
• Describe the relationship each work has to the others under consideration that informs the reader why this case is applicable . Your literature review should include a description of any works that support using the case to investigate the research problem and the underlying research questions.
• Identify new ways to interpret prior research using the case study . If applicable, review any research that has examined the research problem using a different research design. Explain how your use of a case study design may reveal new knowledge or a new perspective or that can redirect research in an important new direction.
• Resolve conflicts amongst seemingly contradictory previous studies . This refers to synthesizing any literature that points to unresolved issues of concern about the research problem and describing how the subject of analysis that forms the case study can help resolve these existing contradictions.
• Point the way in fulfilling a need for additional research . Your review should examine any literature that lays a foundation for understanding why your case study design and the subject of analysis around which you have designed your study may reveal a new way of approaching the research problem or offer a perspective that points to the need for additional research.
• Expose any gaps that exist in the literature that the case study could help to fill . Summarize any literature that not only shows how your subject of analysis contributes to understanding the research problem, but how your case contributes to a new way of understanding the problem that prior research has failed to do.
• Locate your own research within the context of existing literature [very important!] . Collectively, your literature review should always place your case study within the larger domain of prior research about the problem. The overarching purpose of reviewing pertinent literature in a case study paper is to demonstrate that you have thoroughly identified and synthesized prior studies in relation to explaining the relevance of the case in addressing the research problem.

III.  Method

In this section, you explain why you selected a particular case [i.e., subject of analysis] and the strategy you used to identify and ultimately decide that your case was appropriate in addressing the research problem. The way you describe the methods used varies depending on the type of subject of analysis that constitutes your case study.

If your subject of analysis is an incident or event . In the social and behavioral sciences, the event or incident that represents the case to be studied is usually bounded by time and place, with a clear beginning and end and with an identifiable location or position relative to its surroundings. The subject of analysis can be a rare or critical event or it can focus on a typical or regular event. The purpose of studying a rare event is to illuminate new ways of thinking about the broader research problem or to test a hypothesis. Critical incident case studies must describe the method by which you identified the event and explain the process by which you determined the validity of this case to inform broader perspectives about the research problem or to reveal new findings. However, the event does not have to be a rare or uniquely significant to support new thinking about the research problem or to challenge an existing hypothesis. For example, Walo, Bull, and Breen conducted a case study to identify and evaluate the direct and indirect economic benefits and costs of a local sports event in the City of Lismore, New South Wales, Australia. The purpose of their study was to provide new insights from measuring the impact of a typical local sports event that prior studies could not measure well because they focused on large "mega-events." Whether the event is rare or not, the methods section should include an explanation of the following characteristics of the event: a) when did it take place; b) what were the underlying circumstances leading to the event; and, c) what were the consequences of the event in relation to the research problem.

If your subject of analysis is a person. Explain why you selected this particular individual to be studied and describe what experiences they have had that provide an opportunity to advance new understandings about the research problem. Mention any background about this person which might help the reader understand the significance of their experiences that make them worthy of study. This includes describing the relationships this person has had with other people, institutions, and/or events that support using them as the subject for a case study research paper. It is particularly important to differentiate the person as the subject of analysis from others and to succinctly explain how the person relates to examining the research problem [e.g., why is one politician in a particular local election used to show an increase in voter turnout from any other candidate running in the election]. Note that these issues apply to a specific group of people used as a case study unit of analysis [e.g., a classroom of students].

If your subject of analysis is a place. In general, a case study that investigates a place suggests a subject of analysis that is unique or special in some way and that this uniqueness can be used to build new understanding or knowledge about the research problem. A case study of a place must not only describe its various attributes relevant to the research problem [e.g., physical, social, historical, cultural, economic, political], but you must state the method by which you determined that this place will illuminate new understandings about the research problem. It is also important to articulate why a particular place as the case for study is being used if similar places also exist [i.e., if you are studying patterns of homeless encampments of veterans in open spaces, explain why you are studying Echo Park in Los Angeles rather than Griffith Park?]. If applicable, describe what type of human activity involving this place makes it a good choice to study [e.g., prior research suggests Echo Park has more homeless veterans].

If your subject of analysis is a phenomenon. A phenomenon refers to a fact, occurrence, or circumstance that can be studied or observed but with the cause or explanation to be in question. In this sense, a phenomenon that forms your subject of analysis can encompass anything that can be observed or presumed to exist but is not fully understood. In the social and behavioral sciences, the case usually focuses on human interaction within a complex physical, social, economic, cultural, or political system. For example, the phenomenon could be the observation that many vehicles used by ISIS fighters are small trucks with English language advertisements on them. The research problem could be that ISIS fighters are difficult to combat because they are highly mobile. The research questions could be how and by what means are these vehicles used by ISIS being supplied to the militants and how might supply lines to these vehicles be cut off? How might knowing the suppliers of these trucks reveal larger networks of collaborators and financial support? A case study of a phenomenon most often encompasses an in-depth analysis of a cause and effect that is grounded in an interactive relationship between people and their environment in some way.

NOTE:   The choice of the case or set of cases to study cannot appear random. Evidence that supports the method by which you identified and chose your subject of analysis should clearly support investigation of the research problem and linked to key findings from your literature review. Be sure to cite any studies that helped you determine that the case you chose was appropriate for examining the problem.

IV.  Discussion

The main elements of your discussion section are generally the same as any research paper, but centered around interpreting and drawing conclusions about the key findings from your analysis of the case study. Note that a general social sciences research paper may contain a separate section to report findings. However, in a paper designed around a case study, it is common to combine a description of the results with the discussion about their implications. The objectives of your discussion section should include the following:

Reiterate the Research Problem/State the Major Findings Briefly reiterate the research problem you are investigating and explain why the subject of analysis around which you designed the case study were used. You should then describe the findings revealed from your study of the case using direct, declarative, and succinct proclamation of the study results. Highlight any findings that were unexpected or especially profound.

Explain the Meaning of the Findings and Why They are Important Systematically explain the meaning of your case study findings and why you believe they are important. Begin this part of the section by repeating what you consider to be your most important or surprising finding first, then systematically review each finding. Be sure to thoroughly extrapolate what your analysis of the case can tell the reader about situations or conditions beyond the actual case that was studied while, at the same time, being careful not to misconstrue or conflate a finding that undermines the external validity of your conclusions.

Relate the Findings to Similar Studies No study in the social sciences is so novel or possesses such a restricted focus that it has absolutely no relation to previously published research. The discussion section should relate your case study results to those found in other studies, particularly if questions raised from prior studies served as the motivation for choosing your subject of analysis. This is important because comparing and contrasting the findings of other studies helps support the overall importance of your results and it highlights how and in what ways your case study design and the subject of analysis differs from prior research about the topic.

Consider Alternative Explanations of the Findings Remember that the purpose of social science research is to discover and not to prove. When writing the discussion section, you should carefully consider all possible explanations revealed by the case study results, rather than just those that fit your hypothesis or prior assumptions and biases. Be alert to what the in-depth analysis of the case may reveal about the research problem, including offering a contrarian perspective to what scholars have stated in prior research if that is how the findings can be interpreted from your case.

Acknowledge the Study's Limitations You can state the study's limitations in the conclusion section of your paper but describing the limitations of your subject of analysis in the discussion section provides an opportunity to identify the limitations and explain why they are not significant. This part of the discussion section should also note any unanswered questions or issues your case study could not address. More detailed information about how to document any limitations to your research can be found here .

Suggest Areas for Further Research Although your case study may offer important insights about the research problem, there are likely additional questions related to the problem that remain unanswered or findings that unexpectedly revealed themselves as a result of your in-depth analysis of the case. Be sure that the recommendations for further research are linked to the research problem and that you explain why your recommendations are valid in other contexts and based on the original assumptions of your study.

V.  Conclusion

As with any research paper, you should summarize your conclusion in clear, simple language; emphasize how the findings from your case study differs from or supports prior research and why. Do not simply reiterate the discussion section. Provide a synthesis of key findings presented in the paper to show how these converge to address the research problem. If you haven't already done so in the discussion section, be sure to document the limitations of your case study and any need for further research.

The function of your paper's conclusion is to: 1) reiterate the main argument supported by the findings from your case study; 2) state clearly the context, background, and necessity of pursuing the research problem using a case study design in relation to an issue, controversy, or a gap found from reviewing the literature; and, 3) provide a place to persuasively and succinctly restate the significance of your research problem, given that the reader has now been presented with in-depth information about the topic.

Consider the following points to help ensure your conclusion is appropriate:

• If the argument or purpose of your paper is complex, you may need to summarize these points for your reader.
• If prior to your conclusion, you have not yet explained the significance of your findings or if you are proceeding inductively, use the conclusion of your paper to describe your main points and explain their significance.
• Move from a detailed to a general level of consideration of the case study's findings that returns the topic to the context provided by the introduction or within a new context that emerges from your case study findings.

Note that, depending on the discipline you are writing in or the preferences of your professor, the concluding paragraph may contain your final reflections on the evidence presented as it applies to practice or on the essay's central research problem. However, the nature of being introspective about the subject of analysis you have investigated will depend on whether you are explicitly asked to express your observations in this way.

Problems to Avoid

Overgeneralization One of the goals of a case study is to lay a foundation for understanding broader trends and issues applied to similar circumstances. However, be careful when drawing conclusions from your case study. They must be evidence-based and grounded in the results of the study; otherwise, it is merely speculation. Looking at a prior example, it would be incorrect to state that a factor in improving girls access to education in Azerbaijan and the policy implications this may have for improving access in other Muslim nations is due to girls access to social media if there is no documentary evidence from your case study to indicate this. There may be anecdotal evidence that retention rates were better for girls who were engaged with social media, but this observation would only point to the need for further research and would not be a definitive finding if this was not a part of your original research agenda.

Failure to Document Limitations No case is going to reveal all that needs to be understood about a research problem. Therefore, just as you have to clearly state the limitations of a general research study , you must describe the specific limitations inherent in the subject of analysis. For example, the case of studying how women conceptualize the need for water conservation in a village in Uganda could have limited application in other cultural contexts or in areas where fresh water from rivers or lakes is plentiful and, therefore, conservation is understood more in terms of managing access rather than preserving access to a scarce resource.

Failure to Extrapolate All Possible Implications Just as you don't want to over-generalize from your case study findings, you also have to be thorough in the consideration of all possible outcomes or recommendations derived from your findings. If you do not, your reader may question the validity of your analysis, particularly if you failed to document an obvious outcome from your case study research. For example, in the case of studying the accident at the railroad crossing to evaluate where and what types of warning signals should be located, you failed to take into consideration speed limit signage as well as warning signals. When designing your case study, be sure you have thoroughly addressed all aspects of the problem and do not leave gaps in your analysis that leave the reader questioning the results.

Case Studies. Writing@CSU. Colorado State University; Gerring, John. Case Study Research: Principles and Practices . New York: Cambridge University Press, 2007; Merriam, Sharan B. Qualitative Research and Case Study Applications in Education . Rev. ed. San Francisco, CA: Jossey-Bass, 1998; Miller, Lisa L. “The Use of Case Studies in Law and Social Science Research.” Annual Review of Law and Social Science 14 (2018): TBD; Mills, Albert J., Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010; Putney, LeAnn Grogan. "Case Study." In Encyclopedia of Research Design , Neil J. Salkind, editor. (Thousand Oaks, CA: SAGE Publications, 2010), pp. 116-120; Simons, Helen. Case Study Research in Practice . London: SAGE Publications, 2009;  Kratochwill,  Thomas R. and Joel R. Levin, editors. Single-Case Research Design and Analysis: New Development for Psychology and Education .  Hilldsale, NJ: Lawrence Erlbaum Associates, 1992; Swanborn, Peter G. Case Study Research: What, Why and How? London : SAGE, 2010; Yin, Robert K. Case Study Research: Design and Methods . 6th edition. Los Angeles, CA, SAGE Publications, 2014; Walo, Maree, Adrian Bull, and Helen Breen. “Achieving Economic Benefits at Local Events: A Case Study of a Local Sports Event.” Festival Management and Event Tourism 4 (1996): 95-106.

Writing Tip

At Least Five Misconceptions about Case Study Research

Social science case studies are often perceived as limited in their ability to create new knowledge because they are not randomly selected and findings cannot be generalized to larger populations. Flyvbjerg examines five misunderstandings about case study research and systematically "corrects" each one. To quote, these are:

Misunderstanding 1 :  General, theoretical [context-independent] knowledge is more valuable than concrete, practical [context-dependent] knowledge. Misunderstanding 2 :  One cannot generalize on the basis of an individual case; therefore, the case study cannot contribute to scientific development. Misunderstanding 3 :  The case study is most useful for generating hypotheses; that is, in the first stage of a total research process, whereas other methods are more suitable for hypotheses testing and theory building. Misunderstanding 4 :  The case study contains a bias toward verification, that is, a tendency to confirm the researcher’s preconceived notions. Misunderstanding 5 :  It is often difficult to summarize and develop general propositions and theories on the basis of specific case studies [p. 221].

While writing your paper, think introspectively about how you addressed these misconceptions because to do so can help you strengthen the validity and reliability of your research by clarifying issues of case selection, the testing and challenging of existing assumptions, the interpretation of key findings, and the summation of case outcomes. Think of a case study research paper as a complete, in-depth narrative about the specific properties and key characteristics of your subject of analysis applied to the research problem.

Flyvbjerg, Bent. “Five Misunderstandings About Case-Study Research.” Qualitative Inquiry 12 (April 2006): 219-245.

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Quality Legal Services

Article 18 of the Indian Constitution

Home       Articles       Article 18 of the Indian Constitution

May 3, 2018

A. ARTICLE 18 OF THE INDIAN CONSTITUTION:

1. Abolition of titles :

(1) No title, not being a military or academic distinction, shall be conferred by the State.

(2) No citizen of India shall accept any title from any foreign State.

(3) No person who is not a citizen of India shall, while he holds any office of profit or trust under the State, accept without the consent of the President any title from any foreign State.

(4) No person holding any office of profit or trust under the State shall, without the consent of the President, accept any present, emolument, or office of any kind from or under any foreign State.

Explanation:

Article 18(1) abolishes all titles. It prohibits the State to confer titles on anybody whether a citizen or a non-citizen. Military and academic distinctions are, however, exempted from the prohibition. Thus, a university can give title or honor on a man of merit. Clause (2) prohibits a citizen of India from accepting any title from any foreign State. Clause (3) prohibits a person not being a citizen of India, but holding any office of profit or trust under the State, from accepting any title from any foreign State without the consent of the President. Clause (4) provides that no person citizen or non citizen holding any office of profit or trust, shall, without consent of the President, accept any present or emolument or office of any kind from or under any foreign State.. Clauses (3) and (4) have been added to ensure that a non-citizen should remain loyal to the State i.e. do not commit the breach of trust reposed in him.

A ‘title’ is something that hangs to one’s name, as an appendage (either prefix or suffix e.g. Sir, Nawab, Maharaja, etc.). A democracy should not create titles and titular glories. This will go against the realization of social equality.

However, the recent conferment of titles of “Bharat Ratna”, “Padma Vibhushan”, “Padma Shri”, etc. (introduced in 1954) are said to be not prohibited under Article 18 as they merely denote State recognition of good work by citizens in the various fields of activity. It may be noted that Article 18 does not secure any fundamental right but imposes a restriction on executive and legislative power. Further, conferring of titles offended against the fundamental principle of equality of all citizens guaranteed by Article 14.

B. LANDMARK CASE:

In  Balaji Raghavan vs UOI , the Supreme Court upheld the validity of civilian honors but criticized the government for not exercising restraint in awarding these. It held that the national awards were not meant to be used as titles and those who have done so should forfeit the award. In this case, the  petitioners challenged  the conferment of the awards on the ground that it was violative of Article 18(1). They were of the view that the word ‘title’ should be given the widest possible meaning and amplitude in order to give effect to the legislative intent since the only exception to this rule has been carved out in respect of military and academic distinctions. The contention of the Union government ( Respondents ) was that since the national awards are not titles of nobility and are not to be used as suffixes or prefixes, they are not prohibited by Article 18. Further, almost every country in the world follows the practice of conferring awards for meritorious services rendered by its citizens.

The court observed that  during British rule, power to confer titles was being abused for imperialistic purposes and for corrupting public life. In recent years, the conferment of these awards without any firm guidelines and fool-proof method of selection is bound to breed nepotism, favoritism, patronage and even corruption. Thus, an extremely high standard should be prescribed for those awards and the total number of such awards should not exceed 50 every year. “The exercise of such restraint is absolutely necessary to safeguard the importance of these awards”, said Justice Ahmadi. To curb the misuse of this power, the court suggested that a high level committee may be appointed by the Prime Minister in consultation with the President who will ensure that only deserving persons bestowed the decorations. Justice Kuldip Singh in his separate but concurring judgment suggested that the committee may include the Speaker of Lok Sabha, the Chief Justice of India and the leader of the Opposition in the Lok Sabha.

Subsequent to this decision, the Union Government appointed a ‘High Level Review Committee: chaired by the Vice-President, to go into the existing guidelines and fix the criteria for the selection of persons for ‘Padma awards’ so that it would enhance respect for these awards. This Committee suggested the setting up of State-level Committees to forward recommendations to the Centre. The recommended names are to be reviewed by the Centre, by a Committee including the Cabinet Secretary, the Home Secretary and Secretary to the President of India. Thereafter, the finalized names are to be submitted to the Prime Minister’s office and finally sent to the President. There are no guidelines for ‘Bharat Ratna’ awards.

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Distinguishing case study as a research method from case reports as a publication type

The purpose of this editorial is to distinguish between case reports and case studies. In health, case reports are familiar ways of sharing events or efforts of intervening with single patients with previously unreported features. As a qualitative methodology, case study research encompasses a great deal more complexity than a typical case report and often incorporates multiple streams of data combined in creative ways. The depth and richness of case study description helps readers understand the case and whether findings might be applicable beyond that setting.

Single-institution descriptive reports of library activities are often labeled by their authors as “case studies.” By contrast, in health care, single patient retrospective descriptions are published as “case reports.” Both case reports and case studies are valuable to readers and provide a publication opportunity for authors. A previous editorial by Akers and Amos about improving case studies addresses issues that are more common to case reports; for example, not having a review of the literature or being anecdotal, not generalizable, and prone to various types of bias such as positive outcome bias [ 1 ]. However, case study research as a qualitative methodology is pursued for different purposes than generalizability. The authors’ purpose in this editorial is to clearly distinguish between case reports and case studies. We believe that this will assist authors in describing and designating the methodological approach of their publications and help readers appreciate the rigor of well-executed case study research.

Case reports often provide a first exploration of a phenomenon or an opportunity for a first publication by a trainee in the health professions. In health care, case reports are familiar ways of sharing events or efforts of intervening with single patients with previously unreported features. Another type of study categorized as a case report is an “N of 1” study or single-subject clinical trial, which considers an individual patient as the sole unit of observation in a study investigating the efficacy or side effect profiles of different interventions. Entire journals have evolved to publish case reports, which often rely on template structures with limited contextualization or discussion of previous cases. Examples that are indexed in MEDLINE include the American Journal of Case Reports , BMJ Case Reports, Journal of Medical Case Reports, and Journal of Radiology Case Reports . Similar publications appear in veterinary medicine and are indexed in CAB Abstracts, such as Case Reports in Veterinary Medicine and Veterinary Record Case Reports .

As a qualitative methodology, however, case study research encompasses a great deal more complexity than a typical case report and often incorporates multiple streams of data combined in creative ways. Distinctions include the investigator’s definitions and delimitations of the case being studied, the clarity of the role of the investigator, the rigor of gathering and combining evidence about the case, and the contextualization of the findings. Delimitation is a term from qualitative research about setting boundaries to scope the research in a useful way rather than describing the narrow scope as a limitation, as often appears in a discussion section. The depth and richness of description helps readers understand the situation and whether findings from the case are applicable to their settings.

CASE STUDY AS A RESEARCH METHODOLOGY

Case study as a qualitative methodology is an exploration of a time- and space-bound phenomenon. As qualitative research, case studies require much more from their authors who are acting as instruments within the inquiry process. In the case study methodology, a variety of methodological approaches may be employed to explain the complexity of the problem being studied [ 2 , 3 ].

Leading authors diverge in their definitions of case study, but a qualitative research text introduces case study as follows:

Case study research is defined as a qualitative approach in which the investigator explores a real-life, contemporary bounded system (a case) or multiple bound systems (cases) over time, through detailed, in-depth data collection involving multiple sources of information, and reports a case description and case themes. The unit of analysis in the case study might be multiple cases (a multisite study) or a single case (a within-site case study). [ 4 ]

Methodologists writing core texts on case study research include Yin [ 5 ], Stake [ 6 ], and Merriam [ 7 ]. The approaches of these three methodologists have been compared by Yazan, who focused on six areas of methodology: epistemology (beliefs about ways of knowing), definition of cases, design of case studies, and gathering, analysis, and validation of data [ 8 ]. For Yin, case study is a method of empirical inquiry appropriate to determining the “how and why” of phenomena and contributes to understanding phenomena in a holistic and real-life context [ 5 ]. Stake defines a case study as a “well-bounded, specific, complex, and functioning thing” [ 6 ], while Merriam views “the case as a thing, a single entity, a unit around which there are boundaries” [ 7 ].

Case studies are ways to explain, describe, or explore phenomena. Comments from a quantitative perspective about case studies lacking rigor and generalizability fail to consider the purpose of the case study and how what is learned from a case study is put into practice. Rigor in case studies comes from the research design and its components, which Yin outlines as (a) the study’s questions, (b) the study’s propositions, (c) the unit of analysis, (d) the logic linking the data to propositions, and (e) the criteria for interpreting the findings [ 5 ]. Case studies should also provide multiple sources of data, a case study database, and a clear chain of evidence among the questions asked, the data collected, and the conclusions drawn [ 5 ].

Sources of evidence for case studies include interviews, documentation, archival records, direct observations, participant-observation, and physical artifacts. One of the most important sources for data in qualitative case study research is the interview [ 2 , 3 ]. In addition to interviews, documents and archival records can be gathered to corroborate and enhance the findings of the study. To understand the phenomenon or the conditions that created it, direct observations can serve as another source of evidence and can be conducted throughout the study. These can include the use of formal and informal protocols as a participant inside the case or an external or passive observer outside of the case [ 5 ]. Lastly, physical artifacts can be observed and collected as a form of evidence. With these multiple potential sources of evidence, the study methodology includes gathering data, sense-making, and triangulating multiple streams of data. Figure 1 shows an example in which data used for the case started with a pilot study to provide additional context to guide more in-depth data collection and analysis with participants.

Key sources of data for a sample case study

VARIATIONS ON CASE STUDY METHODOLOGY

Case study methodology is evolving and regularly reinterpreted. Comparative or multiple case studies are used as a tool for synthesizing information across time and space to research the impact of policy and practice in various fields of social research [ 9 ]. Because case study research is in-depth and intensive, there have been efforts to simplify the method or select useful components of cases for focused analysis. Micro-case study is a term that is occasionally used to describe research on micro-level cases [ 10 ]. These are cases that occur in a brief time frame, occur in a confined setting, and are simple and straightforward in nature. A micro-level case describes a clear problem of interest. Reporting is very brief and about specific points. The lack of complexity in the case description makes obvious the “lesson” that is inherent in the case; although no definitive “solution” is necessarily forthcoming, making the case useful for discussion. A micro-case write-up can be distinguished from a case report by its focus on briefly reporting specific features of a case or cases to analyze or learn from those features.

DATABASE INDEXING OF CASE REPORTS AND CASE STUDIES

Disciplines such as education, psychology, sociology, political science, and social work regularly publish rich case studies that are relevant to particular areas of health librarianship. Case reports and case studies have been defined as publication types or subject terms by several databases that are relevant to librarian authors: MEDLINE, PsycINFO, CINAHL, and ERIC. Library, Information Science & Technology Abstracts (LISTA) does not have a subject term or publication type related to cases, despite many being included in the database. Whereas “Case Reports” are the main term used by MEDLINE’s Medical Subject Headings (MeSH) and PsycINFO’s thesaurus, CINAHL and ERIC use “Case Studies.”

Case reports in MEDLINE and PsycINFO focus on clinical case documentation. In MeSH, “Case Reports” as a publication type is specific to “clinical presentations that may be followed by evaluative studies that eventually lead to a diagnosis” [ 11 ]. “Case Histories,” “Case Studies,” and “Case Study” are all entry terms mapping to “Case Reports”; however, guidance to indexers suggests that “Case Reports” should not be applied to institutional case reports and refers to the heading “Organizational Case Studies,” which is defined as “descriptions and evaluations of specific health care organizations” [ 12 ].

PsycINFO’s subject term “Case Report” is “used in records discussing issues involved in the process of conducting exploratory studies of single or multiple clinical cases.” The Methodology index offers clinical and non-clinical entries. “Clinical Case Study” is defined as “case reports that include disorder, diagnosis, and clinical treatment for individuals with mental or medical illnesses,” whereas “Non-clinical Case Study” is a “document consisting of non-clinical or organizational case examples of the concepts being researched or studied. The setting is always non-clinical and does not include treatment-related environments” [ 13 ].

Both CINAHL and ERIC acknowledge the depth of analysis in case study methodology. The CINAHL scope note for the thesaurus term “Case Studies” distinguishes between the document and the methodology, though both use the same term: “a review of a particular condition, disease, or administrative problem. Also, a research method that involves an in-depth analysis of an individual, group, institution, or other social unit. For material that contains a case study, search for document type: case study.” The ERIC scope note for the thesaurus term “Case Studies” is simple: “detailed analyses, usually focusing on a particular problem of an individual, group, or organization” [ 14 ].

PUBLICATION OF CASE STUDY RESEARCH IN LIBRARIANSHIP

We call your attention to a few examples published as case studies in health sciences librarianship to consider how their characteristics fit with the preceding definitions of case reports or case study research. All present some characteristics of case study research, but their treatment of the research questions, richness of description, and analytic strategies vary in depth and, therefore, diverge at some level from the qualitative case study research approach. This divergence, particularly in richness of description and analysis, may have been constrained by the publication requirements.

As one example, a case study by Janke and Rush documented a time- and context-bound collaboration involving a librarian and a nursing faculty member [ 15 ]. Three objectives were stated: (1) describing their experience of working together on an interprofessional research team, (2) evaluating the value of the librarian role from librarian and faculty member perspectives, and (3) relating findings to existing literature. Elements that signal the qualitative nature of this case study are that the authors were the research participants and their use of the term “evaluation” is reflection on their experience. This reads like a case study that could have been enriched by including other types of data gathered from others engaging with this team to broaden the understanding of the collaboration.

As another example, the description of the academic context is one of the most salient components of the case study written by Clairoux et al., which had the objectives of (1) describing the library instruction offered and learning assessments used at a single health sciences library and (2) discussing the positive outcomes of instruction in that setting [ 16 ]. The authors focus on sharing what the institution has done more than explaining why this institution is an exemplar to explore a focused question or understand the phenomenon of library instruction. However, like a case study, the analysis brings together several streams of data including course attendance, online material page views, and some discussion of results from surveys. This paper reads somewhat in between an institutional case report and a case study.

The final example is a single author reporting on a personal experience of creating and executing the role of research informationist for a National Institutes of Health (NIH)–funded research team [ 17 ]. There is a thoughtful review of the informationist literature and detailed descriptions of the institutional context and the process of gaining access to and participating in the new role. However, the motivating question in the abstract does not seem to be fully addressed through analysis from either the reflective perspective of the author as the research participant or consideration of other streams of data from those involved in the informationist experience. The publication reads more like a case report about this informationist’s experience than a case study that explores the research informationist experience through the selection of this case.

All of these publications are well written and useful for their intended audiences, but in general, they are much shorter and much less rich in depth than case studies published in social sciences research. It may be that the authors have been constrained by word counts or page limits. For example, the submission category for Case Studies in the Journal of the Medical Library Association (JMLA) limited them to 3,000 words and defined them as “articles describing the process of developing, implementing, and evaluating a new service, program, or initiative, typically in a single institution or through a single collaborative effort” [ 18 ]. This definition’s focus on novelty and description sounds much more like the definition of case report than the in-depth, detailed investigation of a time- and space-bound problem that is often examined through case study research.

Problem-focused or question-driven case study research would benefit from the space provided for Original Investigations that employ any type of quantitative or qualitative method of analysis. One of the best examples in the JMLA of an in-depth multiple case study that was authored by a librarian who published the findings from her doctoral dissertation represented all the elements of a case study. In eight pages, she provided a theoretical basis for the research question, a pilot study, and a multiple case design, including integrated data from interviews and focus groups [ 19 ].

We have distinguished between case reports and case studies primarily to assist librarians who are new to research and critical appraisal of case study methodology to recognize the features that authors use to describe and designate the methodological approaches of their publications. For researchers who are new to case research methodology and are interested in learning more, Hancock and Algozzine provide a guide [ 20 ].

We hope that JMLA readers appreciate the rigor of well-executed case study research. We believe that distinguishing between descriptive case reports and analytic case studies in the journal’s submission categories will allow the depth of case study methodology to increase. We also hope that authors feel encouraged to pursue submitting relevant case studies or case reports for future publication.

Editor’s note: In response to this invited editorial, the Journal of the Medical Library Association will consider manuscripts employing rigorous qualitative case study methodology to be Original Investigations (fewer than 5,000 words), whereas manuscripts describing the process of developing, implementing, and assessing a new service, program, or initiative—typically in a single institution or through a single collaborative effort—will be considered to be Case Reports (formerly known as Case Studies; fewer than 3,000 words).

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Risk and outcomes of healthcare-associated infections in three hospitals in Bobo Dioulasso, 2022 (Burkina Faso): a longitudinal study

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Abstract Background Healthcare-associated infections (HAIs) are one of the most common adverse events in healthcare and represent a major public health problem. However, 40% to 70% of HAIs are considered to be preventable. The present study was conducted to analyze the incidence, etiological factors, and outcomes of HAIs through active surveillance in three hospitals in the city of Bobo Dioulasso. Methods A prospective, longitudinal, multicenter study was conducted from May 1th to November 30rd, 2022, in two district hospitals (DO and Dafra) and the Sourô Sanou Teaching Hospital (CHUSS). Consenting patients hospitalized for reasons other than infection, cancer, immunosuppression in the postoperative care ward of DO or of Dafra district hospitals, intensive care unit (ICU)/CHUSS, neonatal ward/CHUSS, and gynecology and obstetrics postoperative care ward/CHUSS during a 2-month inclusion period in district hospitals and 4 months for CHUSS wards. For this study, we used the operational definitions of the French Technical Committee for Nosocomial Infections and Healthcare-associated Infections, with slight modifications. Logistic regression was used to analyze predictors of HAIs. Results. Of the 664 patients enrolled, 166 experienced an HAI, with a cumulative incidence rate of 25% (CI: 21.7%-28.3%) or an incidence density rate of 36.7 per 1000 patient-days (CI: 31.7-42.9). Surgical site infections (SSI) (44%), followed by neonatal infections (42%) were the most common HAIs. Enterobacteriaceae represented 60% of the bacteria identified in HAIs, and 38.9% of them were extended spectrum β-lactamase (EBLSE) producers. Factors associated with HAIs were admission in the neonatal ward (aOR=7.4; CI:1.3-42.7), ICU (aOR=3.7; CI:1.4-9.5), hospital stay longer than 2 days (aOR=2.1; CI:1.2-3.4), or male sex (aOR=1.8; CI:1.1-3.1). In addition, HAIs were associated with longer follow-up, hospitalization, and mortality (18.1%; 95% CI:12.1 - 24.4). Deaths were only recorded in the ICU and neonatal ward, with case fatality rates of 45.4% (95% CI: 27.5 - 63.4) and 21.4% (95% CI: 11.6 - 31.3), respectively, p=0.019. Conclusions The incidence of HAIs was relatively high in the three hospitals in Bobo Dioulasso. A national strategy to reduce HAIs should be implemented to achieve better control of HAIs.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

The author(s) received no specific funding for this work.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics approval and consent to participate The study was approved by the National Health Ethics Committee of Burkina Faso. An information sheet was given to each participant. After reading this information sheet, those who desired to participate in the study signed a free and informed consent form. The data collected were anonymized to ensure their confidentiality.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

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The datasets, including deidentified provider quantitative and qualitative data, used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Cite this chapter

• R. M. Channaveer 4 &
• Rajendra Baikady 5  

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This chapter reviews the strengths and limitations of case study as a research method in social sciences. It provides an account of an evidence base to justify why a case study is best suitable for some research questions and why not for some other research questions. Case study designing around the research context, defining the structure and modality, conducting the study, collecting the data through triangulation mode, analysing the data, and interpreting the data and theory building at the end give a holistic view of it. In addition, the chapter also focuses on the types of case study and when and where to use case study as a research method in social science research.

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Case Study Research

Ang, C. S., Lee, K. F., & Dipolog-Ubanan, G. F. (2019). Determinants of first-year student identity and satisfaction in higher education: A quantitative case study. SAGE Open, 9 (2), 215824401984668. https://doi.org/10.1177/2158244019846689

Baxter, P., & Jack, S. (2015). Qualitative case study methodology: Study design and implementation for novice researchers. The Qualitative Report . Published. https://doi.org/10.46743/2160-3715/2008.1573

Bhatta, T. P. (2018). Case study research, philosophical position and theory building: A methodological discussion. Dhaulagiri Journal of Sociology and Anthropology, 12 , 72–79. https://doi.org/10.3126/dsaj.v12i0.22182

Article   Google Scholar  

Bromley, P. D. (1990). Academic contributions to psychological counselling. A philosophy of science for the study of individual cases. Counselling Psychology Quarterly , 3 (3), 299–307.

Google Scholar  

Crowe, S., Cresswell, K., Robertson, A., Huby, G., Avery, A., & Sheikh, A. (2011). The case study approach. BMC Medical Research Methodology, 11 (1), 1–9.

Grässel, E., & Schirmer, B. (2006). The use of volunteers to support family carers of dementia patients: Results of a prospective longitudinal study investigating expectations towards and experience with training and professional support. Zeitschrift Fur Gerontologie Und Geriatrie, 39 (3), 217–226.

Greenwood, D., & Lowenthal, D. (2005). Case study as a means of researching social work and improving practitioner education. Journal of Social Work Practice, 19 (2), 181–193. https://doi.org/10.1080/02650530500144782

Gülseçen, S., & Kubat, A. (2006). Teaching ICT to teacher candidates using PBL: A qualitative and quantitative evaluation. Journal of Educational Technology & Society, 9 (2), 96–106.

Gomm, R., Hammersley, M., & Foster, P. (2000). Case study and generalization. Case study method , 98–115.

Hamera, J., Denzin, N. K., & Lincoln, Y. S. (2011). Performance ethnography . SAGE.

Hayes, N. (2000). Doing psychological research (p. 133). Open University Press.

Harrison, H., Birks, M., Franklin, R., & Mills, J. (2017). Case study research: Foundations and methodological orientations. In Forum qualitative sozialforschung/forum: Qualitative social research (Vol. 18, No. 1).

Iwakabe, S., & Gazzola, N. (2009). From single-case studies to practice-based knowledge: Aggregating and synthesizing case studies. Psychotherapy Research, 19 (4–5), 601–611. https://doi.org/10.1080/10503300802688494

Johnson, M. P. (2006). Decision models for the location of community corrections centers. Environment and Planning b: Planning and Design, 33 (3), 393–412. https://doi.org/10.1068/b3125

Kaarbo, J., & Beasley, R. K. (1999). A practical guide to the comparative case study method in political psychology. Political Psychology, 20 (2), 369–391. https://doi.org/10.1111/0162-895x.00149

Lovell, G. I. (2006). Justice excused: The deployment of law in everyday political encounters. Law Society Review, 40 (2), 283–324. https://doi.org/10.1111/j.1540-5893.2006.00265.x

McDonough, S., & McDonough, S. (1997). Research methods as part of English language teacher education. English Language Teacher Education and Development, 3 (1), 84–96.

Meredith, J. (1998). Building operations management theory through case and field research. Journal of Operations Management, 16 (4), 441–454. https://doi.org/10.1016/s0272-6963(98)00023-0

Mills, A. J., Durepos, G., & Wiebe, E. (Eds.). (2009). Encyclopedia of case study research . Sage Publications.

Ochieng, P. A. (2009). An analysis of the strengths and limitation of qualitative and quantitative research paradigms. Problems of Education in the 21st Century , 13 , 13.

Page, E. B., Webb, E. J., Campell, D. T., Schwart, R. D., & Sechrest, L. (1966). Unobtrusive measures: Nonreactive research in the social sciences. American Educational Research Journal, 3 (4), 317. https://doi.org/10.2307/1162043

Rashid, Y., Rashid, A., Warraich, M. A., Sabir, S. S., & Waseem, A. (2019). Case study method: A step-by-step guide for business researchers. International Journal of Qualitative Methods, 18 , 160940691986242. https://doi.org/10.1177/1609406919862424

Ridder, H. G. (2017). The theory contribution of case study research designs. Business Research, 10 (2), 281–305. https://doi.org/10.1007/s40685-017-0045-z

Sadeghi Moghadam, M. R., Ghasemnia Arabi, N., & Khoshsima, G. (2021). A Review of case study method in operations management research. International Journal of Qualitative Methods, 20 , 160940692110100. https://doi.org/10.1177/16094069211010088

Sommer, B. B., & Sommer, R. (1997). A practical guide to behavioral research: Tools and techniques . Oxford University Press.

Stake, R. E. (2010). Qualitative research: Studying how things work .

Stake, R. E. (1995). The Art of Case Study Research . Sage Publications.

Stoecker, R. (1991). Evaluating and rethinking the case study. The Sociological Review, 39 (1), 88–112.

Suryani, A. (2013). Comparing case study and ethnography as qualitative research approaches .

Taylor, S., & Berridge, V. (2006). Medicinal plants and malaria: An historical case study of research at the London School of Hygiene and Tropical Medicine in the twentieth century. Transactions of the Royal Society of Tropical Medicine and Hygiene, 100 (8), 707–714. https://doi.org/10.1016/j.trstmh.2005.11.017

Tellis, W. (1997). Introduction to case study. The Qualitative Report . Published. https://doi.org/10.46743/2160-3715/1997.2024

Towne, L., & Shavelson, R. J. (2002). Scientific research in education . National Academy Press Publications Sales Office.

Widdowson, M. D. J. (2011). Case study research methodology. International Journal of Transactional Analysis Research, 2 (1), 25–34.

Yin, R. K. (2004). The case study anthology . Sage.

Yin, R. K. (2003). Design and methods. Case Study Research , 3 (9.2).

Yin, R. K. (1994). Case study research: Design and methods (2nd ed.). Sage Publishing.

Yin, R. (1984). Case study research: Design and methods . Sage Publications Beverly Hills.

Yin, R. (1993). Applications of case study research . Sage Publishing.

Zainal, Z. (2003). An investigation into the effects of discipline-specific knowledge, proficiency and genre on reading comprehension and strategies of Malaysia ESP Students. Unpublished Ph. D. Thesis. University of Reading , 1 (1).

Zeisel, J. (1984). Inquiry by design: Tools for environment-behaviour research (No. 5). CUP archive.

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Published on 4.7.2024 in Vol 12 (2024)

Assessment of Heat Exposure and Health Outcomes in Rural Populations of Western Kenya by Using Wearable Devices: Observational Case Study

Authors of this article:

Original Paper

• Ina Matzke 1   ; 
• Sophie Huhn 1   ; 
• Mara Koch 1   ; 
• Martina Anna Maggioni 2, 3 , PD, PhD   ; 
• Stephen Munga 4 , PhD   ; 
• Julius Okoth Muma 4   ; 
• Collins Ochieng Odhiambo 4   ; 
• Daniel Kwaro 4 , MD   ; 
• David Obor 4 , MSc   ; 
• Till Bärnighausen 1, 5, 6 , MD, Prof Dr   ; 
• Peter Dambach 1 , PhD   ; 
• Sandra Barteit 1 , Dr sc hum  

1 Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany

2 Charité – Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environment, Berlin, Germany

3 Department of Biomedical Sciences for Health, Universita degli Studi di Milano, Milan, Italy

4 Centre for Global Health Research KISUMU, Kenya Medical Research Institute, Kisumu, Kenya

5 Department of Global Health and Population, Harvard TH Chan School of Public Health, Havard University, Boston, MA, United States

6 Africa Health Research Institute, KwaZulu-Natal, Somkhele, South Africa

Corresponding Author:

Sandra Barteit, Dr sc hum

Heidelberg Institute of Global Health

Heidelberg University Hospital

Heidelberg University

Im Neuenheimer Feld 130

Heidelberg, 69120

Phone: 49 62215634030

Email: [email protected]

Background: Climate change increasingly impacts health, particularly of rural populations in sub-Saharan Africa due to their limited resources for adaptation. Understanding these impacts remains a challenge, as continuous monitoring of vital signs in such populations is limited. Wearable devices (wearables) present a viable approach to studying these impacts on human health in real time.

Objective: The aim of this study was to assess the feasibility and effectiveness of consumer-grade wearables in measuring the health impacts of weather exposure on physiological responses (including activity, heart rate, body shell temperature, and sleep) of rural populations in western Kenya and to identify the health impacts associated with the weather exposures.

Methods: We conducted an observational case study in western Kenya by utilizing wearables over a 3-week period to continuously monitor various health metrics such as step count, sleep patterns, heart rate, and body shell temperature. Additionally, a local weather station provided detailed data on environmental conditions such as rainfall and heat, with measurements taken every 15 minutes.

Results: Our cohort comprised 83 participants (42 women and 41 men), with an average age of 33 years. We observed a positive correlation between step count and maximum wet bulb globe temperature (estimate 0.06, SE 0.02; P =.008). Although there was a negative correlation between minimum nighttime temperatures and heat index with sleep duration, these were not statistically significant. No significant correlations were found in other applied models. A cautionary heat index level was recorded on 194 (95.1%) of 204 days. Heavy rainfall (>20 mm/day) occurred on 16 (7.8%) out of 204 days. Despite 10 (21%) out of 47 devices failing, data completeness was high for sleep and step count (mean 82.6%, SD 21.3% and mean 86.1%, SD 18.9%, respectively), but low for heart rate (mean 7%, SD 14%), with adult women showing significantly higher data completeness for heart rate than men (2-sided t test: P =.003; Mann-Whitney U test: P =.001). Body shell temperature data achieved 36.2% (SD 24.5%) completeness.

Conclusions: Our study provides a nuanced understanding of the health impacts of weather exposures in rural Kenya. Our study’s application of wearables reveals a significant correlation between physical activity levels and high temperature stress, contrasting with other studies suggesting decreased activity in hotter conditions. This discrepancy invites further investigation into the unique socioenvironmental dynamics at play, particularly in sub-Saharan African contexts. Moreover, the nonsignificant trends observed in sleep disruption due to heat expose the need for localized climate change mitigation strategies, considering the vital role of sleep in health. These findings emphasize the need for context-specific research to inform policy and practice in regions susceptible to the adverse health effects of climate change.

Introduction

Climate change and health.

Anthropogenic climate change has led to a mean global temperature increase of approximately 1 °C from preindustrial levels, with projections indicating a continued rise if substantial reductions in greenhouse gas emissions are not achieved; this warming trend poses profound health risks in low-and middle-income countries (LMICs) due to limited resources for environmental adaptation [ 1 , 2 ]. An emerging body of research indicates that wearable devices (wearables)—compact, noninvasive electronic devices capable of continuously monitoring various health metrics—may offer valuable insights into assessing the health impacts of climate change, especially in LMICs, where data on climate change and health are limited [ 3 - 5 ]. Climate change disproportionately affects regions such as sub-Saharan Africa, where increased temperatures exacerbate vulnerabilities, adversely impacting human health and agricultural productivity [ 2 , 6 ]. Kenya, the focus of our study, is increasingly vulnerable to climate change, with forecasts anticipating higher temperatures and more frequent extreme weather events; yet, there remains a lack of preparedness for necessary adaptation measures [ 1 , 7 ].

Need for Nuanced Understanding

In LMIC settings, a more nuanced understanding of individual exposure to extreme weather events and the resulting health outcomes is essential for creating tailored interventions and allocating resources efficiently [ 2 ]. Wearable devices, given their ability to monitor health metrics continuously and noninvasively, provide valuable insights into the health risks faced by vulnerable communities due to climate change [ 4 , 8 ]. Numerous large-scale studies in high-income settings have explored the use of wearables in health care [ 9 , 10 ], highlighting their potential as early warning systems for outbreaks of flu-like illnesses, among other applications. Although wearables have been utilized in studies within LMICs, notably in India [ 11 ], there is a lack in research concerning their use in other LMICs, particularly for assessing the impacts of climate change [ 3 , 4 ].

Objective of This Study

The primary aim of this study was to assess the feasibility and effectiveness of wearable devices in continuously and objectively monitoring the health impacts of weather exposures on individuals, particularly in a rural setting in Siaya, Kenya ( Figure 1 ). We will integrate these technologies into routine data collection methods of the Health and Demographic Surveillance Systems (HDSS) in Siaya, Kenya, aiming to fill the data void in LMICs by providing measured health metrics that can approximate health impacts, thus offering individual-level, objectively measured health responses to weather exposures.

Ethics Approval

Ethics approval was granted by the Kenya Medical Research Institute (KEMRI/RES/7/3/1) and the ethics committee of the University Hospital Heidelberg, Germany (S-294/2019). This study is reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement [ 14 ].

Study Design and Participants

This study employs an observational case study methodology in Siaya, a rural county situated in western Kenya, conducted from September 2021 to April 2022. For comprehensive details on the study protocol and a related case study from Burkina Faso, please refer to [ 15 , 16 ]. The Siaya county, about 40 km from Kisumu and 1000 meters above the sea level, hosts the Kenya Medical Research Institute–operated Siaya HDSS, covering an area of 700 km² and serving a population of around 260,000 people [ 16 , 17 ]. The HDSS has over 20 years of retrospective health and demographic data since 1990. Our study’s sample population was stratified by gender, age, and wearable type, with age categories of 6-16 years, 17-45 years, and >45 years. Participants were assigned to either a group with the Withings Pulse Heart Rate (WPHR) wearable or a group using WPHR and the Tucky thermometer patch. Eligibility criteria included age >6 years, living within 5 km of Wagai health center, not planning to move during the study, and providing informed consent. Recruitment methods varied by age, with random selection for those older than 22 years and snowball sampling for those aged 6-22 years.

The study protocol required participants to provide demographic and anthropometric data for wearable calibration, collected during each 3-week study cycle at the Wagai health center. Participants received a compensation of 200 Kenyan shillings (US $1.82) for travel, a smartphone with mobile data for data sync, and a battery pack for charging the wearables. Field personnel conducted weekly visits for data synchronization. Participants wore either the WPHR or both WPHR and a thermometer patch, with WPHR monitoring activity, sleep, and pulse rate, and the patch measuring body shell temperature at night (for detailed information, see Multimedia Appendix 1 [ 18 , 19 ]). The initial inventory consisted of 22 WPHR and 25 thermometer patches. Before reuse, both devices were cleaned and sanitized. This study also used a weather station in Wagai to record various weather parameters. The wet bulb globe temperature (WBGT), indicating heat strain, was calculated using a specific formula incorporating wet bulb temperature, global radiation, relative humidity, and air temperature [ 20 ]:

WBGT = (0.7*w) + (0.2*[0.009624*y – 0.00404*z + 1.102*x – 2.2776]) + (0.1*x)

where w represents wet bulb temperature, y represents global radiation, x represents relative humidity, and z represents air temperature.

Statistical Analysis

Participants were categorized into 4 age groups: school children (6-11 years), adolescents (12-18 years), young adults (19-45 years), and older adults (>45 years). BMI was classified as underweight (<18.5 kg/m 2 ), normal weight (18.5-24.9 kg/m 2 ), and overweight (>25 kg/m 2 ), following World Health Organization guidelines [ 21 ]. A descriptive analytical approach was used for demographic details and participant dropouts. BMI for adults was measured at recruitment. Wearable condition and wear were tracked for reliability assessment, and community interviewers’ implementation challenges and infrastructure needs were thematically analyzed.

We analyzed 4 variables to ensure data quality: sleep duration, total step count, heart rate, and body shell temperature. The measured pulse rate was assumed to be equivalent to the participant’s heart rate. We systematically excluded data that showed significant bias or anomalies such as unusually high or low heart rate readings (>expected maximum heart rate or <30 bpm) [ 22 , 23 ] and body shell temperature measurements indicative of protein denaturation or hypothermia-triggered loss of consciousness [ 24 ] (detailed criteria for data analysis can be found in Multimedia Appendix 2 ). Expected maximum heart rate was derived using the equation 208 – 0.7 × age [ 23 ]. Based on literature and the WPHR user guide, sleep measurements less than 3 hours (including naps) and those exceeding 13 hours were excluded as nonvalid. Wake times recorded by the wearable were not considered part of sleep duration [ 25 , 26 ]. Sleep episodes exceeding 3 hours were combined if the last episode began before noon on the following day. Differences across gender, study arm, and BMI for adult participants as well as across age groups were analyzed using Welch 2-sided t test and Mann-Whitney U test, with a 95% CI for error calculation.

To evaluate data completeness, we assessed the proportion of study duration covered by the measurements of the 4 key variables from wearables: sleep duration, step count, heart rate, and body shell temperature. The criteria for data completeness were based on existing literature (detailed in Multimedia Appendix 2 [ 15 , 22 - 28 ]). For external data validity, we combined individual measurements into a descriptive summary, including data from participants with at least 50% completeness per variable.

We descriptively analyzed the weather profile during the study period and correlations between weather events and adult study participant’s health metrics that had at least 50% data completeness (sleep duration, step count, and body shell temperature). The measurements of WBGT and heat index were categorized using the reference values according to Parsons [ 12 ] and the National Weather Service [ 13 ]. We employed unadjusted linear regression and multilinear regression analyses [ 4 , 8 , 29 - 32 ] considering factors such as maximum daily and minimal nighttime heat and heavy rainfall. The multilinear models further considered gender, age, and BMI as confounders. This study did not account for within-subject trends or the effects of prior day heat stress due to the limitations of the 21-day duration of wearable usage by each participant. Analyses were conducted on R4.1.2 (RStudio version 4.1.2; PBC) with stats3.6.2 for statistics and ggplot2 and car packages for visualization, providing standard error and adjusted R 2 for error quantification and model assessment (see Multimedia Appendix 3 for variable plots and residual plots of the regression models). Numerical values with final digits <5 were rounded down, while numerical values with final digits >4 were rounded up.

Demographics of the Participants

We initially enrolled 86 participants in our study; 3 withdrew their consent, resulting in 83 participants for analysis ( Figure 2 ). In the 2 study arms, 34 (41%) participants wore solely the WPHR wearable, while the remaining 49 (59%) wore both the WPHR and the thermometer patch. The mean age of the participants was 33.3 (SD 19) years (range 6-83 years). A further breakdown of this age distribution showed that our study involved 14 school children (17%, age range 6-11 years), 7 adolescents (8%, age range 12-18 years), 41 young adults (49%, age range 19-45 years), and 21 older adults (25%, age >45 years). Women comprised 51% (42/83) of the all the participants. In the adult demographics, which accounted for 75% (62/83) of the participants, the average BMI calculated was 23.8 (SD 4.7) kg/m 2 (range 16.0-37.4 kg/m 2 ).

Wearables’ Reliability

Of the 22 WPHRs and 25 thermometer patches initially deployed, 7 (32%) WPHRs and 3 (12%) thermometer patches malfunctioned, primarily from physical damage. Technical issues, including data synchronization, were frequent initially but reduced over the study’s duration. Physical damage was the predominant reason for WPHR failures, causing 5 (23%) devices to malfunction due to broken components or overall failure. One WPHR and its charger (5% of the total) were lost. As for thermometer patches, 2 (8%) had damaged charging ports, 1 (4%) was lost, and 2 (8%) had nonretrievable data, despite being intact.

Data Completeness

Data quality varied across health metrics and participant demographics. Accelerometer metrics such as step count and sleep duration exhibited high completeness, registering 86.1% (SD 18.9%) and 82.6% (SD 21.3%), respectively. Photoplethysmography-based heart rate measurements lagged behind at 7% (SD 14%), while body shell temperature recorded 36.2% (SD 24.5%) completeness. Data completeness was calculated as percentage of study duration covered with measurements in distinct intervals for all participants. Sleep data completeness varied by age: younger adults (19-45 years; n=41) recorded lower data completeness (79%) than older adults (>45 years; n=21; data completeness 90%) ( t test: P =.02; 95% CI –0.20 to –0.02; Mann-Whitney U test [MWU] test: P =.03; 95% CI –0.14 to 0.00). Further, adult women (n=33) showed less data missingness (87%) than adult men (n=29, 78%) (MWU test: P =.03; 95% CI 0.00-0.14). Heart rate data completeness in adult women (12%) was significantly higher than that in men (2%) ( t test: P =.003; 95% CI 0.04-0.17; MWU test: P =.001; 95% CI 0.01-0.04). Body shell temperature data completeness for school children (6-11 years; data completeness 47%) was higher than that for adolescents (12-18 years; data completeness 23%) ( t test: P =.03; 95% CI 0.03-0.45; MWU test: P =.03; 95% CI 0.05-0.48). After correcting for multiple tests using Holm sequential Bonferroni method [ 33 ], only the difference in the completeness of heart rate data between men and women remained statistically significant ( t test: P =.02; MWU: P =.004). For detailed data measurements stratified by age, gender, study arm, and BMI, as well as data completeness results corrected for multiple testing, refer to Multimedia Appendix 4 [ 33 ].

Environmental Exposure

During the 204 days study, rainfall was recorded on 97 (47.6%) days. Out of these, heavy rain (≥20 mm per day) was recorded on 16 (7.8%) days. The average daily heat index and WBGT were 22.1 (SD 1.1) °C and 20 (SD 0.7) °C, respectively. The heat index caution limit (26.67 °C or 80 °F) was reached on 194 (95.1%) of 204 days, and the extreme caution limit (32.22 °C or 90 °F) exceeded on only 2 (<1%) days. For the WBGT, reference values for outdoor work with very high metabolic rates were met on 197 (96.6%) days and for work with high metabolic rates on 96 (47.1%) days. Figure 3 illustrates the instances where individual reference values for WBGT, as proposed by Parsons [ 12 ], and the heat index, as per the standards of the National Weather Service [ 13 ], were exceeded ( Table 1 ).

Data Applicability: Heat Exposure and Health Outcomes

The unadjusted regression analysis for daily step count indicated a significant positive correlation with maximal daily WBGT and heat index (WBGT: estimate 974.4, SE 242.3; P <.001; heat index: estimate 317.6, SE 152.4; P =.04) with a low R 2 value (WBGT: R 2 =0.014; heat index: R 2 =0.003). On days without heavy rainfall, a similar positive yet nonsignificant correlation was observed for daily step count (estimate 1466.2, SE 852.9; P =.09; R 2 =0.002). The analysis for daily maximal temperature did not demonstrate any predictive power for step count ( R 2 =–0.001; estimate 87.54, SE 145.08; P =.55). After a logarithmic transformation of the dependent variable (step count) due to a funnel shape observed in residuals, the confounder-adjusted models revealed a significant positive relationship with the maximum WBGT (estimate 0.06, SE 0.02; P =.008; R 2 =0.248) (see Figure 4 for details). Other heat indicators showed positive yet nonsignificant associations with daily step count. Age and BMI emerged as significant predictors of daily step count ( P <.001).

For sleep duration in minutes, the linear regression model revealed a negative, however nonsignificant, correlation with minimal nighttime temperature and heat index at small P values, but with low predictive power (temperature: estimate –5.61, SE 3.24; P =.08, R 2 =0.002; heat index: estimate –4.77, SE 2.91; P =.10; R 2 =0.002). For minimal nighttime WBGT and sleep duration, simple linear regression had no explanatory power ( R 2 =–0.001, estimate –0.67, SE 2.98; P =.82). Similarly, the multiple linear regression analysis indicated that an increase in minimum nighttime temperatures and nightly minimal heat index corresponded with nonsignificant reductions in sleep duration, that is, by 5.56 minutes per °C increase ( P =.09; SE 3.234; R 2 =0.006) and 4.50 minutes per °C increase ( P =.12; SE 2.905; R 2 =0.006), respectively. We did not detect a significant relationship between nightly minimum WBGT and sleep duration (estimate 0.07 minutes; P =.98; SE 2.985; R 2 =0.003). Age proved to be a significant determinant of sleep duration across all models ( P =.03).

Unadjusted linear regression analysis of body shell temperature and minimal nighttime heat had no explanatory power giving their negative adjusted R 2 of –0.003 across all heat indicators (temperature: estimate 0.05, SE 0.07; P =.51; WBGT: estimate 0.05, SE 0.07; P =.51; heat index: estimate 0.04, SE 0.07; P =.53). The multiple linear regression models of nightly body shell temperature did not show significant results either, however at relatively high explanatory power, as indicated by their R 2 values (0.168, 0.170, and 0.170, respectively; temperature: estimate 0.03, SE 0.07; P =.63; WBGT: estimate 0.05, SE 0.07; P =.42; heat index: estimate 0.05, SE 0.06; P =.41, respectively). Gender ( P <.001) and BMI ( P =.04) were significant predictors in all 3 models.

The additional analysis incorporating the temporal confounder of weekday or weekend, detailed in Multimedia Appendix 5 , did not reveal any significant impact in the models. Regression models were not applied to heart rate measurements, as only the data sets of the 3 participants met the required 50% completeness. A summary of all the multiple regression models, including estimates, standard errors, P values, and other considered confounders for each health parameter and the associated extreme weather indicators is provided in Table 2 .

a This is a logarithmically transformed model for step count and standard models for sleep duration and body temperature. The table includes estimates, standard errors, and P values for each health parameter—sleep duration, step count, and body temperature—along with their associated extreme weather indicators. Health parameters were included of adult participants having at least 50% data completeness for the respective health parameter. Depending on the model, the weather indicators considered were temperature, heat index, wet bulb globe temperature, and precipitation. Additionally, the multiple linear regression models incorporated gender, age, and BMI, as the data validity analysis demonstrated the significance of these confounders.

b WBGT: wet bulb globe temperature.

c Not available.

Principal Results

The findings of our study highlight the advantages and challenges associated with the use of wearable devices for the continuous monitoring of vital signs in rural sub-Saharan populations. We found using wearables a pertinent approach for understanding individual impacts of weather exposures. Our research emphasizes the feasibility and effectiveness of integrating wearable technology into health research, in particular, to understand individual exposures and activity patterns such as daily steps and sleep duration. We identified a correlation between weather exposures and various health metrics. Notably, there is a positive relationship between daily step count and the maximum WBGT as well as a potential negative association between nighttime temperatures and sleep duration. These findings contribute to our understanding of the possible health impacts of climate change, with a particular focus on rural regions in western Kenya.

Comparison With Prior Work

Our study shows environmental exposures such as frequent heavy rainfall and extreme heat, with approximately 20.7% (4044/19,576) of our weather station readings surpassing the heat index caution threshold [ 13 ]—a pattern consistent with WBGT findings. We found a strong positive correlation between daily step count and maximum WBGT across both models. Additionally, a positive relationship with the heat index was observed in the unadjusted model. Although many studies indicate a negative link between heat and physical activity [ 30 ], the relationship between temperature and activity levels remains inconsistent. This discrepancy necessitates further investigation. For instance, a study [ 34 ] conducted in Qatar utilizing wearable pedometers discovered negative correlations between daily step count and both precipitation and temperature. However, that study reported varying associations with WBGT depending on the analytical model employed. Our findings emphasize the need for deeper investigation into this relationship [ 4 ]. External factors such as seasonal farming activities illustrated in Figure 4 or specific mitigation practices might significantly influence this correlation and therefore merit additional investigation [ 17 ], especially given the scarcity of objectively generated data on activity levels and physical activity profiles in rural sub-Saharan African populations [ 35 ].

In our study, we observed a negative trend between minimum nighttime temperature and sleep duration as well as between the minimal nighttime heat index and sleep duration, but these relationships were not statistically significant in either model. However, this trend aligns with previous research that has linked warmer nights to shorter sleep durations, suggesting that climate change could significantly affect sleep health [ 4 , 8 , 32 ]. For example, a comprehensive study by Minor et al [ 8 ] utilizing sleep data of 47,628 participants across 68 countries found a correlation between shorter sleep duration and warmer nights. In line with these findings, all studies in the scoping review of Koch et al [ 4 ] reported a negative correlation between sleep duration and heat. These studies underscore the risk of insufficient sleep, in light of the expected impact of global warming due to climate change on local heat exposure [ 8 ]. The review of Caddick et al [ 36 ] suggests that optimal ambient temperatures for sleep lie between 17 °C and 28 °C, with 40%-60% humidity, although this may vary based on other factors. Insufficient sleep, whether due to short duration or disruptions, can negatively affect human health, potentially compromising the immune system [ 37 ] and increasing cardiovascular risk [ 38 ].

Regarding body shell temperature, our study did not find significant associations with average nightly body shell temperature and heat. However, previous studies [ 4 , 31 ] have suggested a possible connection. In our analysis, gender and age emerged as critical factors in all 3 models, emphasizing the importance of demographic and physiological factors in body temperature regulation. The inconclusive results in our study might be attributed to the limited sample size and issues with data integrity. Furthermore, natural thermoregulatory processes such as evaporation and the thermoregulatory behaviors of participants should be considered when evaluating body shell temperature [ 24 ].

Our study shows improved data completeness compared to previous research in Burkina Faso [ 15 ] and the United States [ 27 ], especially in thermometer patch data, likely due to enhanced adhesion using medical tape [ 15 ]. However, heart rate data showed lower completeness, which may have been affected by technical factors such as the proximity of the sensors to the skin, the impact of motion, and potential device errors. Similar studies using certain wearable devices reported data loss due to wearable malfunctions such as connection issues [ 39 ]. Other factors such as blood vessel thickness, skin thickness, obesity, and age might also affect measurement quality and completeness, potentially explaining the gender-specific differences observed in our data, where factors such as thinner skin in women or older populations or thicker blood vessels in men could enhance photoplethysmography signals [ 40 , 41 ]. Other factors that have been mentioned in the scientific literature are the skin pigmentations of the participants; several studies have noted a correlation between the Fitz-Patrick skin scale and heart rate measurements via photoplethysmography, suggesting reduced heart rate measurement accuracy in individuals with higher Fitz-Patrick scale values [ 40 , 42 ], although some studies [ 43 ] did not find this correlation. To mitigate this, wearables are starting to implement enhanced photoplethysmography sensors or infrared measurements [ 42 ]. Moreover, gender may present contradictory effects on the data collection [ 40 ]. The influence of BMI on signal quality remains uncertain [ 40 ], with additional variables such as blood vessel dilation during physical activity also playing a role [ 40 ]. Participant adherence challenges were also observed, as some felt uncomfortable wearing the device continuously, especially at night.

Our research aligns with previous studies on average daily activity and sleep duration, particularly regarding the influence of age [ 15 , 32 , 34 ]. Although body shell temperature readings aligned with physiological norms, indicating their usefulness in identifying individual anomalies [ 24 ], they were notably low, suggesting potential nighttime evaporation processes [ 24 ]. As with prior research, factors such as gender and BMI affected body shell temperature [ 4 , 24 ], necessitating further research to comprehensively grasp temperature impacts.

Limitations

The internal validity of the wearables used in this study was not evaluated; however, models older than the WPHR used here, some requiring manual sleep initiation, have shown largely satisfactory results. Gruwez et al [ 44 ] identified a significant correlation between Withings wearables and a research-grade actigraph for step count during daily activities. However, a review by Fuller et al [ 45 ] revealed an underestimation of step count in Withings wearables in most examined studies. Comparisons of Withings wearables to polysomnography revealed no significant differences in sleep duration measurements [ 39 ], and various studies have noted consistent correlations with polysomnography-recorded total sleep duration [ 39 , 44 ]. Regulatory constraints restricted the recruitment of younger participants in our study, affecting its generalizability. Furthermore, smartphone usage restrictions in Kenyan boarding schools, especially pertinent to the substantial under-15 years demographic, could pose challenges for future research [ 17 ]. In addition, as explained in the methods section, only the data sets of the adult participants were analyzed with regard to weather effects. Our study has other limitations such as uncorrected multiple testing and potential influences of the COVID-19 pandemic on data. In Kenya, the COVID-19 pandemic caused governmental restrictions on public life such as nighttime curfew until October 20, 2021, which affected 22 (26.5%) participants during their study participation—likely influencing the data collected [ 46 ]. Research during the 2020 COVID lockdowns reported reduced total sleep duration and increased napping [ 47 ], and a South African study observed decreased mobility, particularly on weekends [ 48 ]. Future research should consider a wider range of variables, account for the carryover effects of prior day heat strain [ 49 ], and address technical challenges such as inaccessible raw data, software issues, high data missingness for heart rate due to factors such as skin type [ 40 ], and possible algorithmic biases. Our study does not account for factors such as clothing, air circulation, bedding, and individual differences such as gender, which can influence the relationship between heat and sleep duration [ 36 ].

Conclusions

Our study shows the potential of wearable devices to monitor vital signs and assess the impact of environmental exposures on health in rural sub-Saharan settings, with implications for understanding the nuanced effects of climate change. Despite a robust data set, our findings indicate the need for improved wearable technology to ensure data completeness across diverse demographic groups, acknowledging the impact of factors such as age, gender, and BMI. The positive correlation between physical activity levels and high WBGT offers new insights into behavior during extreme weather conditions, while the nonsignificant trends in sleep duration in relation to temperature call for further investigation. These observations are crucial for public health strategies in climate-vulnerable regions, guiding the integration of wearables in longitudinal health monitoring and climate resilience research. Future studies should expand on the relationship between weather and health outcomes, including a broader demographic and addressing technical challenges identified in wearable data collection. This research contributes to a growing body of knowledge that will inform both technological innovation in health monitoring and the development of interventions to mitigate the health impacts of global climate dynamics.

Acknowledgments

We thank the German Research Foundation (Deutsche Forschungsgemeinschaft) for supporting this work as part of a Deutsche Forschungsgemeinschaft–funded research unit (Forschungsgruppe FOR 2936/project: 409670289). We acknowledge the support of Else Kröner-Fresenius-Stiftung from the Heidelberg Graduate School of Global Health. For the publication fee we acknowledge financial support by Heidelberg University and by the Else Kröner-Fresenius-Stiftung within the Heidelberg Graduate School of Global Health. The funders had no influence on the design, data collection and analysis, the decision to publish or the preparation of the manuscript. During the preparation of this work, the author(s) used ChatGPT in order to improve language and readability of this manuscript. After using this tool/service, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.

Data Availability

Deidentified wearable data, weather data, and R scripts will be available for scientific purposes with publication on reasonable request to the corresponding author SB ([email protected]).

Authors' Contributions

SB, TB, and SM planned this study and led its implementation. SM, DO, DK, JOM, COO, and IM conducted and supervised the study on site, remotely advised by SB and IM. SH, MK, MAM, SB, and IM assessed the data and performed the data analysis. IM analyzed the data, supervised and verified by SB. All authors critically and freely contributed to the final draft and confirmed the publication.

Conflicts of Interest

None declared.

Detailed technical information on the wearables used.

Additional information on data analysis.

Added variables and residual plots of regression models.

Detailed results on data completeness and data validity.

Additional regression models incorporating weekday or weekend.

ChatGPT conversation.

• Green H, Bailey J, Schwarz L, Vanos J, Ebi K, Benmarhnia T. Impact of heat on mortality and morbidity in low and middle income countries: A review of the epidemiological evidence and considerations for future research. Environ Res. Apr 2019;171:80-91. [ CrossRef ] [ Medline ]
• IPCC. Climate change 2022: impacts, adaption, and vulnerability. Working group II contribution to the IPCC sixth assessment report. In: Pörtner HO, Roberts DC, Tignor M, Poloczanska ES, Mintenbeck K, Alegría A, et al, editors. IPCC. Cambridge, UK. Cambridge University Press; 2022.
• Huhn S, Axt M, Gunga Hanns-Christian, Maggioni MA, Munga S, Obor D, et al. The impact of wearable technologies in health research: scoping review. JMIR Mhealth Uhealth. Jan 25, 2022;10(1):e34384. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Koch M, Matzke I, Huhn S, Gunga H, Maggioni MA, Munga S, et al. Wearables for measuring health effects of climate change-induced weather extremes: scoping review. JMIR Mhealth Uhealth. Sep 09, 2022;10(9):e39532. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Ming DK, Sangkaew S, Chanh HQ, Nhat PTH, Yacoub S, Georgiou P, et al. Continuous physiological monitoring using wearable technology to inform individual management of infectious diseases, public health and outbreak responses. Int J Infect Dis. Jul 2020;96:648-654. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Ortiz-Bobea A, Ault TR, Carrillo CM, Chambers RG, Lobell DB. Anthropogenic climate change has slowed global agricultural productivity growth. Nat Clim Chang. Apr 01, 2021;11(4):306-312. [ CrossRef ]
• Gleixner S, Lüttringhaus S, Kaufmann J, Smytzek P, Gornott C. Assessment of climatic impact drivers in Kenya. United Nations Office for Disaster Risk Reduction. Bonn and Eschborn, Germany. Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH; 2022. URL: https://www.preventionweb.net/publication/assessment-climatic-impact-drivers-kenya [accessed 2022-09-15]
• Minor K, Bjerre-Nielsen A, Jonasdottir SS, Lehmann S, Obradovich N. Rising temperatures erode human sleep globally. One Earth. May 2022;5(5):534-549. [ CrossRef ]
• Natarajan A, Pantelopoulos A, Emir-Farinas H, Natarajan P. Heart rate variability with photoplethysmography in 8 million individuals: a cross-sectional study. Lancet Digit Health. Dec 2020;2(12):e650-e657. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Radin JM, Wineinger NE, Topol EJ, Steinhubl SR. Harnessing wearable device data to improve state-level real-time surveillance of influenza-like illness in the USA: a population-based study. The Lancet Digital Health. Feb 2020;2(2):e85-e93. [ CrossRef ]
• Sahu S, Sett M, Kjellstrom T. Heat exposure, cardiovascular stress and work productivity in rice harvesters in India: implications for a climate change future. Ind Health. 2013;51(4):424-431. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Parsons K. Heat stress standard ISO 7243 and its global application. Ind Health. Jul 2006;44(3):368-379. [ FREE Full text ] [ CrossRef ] [ Medline ]
• What is the heat index? National Weather Service. URL: https://www.weather.gov/ama/heatindex [accessed 2022-09-19]
• von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. Oct 16, 2007;4(10):e296. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Huhn S, Matzke I, Koch M, Gunga H, Maggioni M, Sié A, et al. Using wearable devices to generate real-world, individual-level data in rural, low-resource contexts in Burkina Faso, Africa: A case study. Frontiers in Public Health. 2022;10:972177. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Barteit S, Boudo V, Ouedraogo A, Zabré P, Ouremi L, Sié A, et al. Feasibility, acceptability and validation of wearable devices for climate change and health research in the low-resource contexts of Burkina Faso and Kenya: Study protocol. PLoS One. 2021;16(9):e0257170. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Odhiambo FO, Laserson KF, Sewe M, Hamel MJ, Feikin DR, Adazu K, et al. Profile: the KEMRI/CDC Health and Demographic Surveillance System--Western Kenya. Int J Epidemiol. Aug 2012;41(4):977-987. [ CrossRef ] [ Medline ]
• Pulse HR - User Guide. URL: https://support.withings.com/hc/en-us/articles/360015826813-Pulse-HR-User-Guid [accessed 2022-09-18]
• e-TakesCare - Client Support. URL: https://www.e-takescare.com/en/assistance-particuliers [accessed 2022-09-18]
• Carter AW, Zaitchik BF, Gohlke JM, Wang S, Richardson MB. Methods for estimating wet bulb globe temperature from remote and low‐cost data: a comparative study in Central Alabama. GeoHealth. May 21, 2020;4(5):e2019GH000231. [ CrossRef ]
• A healthy lifestyle - WHO recommendations. World Health Organization. 2010. URL: https://www.who.int/europe/news-room/fact-sheets/item/a-healthy-lifestyle---who-recommendations [accessed 2022-11-17]
• Mangrum JM, DiMarco JP. The evaluation and management of bradycardia. N Engl J Med. Mar 09, 2000;342(10):703-709. [ CrossRef ] [ Medline ]
• Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol. Jan 2001;37(1):153-156. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Campbell I. Body temperature and its regulation. Anaesthesia & Intensive Care Medicine. Jun 2008;9(6):259-263. [ CrossRef ]
• Jonasdottir SS, Minor K, Lehmann S. Gender differences in nighttime sleep patterns and variability across the adult lifespan: a global-scale wearables study. Sleep. Feb 12, 2021;44(2):zsaa169. [ CrossRef ] [ Medline ]
• Pulse HR - I'm having issues with my sleep data. Withings. URL: https:/​/support.​withings.com/​hc/​en-us/​articles/​360011368074-Pulse-HR-I-m-having-issues-with-my-sleep-data-What-should-I-do- [accessed 2022-03-31]
• Troiano RP, Berrigan D, Dodd KW, Mâsse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. Jan 2008;40(1):181-188. [ CrossRef ] [ Medline ]
• Sallis JF, Cerin E, Conway TL, Adams MA, Frank LD, Pratt M, et al. Physical activity in relation to urban environments in 14 cities worldwide: a cross-sectional study. Lancet. May 28, 2016;387(10034):2207-2217. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Davis C, Engelbrecht F, Tadross M, Wolski P, Archer E. Future climate change over Southern Africa. CSIR. Oct 2017. URL: https://researchspace.csir.co.za/dspace/handle/10204/10085 [accessed 2024-03-12]
• Jehn M, Gebhardt A, Liebers U, Kiran B, Scherer D, Endlicher W, et al. Heat stress is associated with reduced health status in pulmonary arterial hypertension: a prospective study cohort. Lung. Aug 2014;192(4):619-624. [ CrossRef ] [ Medline ]
• Okamoto-Mizuno K, Tsuzuki K, Mizuno K, Iwaki T. Effects of partial humid heat exposure during different segments of sleep on human sleep stages and body temperature. Physiol Behav. Jan 17, 2005;83(5):759-765. [ CrossRef ] [ Medline ]
• Rifkin DI, Long MW, Perry MJ. Climate change and sleep: A systematic review of the literature and conceptual framework. Sleep Med Rev. Dec 2018;42:3-9. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Abdi H. Holm’s sequential Bonferroni procedure. In: Salkind N, editor. Encyclopedia of Research Design. Thousand Oaks, CA. SAGE Publications, Inc; 2010.
• Al-Mohannadi AS, Farooq A, Burnett A, Van Der Walt M, Al-Kuwari MG. Impact of climatic conditions on physical activity: a 2-year cohort study in the arabian gulf region. Journal of Physical Activity and Health. Sep 2016;13(9):929-937. [ CrossRef ] [ Medline ]
• Yiga P, Seghers J, Ogwok P, Matthys C. Determinants of dietary and physical activity behaviours among women of reproductive age in urban sub-Saharan Africa: a systematic review. Br J Nutr. May 28, 2020;124(8):761-772. [ CrossRef ]
• Caddick ZA, Gregory K, Arsintescu L, Flynn-Evans EE. A review of the environmental parameters necessary for an optimal sleep environment. Building and Environment. Mar 2018;132:11-20. [ CrossRef ]
• Irwin MR. Why sleep is important for health: a psychoneuroimmunology perspective. Annu Rev Psychol. Jan 03, 2015;66:143-172. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Krittanawong C, Tunhasiriwet A, Wang Z, Zhang H, Farrell A, Chirapongsathorn S, et al. Association between short and long sleep durations and cardiovascular outcomes: a systematic review and meta-analysis. Eur Heart J Acute Cardiovasc Care. Dec 2019;8(8):762-770. [ CrossRef ] [ Medline ]
• Mantua J, Gravel N, Spencer RMC. Reliability of sleep measures from four personal health monitoring devices compared to research-based actigraphy and polysomnography. Sensors (Basel). May 05, 2016;16(5):646. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Fine J, Branan KL, Rodriguez AJ, Boonya-Ananta T, Ajmal, Ramella-Roman JC, et al. Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring. Biosensors (Basel). Apr 16, 2021;11(4):126. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Moço AV, Stuijk S, de Haan G. Skin inhomogeneity as a source of error in remote PPG-imaging. Biomed. Opt. Express. Oct 26, 2016;7(11):4718. [ CrossRef ]
• Colvonen PJ, DeYoung PN, Bosompra NA, Owens RL. Limiting racial disparities and bias for wearable devices in health science research. Sleep. Oct 13, 2020;43(10):zsaa159. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Bent B, Goldstein BA, Kibbe WA, Dunn JP. Investigating sources of inaccuracy in wearable optical heart rate sensors. NPJ Digit Med. 2020;3:18. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Gruwez A, Libert W, Ameye L, Bruyneel M. Reliability of commercially available sleep and activity trackers with manual switch-to-sleep mode activation in free-living healthy individuals. Int J Med Inform. Jun 2017;102:87-92. [ CrossRef ] [ Medline ]
• Fuller D, Colwell E, Low J, Orychock K, Tobin MA, Simango B, et al. Reliability and validity of commercially available wearable devices for measuring steps, energy expenditure, and heart rate: systematic review. JMIR Mhealth Uhealth. Sep 08, 2020;8(9):e18694. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Otieno J. Council of governors say no to lockdown over COVID-19 surge. The Star. Dec 20, 2021. URL: https:/​/www.​the-star.co.ke/​news/​2021-12-20-council-of-governors-say-no-to-lockdown-over-covid-19-surge/​ [accessed 2022-09-19]
• Petrov ME, Pituch KA, Kasraeian K, Jiao N, Mattingly J, Hasanaj K, et al. Impact of the COVID-19 pandemic on change in sleep patterns in an exploratory, cross-sectional online sample of 79 countries. Sleep Health. Aug 2021;7(4):451-458. [ CrossRef ] [ Medline ]
• Borofsky Y, Günther I. Mobility in informal settlements during a public lockdown: A case study in South Africa. PLoS One. 2022;17(12):e0277465. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Garzon-Villalba XP, Mbah A, Wu Y, Hiles M, Moore H, Schwartz SW, et al. Exertional heat illness and acute injury related to ambient wet bulb globe temperature. Am J Ind Med. Dec 2016;59(12):1169-1176. [ CrossRef ] [ Medline ]

Abbreviations

Edited by G Eysenbach, L Buis; submitted 18.11.23; peer-reviewed by H Aghayan Golkashani; comments to author 22.12.23; revised version received 16.01.24; accepted 26.01.24; published 04.07.24.

©Ina Matzke, Sophie Huhn, Mara Koch, Martina Anna Maggioni, Stephen Munga, Julius Okoth Muma, Collins Ochieng Odhiambo, Daniel Kwaro, David Obor, Till Bärnighausen, Peter Dambach, Sandra Barteit. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 04.07.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mHealth and uHealth, is properly cited. The complete bibliographic information, a link to the original publication on https://mhealth.jmir.org/, as well as this copyright and license information must be included.

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Spatiotemporal variations of vegetation and its response to climate change and human activities in arid areas—a case study of the shule river basin, northwestern china.

1. Introduction

2. materials and methods, 2.1. study area, 2.2. datasets, 2.2.1. vegetation, 2.2.2. land cover, 2.2.3. precipitation, 2.2.4. land surface temperature, 2.2.5. surface water area, 2.2.6. dem and road, 2.3. methods, 2.3.1. retrieval of fvc time series data, 2.3.2. vegetation trend analysis, 2.3.3. partial correlation analysis, 2.3.4. calculating contribution of driving factors to variation in fvc, 3.1. temporal change of vegetation, 3.2. spatial pattern of vegetation dynamics, 3.3. correlations between climate factors and fvc, 4. discussion, 4.1. contributions of climate change and human activities to vegetation dynamics, 4.2. land cover dynamics and their response to climate change and human activities, 5. conclusions, author contributions, data availability statement, conflicts of interest.

• Lunetta, R.S.; Knight, J.F.; Ediriwickrema, J.; Lyon, J.G.; Worthy, L.D. Land-cover change detection using multi-temporal MODIS NDVI data. Remote Sens. Environ. 2006 , 105 , 142–154. [ Google Scholar ] [ CrossRef ]
• Guan, Q.; Yang, L.; Guan, W.; Wang, F.; Liu, Z.; Xu, C. Assessing vegetation response to climatic variations and human activities: Spatiotemporal NDVI variations in the Hexi Corridor and surrounding areas from 2000 to 2010. Theor. Appl. Climatol. 2018 , 135 , 1179–1193. [ Google Scholar ] [ CrossRef ]
• Wang, H.; Liu, G.; Li, Z.; Wang, P.; Wang, Z. Comparative Assessment of Vegetation Dynamics under the Influence of Climate Change and Human Activities in Five Ecologically Vulnerable Regions of China from 2000 to 2015. Forests 2019 , 10 , 317. [ Google Scholar ] [ CrossRef ]
• Chen, Y.; Li, Z.; Fan, Y.; Wang, H.; Deng, H. Progress and prospects of climate change impacts on hydrology in the arid region of northwest China. Environ. Res. 2015 , 139 , 11–19. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Fokeng, R.M.; Fogwe, Z.N. Landsat NDVI-based vegetation degradation dynamics and its response to rainfall variability and anthropogenic stressors in Southern Bui Plateau, Cameroon. Geosyst. Geoenviron. 2022 , 1 , 100075. [ Google Scholar ] [ CrossRef ]
• Jiang, H.; Xu, X.; Guan, M.; Wang, L.; Huang, Y.; Jiang, Y. Determining the contributions of climate change and human activities to vegetation dynamics in agro-pastural transitional zone of northern China from 2000 to 2015. Sci. Total Environ. 2020 , 718 , 134871. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Liu, Y.; Zhang, Z.; Tong, L.; Khalifa, M.; Wang, Q.; Gang, C.; Wang, Z.; Li, J.; Sun, Z. Assessing the effects of climate variation and human activities on grassland degradation and restoration across the globe. Ecol. Indic. 2019 , 106 , 105504. [ Google Scholar ] [ CrossRef ]
• Sun, B.; Li, Z.; Gao, W.; Zhang, Y.; Gao, Z.; Song, Z.; Qin, P.; Tian, X. Identification and assessment of the factors driving vegetation degradation/regeneration in drylands using synthetic high spatiotemporal remote sensing Data—A case study in Zhenglanqi, Inner Mongolia, China. Ecol. Indic. 2019 , 107 , 105614. [ Google Scholar ] [ CrossRef ]
• Xue, X.; Wang, Z.; Hou, S. NDVI-Based Vegetation Dynamics and Response to Climate Changes and Human Activities in Guizhou Province, China. Forests 2023 , 14 , 753. [ Google Scholar ] [ CrossRef ]
• Gao, W.; Zheng, C.; Liu, X.; Lu, Y.; Chen, Y.; Wei, Y.; Ma, Y. NDVI-based vegetation dynamics and their responses to climate change and human activities from 1982 to 2020: A case study in the Mu Us Sandy Land, China. Ecol. Indic. 2022 , 137 , 108745. [ Google Scholar ] [ CrossRef ]
• Yu, M.; Song, S.; He, G.; Shi, Y. Vegetation Landscape Changes and Driving Factors of Typical Karst Region in the Anthropocene. Remote Sens. 2022 , 14 , 5391. [ Google Scholar ] [ CrossRef ]
• He, J.; Shi, X.; Fu, Y. Identifying vegetation restoration effectiveness and driving factors on different micro-topographic types of hilly Loess Plateau: From the perspective of ecological resilience. J. Environ. Manag. 2021 , 289 , 112562. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Zhang, X.; Jin, X. Vegetation dynamics and responses to climate change and anthropogenic activities in the Three-River Headwaters Region, China. Ecol. Indic. 2021 , 131 , 108223. [ Google Scholar ] [ CrossRef ]
• Liu, N.; Ding, Y.; Peng, S. Temporal effects of climate on vegetation trigger the response biases of vegetation to human activities. Glob. Ecol. Conserv. 2021 , 31 , e01822. [ Google Scholar ] [ CrossRef ]
• Teng, M.; Zeng, L.; Hu, W.; Wang, P.; Yan, Z.; He, W.; Zhang, Y.; Huang, Z.; Xiao, W. The impacts of climate changes and human activities on net primary productivity vary across an ecotone zone in Northwest China. Sci. Total Environ. 2020 , 714 , 136691. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Zhao, S.; Pereira, P.; Wu, X.; Zhou, J.; Cao, J.; Zhang, W. Global karst vegetation regime and its response to climate change and human activities. Ecol. Indic. 2020 , 113 , 106208. [ Google Scholar ] [ CrossRef ]
• Yin, L.; Dai, E.; Zheng, D.; Wang, Y.; Ma, L.; Tong, M. What drives the vegetation dynamics in the Hengduan Mountain region, southwest China: Climate change or human activity? Ecol. Indic. 2020 , 112 , 106013. [ Google Scholar ] [ CrossRef ]
• Chen, T.; Bao, A.; Jiapaer, G.; Guo, H.; Zheng, G.; Jiang, L.; Chang, C.; Tuerhanjiang, L. Disentangling the relative impacts of climate change and human activities on arid and semiarid grasslands in Central Asia during 1982-2015. Sci. Total Environ. 2019 , 653 , 1311–1325. [ Google Scholar ] [ CrossRef ]
• Meng, M.; Huang, N.; Wu, M.; Pei, J.; Wang, J.; Niu, Z. Vegetation change in response to climate factors and human activities on the Mongolian Plateau. PeerJ 2019 , 7 , e7735. [ Google Scholar ] [ CrossRef ]
• Ma, Q.; Long, Y.; Jia, X.; Wang, H.; Li, Y. Vegetation response to climatic variation and human activities on the Ordos Plateau from 2000 to 2016. Environ. Earth Sci. 2019 , 78 , 709. [ Google Scholar ] [ CrossRef ]
• Liu, R.; Xiao, L.; Liu, Z.; Dai, J. Quantifying the relative impacts of climate and human activities on vegetation changes at the regional scale. Ecol. Indic. 2018 , 93 , 91–99. [ Google Scholar ] [ CrossRef ]
• Wu, Z.Y.; Saito, Y.; Zhao, D.N.; Zhou, J.Q.; Cao, Z.Y.; Li, S.J.; Shang, J.H.; Liang, Y.Y. Impact of human activities on subaqueous topographic change in Lingding Bay of the Pearl River estuary, China, during 1955–2013. Sci. Rep. 2016 , 6 , 37742. [ Google Scholar ] [ CrossRef ]
• Zhang, J.; Niu, J.; Bao, T.; Buyantuyev, A.; Zhang, Q.; Dong, J.; Zhang, X. Human induced dryland degradation in Ordos Plateau, China, revealed by multilevel statistical modeling of normalized difference vegetation index and rainfall time-series. J. Arid. Land. 2013 , 6 , 219–229. [ Google Scholar ] [ CrossRef ]
• Yang, T.; Zhang, Q.; Wang, W.; Yu, Z.; Chen, Y.D.; Lu, G.; Hao, Z.; Baron, A.; Zhao, C.; Chen, X.; et al. Review of Advances in Hydrologic Science in China in the Last Decades: Impact Study of Climate Change and Human Activities. J. Hydrol. Eng. 2013 , 18 , 1380–1384. [ Google Scholar ] [ CrossRef ]
• Tu, X.; Zhang, Q.; Singh, V.P.; Chen, X.; Liu, C.-L.; Wang, S.-B. Space–time changes in hydrological processes in response to human activities and climatic change in the south China. Stoch. Environ. Res. Risk Assess. 2011 , 26 , 823–834. [ Google Scholar ] [ CrossRef ]
• Liu, X.; Du, G.; Bi, H.; Li, Z.; Zhang, X. Normal Difference Vegetation Index Simulation and Driving Analysis of the Tibetan Plateau Based on Deep Learning Algorithms. Forests 2024 , 15 , 137. [ Google Scholar ] [ CrossRef ]
• Li, G.; Liang, J.; Wang, S.; Zhou, M.; Sun, Y.; Wang, J.; Fan, J. Characteristics and Drivers of Vegetation Change in Xinjiang, 2000–2020. Forests 2024 , 15 , 231. [ Google Scholar ] [ CrossRef ]
• Hou, X.; Zhang, B.; Chen, J.; Zhou, J.; He, Q.-Q.; Yu, H. Response of Vegetation Productivity to Greening and Drought in the Loess Plateau Based on VIs and SIF. Forests 2024 , 15 , 339. [ Google Scholar ] [ CrossRef ]
• Zhang, Q.; Gu, L.; Liu, Y.; Zhang, Y. Spatio-Temporal Dynamics of Normalized Difference Vegetation Index and Its Response to Climate Change in Xinjiang, 2000–2022. Forests 2024 , 15 , 370. [ Google Scholar ] [ CrossRef ]
• He, Q.; Yang, Q.; Jiang, S.; Zhan, C. A Comprehensive Analysis of Vegetation Dynamics and Their Response to Climate Change in the Loess Plateau: Insight from Long-Term kernel Normalized Difference Vegetation Index Data. Forests 2024 , 15 , 471. [ Google Scholar ] [ CrossRef ]
• Shi, S.; Yu, J.; Wang, F.; Wang, P.; Zhang, Y.; Jin, K. Quantitative contributions of climate change and human activities to vegetation changes over multiple time scales on the Loess Plateau. Sci. Total Environ. 2021 , 755 , 142419. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Li, B.; Chen, L.; Wang, Q.; Wang, P. Analysis of Linkage between Long-Term Morphological Spatial Pattern Analysis and Vegetation Carbon Storage of Forests in Hunan, China. Forests 2024 , 15 , 428. [ Google Scholar ] [ CrossRef ]
• Araujo, H.F.P.; Canassa, N.F.; Machado, C.C.C.; Tabarelli, M. Human disturbance is the major driver of vegetation changes in the Caatinga dry forest region. Sci. Rep. 2023 , 13 , 18440. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Zhu, B.; Zhang, Z.; Tian, J.; Kong, R.; Chen, X. Increasing Negative Impacts of Climatic Change and Anthropogenic Activities on Vegetation Variation on the Qinghai–Tibet Plateau during 1982–2019. Remote Sens. 2022 , 14 , 4735. [ Google Scholar ] [ CrossRef ]
• Wang, X.; Zhang, X.; Li, W.; Cheng, X.; Zhou, Z.; Liu, Y.; Wu, X.; Hao, J.; Ling, Q.; Deng, L.; et al. Quantitative Analysis of Climate Variability and Human Activities on Vegetation Variations in the Qilian Mountain National Nature Reserve from 1986 to 2021. Forests 2023 , 14 , 2042. [ Google Scholar ] [ CrossRef ]
• Ma, S.; Wang, L.-J.; Jiang, J.; Chu, L.; Zhang, J.-C. Threshold effect of ecosystem services in response to climate change and vegetation coverage change in the Qinghai-Tibet Plateau ecological shelter. J. Clean. Prod. 2021 , 318 , 128592. [ Google Scholar ] [ CrossRef ]
• Luo, D.L.; Jin, H.J.; Bense, V.F. Ground surface temperature and the detection of permafrost in the rugged topography on NE Qinghai-Tibet Plateau. Geoderma 2019 , 333 , 57–68. [ Google Scholar ] [ CrossRef ]
• Aizizi, Y.; Kasimu, A.; Liang, H.; Zhang, X.; Wei, B.; Zhao, Y.; Ainiwaer, M. Evaluation of Ecological Quality Status and Changing Trend in Arid Land Based on the Remote Sensing Ecological Index: A Case Study in Xinjiang, China. Forests 2023 , 14 , 1830. [ Google Scholar ] [ CrossRef ]
• Sharma, R.C. Dominant Species-Physiognomy-Ecological (DSPE) System for the Classification of Plant Ecological Communities from Remote Sensing Images. Ecologies 2022 , 3 , 323–335. [ Google Scholar ] [ CrossRef ]
• Li, S.; Yan, J.; Liu, X.; Wan, J. Response of vegetation restoration to climate change and human activities in Shaanxi-Gansu-Ningxia Region. J. Geogr. Sci. 2013 , 23 , 98–112. [ Google Scholar ] [ CrossRef ]
• Akiyama, T.; Kharrazi, A.; Li, J.; Avtar, R. Agricultural water policy reforms in China: A representative look at Zhangye City, Gansu Province, China. Environ. Monit. Assess. 2017 , 190 , 9. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Zhang, H.; He, Z.; Xu, J.; Mu, W.; Chen, Y.; Wang, G. Analysis of Spatial and Temporal Changes in Vegetation Cover and Driving Forces in the Wuding River Basin, Loess Plateau. Forests 2024 , 15 , 82. [ Google Scholar ] [ CrossRef ]
• Liu, C.; Zhang, X.; Wang, T.; Chen, G.; Zhu, K.; Wang, Q.; Wang, J. Detection of vegetation coverage changes in the Yellow River Basin from 2003 to 2020. Ecol. Indic. 2022 , 138 , 108818. [ Google Scholar ] [ CrossRef ]
• Ma, L.; Bo, J.; Li, X.; Fang, F.; Cheng, W. Identifying key landscape pattern indices influencing the ecological security of inland river basin: The middle and lower reaches of Shule River Basin as an example. Sci. Total Environ. 2019 , 674 , 424–438. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Funk, C.; Peterson, P.; Landsfeld, M.; Pedreros, D.; Verdin, J.; Shukla, S.; Husak, G.; Rowland, J.; Harrison, L.; Hoell, A.; et al. The climate hazards infrared precipitation with stations—A new environmental record for monitoring extremes. Sci. Data 2015 , 2 , 150066. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Ermida, S.L.; Soares, P.; Mantas, V.; Göttsche, F.-M.; Trigo, I.F. Google Earth Engine Open-Source Code for Land Surface Temperature Estimation from the Landsat Series. Remote Sens. 2020 , 12 , 1471. [ Google Scholar ] [ CrossRef ]
• Luo, D.; Jin, H.; Wu, Q.; Bense, V.F.; He, R.; Ma, Q.; Gao, S.; Jin, X.; Lu, L. Thermal regime of warm-dry permafrost in relation to ground surface temperature in the Source Areas of the Yangtze and Yellow rivers on the Qinghai-Tibet Plateau, SW China. Sci. Total Environ. 2018 , 618 , 1033–1045. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Pekel, J.F.; Cottam, A.; Gorelick, N.; Belward, A.S. High-resolution mapping of global surface water and its long-term changes. Nature 2016 , 540 , 418–422. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Xia, C.; Liu, G.; Zhou, J.; Meng, Y.; Chen, K.; Gu, P.; Yang, M.; Huang, X.; Mei, J. Revealing the impact of water conservancy projects and urbanization on hydrological cycle based on the distribution of hydrogen and oxygen isotopes in water. Environ. Sci. Pollut. Res. Int. 2021 , 28 , 40160–40177. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Liang, W.; Quan, Q.; Wu, B.; Mo, S. Response of Vegetation Dynamics in the Three-North Region of China to Climate and Human Activities from 1982 to 2018. Sustainability 2023 , 15 , 3073. [ Google Scholar ] [ CrossRef ]
• Carlson, T.N.; Ripley, D.A. On the relation between NDVI, fractional vegetation cover, and leaf area index. Remote Sens. Environ. 1997 , 62 , 241–252. [ Google Scholar ] [ CrossRef ]
• Wang, Y.; Zhang, J.; Tong, S.; Guo, E. Monitoring the trends of aeolian desertified lands based on time-series remote sensing data in the Horqin Sandy Land, China. Catena 2017 , 157 , 286–298. [ Google Scholar ] [ CrossRef ]
• Xu, X.; Liu, H.; Jiao, F.; Gong, H.; Lin, Z. Time-varying trends of vegetation change and their driving forces during 1981–2016 along the silk road economic belt. Catena 2020 , 195 , 104796. [ Google Scholar ] [ CrossRef ]
• Zhang, Y.; Zhang, C.; Wang, Z.; Chen, Y.; Gang, C.; An, R.; Li, J. Vegetation dynamics and its driving forces from climate change and human activities in the Three-River Source Region, China from 1982 to 2012. Sci. Total Environ. 2016 , 563–564 , 210–220. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Zhang, D.; Ge, W.; Zhang, Y. Evaluating the vegetation restoration sustainability of ecological projects: A case study of Wuqi County in China. J. Clean. Prod. 2020 , 264 , 121751. [ Google Scholar ] [ CrossRef ]
• Hou, W.; Gao, J.; Wu, S.; Dai, E. Interannual Variations in Growing-Season NDVI and Its Correlation with Climate Variables in the Southwestern Karst Region of China. Remote Sens. 2015 , 7 , 11105–11124. [ Google Scholar ] [ CrossRef ]
• Yin, L.; Wang, X.; Feng, X.; Fu, B.; Chen, Y. A comparison of SSEBop-Model-Based evapotranspiration with eight evapotranspiration products in the Yellow River Basin, China. Remote Sens. 2020 , 12 , 2528. [ Google Scholar ] [ CrossRef ]
• Yin, L.; Feng, X.; Fu, B.; Chen, Y.; Wang, X.; Tao, F. Irrigation water consumption of irrigated cropland and its dominant factor in China from 1982 to 2015. Adv. Water Resour. 2020 , 143 , 103661. [ Google Scholar ] [ CrossRef ]
• Yang, S.; Liu, J.; Wang, C.; Zhang, T.; Dong, X.; Liu, Y. Vegetation dynamics influenced by climate change and human activities in the Hanjiang River Basin, central China. Ecol. Indic. 2022 , 145 , 109586. [ Google Scholar ] [ CrossRef ]
• Ma, Y.; Wang, W.; Jin, S.; Li, H.; Liu, B.; Gong, W.; Fan, R.; Li, H. Spatiotemporal variation of LAI in different vegetation types and its response to climate change in China from 2001 to 2020. Ecol. Indic. 2023 , 156 , 111101. [ Google Scholar ] [ CrossRef ]
• Wang, N.; Du, Y.; Liang, F.; Wang, H.; Yi, J. The spatiotemporal response of China’s vegetation greenness to human socio-economic activities. J. Environ. Manag. 2022 , 305 , 114304. [ Google Scholar ] [ CrossRef ]
• Gu, Y.; Pang, B.; Qiao, X.; Xu, D.; Li, W.; Yan, Y.; Dou, H.; Ao, W.; Wang, W.; Zou, C.; et al. Vegetation dynamics in response to climate change and human activities in the Hulun Lake basin from 1981 to 2019. Ecol. Indic. 2022 , 136 , 108700. [ Google Scholar ] [ CrossRef ]
• Peng, J.; Jiang, H.; Liu, Q.; Green, S.M.; Quine, T.A.; Liu, H.; Qiu, S.; Liu, Y.; Meersmans, J. Human activity vs. climate change: Distinguishing dominant drivers on LAI dynamics in karst region of southwest China. Sci. Total Environ. 2021 , 769 , 144297. [ Google Scholar ] [ CrossRef ]
• Ibisch, P.L.; Hoffmann, M.T.; Kreft, S.; Pe’er, G.; Kati, V.; Biber-Freudenberger, L.; DellaSala, D.A.; Vale, M.M.; Hobson, P.R.; Selva, N. A global map of roadless areas and their conservation status. Science 2016 , 354 , 1423–1427. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Ge, W.; Deng, L.; Wang, F.; Han, J. Quantifying the contributions of human activities and climate change to vegetation net primary productivity dynamics in China from 2001 to 2016. Sci. Total Environ. 2021 , 773 , 145648. [ Google Scholar ] [ CrossRef ]
• Chen, X.; Guan, T.; Zhang, J.; Liu, Y.; Jin, J.; Liu, C.; Wang, G.; Bao, Z. Identifying and Predicting the Responses of Multi-Altitude Vegetation to Climate Change in the Alpine Zone. Forests 2024 , 15 , 308. [ Google Scholar ] [ CrossRef ]
• Ma, M.; Zhang, H.; Qin, J.; Liu, Y.; Wu, B.; Su, X. Analysis of Factors Driving Subtropical Forest Phenology Differentiation, Considering Temperature and Precipitation Time-Lag Effects: A Case Study of Fujian Province. Forests 2024 , 15 , 334. [ Google Scholar ] [ CrossRef ]
• Lin, N.; Li, J.; Jiang, R.; Li, X.; Liu, S. Quantifying the Spatiotemporal Variation of NPP of Different Land Cover Types and the Contribution of Its Associated Factors in the Songnen Plain. Forests 2023 , 14 , 1841. [ Google Scholar ] [ CrossRef ]
• Lai, J.; Zhao, T.; Qi, S. Spatiotemporal Variation in Vegetation and Its Driving Mechanisms in the Southwest Alpine Canyon Area of China. Forests 2023 , 14 , 2357. [ Google Scholar ] [ CrossRef ]
• Liu, L.; Zhang, X.; Gao, Y.; Chen, X.; Shuai, X.; Mi, J. Finer-Resolution Mapping of Global Land Cover: Recent Developments, Consistency Analysis, and Prospects. J. Remote Sens. 2021 , 2021 , 5289697. [ Google Scholar ] [ CrossRef ]
• Gao, Y.; Liu, Z.; Li, R.; Shi, Z. Long-Term Impact of China’s Returning Farmland to Forest Program on Rural Economic Development. Sustainability 2020 , 12 , 1492. [ Google Scholar ] [ CrossRef ]
• Li, Z.; Sun, X.; Huang, Z.; Zhang, X.; Wang, Z.; Li, S.; Zheng, W.; Zhai, B. Changes in nutrient balance, environmental effects, and green development after returning farmland to forests: A case study in Ningxia, China. Sci. Total Environ. 2020 , 735 , 139370. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Zhang, X.; Liu, L.; Wu, C.; Chen, X.; Gao, Y.; Xie, S.; Zhang, B. Development of a global 30 m impervious surface map using multisource and multitemporal remote sensing datasets with the Google Earth Engine platform. Earth Syst. Sci. Data 2020 , 12 , 1625–1648. [ Google Scholar ] [ CrossRef ]

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He, X.; Zhang, L.; Lu, Y.; Chai, L. Spatiotemporal Variations of Vegetation and Its Response to Climate Change and Human Activities in Arid Areas—A Case Study of the Shule River Basin, Northwestern China. Forests 2024 , 15 , 1147. https://doi.org/10.3390/f15071147

He X, Zhang L, Lu Y, Chai L. Spatiotemporal Variations of Vegetation and Its Response to Climate Change and Human Activities in Arid Areas—A Case Study of the Shule River Basin, Northwestern China. Forests . 2024; 15(7):1147. https://doi.org/10.3390/f15071147

He, Xiaorui, Luqing Zhang, Yuehan Lu, and Linghuan Chai. 2024. "Spatiotemporal Variations of Vegetation and Its Response to Climate Change and Human Activities in Arid Areas—A Case Study of the Shule River Basin, Northwestern China" Forests 15, no. 7: 1147. https://doi.org/10.3390/f15071147

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28 Case Study Examples Every Marketer Should See

Published: March 08, 2023

Putting together a compelling case study is one of the most powerful strategies for showcasing your product and attracting future customers. But it's not easy to create case studies that your audience can’t wait to read.

In this post, we’ll go over the definition of a case study and the best examples to inspire you.

What is a case study?

A case study is a detailed story of something your company did. It includes a beginning — often discussing a conflict, an explanation of what happened next, and a resolution that explains how the company solved or improved on something.

A case study proves how your product has helped other companies by demonstrating real-life results. Not only that, but marketing case studies with solutions typically contain quotes from the customer. This means that they’re not just ads where you praise your own product. Rather, other companies are praising your company — and there’s no stronger marketing material than a verbal recommendation or testimonial. A great case study is also filled with research and stats to back up points made about a project's results.

There are myriad ways to use case studies in your marketing strategy . From featuring them on your website to including them in a sales presentation, a case study is a strong, persuasive tool that shows customers why they should work with you — straight from another customer. Writing one from scratch is hard, though, which is why we’ve created a collection of case study templates for you to get started.

Fill out the form below to access the free case study templates.

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There’s no better way to generate more leads than by writing case studies . But without case study examples to draw inspiration from, it can be difficult to write impactful studies that convince visitors to submit a form.

Marketing Case Study Examples

To help you create an attractive and high-converting case study, we've put together a list of some of our favorites. This list includes famous case studies in marketing, technology, and business.

These studies can show you how to frame your company offers in a way that is both meaningful and useful to your audience. So, take a look, and let these examples inspire your next brilliant case study design.

These marketing case studies with solutions show the value proposition of each product. They also show how each company benefited in both the short and long term using quantitative data. In other words, you don’t get just nice statements, like "This company helped us a lot." You see actual change within the firm through numbers and figures.

You can put your learnings into action with HubSpot's Free Case Study Templates . Available as custom designs and text-based documents, you can upload these templates to your CMS or send them to prospects as you see fit.

1. " How Handled Scaled from Zero to 121 Locations with the Help of HubSpot ," by HubSpot

What's interesting about this case study is the way it leads with the customer. That reflects a major HubSpot cornerstone, which is to always solve for the customer first. The copy leads with a brief description of why the CEO of Handled founded the company and why he thought Handled could benefit from adopting a CRM. The case study also opens up with one key data point about Handled’s success using HubSpot, namely that it grew to 121 locations.

Notice that this case study uses mixed media. Yes, there is a short video, but it's elaborated upon in the other text on the page. So while your case studies can use one or the other, don't be afraid to combine written copy with visuals to emphasize the project's success.

Key Learnings from the HubSpot Case Study Example

• Give the case study a personal touch by focusing on the CEO rather than the company itself.
• Use multimedia to engage website visitors as they read the case study.

2. " The Whole Package ," by IDEO

Here's a design company that knows how to lead with simplicity in its case studies. As soon as the visitor arrives at the page, they’re greeted with a big, bold photo and the title of the case study — which just so happens to summarize how IDEO helped its client. It summarizes the case study in three snippets: The challenge, the impact, and the outcome.

Immediately, IDEO communicates its impact — the company partnered with H&M to remove plastic from its packaging — but it doesn't stop there. As the user scrolls down, the challenge, impact, and progress are elaborated upon with comprehensive (but not overwhelming) copy that outlines what that process looked like, replete with quotes and intriguing visuals.

Key Learnings from the IDEO Case Study Example

• Split up the takeaways of your case studies into bite-sized sections.
• Always use visuals and images to enrich the case study experience, especially if it’s a comprehensive case study.

3. " Rozum Robotics intensifies its PR game with Awario ," by Awario

In this case study, Awario greets the user with a summary straight away — so if you’re feeling up to reading the entire case study, you can scan the snapshot and understand how the company serves its customers. The case study then includes jump links to several sections, such as "Company Profile," "Rozum Robotics' Pains," "Challenge," "Solution," and "Results and Improvements."

The sparse copy and prominent headings show that you don’t need a lot of elaborate information to show the value of your products and services. Like the other case study examples on this list, it includes visuals and quotes to demonstrate the effectiveness of the company’s efforts. The case study ends with a bulleted list that shows the results.

Key Learnings from the Awario Robotics Case Study Example

• Create a table of contents to make your case study easier to navigate.
• Include a bulleted list of the results you achieved for your client.

4. " Chevrolet DTU ," by Carol H. Williams

If you’ve worked with a company that’s well-known, use only the name in the title — like Carol H. Williams, one of the nation’s top advertising agencies, does here. The "DTU," stands for "Discover the Unexpected." It generates interest because you want to find out what the initials mean.

They keep your interest in this case study by using a mixture of headings, images, and videos to describe the challenges, objectives, and solutions of the project. The case study closes with a summary of the key achievements that Chevrolet’s DTU Journalism Fellows reached during the project.

Key Learnings from the Carol H. Williams Case Study Example

• If you’ve worked with a big brand before, consider only using the name in the title — just enough to pique interest.
• Use a mixture of headings and subheadings to guide users through the case study.

5. " How Fractl Earned Links from 931 Unique Domains for Porch.com in a Single Year ," by Fractl

Fractl uses both text and graphic design in their Porch.com case study to immerse the viewer in a more interesting user experience. For instance, as you scroll, you'll see the results are illustrated in an infographic-design form as well as the text itself.

Further down the page, they use icons like a heart and a circle to illustrate their pitch angles, and graphs to showcase their results. Rather than writing which publications have mentioned Porch.com during Fractl’s campaign, they incorporated the media outlets’ icons for further visual diversity.

Key Learnings from the Fractl Case Study Example

• Let pictures speak for you by incorporating graphs, logos, and icons all throughout the case study.
• Start the case study by right away stating the key results, like Fractl does, instead of putting the results all the way at the bottom.

6. " The Met ," by Fantasy

What's the best way to showcase the responsiveness and user interface of a website? Probably by diving right into it with a series of simple showcases— which is exactly what Fantasy does on their case study page for the Metropolitan Museum of Art. They keep the page simple and clean, inviting you to review their redesign of the Met’s website feature-by-feature.

Each section is simple, showing a single piece of the new website's interface so that users aren’t overwhelmed with information and can focus on what matters most.

If you're more interested in text, you can read the objective for each feature. Fantasy understands that, as a potential customer, this is all you need to know. Scrolling further, you're greeted with a simple "Contact Us" CTA.

Key Learnings from the Fantasy Case Study Example

• You don’t have to write a ton of text to create a great case study. Focus on the solution you delivered itself.
• Include a CTA at the bottom inviting visitors to contact you.

7. " Rovio: How Rovio Grew Into a Gaming Superpower ," by App Annie

If your client had a lot of positive things to say about you, take a note from App Annie’s Rovio case study and open up with a quote from your client. The case study also closes with a quote, so that the case study doesn’t seem like a promotion written by your marketing team but a story that’s taken straight from your client’s mouth. It includes a photo of a Rovio employee, too.

Another thing this example does well? It immediately includes a link to the product that Rovio used (namely, App Annie Intelligence) at the top of the case study. The case study closes with a call-to-action button prompting users to book a demo.

Key Learnings from the App Annie Case Study Example

• Feature quotes from your client at the beginning and end of the case study.
• Include a mention of the product right at the beginning and prompt users to learn more about the product.

8. " Embracing first-party data: 3 success stories from HubSpot ," by Think with Google

Google takes a different approach to text-focused case studies by choosing three different companies to highlight.

The case study is clean and easily scannable. It has sections for each company, with quotes and headers that clarify the way these three distinct stories connect. The simple format also uses colors and text that align with the Google brand.

Another differentiator is the focus on data. This case study is less than a thousand words, but it's packed with useful data points. Data-driven insights quickly and clearly show how the value of leveraging first-party data while prioritizing consumer privacy.

Key Learnings from the Think with Google Case Study Example

• A case study doesn’t need to be long or complex to be powerful.
• Clear data points are a quick and effective way to prove value.

9. " In-Depth Performance Marketing Case Study ," by Switch

Switch is an international marketing agency based in Malta that knocks it out of the park with this case study. Its biggest challenge is effectively communicating what it did for its client without ever revealing the client’s name. It also effectively keeps non-marketers in the loop by including a glossary of terms on page 4.

The PDF case study reads like a compelling research article, including titles like "In-Depth Performance Marketing Case Study," "Scenario," and "Approach," so that readers get a high-level overview of what the client needed and why they approached Switch. It also includes a different page for each strategy. For instance, if you’d only be interested in hiring Switch for optimizing your Facebook ads, you can skip to page 10 to see how they did it.

The PDF is fourteen pages long but features big fonts and plenty of white space, so viewers can easily skim it in only a few minutes.

Key Learnings from the Switch Case Study Example

• If you want to go into specialized information, include a glossary of terms so that non-specialists can easily understand.
• Close with a CTA page in your case study PDF and include contact information for prospective clients.

10. " Gila River ," by OH Partners

Let pictures speak for you, like OH Partners did in this case study. While you’ll quickly come across a heading and some text when you land on this case study page, you’ll get the bulk of the case study through examples of actual work OH Partners did for its client. You will see OH Partners’ work in a billboard, magazine, and video. This communicates to website visitors that if they work with OH Partners, their business will be visible everywhere.

And like the other case studies here, it closes with a summary of what the firm achieved for its client in an eye-catching way.

Key Learnings from the OH Partners Case Study Example

• Let the visuals speak by including examples of the actual work you did for your client — which is especially useful for branding and marketing agencies.
• Always close out with your achievements and how they impacted your client.

11. " Facing a Hater ," by Digitas

Digitas' case study page for Sprite’s #ILOVEYOUHATER campaign keeps it brief while communicating the key facts of Digitas’ work for the popular soda brand. The page opens with an impactful image of a hundred people facing a single man. It turns out, that man is the biggest "bully" in Argentina, and the people facing him are those whom he’s bullied before.

Scrolling down, it's obvious that Digitas kept Sprite at the forefront of their strategy, but more than that, they used real people as their focal point. They leveraged the Twitter API to pull data from Tweets that people had actually tweeted to find the identity of the biggest "hater" in the country. That turned out to be @AguanteElCofler, a Twitter user who has since been suspended.

Key Learnings from the Digitas Case Study Example

• If a video was part of your work for your client, be sure to include the most impactful screenshot as the heading.
• Don’t be afraid to provide details on how you helped your client achieve their goals, including the tools you leveraged.

12. " Better Experiences for All ," by HermanMiller

HermanMiller sells sleek, utilitarian furniture with no frills and extreme functionality, and that ethos extends to its case study page for a hospital in Dubai.

What first attracted me to this case study was the beautiful video at the top and the clean user experience. User experience matters a lot in a case study. It determines whether users will keep reading or leave. Another notable aspect of this case study is that the video includes closed-captioning for greater accessibility, and users have the option of expanding the CC and searching through the text.

HermanMiller’s case study also offers an impressive amount of information packed in just a few short paragraphs for those wanting to understand the nuances of their strategy. It closes out with a quote from their client and, most importantly, the list of furniture products that the hospital purchased from the brand.

Key Learnings from the HermanMiller Case Study Example

• Close out with a list of products that users can buy after reading the case study.
• Include accessibility features such as closed captioning and night mode to make your case study more user-friendly.

13. " Capital One on AWS ," by Amazon

Do you work continuously with your clients? Consider structuring your case study page like Amazon did in this stellar case study example. Instead of just featuring one article about Capital One and how it benefited from using AWS, Amazon features a series of articles that you can then access if you’re interested in reading more. It goes all the way back to 2016, all with different stories that feature Capital One’s achievements using AWS.

This may look unattainable for a small firm, but you don’t have to go to extreme measures and do it for every single one of your clients. You could choose the one you most wish to focus on and establish a contact both on your side and your client’s for coming up with the content. Check in every year and write a new piece. These don’t have to be long, either — five hundred to eight hundred words will do.

Key Learnings from the Amazon AWS Case Study Example

• Write a new article each year featuring one of your clients, then include links to those articles in one big case study page.
• Consider including external articles as well that emphasize your client’s success in their industry.

14. " HackReactor teaches the world to code #withAsana ," by Asana

While Asana's case study design looks text-heavy, there's a good reason. It reads like a creative story, told entirely from the customer's perspective.

For instance, Asana knows you won't trust its word alone on why this product is useful. So, they let Tony Phillips, HackReactor CEO, tell you instead: "We take in a lot of information. Our brains are awful at storage but very good at thinking; you really start to want some third party to store your information so you can do something with it."

Asana features frequent quotes from Phillips to break up the wall of text and humanize the case study. It reads like an in-depth interview and captivates the reader through creative storytelling. Even more, Asana includes in-depth detail about how HackReactor uses Asana. This includes how they build templates and workflows:

"There's a huge differentiator between Asana and other tools, and that’s the very easy API access. Even if Asana isn’t the perfect fit for a workflow, someone like me— a relatively mediocre software engineer—can add functionality via the API to build a custom solution that helps a team get more done."

Key Learnings from the Asana Example

• Include quotes from your client throughout the case study.
• Provide extensive detail on how your client worked with you or used your product.

15. " Rips Sewed, Brand Love Reaped ," by Amp Agency

Amp Agency's Patagonia marketing strategy aimed to appeal to a new audience through guerrilla marketing efforts and a coast-to-coast road trip. Their case study page effectively conveys a voyager theme, complete with real photos of Patagonia customers from across the U.S., and a map of the expedition. I liked Amp Agency's storytelling approach best. It captures viewers' attention from start to finish simply because it's an intriguing and unique approach to marketing.

Key Learnings from the Amp Agency Example

• Open up with a summary that communicates who your client is and why they reached out to you.
• Like in the other case study examples, you’ll want to close out with a quantitative list of your achievements.

16. " NetApp ," by Evisort

Evisort opens up its NetApp case study with an at-a-glance overview of the client. It’s imperative to always focus on the client in your case study — not on your amazing product and equally amazing team. By opening up with a snapshot of the client’s company, Evisort places the focus on the client.

This case study example checks all the boxes for a great case study that’s informative, thorough, and compelling. It includes quotes from the client and details about the challenges NetApp faced during the COVID pandemic. It closes out with a quote from the client and with a link to download the case study in PDF format, which is incredibly important if you want your case study to be accessible in a wider variety of formats.

Key Learnings from the Evisort Example

• Place the focus immediately on your client by including a snapshot of their company.
• Mention challenging eras, such as a pandemic or recession, to show how your company can help your client succeed even during difficult times.

17. " Copernicus Land Monitoring – CLC+ Core ," by Cloudflight

Including highly specialized information in your case study is an effective way to show prospects that you’re not just trying to get their business. You’re deep within their industry, too, and willing to learn everything you need to learn to create a solution that works specifically for them.

Cloudflight does a splendid job at that in its Copernicus Land Monitoring case study. While the information may be difficult to read at first glance, it will capture the interest of prospects who are in the environmental industry. It thus shows Cloudflight’s value as a partner much more effectively than a general case study would.

The page is comprehensive and ends with a compelling call-to-action — "Looking for a solution that automates, and enhances your Big Data system? Are you struggling with large datasets and accessibility? We would be happy to advise and support you!" The clean, whitespace-heavy page is an effective example of using a case study to capture future leads.

Key Learnings from the Cloudflight Case Study Example

• Don’t be afraid to get technical in your explanation of what you did for your client.
• Include a snapshot of the sales representative prospects should contact, especially if you have different sales reps for different industries, like Cloudflight does.

18. " Valvoline Increases Coupon Send Rate by 76% with Textel’s MMS Picture Texting ," by Textel

If you’re targeting large enterprises with a long purchasing cycle, you’ll want to include a wealth of information in an easily transferable format. That’s what Textel does here in its PDF case study for Valvoline. It greets the user with an eye-catching headline that shows the value of using Textel. Valvoline saw a significant return on investment from using the platform.

Another smart decision in this case study is highlighting the client’s quote by putting it in green font and doing the same thing for the client’s results because it helps the reader quickly connect the two pieces of information. If you’re in a hurry, you can also take a look at the "At a Glance" column to get the key facts of the case study, starting with information about Valvoline.

Key Learnings from the Textel Case Study Example

• Include your client’s ROI right in the title of the case study.
• Add an "At a Glance" column to your case study PDF to make it easy to get insights without needing to read all the text.

19. " Hunt Club and Happeo — a tech-enabled love story ," by Happeo

In this blog-post-like case study, Happeo opens with a quote from the client, then dives into a compelling heading: "Technology at the forefront of Hunt Club's strategy." Say you’re investigating Happeo as a solution and consider your firm to be technology-driven. This approach would spark your curiosity about why the client chose to work with Happeo. It also effectively communicates the software’s value proposition without sounding like it’s coming from an in-house marketing team.

Every paragraph is a quote written from the customer’s perspective. Later down the page, the case study also dives into "the features that changed the game for Hunt Club," giving Happeo a chance to highlight some of the platform’s most salient features.

Key Learnings from the Happeo Case Study Example

• Consider writing the entirety of the case study from the perspective of the customer.
• Include a list of the features that convinced your client to go with you.

20. " Red Sox Season Campaign ," by CTP Boston

What's great about CTP's case study page for their Red Sox Season Campaign is their combination of video, images, and text. A video automatically begins playing when you visit the page, and as you scroll, you'll see more embedded videos of Red Sox players, a compilation of print ads, and social media images you can click to enlarge.

At the bottom, it says "Find out how we can do something similar for your brand." The page is clean, cohesive, and aesthetically pleasing. It invites viewers to appreciate the well-roundedness of CTP's campaign for Boston's beloved baseball team.

Key Learnings from the CTP Case Study Example

• Include a video in the heading of the case study.
• Close with a call-to-action that makes leads want to turn into prospects.

21. " Acoustic ," by Genuine

Sometimes, simple is key. Genuine's case study for Acoustic is straightforward and minimal, with just a few short paragraphs, including "Reimagining the B2B website experience," "Speaking to marketers 1:1," and "Inventing Together." After the core of the case study, we then see a quote from Acoustic’s CMO and the results Genuine achieved for the company.

The simplicity of the page allows the reader to focus on both the visual aspects and the copy. The page displays Genuine's brand personality while offering the viewer all the necessary information they need.

• You don’t need to write a lot to create a great case study. Keep it simple.
• Always include quantifiable data to illustrate the results you achieved for your client.

22. " Using Apptio Targetprocess Automated Rules in Wargaming ," by Apptio

Apptio’s case study for Wargaming summarizes three key pieces of information right at the beginning: The goals, the obstacles, and the results.

Readers then have the opportunity to continue reading — or they can walk away right then with the information they need. This case study also excels in keeping the human interest factor by formatting the information like an interview.

The piece is well-organized and uses compelling headers to keep the reader engaged. Despite its length, Apptio's case study is appealing enough to keep the viewer's attention. Every Apptio case study ends with a "recommendation for other companies" section, where the client can give advice for other companies that are looking for a similar solution but aren’t sure how to get started.

Key Learnings from the Apptio Case Study Example

• Put your client in an advisory role by giving them the opportunity to give recommendations to other companies that are reading the case study.
• Include the takeaways from the case study right at the beginning so prospects quickly get what they need.

23. " Airbnb + Zendesk: building a powerful solution together ," by Zendesk

Zendesk's Airbnb case study reads like a blog post, and focuses equally on Zendesk and Airbnb, highlighting a true partnership between the companies. To captivate readers, it begins like this: "Halfway around the globe is a place to stay with your name on it. At least for a weekend."

The piece focuses on telling a good story and provides photographs of beautiful Airbnb locations. In a case study meant to highlight Zendesk's helpfulness, nothing could be more authentic than their decision to focus on Airbnb's service in such great detail.

Key Learnings from the Zendesk Case Study Example

• Include images of your client’s offerings — not necessarily of the service or product you provided. Notice how Zendesk doesn’t include screenshots of its product.
• Include a call-to-action right at the beginning of the case study. Zendesk gives you two options: to find a solution or start a trial.

24. " Biobot Customer Success Story: Rollins College, Winter Park, Florida ," by Biobot

Like some of the other top examples in this list, Biobot opens its case study with a quote from its client, which captures the value proposition of working with Biobot. It mentions the COVID pandemic and goes into detail about the challenges the client faced during this time.

This case study is structured more like a news article than a traditional case study. This format can work in more formal industries where decision-makers need to see in-depth information about the case. Be sure to test different methods and measure engagement .

Key Learnings from the Biobot Case Study Example

• Mention environmental, public health, or economic emergencies and how you helped your client get past such difficult times.
• Feel free to write the case study like a normal blog post, but be sure to test different methods to find the one that best works for you.

25. " Discovering Cost Savings With Efficient Decision Making ," by Gartner

You don't always need a ton of text or a video to convey your message — sometimes, you just need a few paragraphs and bullet points. Gartner does a fantastic job of quickly providing the fundamental statistics a potential customer would need to know, without boggling down their readers with dense paragraphs. The case study closes with a shaded box that summarizes the impact that Gartner had on its client. It includes a quote and a call-to-action to "Learn More."

Key Learnings from the Gartner Case Study Example

• Feel free to keep the case study short.
• Include a call-to-action at the bottom that takes the reader to a page that most relates to them.

26. " Bringing an Operator to the Game ," by Redapt

This case study example by Redapt is another great demonstration of the power of summarizing your case study’s takeaways right at the start of the study. Redapt includes three easy-to-scan columns: "The problem," "the solution," and "the outcome." But its most notable feature is a section titled "Moment of clarity," which shows why this particular project was difficult or challenging.

The section is shaded in green, making it impossible to miss. Redapt does the same thing for each case study. In the same way, you should highlight the "turning point" for both you and your client when you were working toward a solution.

Key Learnings from the Redapt Case Study Example

• Highlight the turning point for both you and your client during the solution-seeking process.
• Use the same structure (including the same headings) for your case studies to make them easy to scan and read.

27. " Virtual Call Center Sees 300% Boost In Contact Rate ," by Convoso

Convoso’s PDF case study for Digital Market Media immediately mentions the results that the client achieved and takes advantage of white space. On the second page, the case study presents more influential results. It’s colorful and engaging and closes with a spread that prompts readers to request a demo.

Key Learnings from the Convoso Case Study Example

• List the results of your work right at the beginning of the case study.
• Use color to differentiate your case study from others. Convoso’s example is one of the most colorful ones on this list.

28. " Ensuring quality of service during a pandemic ," by Ericsson

Ericsson’s case study page for Orange Spain is an excellent example of using diverse written and visual media — such as videos, graphs, and quotes — to showcase the success a client experienced. Throughout the case study, Ericsson provides links to product and service pages users might find relevant as they’re reading the study.

For instance, under the heading "Preloaded with the power of automation," Ericsson mentions its Ericsson Operations Engine product, then links to that product page. It closes the case study with a link to another product page.

Key Learnings from the Ericsson Case Study Example

• Link to product pages throughout the case study so that readers can learn more about the solution you offer.
• Use multimedia to engage users as they read the case study.

Start creating your case study.

Now that you've got a great list of examples of case studies, think about a topic you'd like to write about that highlights your company or work you did with a customer.

A customer’s success story is the most persuasive marketing material you could ever create. With a strong portfolio of case studies, you can ensure prospects know why they should give you their business.

Editor's note: This post was originally published in August 2018 and has been updated for comprehensiveness.

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• Introduction
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• Article Information

The reports to the Vaccine Adverse Event Reporting System met the case definition of myocarditis (reported cases). Among individuals older than 40 years of age, there were no more than 8 reports of myocarditis for any individual age after receiving either vaccine. For the BNT162b2 vaccine, there were 114 246 837 first vaccination doses and 95 532 396 second vaccination doses; and for the mRNA-1273 vaccine, there were 78 158 611 and 66 163 001, respectively. The y-axis range differs between panels A and B.

The reports to the Vaccine Adverse Event Reporting System met the case definition of myocarditis (reported cases). Among recipients of either vaccine, there were only 13 reports or less of myocarditis beyond 10 days for any individual time from vaccination to symptom onset. The y-axis range differs between panels A and B.

A, For the BNT162b2 vaccine, there were 138 reported cases of myocarditis with known date for symptom onset and dose after 114 246 837 first vaccination doses and 888 reported cases after 95 532 396 second vaccination doses.

B, For the mRNA-1273 vaccine, there were 116 reported cases of myocarditis with known date for symptom onset and dose after 78 158 611 first vaccination doses and 311 reported cases after 66 163 001 second vaccination doses.

eMethods. Medical Dictionary for Regulatory Activities Preferred Terms, Definitions of Myocarditis and Pericarditis, Myocarditis medical review form

eFigure. Flow diagram of cases of myocarditis and pericarditis reported to Vaccine Adverse Event Reporting System (VAERS) after receiving mRNA-based COVID-19 vaccine, United States, December 14, 2020-August 31, 2021.

eTable 1. Characteristics of all myocarditis cases reported to Vaccine Adverse Event Reporting System (VAERS) after mRNA-based COVID-19 vaccination, United States, December 14, 2020–August 31, 2021.

eTable 2. Characteristics of all pericarditis cases reported to Vaccine Adverse Event Reporting System (VAERS) after mRNA-based COVID-19 vaccination, United States, December 14, 2020–August 31, 2021.

eTable 3. Characteristics of myocarditis cases reported to Vaccine Adverse Event Reporting System after mRNA-based COVID-19 vaccination by case definition status.

• Myocarditis and Pericarditis After Vaccination for COVID-19 JAMA Research Letter September 28, 2021 This study investigates the incidence of myocarditis and pericarditis emergency department or inpatient hospital encounters before COVID-19 vaccine availability (January 2019–January 2021) and during a COVID-19 vaccination period (February-May 2021) in a large US health care system. George A. Diaz, MD; Guilford T. Parsons, MD, MS; Sara K. Gering, BS, BSN; Audrey R. Meier, MPH; Ian V. Hutchinson, PhD, DSc; Ari Robicsek, MD
• Myocarditis Following a Third BNT162b2 Vaccination Dose in Military Recruits in Israel JAMA Research Letter April 26, 2022 This study assessed whether a third vaccine dose was associated with the risk of myocarditis among military personnel in Israel. Limor Friedensohn, MD; Dan Levin, MD; Maggie Fadlon-Derai, MHA; Liron Gershovitz, MD; Noam Fink, MD; Elon Glassberg, MD; Barak Gordon, MD
• Myocarditis Cases After mRNA-Based COVID-19 Vaccination in the US—Reply JAMA Comment & Response May 24, 2022 Matthew E. Oster, MD, MPH; David K. Shay, MD, MPH; Tom T. Shimabukuro, MD, MPH, MBA
• Myocarditis Cases After mRNA-Based COVID-19 Vaccination in the US JAMA Comment & Response May 24, 2022 Sheila R. Weiss, PhD
• JAMA Network Articles of the Year 2022 JAMA Medical News & Perspectives December 27, 2022 This Medical News article is our annual roundup of the top-viewed articles from all JAMA Network journals. Melissa Suran, PhD, MSJ
• Diagnosis and Treatment of Acute Myocarditis—A Review JAMA Review April 4, 2023 This Review summarizes current evidence regarding the diagnosis and treatment of acute myocarditis. Enrico Ammirati, MD, PhD; Javid J. Moslehi, MD
• Patient Information: Acute Myocarditis JAMA JAMA Patient Page August 8, 2023 This JAMA Patient Page describes acute myocarditis and its symptoms, causes, diagnosis, and treatment. Kristin Walter, MD, MS
• Myocarditis Following Immunization With mRNA COVID-19 Vaccines in Members of the US Military JAMA Cardiology Brief Report October 1, 2021 This case series describes myocarditis presenting after COVID-19 vaccination within the Military Health System. Jay Montgomery, MD; Margaret Ryan, MD, MPH; Renata Engler, MD; Donna Hoffman, MSN; Bruce McClenathan, MD; Limone Collins, MD; David Loran, DNP; David Hrncir, MD; Kelsie Herring, MD; Michael Platzer, MD; Nehkonti Adams, MD; Aliye Sanou, MD; Leslie T. Cooper Jr, MD
• Patients With Acute Myocarditis Following mRNA COVID-19 Vaccination JAMA Cardiology Brief Report October 1, 2021 This study describes 4 patients who presented with acute myocarditis after mRNA COVID-19 vaccination. Han W. Kim, MD; Elizabeth R. Jenista, PhD; David C. Wendell, PhD; Clerio F. Azevedo, MD; Michael J. Campbell, MD; Stephen N. Darty, BS; Michele A. Parker, MS; Raymond J. Kim, MD
• Association of Myocarditis With BNT162b2 Vaccination in Children JAMA Cardiology Brief Report December 1, 2021 This case series reviews comprehensive cardiac imaging in children with myocarditis after COVID-19 vaccine. Audrey Dionne, MD; Francesca Sperotto, MD; Stephanie Chamberlain; Annette L. Baker, MSN, CPNP; Andrew J. Powell, MD; Ashwin Prakash, MD; Daniel A. Castellanos, MD; Susan F. Saleeb, MD; Sarah D. de Ferranti, MD, MPH; Jane W. Newburger, MD, MPH; Kevin G. Friedman, MD

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Oster ME , Shay DK , Su JR, et al. Myocarditis Cases Reported After mRNA-Based COVID-19 Vaccination in the US From December 2020 to August 2021. JAMA. 2022;327(4):331–340. doi:10.1001/jama.2021.24110

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Myocarditis Cases Reported After mRNA-Based COVID-19 Vaccination in the US From December 2020 to August 2021

• 1 US Centers for Disease Control and Prevention, Atlanta, Georgia
• 2 School of Medicine, Emory University, Atlanta, Georgia
• 3 Children’s Healthcare of Atlanta, Atlanta, Georgia
• 4 Vanderbilt University Medical Center, Nashville, Tennessee
• 5 Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
• 6 Boston Medical Center, Boston, Massachusetts
• 7 Duke University, Durham, North Carolina
• 8 US Food and Drug Administration, Silver Spring, Maryland
• Research Letter Myocarditis and Pericarditis After Vaccination for COVID-19 George A. Diaz, MD; Guilford T. Parsons, MD, MS; Sara K. Gering, BS, BSN; Audrey R. Meier, MPH; Ian V. Hutchinson, PhD, DSc; Ari Robicsek, MD JAMA
• Research Letter Myocarditis Following a Third BNT162b2 Vaccination Dose in Military Recruits in Israel Limor Friedensohn, MD; Dan Levin, MD; Maggie Fadlon-Derai, MHA; Liron Gershovitz, MD; Noam Fink, MD; Elon Glassberg, MD; Barak Gordon, MD JAMA
• Comment & Response Myocarditis Cases After mRNA-Based COVID-19 Vaccination in the US—Reply Matthew E. Oster, MD, MPH; David K. Shay, MD, MPH; Tom T. Shimabukuro, MD, MPH, MBA JAMA
• Comment & Response Myocarditis Cases After mRNA-Based COVID-19 Vaccination in the US Sheila R. Weiss, PhD JAMA
• Medical News & Perspectives JAMA Network Articles of the Year 2022 Melissa Suran, PhD, MSJ JAMA
• Review Diagnosis and Treatment of Acute Myocarditis—A Review Enrico Ammirati, MD, PhD; Javid J. Moslehi, MD JAMA
• JAMA Patient Page Patient Information: Acute Myocarditis Kristin Walter, MD, MS JAMA
• Brief Report Myocarditis Following Immunization With mRNA COVID-19 Vaccines in Members of the US Military Jay Montgomery, MD; Margaret Ryan, MD, MPH; Renata Engler, MD; Donna Hoffman, MSN; Bruce McClenathan, MD; Limone Collins, MD; David Loran, DNP; David Hrncir, MD; Kelsie Herring, MD; Michael Platzer, MD; Nehkonti Adams, MD; Aliye Sanou, MD; Leslie T. Cooper Jr, MD JAMA Cardiology
• Brief Report Patients With Acute Myocarditis Following mRNA COVID-19 Vaccination Han W. Kim, MD; Elizabeth R. Jenista, PhD; David C. Wendell, PhD; Clerio F. Azevedo, MD; Michael J. Campbell, MD; Stephen N. Darty, BS; Michele A. Parker, MS; Raymond J. Kim, MD JAMA Cardiology
• Brief Report Association of Myocarditis With BNT162b2 Vaccination in Children Audrey Dionne, MD; Francesca Sperotto, MD; Stephanie Chamberlain; Annette L. Baker, MSN, CPNP; Andrew J. Powell, MD; Ashwin Prakash, MD; Daniel A. Castellanos, MD; Susan F. Saleeb, MD; Sarah D. de Ferranti, MD, MPH; Jane W. Newburger, MD, MPH; Kevin G. Friedman, MD JAMA Cardiology

Question   What is the risk of myocarditis after mRNA-based COVID-19 vaccination in the US?

Findings   In this descriptive study of 1626 cases of myocarditis in a national passive reporting system, the crude reporting rates within 7 days after vaccination exceeded the expected rates across multiple age and sex strata. The rates of myocarditis cases were highest after the second vaccination dose in adolescent males aged 12 to 15 years (70.7 per million doses of the BNT162b2 vaccine), in adolescent males aged 16 to 17 years (105.9 per million doses of the BNT162b2 vaccine), and in young men aged 18 to 24 years (52.4 and 56.3 per million doses of the BNT162b2 vaccine and the mRNA-1273 vaccine, respectively).

Meaning   Based on passive surveillance reporting in the US, the risk of myocarditis after receiving mRNA-based COVID-19 vaccines was increased across multiple age and sex strata and was highest after the second vaccination dose in adolescent males and young men.

Importance   Vaccination against COVID-19 provides clear public health benefits, but vaccination also carries potential risks. The risks and outcomes of myocarditis after COVID-19 vaccination are unclear.

Objective   To describe reports of myocarditis and the reporting rates after mRNA-based COVID-19 vaccination in the US.

Design, Setting, and Participants   Descriptive study of reports of myocarditis to the Vaccine Adverse Event Reporting System (VAERS) that occurred after mRNA-based COVID-19 vaccine administration between December 2020 and August 2021 in 192 405 448 individuals older than 12 years of age in the US; data were processed by VAERS as of September 30, 2021.

Exposures   Vaccination with BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna).

Main Outcomes and Measures   Reports of myocarditis to VAERS were adjudicated and summarized for all age groups. Crude reporting rates were calculated across age and sex strata. Expected rates of myocarditis by age and sex were calculated using 2017-2019 claims data. For persons younger than 30 years of age, medical record reviews and clinician interviews were conducted to describe clinical presentation, diagnostic test results, treatment, and early outcomes.

Results   Among 192 405 448 persons receiving a total of 354 100 845 mRNA-based COVID-19 vaccines during the study period, there were 1991 reports of myocarditis to VAERS and 1626 of these reports met the case definition of myocarditis. Of those with myocarditis, the median age was 21 years (IQR, 16-31 years) and the median time to symptom onset was 2 days (IQR, 1-3 days). Males comprised 82% of the myocarditis cases for whom sex was reported. The crude reporting rates for cases of myocarditis within 7 days after COVID-19 vaccination exceeded the expected rates of myocarditis across multiple age and sex strata. The rates of myocarditis were highest after the second vaccination dose in adolescent males aged 12 to 15 years (70.7 per million doses of the BNT162b2 vaccine), in adolescent males aged 16 to 17 years (105.9 per million doses of the BNT162b2 vaccine), and in young men aged 18 to 24 years (52.4 and 56.3 per million doses of the BNT162b2 vaccine and the mRNA-1273 vaccine, respectively). There were 826 cases of myocarditis among those younger than 30 years of age who had detailed clinical information available; of these cases, 792 of 809 (98%) had elevated troponin levels, 569 of 794 (72%) had abnormal electrocardiogram results, and 223 of 312 (72%) had abnormal cardiac magnetic resonance imaging results. Approximately 96% of persons (784/813) were hospitalized and 87% (577/661) of these had resolution of presenting symptoms by hospital discharge. The most common treatment was nonsteroidal anti-inflammatory drugs (589/676; 87%).

Conclusions and Relevance   Based on passive surveillance reporting in the US, the risk of myocarditis after receiving mRNA-based COVID-19 vaccines was increased across multiple age and sex strata and was highest after the second vaccination dose in adolescent males and young men. This risk should be considered in the context of the benefits of COVID-19 vaccination.

Myocarditis is an inflammatory condition of the heart muscle that has a bimodal peak incidence during infancy and adolescence or young adulthood. 1 - 4 The clinical presentation and course of myocarditis is variable, with some patients not requiring treatment and others experiencing severe heart failure that requires subsequent heart transplantation or leads to death. 5 Onset of myocarditis typically follows an inciting process, often a viral illness; however, no antecedent cause is identified in many cases. 6 It has been hypothesized that vaccination can serve as a trigger for myocarditis; however, only the smallpox vaccine has previously been causally associated with myocarditis based on reports among US military personnel, with cases typically occurring 7 to 12 days after vaccination. 7

With the implementation of a large-scale, national COVID-19 vaccination program starting in December 2020, the US Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration began monitoring for a number of adverse events of special interest, including myocarditis and pericarditis, in the Vaccine Adverse Event Reporting System (VAERS), a long-standing national spontaneous reporting (passive surveillance) system. 8 As the reports of myocarditis after COVID-19 vaccination were reported to VAERS, the Clinical Immunization Safety Assessment Project, 9 a collaboration between the CDC and medical research centers, which includes physicians treating infectious diseases and other specialists (eg, cardiologists), consulted on several of the cases. In addition, reports from several countries raised concerns that mRNA-based COVID-19 vaccines may be associated with acute myocarditis. 10 - 15

Given this concern, the aims were to describe reports and confirmed cases of myocarditis initially reported to VAERS after mRNA-based COVID-19 vaccination and to provide estimates of the risk of myocarditis after mRNA-based COVID-19 vaccination based on age, sex, and vaccine type.

VAERS is a US spontaneous reporting (passive surveillance) system that functions as an early warning system for potential vaccine adverse events. 8 Co-administered by the CDC and the US Food and Drug Administration, VAERS accepts reports of all adverse events after vaccination from patients, parents, clinicians, vaccine manufacturers, and others regardless of whether the events could plausibly be associated with receipt of the vaccine. Reports to VAERS include information about the vaccinated person, the vaccine or vaccines administered, and the adverse events experienced by the vaccinated person. The reports to VAERS are then reviewed by third-party professional coders who have been trained in the assignment of Medical Dictionary for Regulatory Activities preferred terms. 16 The coders then assign appropriate terms based on the information available in the reports.

This activity was reviewed by the CDC and was conducted to be consistent with applicable federal law and CDC policy. The activities herein were confirmed to be nonresearch under the Common Rule in accordance with institutional procedures and therefore were not subject to institutional review board requirements. Informed consent was not obtained for this secondary use of existing information; see 45 CFR part 46.102(l)(2), 21 CFR part 56, 42 USC §241(d), 5 USC §552a, and 44 USC §3501 et seq.

The exposure of concern was vaccination with one of the mRNA-based COVID-19 vaccines: the BNT162b2 vaccine (Pfizer-BioNTech) or the mRNA-1273 vaccine (Moderna). During the analytic period, persons aged 12 years or older were eligible for the BNT162b2 vaccine and persons aged 18 years or older were eligible for the mRNA-1273 vaccine. The number of COVID-19 vaccine doses administered during the analytic period was obtained through the CDC’s COVID-19 Data Tracker. 17

The primary outcome was the occurrence of myocarditis and the secondary outcome was pericarditis. Reports to VAERS with these outcomes were initially characterized using the Medical Dictionary for Regulatory Activities preferred terms of myocarditis or pericarditis (specific terms are listed in the eMethods in the Supplement ). After initial review of reports of myocarditis to VAERS and review of the patient’s medical records (when available), the reports were further reviewed by CDC physicians and public health professionals to verify that they met the CDC’s case definition for probable or confirmed myocarditis (descriptions previously published and included in the eMethods in the Supplement ). 18 The CDC’s case definition of probable myocarditis requires the presence of new concerning symptoms, abnormal cardiac test results, and no other identifiable cause of the symptoms and findings. Confirmed cases of myocarditis further require histopathological confirmation of myocarditis or cardiac magnetic resonance imaging (MRI) findings consistent with myocarditis.

Deaths were included only if the individual had met the case definition for confirmed myocarditis and there was no other identifiable cause of death. Individual cases not involving death were included only if the person had met the case definition for probable myocarditis or confirmed myocarditis.

We characterized reports of myocarditis or pericarditis after COVID-19 vaccination that met the CDC’s case definition and were received by VAERS between December 14, 2020 (when COVID-19 vaccines were first publicly available in the US), and August 31, 2021, by age, sex, race, ethnicity, and vaccine type; data were processed by VAERS as of September 30, 2021. Race and ethnicity were optional fixed categories available by self-identification at the time of vaccination or by the individual filing a VAERS report. Race and ethnicity were included to provide the most complete baseline description possible for individual reports; however, further analyses were not stratified by race and ethnicity due to the high percentage of missing data. Reports of pericarditis with evidence of potential myocardial involvement were included in the review of reports of myocarditis. The eFigure in the Supplement outlines the categorization of the reports of myocarditis and pericarditis reviewed.

Further analyses were conducted only for myocarditis because of the preponderance of those reports to VAERS, in Clinical Immunization Safety Assessment Project consultations, and in published articles. 10 - 12 , 19 - 21 Crude reporting rates for myocarditis during a 7-day risk interval were calculated using the number of reports of myocarditis to VAERS per million doses of COVID-19 vaccine administered during the analytic period and stratified by age, sex, vaccination dose (first, second, or unknown), and vaccine type. Expected rates of myocarditis by age and sex were calculated using 2017-2019 data from the IBM MarketScan Commercial Research Database. This database contains individual-level, deidentified, inpatient and outpatient medical and prescription drug claims, and enrollment information submitted to IBM Watson Health by large employers and health plans. The data were accessed using version 4.0 of the IBM MarketScan Treatment Pathways analytic platform. Age- and sex-specific rates were calculated by determining the number of individuals with myocarditis ( International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] codes B33.20, B33.22, B33.24, I40.0, I40.1, I40.8, I40.9, or I51.4) 22 identified during an inpatient encounter in 2017-2019 relative to the number of individuals of similar age and sex who were continually enrolled during the year in which the myocarditis-related hospitalization occurred; individuals with any diagnosis of myocarditis prior to that year were excluded. Given the limitations of the IBM MarketScan Commercial Research Database to capture enrollees aged 65 years or older, an expected rate for myocarditis was not calculated for this population. A 95% CI was calculated using Poisson distribution in SAS version 9.4 (SAS Institute Inc) for each expected rate of myocarditis and for each observed rate in a strata with at least 1 case.

In cases of probable or confirmed myocarditis among those younger than 30 years of age, their clinical course was then summarized to the extent possible based on medical review and clinician interviews. This clinical course included presenting symptoms, diagnostic test results, treatment, and early outcomes (abstraction form appears in the eMethods in the Supplement ). 23

When applicable, missing data were delineated in the results or the numbers with complete data were listed. No assumptions or imputations were made regarding missing data. Any percentages that were calculated included only those cases of myocarditis with adequate data to calculate the percentages.

Between December 14, 2020, and August 31, 2021, 192 405 448 individuals older than 12 years of age received a total of 354 100 845 mRNA-based COVID-19 vaccines. VAERS received 1991 reports of myocarditis (391 of which also included pericarditis) after receipt of at least 1 dose of mRNA-based COVID-19 vaccine (eTable 1 in the Supplement ) and 684 reports of pericarditis without the presence of myocarditis (eTable 2 in the Supplement ).

Of the 1991 reports of myocarditis, 1626 met the CDC’s case definition for probable or confirmed myocarditis ( Table 1 ). There were 208 reports that did not meet the CDC’s case definition for myocarditis and 157 reports that required more information to perform adjudication (eTable 3 in the Supplement ). Of the 1626 reports that met the CDC’s case definition for myocarditis, 1195 (73%) were younger than 30 years of age, 543 (33%) were younger than 18 years of age, and the median age was 21 years (IQR, 16-31 years) ( Figure 1 ). Of the reports of myocarditis with dose information, 82% (1265/1538) occurred after the second vaccination dose. Of those with a reported dose and time to symptom onset, the median time from vaccination to symptom onset was 3 days (IQR, 1-8 days) after the first vaccination dose and 74% (187/254) of myocarditis events occurred within 7 days. After the second vaccination dose, the median time to symptom onset was 2 days (IQR, 1-3 days) and 90% (1081/1199) of myocarditis events occurred within 7 days ( Figure 2 ).

Males comprised 82% (1334/1625) of the cases of myocarditis for whom sex was reported. The largest proportions of cases of myocarditis were among White persons (non-Hispanic or ethnicity not reported; 69% [914/1330]) and Hispanic persons (of all races; 17% [228/1330]). Among persons younger than 30 years of age, there were no confirmed cases of myocarditis in those who died after mRNA-based COVID-19 vaccination without another identifiable cause and there was 1 probable case of myocarditis but there was insufficient information available for a thorough investigation. At the time of data review, there were 2 reports of death in persons younger than 30 years of age with potential myocarditis that remain under investigation and are not included in the case counts.

Symptom onset of myocarditis was within 7 days after vaccination for 947 reports of individuals who received the BNT162b2 vaccine and for 382 reports of individuals who received the mRNA-1273 vaccine. The rates of myocarditis varied by vaccine type, sex, age, and first or second vaccination dose ( Table 2 ). The reporting rates of myocarditis were highest after the second vaccination dose in adolescent males aged 12 to 15 years (70.73 [95% CI, 61.68-81.11] per million doses of the BNT162b2 vaccine), in adolescent males aged 16 to 17 years (105.86 [95% CI, 91.65-122.27] per million doses of the BNT162b2 vaccine), and in young men aged 18 to 24 years (52.43 [95% CI, 45.56-60.33] per million doses of the BNT162b2 vaccine and 56.31 [95% CI, 47.08-67.34] per million doses of the mRNA-1273 vaccine). The lower estimate of the 95% CI for reporting rates of myocarditis in adolescent males and young men exceeded the upper bound of the expected rates after the first vaccination dose with the BNT162b2 vaccine in those aged 12 to 24 years, after the second vaccination dose with the BNT162b2 vaccine in those aged 12 to 49 years, after the first vaccination dose with the mRNA-1273 vaccine in those aged 18 to 39 years, and after the second vaccination dose with the mRNA-1273 vaccine in those aged 18 to 49 years.

The reporting rates of myocarditis in females were lower than those in males across all age strata younger than 50 years of age. The reporting rates of myocarditis were highest after the second vaccination dose in adolescent females aged 12 to 15 years (6.35 [95% CI, 4.05-9.96] per million doses of the BNT162b2 vaccine), in adolescent females aged 16 to 17 years (10.98 [95% CI, 7.16-16.84] per million doses of the BNT162b2 vaccine), in young women aged 18 to 24 years (6.87 [95% CI, 4.27-11.05] per million doses of the mRNA-1273 vaccine), and in women aged 25 to 29 years (8.22 [95% CI, 5.03-13.41] per million doses of the mRNA-1273 vaccine). The lower estimate of the 95% CI for reporting rates of myocarditis in females exceeded the upper bound of the expected rates after the second vaccination dose with the BNT162b2 vaccine in those aged 12 to 29 years and after the second vaccination dose with the mRNA-1273 vaccine in those aged 18 to 29 years.

Among the 1372 reports of myocarditis in persons younger than 30 years of age, 1305 were able to be adjudicated, with 92% (1195/1305) meeting the CDC’s case definition. Of these, chart abstractions or medical interviews were completed for 69% (826/1195) ( Table 3 ). The symptoms commonly reported in the verified cases of myocarditis in persons younger than 30 years of age included chest pain, pressure, or discomfort (727/817; 89%) and dyspnea or shortness of breath (242/817; 30%). Troponin levels were elevated in 98% (792/809) of the cases of myocarditis. The electrocardiogram result was abnormal in 72% (569/794) of cases of myocarditis. Of the patients who had received a cardiac MRI, 72% (223/312) had abnormal findings consistent with myocarditis. The echocardiogram results were available for 721 cases of myocarditis; of these, 84 (12%) demonstrated a notable decreased left ventricular ejection fraction (<50%). Among the 676 cases for whom treatment data were available, 589 (87%) received nonsteroidal anti-inflammatory drugs. Intravenous immunoglobulin and glucocorticoids were each used in 12% of the cases of myocarditis (78/676 and 81/676, respectively). Intensive therapies such as vasoactive medications (12 cases of myocarditis) and intubation or mechanical ventilation (2 cases) were rare. There were no verified cases of myocarditis requiring a heart transplant, extracorporeal membrane oxygenation, or a ventricular assist device. Of the 96% (784/813) of cases of myocarditis who were hospitalized, 98% (747/762) were discharged from the hospital at time of review. In 87% (577/661) of discharged cases of myocarditis, there was resolution of the presenting symptoms by hospital discharge.

In this review of reports to VAERS between December 2020 and August 2021, myocarditis was identified as a rare but serious adverse event that can occur after mRNA-based COVID-19 vaccination, particularly in adolescent males and young men. However, this increased risk must be weighed against the benefits of COVID-19 vaccination. 18

Compared with cases of non–vaccine-associated myocarditis, the reports of myocarditis to VAERS after mRNA-based COVID-19 vaccination were similar in demographic characteristics but different in their acute clinical course. First, the greater frequency noted among vaccine recipients aged 12 to 29 years vs those aged 30 years or older was similar to the age distribution seen in typical cases of myocarditis. 2 , 4 This pattern may explain why cases of myocarditis were not discovered until months after initial Emergency Use Authorization of the vaccines in the US (ie, until the vaccines were widely available to younger persons). Second, the sex distribution in cases of myocarditis after COVID-19 vaccination was similar to that seen in typical cases of myocarditis; there is a strong male predominance for both conditions. 2 , 4

However, the onset of myocarditis symptoms after exposure to a potential immunological trigger was shorter for COVID-19 vaccine–associated cases of myocarditis than is typical for myocarditis cases diagnosed after a viral illness. 24 - 26 Cases of myocarditis reported after COVID-19 vaccination were typically diagnosed within days of vaccination, whereas cases of typical viral myocarditis can often have indolent courses with symptoms sometimes present for weeks to months after a trigger if the cause is ever identified. 1 The major presenting symptoms appeared to resolve faster in cases of myocarditis after COVID-19 vaccination than in typical viral cases of myocarditis. Even though almost all individuals with cases of myocarditis were hospitalized and clinically monitored, they typically experienced symptomatic recovery after receiving only pain management. In contrast, typical viral cases of myocarditis can have a more variable clinical course. For example, up to 6% of typical viral myocarditis cases in adolescents require a heart transplant or result in mortality. 27

In the current study, the initial evaluation and treatment of COVID-19 vaccine–associated myocarditis cases was similar to that of typical myocarditis cases. 28 - 31 Initial evaluation usually included measurement of troponin level, electrocardiography, and echocardiography. 1 Cardiac MRI was often used for diagnostic purposes and also for possible prognostic purposes. 32 , 33 Supportive care was a mainstay of treatment, with specific cardiac or intensive care therapies as indicated by the patient’s clinical status.

Long-term outcome data are not yet available for COVID-19 vaccine–associated myocarditis cases. The CDC has started active follow-up surveillance in adolescents and young adults to assess the health and functional status and cardiac outcomes at 3 to 6 months in probable and confirmed cases of myocarditis reported to VAERS after COVID-19 vaccination. 34 For patients with myocarditis, the American Heart Association and the American College of Cardiology guidelines advise that patients should be instructed to refrain from competitive sports for 3 to 6 months, and that documentation of a normal electrocardiogram result, ambulatory rhythm monitoring, and an exercise test should be obtained prior to resumption of sports. 35 The use of cardiac MRI is unclear, but it may be useful in evaluating the progression or resolution of myocarditis in those with abnormalities on the baseline cardiac MRI. 36 Further doses of mRNA-based COVID-19 vaccines should be deferred, but may be considered in select circumstances. 37

This study has several limitations. First, although clinicians are required to report serious adverse events after COVID-19 vaccination, including all events leading to hospitalization, VAERS is a passive reporting system. As such, the reports of myocarditis to VAERS may be incomplete, and the quality of the information reported is variable. Missing data for sex, vaccination dose number, and race and ethnicity were not uncommon in the reports received; history of prior SARS-CoV-2 infection also was not known. Furthermore, as a passive system, VAERS data are subject to reporting biases in that both underreporting and overreporting are possible. 38 Given the high verification rate of reports of myocarditis to VAERS after mRNA-based COVID-19 vaccination, underreporting is more likely. Therefore, the actual rates of myocarditis per million doses of vaccine are likely higher than estimated.

Second, efforts by CDC investigators to obtain medical records or interview physicians were not always successful despite the special allowance for sharing information with the CDC under the Health Insurance Portability and Accountability Act of 1996. 39 This challenge limited the ability to perform case adjudication and complete investigations for some reports of myocarditis, although efforts are still ongoing when feasible.

Third, the data from vaccination administration were limited to what is reported to the CDC and thus may be incomplete, particularly with regard to demographics.

Fourth, calculation of expected rates from the IBM MarketScan Commercial Research Database relied on administrative data via the use of ICD-10 codes and there was no opportunity for clinical review. Furthermore, these data had limited information regarding the Medicare population; thus expected rates for those older than 65 years of age were not calculated. However, it is expected that the rates in those older than 65 years of age would not be higher than the rates in those aged 50 to 64 years. 4

Based on passive surveillance reporting in the US, the risk of myocarditis after receiving mRNA-based COVID-19 vaccines was increased across multiple age and sex strata and was highest after the second vaccination dose in adolescent males and young men. This risk should be considered in the context of the benefits of COVID-19 vaccination.

Corresponding Author: Matthew E. Oster, MD, MPH, US Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333 ( [email protected] ).

Correction: This article was corrected March 21, 2022, to change “pericarditis” to “myocarditis” in the first row, first column of eTable 1 in the Supplement.

Accepted for Publication: December 16, 2021.

Author Contributions: Drs Oster and Su had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Oster, Shay, Su, Creech, Edwards, Dendy, Schlaudecker, Woo, Shimabukuro.

Acquisition, analysis, or interpretation of data: Oster, Shay, Su, Gee, Creech, Broder, Edwards, Soslow, Schlaudecker, Lang, Barnett, Ruberg, Smith, Campbell, Lopes, Sperling, Baumblatt, Thompson, Marquez, Strid, Woo, Pugsley, Reagan-Steiner, DeStefano, Shimabukuro.

Drafting of the manuscript: Oster, Shay, Su, Gee, Creech, Marquez, Strid, Woo, Shimabukuro.

Critical revision of the manuscript for important intellectual content: Oster, Shay, Su, Creech, Broder, Edwards, Soslow, Dendy, Schlaudecker, Lang, Barnett, Ruberg, Smith, Campbell, Lopes, Sperling, Baumblatt, Thompson, Pugsley, Reagan-Steiner, DeStefano, Shimabukuro.

Statistical analysis: Oster, Su, Marquez, Strid, Woo, Shimabukuro.

Obtained funding: Edwards, DeStefano.

Administrative, technical, or material support: Oster, Gee, Creech, Broder, Edwards, Soslow, Schlaudecker, Smith, Baumblatt, Thompson, Reagan-Steiner, DeStefano.

Supervision: Su, Edwards, Soslow, Dendy, Schlaudecker, Campbell, Sperling, DeStefano, Shimabukuro.

Conflict of Interest Disclosures: Dr Creech reported receiving grants from the National Institutes of Health for the Moderna and Janssen clinical trials and receiving personal fees from Astellas and Horizon. Dr Edwards reported receiving grants from the National Institutes of Health; receiving personal fees from BioNet, IBM, X-4 Pharma, Seqirus, Roche, Pfizer, Merck, Moderna, and Sanofi; and receiving compensation for being the associate editor of Clinical Infectious Diseases . Dr Soslow reported receiving personal fees from Esperare. Dr Schlaudecker reported receiving grants from Pfizer and receiving personal fees from Sanofi Pasteur. Drs Barnett, Ruberg, and Smith reported receiving grants from Pfizer. Dr Lopes reported receiving personal fees from Bayer, Boehringer Ingleheim, Bristol Myers Squibb, Daiichi Sankyo, GlaxoSmithKline, Medtronic, Merck, Pfizer, Portola, and Sanofi and receiving grants from Bristol Myers Squibb, GlaxoSmithKline, Medtronic, Pfizer, and Sanofi. No other disclosures were reported.

Funding/Support: This work was supported by contracts 200-2012-53709 (Boston Medical Center), 200-2012-53661 (Cincinnati Children’s Hospital Medical Center), 200-2012-53663 (Duke University), and 200-2012-50430 (Vanderbilt University Medical Center) with the US Centers for Disease Control and Prevention (CDC) Clinical Immunization Safety Assessment Project.

Role of the Funder/Sponsor: The CDC provided funding via the Clinical Immunization Safety Assessment Project to Drs Creech, Edwards, Soslow, Dendy, Schlaudecker, Lang, Barnett, Ruberg, Smith, Campbell, and Lopes. The authors affiliated with the CDC along with the other coauthors conducted the investigations; performed collection, management, analysis, and interpretation of the data; were involved in the preparation, review, and approval of the manuscript; and made the decision to submit the manuscript for publication.

Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the CDC or the US Food and Drug Administration. Mention of a product or company name is for identification purposes only and does not constitute endorsement by the CDC or the US Food and Drug Administration.

Additional Contributions: We thank the following CDC staff who contributed to this article without compensation outside their normal salaries (in alphabetical order and contribution specified in parenthesis at end of each list of names): Nickolas Agathis, MD, MPH, Stephen R. Benoit, MD, MPH, Beau B. Bruce, MD, PhD, Abigail L. Carlson, MD, MPH, Meredith G. Dixon, MD, Jonathan Duffy, MD, MPH, Charles Duke, MD, MPH, Charles Edge, MSN, MS, Robyn Neblett Fanfair, MD, MPH, Nathan W. Furukawa, MD, MPH, Gavin Grant, MD, MPH, Grace Marx, MD, MPH, Maureen J. Miller, MD, MPH, Pedro Moro, MD, MPH, Meredith Oakley, DVM, MPH, Kia Padgett, MPH, BSN, RN, Janice Perez-Padilla, MPH, BSN, RN, Robert Perry, MD, MPH, Nimia Reyes, MD, MPH, Ernest E. Smith, MD, MPH&TM, David Sniadack, MD, MPH, Pamela Tucker, MD, Edward C. Weiss, MD, MPH, Erin Whitehouse, PhD, MPH, RN, Pascale M. Wortley, MD, MPH, and Rachael Zacks, MD (for clinical investigations and interviews); Amelia Jazwa, MSPH, Tara Johnson, MPH, MS, and Jamila Shields, MPH (for project coordination); Charles Licata, PhD, and Bicheng Zhang, MS (for data acquisition and organization); Charles E. Rose, PhD (for statistical consultation); and Scott D. Grosse, PhD (for calculation of expected rates of myocarditis). We also thank the clinical staff who cared for these patients and reported the adverse events to the Vaccine Adverse Event Reporting System.

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