research methodology case study with solution

Have a language expert improve your writing

Run a free plagiarism check in 10 minutes, generate accurate citations for free.

• Knowledge Base

Methodology

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

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

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

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

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

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.

Receive feedback on language, structure, and formatting

Professional editors proofread and edit your paper by focusing on:

• Academic style
• Vague sentences
• Style consistency

See an example

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.

Here's why students love Scribbr's proofreading services

Discover proofreading & editing

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

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

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

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

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

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

Research bias

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

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the “Cite this Scribbr article” button to automatically add the citation to our free Citation Generator.

McCombes, S. (2023, November 20). What Is a Case Study? | Definition, Examples & Methods. Scribbr. Retrieved June 18, 2024, from https://www.scribbr.com/methodology/case-study/

Is this article helpful?

Shona McCombes

Other students also liked, primary vs. secondary sources | difference & examples, what is a theoretical framework | guide to organizing, what is action research | definition & examples, get unlimited documents corrected.

✔ Free APA citation check included ✔ Unlimited document corrections ✔ Specialized in correcting academic texts

• Privacy Policy

Home » Case Study – Methods, Examples and Guide

Case Study – Methods, Examples and Guide

Table of Contents

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

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

Types of Case Study

Types and Methods of Case Study are as follows:

Single-Case Study

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

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

Multiple-Case Study

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

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

Exploratory Case Study

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

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

Descriptive Case Study

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

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

Instrumental Case Study

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

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

Case Study Data Collection Methods

Here are some common data collection methods for case studies:

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

Observations

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

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

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

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

How to conduct Case Study Research

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

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

Examples of Case Study

Here are some examples of case study research:

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

Application of Case Study

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

Business and Management

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

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

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

Social Sciences

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

Law and Ethics

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

Purpose of Case Study

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

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

Case studies can also serve other purposes, including:

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

Advantages of Case Study Research

There are several advantages of case study research, including:

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

Limitations of Case Study Research

There are several limitations of case study research, including:

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

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

You may also like

Phenomenology – Methods, Examples and Guide

Quasi-Experimental Research Design – Types...

Questionnaire – Definition, Types, and Examples

Transformative Design – Methods, Types, Guide

Textual Analysis – Types, Examples and Guide

Observational Research – Methods and Guide

Case Studies

Case studies are a popular research method in business area. Case studies aim to analyze specific issues within the boundaries of a specific environment, situation or organization.

According to its design, case studies in business research can be divided into three categories: explanatory, descriptive and exploratory.

Explanatory case studies aim to answer ‘how’ or ’why’ questions with little control on behalf of researcher over occurrence of events. This type of case studies focus on phenomena within the contexts of real-life situations. Example: “An investigation into the reasons of the global financial and economic crisis of 2008 – 2010.”

Descriptive case studies aim to analyze the sequence of interpersonal events after a certain amount of time has passed. Studies in business research belonging to this category usually describe culture or sub-culture, and they attempt to discover the key phenomena. Example: “Impact of increasing levels of multiculturalism on marketing practices: A case study of McDonald’s Indonesia.”

Exploratory case studies aim to find answers to the questions of ‘what’ or ‘who’. Exploratory case study data collection method is often accompanied by additional data collection method(s) such as interviews, questionnaires, experiments etc. Example: “A study into differences of leadership practices between private and public sector organizations in Atlanta, USA.”

Advantages of case study method include data collection and analysis within the context of phenomenon, integration of qualitative and quantitative data in data analysis, and the ability to capture complexities of real-life situations so that the phenomenon can be studied in greater levels of depth. Case studies do have certain disadvantages that may include lack of rigor, challenges associated with data analysis and very little basis for generalizations of findings and conclusions.

John Dudovskiy

Have a language expert improve your writing

Run a free plagiarism check in 10 minutes, automatically generate references for free.

• Knowledge Base
• Methodology
• Case Study | Definition, Examples & Methods

Case Study | Definition, Examples & Methods

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

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

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

Table of contents

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

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

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

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

Prevent plagiarism, run a free check.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the ‘Cite this Scribbr article’ button to automatically add the citation to our free Reference Generator.

McCombes, S. (2023, January 30). Case Study | Definition, Examples & Methods. Scribbr. Retrieved 18 June 2024, from https://www.scribbr.co.uk/research-methods/case-studies/

Is this article helpful?

Shona McCombes

Other students also liked, correlational research | guide, design & examples, a quick guide to experimental design | 5 steps & examples, descriptive research design | definition, methods & examples.

A Case Study is a research method involving a detailed examination and in-depth description of a particular empirical case. This can be done in many different ways, and the unit of analysis can vary (a person, an institution, a country, etc.). Case Studies can include both quantitative and qualitative evidence (Stake, 1995) and typically rely on bringing together many different articles of evidence from various sources to illuminate the case as a whole.

Case Studies benefit from having a developed theoretical framework before data collection begins (Yin, 2003). At the same time, the Case Study approach allows flexibility and can be used in exploratory contexts. This can be attractive to the researcher because it allows data collection to begin immediately (though there remains a need to impose a theoretical structure in the analysis phase). Consequently, Case Studies can be conducted at different levels of formality and replicability (Hetherington, 2013).

The case study research design can be used to test whether theories and models work in real contexts of application (Shuttleworth, 2008) and, conversely, to generate hypotheses and theories.

Case Study: GO-GN Insights

Sarah Hutton used a hermeneutic phenomenological case study to illuminate a direct connection between undergraduate student participation in courses with a participatory OER authorship or open access publishing of student artefacts model, to the development of internal goals and deepened engagement:

“Participatory OER development and an open pedagogical model provide the potential for students to have autonomous control over the development of course content, fostering greater intrinsic motivation, and therefore more successful and transferable learning outcomes. The resulting analysis creates a compelling case for the adoption of OER materials beyond the affordability argument, further advocating for the engagement of students in open scholarship at the undergraduate level.”

Viviane Vladimirschi explored evidence-based guidelines in the context of Teacher Professional Development (TPD) for Brazilian fundamental education public school teachers by undertaking an intervention in one school. The main goal of the OER Development Program was to raise awareness and build teachers’ knowledge regarding OER adoption and use:

“The case study methodology used in this research is a very common approach within Educational Studies. It is also a fairly easy method to use and the analysis of multiple sources of data have the potential to not only generate new insights throughout the case study but also generate new theory. Theory-building is very well-suited to new research areas, which was the case of this research. However, there are some disadvantages to using this methodology. First, it is not possible to generalize the findings from a single case study. Second, achieving the balance between producing an overly complex theory or a narrow idiosyncratic theory is quite challenging. Theory generated by case studies must be testable, replicable and coherent. The TPD guidelines generated by this research are testable, replicable and pretty straightforward so I am confident I managed to achieve this balance. The Design Thinking for Educators approach (please note that it is not a method) that I used in this research for the face-to-face workshops I highly recommend to any researcher who wishes to undertake an intervention, especially in the K-12 sector. This approach not only enables researchers to gain more insight into potential solutions for introducing new professional practices, but also affords teachers multiple opportunities to participate in the process of determining how innovation may be best implemented. Its only potential disadvantage is that it requires a longer period of time of application during each of its distinct phases to obtain bottom-up buy-in to an innovation.”

Useful references for Case Studies: Hetherington (2013); Shuttleworth (2008); Stake (1995); Yin (2003)

Research Methods Handbook Copyright © 2020 by Rob Farrow; Francisco Iniesto; Martin Weller; and Rebecca Pitt is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

Share This Book

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• BMC Med Res Methodol

The case study approach

Sarah crowe.

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

Kathrin Cresswell

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

Ann Robertson

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

Anthony Avery

Aziz sheikh.

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

Introduction

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

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

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

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

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

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

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

What is a case study?

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

Definitions of a case study

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

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

What are case studies used for?

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

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

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

How are case studies conducted?

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

Defining the case

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

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

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

Selecting the case(s)

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

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

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

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

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

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

Collecting the data

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

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

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

Analysing, interpreting and reporting case studies

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

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

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

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

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

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

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

Potential pitfalls and mitigating actions when undertaking case study research

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

Conclusions

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

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

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

Pre-publication history

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

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

Acknowledgements

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

• Yin RK. Case study research, design and method. 4. London: Sage Publications Ltd.; 2009. [ Google Scholar ]
• Keen J, Packwood T. Qualitative research; case study evaluation. BMJ. 1995; 311 :444–446. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Sheikh A, Halani L, Bhopal R, Netuveli G, Partridge M, Car J. et al. Facilitating the Recruitment of Minority Ethnic People into Research: Qualitative Case Study of South Asians and Asthma. PLoS Med. 2009; 6 (10):1–11. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Pinnock H, Huby G, Powell A, Kielmann T, Price D, Williams S, The process of planning, development and implementation of a General Practitioner with a Special Interest service in Primary Care Organisations in England and Wales: a comparative prospective case study. Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R&D (NCCSDO) 2008. http://www.sdo.nihr.ac.uk/files/project/99-final-report.pdf
• Robertson A, Cresswell K, Takian A, Petrakaki D, Crowe S, Cornford T. et al. Prospective evaluation of the implementation and adoption of NHS Connecting for Health's national electronic health record in secondary care in England: interim findings. BMJ. 2010; 41 :c4564. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Pearson P, Steven A, Howe A, Sheikh A, Ashcroft D, Smith P. the Patient Safety Education Study Group. Learning about patient safety: organisational context and culture in the education of healthcare professionals. J Health Serv Res Policy. 2010; 15 :4–10. doi: 10.1258/jhsrp.2009.009052. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• van Harten WH, Casparie TF, Fisscher OA. The evaluation of the introduction of a quality management system: a process-oriented case study in a large rehabilitation hospital. Health Policy. 2002; 60 (1):17–37. doi: 10.1016/S0168-8510(01)00187-7. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Stake RE. The art of case study research. London: Sage Publications Ltd.; 1995. [ Google Scholar ]
• Sheikh A, Smeeth L, Ashcroft R. Randomised controlled trials in primary care: scope and application. Br J Gen Pract. 2002; 52 (482):746–51. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• King G, Keohane R, Verba S. Designing Social Inquiry. Princeton: Princeton University Press; 1996. [ Google Scholar ]
• Doolin B. Information technology as disciplinary technology: being critical in interpretative research on information systems. Journal of Information Technology. 1998; 13 :301–311. doi: 10.1057/jit.1998.8. [ CrossRef ] [ Google Scholar ]
• George AL, Bennett A. Case studies and theory development in the social sciences. Cambridge, MA: MIT Press; 2005. [ Google Scholar ]
• Eccles M. the Improved Clinical Effectiveness through Behavioural Research Group (ICEBeRG) Designing theoretically-informed implementation interventions. Implementation Science. 2006; 1 :1–8. doi: 10.1186/1748-5908-1-1. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Netuveli G, Hurwitz B, Levy M, Fletcher M, Barnes G, Durham SR, Sheikh A. Ethnic variations in UK asthma frequency, morbidity, and health-service use: a systematic review and meta-analysis. Lancet. 2005; 365 (9456):312–7. [ PubMed ] [ Google Scholar ]
• Sheikh A, Panesar SS, Lasserson T, Netuveli G. Recruitment of ethnic minorities to asthma studies. Thorax. 2004; 59 (7):634. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Hellström I, Nolan M, Lundh U. 'We do things together': A case study of 'couplehood' in dementia. Dementia. 2005; 4 :7–22. doi: 10.1177/1471301205049188. [ CrossRef ] [ Google Scholar ]
• Som CV. Nothing seems to have changed, nothing seems to be changing and perhaps nothing will change in the NHS: doctors' response to clinical governance. International Journal of Public Sector Management. 2005; 18 :463–477. doi: 10.1108/09513550510608903. [ CrossRef ] [ Google Scholar ]
• Lincoln Y, Guba E. Naturalistic inquiry. Newbury Park: Sage Publications; 1985. [ Google Scholar ]
• Barbour RS. Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? BMJ. 2001; 322 :1115–1117. doi: 10.1136/bmj.322.7294.1115. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Mays N, Pope C. Qualitative research in health care: Assessing quality in qualitative research. BMJ. 2000; 320 :50–52. doi: 10.1136/bmj.320.7226.50. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Mason J. Qualitative researching. London: Sage; 2002. [ Google Scholar ]
• Brazier A, Cooke K, Moravan V. Using Mixed Methods for Evaluating an Integrative Approach to Cancer Care: A Case Study. Integr Cancer Ther. 2008; 7 :5–17. doi: 10.1177/1534735407313395. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Miles MB, Huberman M. Qualitative data analysis: an expanded sourcebook. 2. CA: Sage Publications Inc.; 1994. [ Google Scholar ]
• Pope C, Ziebland S, Mays N. Analysing qualitative data. Qualitative research in health care. BMJ. 2000; 320 :114–116. doi: 10.1136/bmj.320.7227.114. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Cresswell KM, Worth A, Sheikh A. Actor-Network Theory and its role in understanding the implementation of information technology developments in healthcare. BMC Med Inform Decis Mak. 2010; 10 (1):67. doi: 10.1186/1472-6947-10-67. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Malterud K. Qualitative research: standards, challenges, and guidelines. Lancet. 2001; 358 :483–488. doi: 10.1016/S0140-6736(01)05627-6. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Yin R. Case study research: design and methods. 2. Thousand Oaks, CA: Sage Publishing; 1994. [ Google Scholar ]
• Yin R. Enhancing the quality of case studies in health services research. Health Serv Res. 1999; 34 :1209–1224. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Green J, Thorogood N. Qualitative methods for health research. 2. Los Angeles: Sage; 2009. [ Google Scholar ]
• Howcroft D, Trauth E. Handbook of Critical Information Systems Research, Theory and Application. Cheltenham, UK: Northampton, MA, USA: Edward Elgar; 2005. [ Google Scholar ]
• Blakie N. Approaches to Social Enquiry. Cambridge: Polity Press; 1993. [ Google Scholar ]
• Doolin B. Power and resistance in the implementation of a medical management information system. Info Systems J. 2004; 14 :343–362. doi: 10.1111/j.1365-2575.2004.00176.x. [ CrossRef ] [ Google Scholar ]
• Bloomfield BP, Best A. Management consultants: systems development, power and the translation of problems. Sociological Review. 1992; 40 :533–560. [ Google Scholar ]
• Shanks G, Parr A. Proceedings of the European Conference on Information Systems. Naples; 2003. Positivist, single case study research in information systems: A critical analysis. [ Google Scholar ]

What is case study research?

Last updated

8 February 2023

Reviewed by

Cathy Heath

Short on time? Get an AI generated summary of this article instead

Suppose a company receives a spike in the number of customer complaints, or medical experts discover an outbreak of illness affecting children but are not quite sure of the reason. In both cases, carrying out a case study could be the best way to get answers.

Organization

Case studies can be carried out across different disciplines, including education, medicine, sociology, and business.

Most case studies employ qualitative methods, but quantitative methods can also be used. Researchers can then describe, compare, evaluate, and identify patterns or cause-and-effect relationships between the various variables under study. They can then use this knowledge to decide what action to take. 

Another thing to note is that case studies are generally singular in their focus. This means they narrow focus to a particular area, making them highly subjective. You cannot always generalize the results of a case study and apply them to a larger population. However, they are valuable tools to illustrate a principle or develop a thesis.

Analyze case study research

Dovetail streamlines case study research to help you uncover and share actionable insights

• What are the different types of case study designs?

Researchers can choose from a variety of case study designs. The design they choose is dependent on what questions they need to answer, the context of the research environment, how much data they already have, and what resources are available.

Here are the common types of case study design:

Explanatory

An explanatory case study is an initial explanation of the how or why that is behind something. This design is commonly used when studying a real-life phenomenon or event. Once the organization understands the reasons behind a phenomenon, it can then make changes to enhance or eliminate the variables causing it. 

Here is an example: How is co-teaching implemented in elementary schools? The title for a case study of this subject could be “Case Study of the Implementation of Co-Teaching in Elementary Schools.”

Descriptive

An illustrative or descriptive case study helps researchers shed light on an unfamiliar object or subject after a period of time. The case study provides an in-depth review of the issue at hand and adds real-world examples in the area the researcher wants the audience to understand. 

The researcher makes no inferences or causal statements about the object or subject under review. This type of design is often used to understand cultural shifts.

Here is an example: How did people cope with the 2004 Indian Ocean Tsunami? This case study could be titled "A Case Study of the 2004 Indian Ocean Tsunami and its Effect on the Indonesian Population."

Exploratory

Exploratory research is also called a pilot case study. It is usually the first step within a larger research project, often relying on questionnaires and surveys . Researchers use exploratory research to help narrow down their focus, define parameters, draft a specific research question , and/or identify variables in a larger study. This research design usually covers a wider area than others, and focuses on the ‘what’ and ‘who’ of a topic.

Here is an example: How do nutrition and socialization in early childhood affect learning in children? The title of the exploratory study may be “Case Study of the Effects of Nutrition and Socialization on Learning in Early Childhood.”

An intrinsic case study is specifically designed to look at a unique and special phenomenon. At the start of the study, the researcher defines the phenomenon and the uniqueness that differentiates it from others. 

In this case, researchers do not attempt to generalize, compare, or challenge the existing assumptions. Instead, they explore the unique variables to enhance understanding. Here is an example: “Case Study of Volcanic Lightning.”

This design can also be identified as a cumulative case study. It uses information from past studies or observations of groups of people in certain settings as the foundation of the new study. Given that it takes multiple areas into account, it allows for greater generalization than a single case study. 

The researchers also get an in-depth look at a particular subject from different viewpoints.  Here is an example: “Case Study of how PTSD affected Vietnam and Gulf War Veterans Differently Due to Advances in Military Technology.”

Critical instance

A critical case study incorporates both explanatory and intrinsic study designs. It does not have predetermined purposes beyond an investigation of the said subject. It can be used for a deeper explanation of the cause-and-effect relationship. It can also be used to question a common assumption or myth. 

The findings can then be used further to generalize whether they would also apply in a different environment.  Here is an example: “What Effect Does Prolonged Use of Social Media Have on the Mind of American Youth?”

Instrumental

Instrumental research attempts to achieve goals beyond understanding the object at hand. Researchers explore a larger subject through different, separate studies and use the findings to understand its relationship to another subject. This type of design also provides insight into an issue or helps refine a theory. 

For example, you may want to determine if violent behavior in children predisposes them to crime later in life. The focus is on the relationship between children and violent behavior, and why certain children do become violent. Here is an example: “Violence Breeds Violence: Childhood Exposure and Participation in Adult Crime.”

Evaluation case study design is employed to research the effects of a program, policy, or intervention, and assess its effectiveness and impact on future decision-making. 

For example, you might want to see whether children learn times tables quicker through an educational game on their iPad versus a more teacher-led intervention. Here is an example: “An Investigation of the Impact of an iPad Multiplication Game for Primary School Children.” 

• When do you use case studies?

Case studies are ideal when you want to gain a contextual, concrete, or in-depth understanding of a particular subject. It helps you understand the characteristics, implications, and meanings of the subject.

They are also an excellent choice for those writing a thesis or dissertation, as they help keep the project focused on a particular area when resources or time may be too limited to cover a wider one. You may have to conduct several case studies to explore different aspects of the subject in question and understand the problem.

• What are the steps to follow when conducting a case study?

1. Select a case

Once you identify the problem at hand and come up with questions, identify the case you will focus on. The study can provide insights into the subject at hand, challenge existing assumptions, propose a course of action, and/or open up new areas for further research.

2. Create a theoretical framework

While you will be focusing on a specific detail, the case study design you choose should be linked to existing knowledge on the topic. This prevents it from becoming an isolated description and allows for enhancing the existing information. 

It may expand the current theory by bringing up new ideas or concepts, challenge established assumptions, or exemplify a theory by exploring how it answers the problem at hand. A theoretical framework starts with a literature review of the sources relevant to the topic in focus. This helps in identifying key concepts to guide analysis and interpretation.

3. Collect the data

Case studies are frequently supplemented with qualitative data such as observations, interviews, and a review of both primary and secondary sources such as official records, news articles, and photographs. There may also be quantitative data —this data assists in understanding the case thoroughly.

4. Analyze your case

The results of the research depend on the research design. Most case studies are structured with chapters or topic headings for easy explanation and presentation. Others may be written as narratives to allow researchers to explore various angles of the topic and analyze its meanings and implications.

In all areas, always give a detailed contextual understanding of the case and connect it to the existing theory and literature before discussing how it fits into your problem area.

• What are some case study examples?

What are the best approaches for introducing our product into the Kenyan market?

How does the change in marketing strategy aid in increasing the sales volumes of product Y?

How can teachers enhance student participation in classrooms?

How does poverty affect literacy levels in children?

Case study topics

Case study of product marketing strategies in the Kenyan market

Case study of the effects of a marketing strategy change on product Y sales volumes

Case study of X school teachers that encourage active student participation in the classroom

Case study of the effects of poverty on literacy levels in children

Should you be using a customer insights hub?

Do you want to discover previous research faster?

Do you share your research findings with others?

Do you analyze research data?

Start for free today, add your research, and get to key insights faster

Editor’s picks

Last updated: 18 April 2023

Last updated: 27 February 2023

Last updated: 6 February 2023

Last updated: 15 January 2024

Last updated: 6 October 2023

Last updated: 5 February 2023

Last updated: 16 April 2023

Last updated: 7 March 2023

Last updated: 9 March 2023

Last updated: 12 December 2023

Last updated: 11 March 2024

Last updated: 13 May 2024

Latest articles

Related topics, .css-je19u9{-webkit-align-items:flex-end;-webkit-box-align:flex-end;-ms-flex-align:flex-end;align-items:flex-end;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:row;-ms-flex-direction:row;flex-direction:row;-webkit-box-flex-wrap:wrap;-webkit-flex-wrap:wrap;-ms-flex-wrap:wrap;flex-wrap:wrap;-webkit-box-pack:center;-ms-flex-pack:center;-webkit-justify-content:center;justify-content:center;row-gap:0;text-align:center;max-width:671px;}@media (max-width: 1079px){.css-je19u9{max-width:400px;}.css-je19u9>span{white-space:pre;}}@media (max-width: 799px){.css-je19u9{max-width:400px;}.css-je19u9>span{white-space:pre;}} decide what to .css-1kiodld{max-height:56px;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}@media (max-width: 1079px){.css-1kiodld{display:none;}} build next, decide what to build next.

Users report unexpectedly high data usage, especially during streaming sessions.

Users find it hard to navigate from the home page to relevant playlists in the app.

It would be great to have a sleep timer feature, especially for bedtime listening.

I need better filters to find the songs or artists I’m looking for.

Log in or sign up

Get started for free

Take inspiration from candid case studies focused on project design

Written by the researchers themselves, these eye-opening case studies follow real research projects – walking you through why methods were chosen and how the inevitable unforeseen challenges were overcome. Explore and learn from the realities of research, so often left out of journal articles and textbooks.

Advantages of using Cases

• Discover methods appropriate for your study – search by discipline for methods used successfully in similar projects to yours
• Learn first-hand about the decisions and pivots that researchers often need to make
• Easily adapt cases for coursework with the provided learning objectives and discussion questions

Try it FREE for 30 days

Librarians   Faculty

Or recommend this resource to your librarian

See sample content

Making short-term research projects a success:.

Navigating the Unique Challenges of Doing Research With Marginalized Communities on a Tight Timeline

Sage Research Methods

For information, demos, and pricing, try it free, for 30 days, also available on sage research methods.

• Open access
• Published: 10 November 2020

Case study research for better evaluations of complex interventions: rationale and challenges

• Sara Paparini   ORCID: orcid.org/0000-0002-1909-2481 1 ,
• Judith Green 2 ,
• Chrysanthi Papoutsi 1 ,
• Jamie Murdoch 3 ,
• Mark Petticrew 4 ,
• Trish Greenhalgh 1 ,
• Benjamin Hanckel 5 &
• Sara Shaw 1  

BMC Medicine volume  18 , Article number:  301 ( 2020 ) Cite this article

18k Accesses

43 Citations

35 Altmetric

Metrics details

The need for better methods for evaluation in health research has been widely recognised. The ‘complexity turn’ has drawn attention to the limitations of relying on causal inference from randomised controlled trials alone for understanding whether, and under which conditions, interventions in complex systems improve health services or the public health, and what mechanisms might link interventions and outcomes. We argue that case study research—currently denigrated as poor evidence—is an under-utilised resource for not only providing evidence about context and transferability, but also for helping strengthen causal inferences when pathways between intervention and effects are likely to be non-linear.

Case study research, as an overall approach, is based on in-depth explorations of complex phenomena in their natural, or real-life, settings. Empirical case studies typically enable dynamic understanding of complex challenges and provide evidence about causal mechanisms and the necessary and sufficient conditions (contexts) for intervention implementation and effects. This is essential evidence not just for researchers concerned about internal and external validity, but also research users in policy and practice who need to know what the likely effects of complex programmes or interventions will be in their settings. The health sciences have much to learn from scholarship on case study methodology in the social sciences. However, there are multiple challenges in fully exploiting the potential learning from case study research. First are misconceptions that case study research can only provide exploratory or descriptive evidence. Second, there is little consensus about what a case study is, and considerable diversity in how empirical case studies are conducted and reported. Finally, as case study researchers typically (and appropriately) focus on thick description (that captures contextual detail), it can be challenging to identify the key messages related to intervention evaluation from case study reports.

Whilst the diversity of published case studies in health services and public health research is rich and productive, we recommend further clarity and specific methodological guidance for those reporting case study research for evaluation audiences.

Peer Review reports

The need for methodological development to address the most urgent challenges in health research has been well-documented. Many of the most pressing questions for public health research, where the focus is on system-level determinants [ 1 , 2 ], and for health services research, where provisions typically vary across sites and are provided through interlocking networks of services [ 3 ], require methodological approaches that can attend to complexity. The need for methodological advance has arisen, in part, as a result of the diminishing returns from randomised controlled trials (RCTs) where they have been used to answer questions about the effects of interventions in complex systems [ 4 , 5 , 6 ]. In conditions of complexity, there is limited value in maintaining the current orientation to experimental trial designs in the health sciences as providing ‘gold standard’ evidence of effect.

There are increasing calls for methodological pluralism [ 7 , 8 ], with the recognition that complex intervention and context are not easily or usefully separated (as is often the situation when using trial design), and that system interruptions may have effects that are not reducible to linear causal pathways between intervention and outcome. These calls are reflected in a shifting and contested discourse of trial design, seen with the emergence of realist [ 9 ], adaptive and hybrid (types 1, 2 and 3) [ 10 , 11 ] trials that blend studies of effectiveness with a close consideration of the contexts of implementation. Similarly, process evaluation has now become a core component of complex healthcare intervention trials, reflected in MRC guidance on how to explore implementation, causal mechanisms and context [ 12 ].

Evidence about the context of an intervention is crucial for questions of external validity. As Woolcock [ 4 ] notes, even if RCT designs are accepted as robust for maximising internal validity, questions of transferability (how well the intervention works in different contexts) and generalisability (how well the intervention can be scaled up) remain unanswered [ 5 , 13 ]. For research evidence to have impact on policy and systems organisation, and thus to improve population and patient health, there is an urgent need for better methods for strengthening external validity, including a better understanding of the relationship between intervention and context [ 14 ].

Policymakers, healthcare commissioners and other research users require credible evidence of relevance to their settings and populations [ 15 ], to perform what Rosengarten and Savransky [ 16 ] call ‘careful abstraction’ to the locales that matter for them. They also require robust evidence for understanding complex causal pathways. Case study research, currently under-utilised in public health and health services evaluation, can offer considerable potential for strengthening faith in both external and internal validity. For example, in an empirical case study of how the policy of free bus travel had specific health effects in London, UK, a quasi-experimental evaluation (led by JG) identified how important aspects of context (a good public transport system) and intervention (that it was universal) were necessary conditions for the observed effects, thus providing useful, actionable evidence for decision-makers in other contexts [ 17 ].

The overall approach of case study research is based on the in-depth exploration of complex phenomena in their natural, or ‘real-life’, settings. Empirical case studies typically enable dynamic understanding of complex challenges rather than restricting the focus on narrow problem delineations and simple fixes. Case study research is a diverse and somewhat contested field, with multiple definitions and perspectives grounded in different ways of viewing the world, and involving different combinations of methods. In this paper, we raise awareness of such plurality and highlight the contribution that case study research can make to the evaluation of complex system-level interventions. We review some of the challenges in exploiting the current evidence base from empirical case studies and conclude by recommending that further guidance and minimum reporting criteria for evaluation using case studies, appropriate for audiences in the health sciences, can enhance the take-up of evidence from case study research.

Case study research offers evidence about context, causal inference in complex systems and implementation

Well-conducted and described empirical case studies provide evidence on context, complexity and mechanisms for understanding how, where and why interventions have their observed effects. Recognition of the importance of context for understanding the relationships between interventions and outcomes is hardly new. In 1943, Canguilhem berated an over-reliance on experimental designs for determining universal physiological laws: ‘As if one could determine a phenomenon’s essence apart from its conditions! As if conditions were a mask or frame which changed neither the face nor the picture!’ ([ 18 ] p126). More recently, a concern with context has been expressed in health systems and public health research as part of what has been called the ‘complexity turn’ [ 1 ]: a recognition that many of the most enduring challenges for developing an evidence base require a consideration of system-level effects [ 1 ] and the conceptualisation of interventions as interruptions in systems [ 19 ].

The case study approach is widely recognised as offering an invaluable resource for understanding the dynamic and evolving influence of context on complex, system-level interventions [ 20 , 21 , 22 , 23 ]. Empirically, case studies can directly inform assessments of where, when, how and for whom interventions might be successfully implemented, by helping to specify the necessary and sufficient conditions under which interventions might have effects and to consolidate learning on how interdependencies, emergence and unpredictability can be managed to achieve and sustain desired effects. Case study research has the potential to address four objectives for improving research and reporting of context recently set out by guidance on taking account of context in population health research [ 24 ], that is to (1) improve the appropriateness of intervention development for specific contexts, (2) improve understanding of ‘how’ interventions work, (3) better understand how and why impacts vary across contexts and (4) ensure reports of intervention studies are most useful for decision-makers and researchers.

However, evaluations of complex healthcare interventions have arguably not exploited the full potential of case study research and can learn much from other disciplines. For evaluative research, exploratory case studies have had a traditional role of providing data on ‘process’, or initial ‘hypothesis-generating’ scoping, but might also have an increasing salience for explanatory aims. Across the social and political sciences, different kinds of case studies are undertaken to meet diverse aims (description, exploration or explanation) and across different scales (from small N qualitative studies that aim to elucidate processes, or provide thick description, to more systematic techniques designed for medium-to-large N cases).

Case studies with explanatory aims vary in terms of their positioning within mixed-methods projects, with designs including (but not restricted to) (1) single N of 1 studies of interventions in specific contexts, where the overall design is a case study that may incorporate one or more (randomised or not) comparisons over time and between variables within the case; (2) a series of cases conducted or synthesised to provide explanation from variations between cases; and (3) case studies of particular settings within RCT or quasi-experimental designs to explore variation in effects or implementation.

Detailed qualitative research (typically done as ‘case studies’ within process evaluations) provides evidence for the plausibility of mechanisms [ 25 ], offering theoretical generalisations for how interventions may function under different conditions. Although RCT designs reduce many threats to internal validity, the mechanisms of effect remain opaque, particularly when the causal pathways between ‘intervention’ and ‘effect’ are long and potentially non-linear: case study research has a more fundamental role here, in providing detailed observational evidence for causal claims [ 26 ] as well as producing a rich, nuanced picture of tensions and multiple perspectives [ 8 ].

Longitudinal or cross-case analysis may be best suited for evidence generation in system-level evaluative research. Turner [ 27 ], for instance, reflecting on the complex processes in major system change, has argued for the need for methods that integrate learning across cases, to develop theoretical knowledge that would enable inferences beyond the single case, and to develop generalisable theory about organisational and structural change in health systems. Qualitative Comparative Analysis (QCA) [ 28 ] is one such formal method for deriving causal claims, using set theory mathematics to integrate data from empirical case studies to answer questions about the configurations of causal pathways linking conditions to outcomes [ 29 , 30 ].

Nonetheless, the single N case study, too, provides opportunities for theoretical development [ 31 ], and theoretical generalisation or analytical refinement [ 32 ]. How ‘the case’ and ‘context’ are conceptualised is crucial here. Findings from the single case may seem to be confined to its intrinsic particularities in a specific and distinct context [ 33 ]. However, if such context is viewed as exemplifying wider social and political forces, the single case can be ‘telling’, rather than ‘typical’, and offer insight into a wider issue [ 34 ]. Internal comparisons within the case can offer rich possibilities for logical inferences about causation [ 17 ]. Further, case studies of any size can be used for theory testing through refutation [ 22 ]. The potential lies, then, in utilising the strengths and plurality of case study to support theory-driven research within different methodological paradigms.

Evaluation research in health has much to learn from a range of social sciences where case study methodology has been used to develop various kinds of causal inference. For instance, Gerring [ 35 ] expands on the within-case variations utilised to make causal claims. For Gerring [ 35 ], case studies come into their own with regard to invariant or strong causal claims (such as X is a necessary and/or sufficient condition for Y) rather than for probabilistic causal claims. For the latter (where experimental methods might have an advantage in estimating effect sizes), case studies offer evidence on mechanisms: from observations of X affecting Y, from process tracing or from pattern matching. Case studies also support the study of emergent causation, that is, the multiple interacting properties that account for particular and unexpected outcomes in complex systems, such as in healthcare [ 8 ].

Finally, efficacy (or beliefs about efficacy) is not the only contributor to intervention uptake, with a range of organisational and policy contingencies affecting whether an intervention is likely to be rolled out in practice. Case study research is, therefore, invaluable for learning about contextual contingencies and identifying the conditions necessary for interventions to become normalised (i.e. implemented routinely) in practice [ 36 ].

The challenges in exploiting evidence from case study research

At present, there are significant challenges in exploiting the benefits of case study research in evaluative health research, which relate to status, definition and reporting. Case study research has been marginalised at the bottom of an evidence hierarchy, seen to offer little by way of explanatory power, if nonetheless useful for adding descriptive data on process or providing useful illustrations for policymakers [ 37 ]. This is an opportune moment to revisit this low status. As health researchers are increasingly charged with evaluating ‘natural experiments’—the use of face masks in the response to the COVID-19 pandemic being a recent example [ 38 ]—rather than interventions that take place in settings that can be controlled, research approaches using methods to strengthen causal inference that does not require randomisation become more relevant.

A second challenge for improving the use of case study evidence in evaluative health research is that, as we have seen, what is meant by ‘case study’ varies widely, not only across but also within disciplines. There is indeed little consensus amongst methodologists as to how to define ‘a case study’. Definitions focus, variously, on small sample size or lack of control over the intervention (e.g. [ 39 ] p194), on in-depth study and context [ 40 , 41 ], on the logic of inference used [ 35 ] or on distinct research strategies which incorporate a number of methods to address questions of ‘how’ and ‘why’ [ 42 ]. Moreover, definitions developed for specific disciplines do not capture the range of ways in which case study research is carried out across disciplines. Multiple definitions of case study reflect the richness and diversity of the approach. However, evidence suggests that a lack of consensus across methodologists results in some of the limitations of published reports of empirical case studies [ 43 , 44 ]. Hyett and colleagues [ 43 ], for instance, reviewing reports in qualitative journals, found little match between methodological definitions of case study research and how authors used the term.

This raises the third challenge we identify that case study reports are typically not written in ways that are accessible or useful for the evaluation research community and policymakers. Case studies may not appear in journals widely read by those in the health sciences, either because space constraints preclude the reporting of rich, thick descriptions, or because of the reported lack of willingness of some biomedical journals to publish research that uses qualitative methods [ 45 ], signalling the persistence of the aforementioned evidence hierarchy. Where they do, however, the term ‘case study’ is used to indicate, interchangeably, a qualitative study, an N of 1 sample, or a multi-method, in-depth analysis of one example from a population of phenomena. Definitions of what constitutes the ‘case’ are frequently lacking and appear to be used as a synonym for the settings in which the research is conducted. Despite offering insights for evaluation, the primary aims may not have been evaluative, so the implications may not be explicitly drawn out. Indeed, some case study reports might properly be aiming for thick description without necessarily seeking to inform about context or causality.

Acknowledging plurality and developing guidance

We recognise that definitional and methodological plurality is not only inevitable, but also a necessary and creative reflection of the very different epistemological and disciplinary origins of health researchers, and the aims they have in doing and reporting case study research. Indeed, to provide some clarity, Thomas [ 46 ] has suggested a typology of subject/purpose/approach/process for classifying aims (e.g. evaluative or exploratory), sample rationale and selection and methods for data generation of case studies. We also recognise that the diversity of methods used in case study research, and the necessary focus on narrative reporting, does not lend itself to straightforward development of formal quality or reporting criteria.

Existing checklists for reporting case study research from the social sciences—for example Lincoln and Guba’s [ 47 ] and Stake’s [ 33 ]—are primarily orientated to the quality of narrative produced, and the extent to which they encapsulate thick description, rather than the more pragmatic issues of implications for intervention effects. Those designed for clinical settings, such as the CARE (CAse REports) guidelines, provide specific reporting guidelines for medical case reports about single, or small groups of patients [ 48 ], not for case study research.

The Design of Case Study Research in Health Care (DESCARTE) model [ 44 ] suggests a series of questions to be asked of a case study researcher (including clarity about the philosophy underpinning their research), study design (with a focus on case definition) and analysis (to improve process). The model resembles toolkits for enhancing the quality and robustness of qualitative and mixed-methods research reporting, and it is usefully open-ended and non-prescriptive. However, even if it does include some reflections on context, the model does not fully address aspects of context, logic and causal inference that are perhaps most relevant for evaluative research in health.

Hence, for evaluative research where the aim is to report empirical findings in ways that are intended to be pragmatically useful for health policy and practice, this may be an opportune time to consider how to best navigate plurality around what is (minimally) important to report when publishing empirical case studies, especially with regards to the complex relationships between context and interventions, information that case study research is well placed to provide.

The conventional scientific quest for certainty, predictability and linear causality (maximised in RCT designs) has to be augmented by the study of uncertainty, unpredictability and emergent causality [ 8 ] in complex systems. This will require methodological pluralism, and openness to broadening the evidence base to better understand both causality in and the transferability of system change intervention [ 14 , 20 , 23 , 25 ]. Case study research evidence is essential, yet is currently under exploited in the health sciences. If evaluative health research is to move beyond the current impasse on methods for understanding interventions as interruptions in complex systems, we need to consider in more detail how researchers can conduct and report empirical case studies which do aim to elucidate the contextual factors which interact with interventions to produce particular effects. To this end, supported by the UK’s Medical Research Council, we are embracing the challenge to develop guidance for case study researchers studying complex interventions. Following a meta-narrative review of the literature, we are planning a Delphi study to inform guidance that will, at minimum, cover the value of case study research for evaluating the interrelationship between context and complex system-level interventions; for situating and defining ‘the case’, and generalising from case studies; as well as provide specific guidance on conducting, analysing and reporting case study research. Our hope is that such guidance can support researchers evaluating interventions in complex systems to better exploit the diversity and richness of case study research.

Availability of data and materials

Not applicable (article based on existing available academic publications)

Abbreviations

Qualitative comparative analysis

Quasi-experimental design

Randomised controlled trial

Diez Roux AV. Complex systems thinking and current impasses in health disparities research. Am J Public Health. 2011;101(9):1627–34.

Article   Google Scholar  

Ogilvie D, Mitchell R, Mutrie N, M P, Platt S. Evaluating health effects of transport interventions: methodologic case study. Am J Prev Med 2006;31:118–126.

Walshe C. The evaluation of complex interventions in palliative care: an exploration of the potential of case study research strategies. Palliat Med. 2011;25(8):774–81.

Woolcock M. Using case studies to explore the external validity of ‘complex’ development interventions. Evaluation. 2013;19:229–48.

Cartwright N. Are RCTs the gold standard? BioSocieties. 2007;2(1):11–20.

Deaton A, Cartwright N. Understanding and misunderstanding randomized controlled trials. Soc Sci Med. 2018;210:2–21.

Salway S, Green J. Towards a critical complex systems approach to public health. Crit Public Health. 2017;27(5):523–4.

Greenhalgh T, Papoutsi C. Studying complexity in health services research: desperately seeking an overdue paradigm shift. BMC Med. 2018;16(1):95.

Bonell C, Warren E, Fletcher A. Realist trials and the testing of context-mechanism-outcome configurations: a response to Van Belle et al. Trials. 2016;17:478.

Pallmann P, Bedding AW, Choodari-Oskooei B. Adaptive designs in clinical trials: why use them, and how to run and report them. BMC Med. 2018;16:29.

Curran G, Bauer M, Mittman B, Pyne J, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012;50(3):217–26. https://doi.org/10.1097/MLR.0b013e3182408812 .

Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, et al. Process evaluation of complex interventions: Medical Research Council guidance. BMJ. 2015 [cited 2020 Jun 27];350. Available from: https://www.bmj.com/content/350/bmj.h1258 .

Evans RE, Craig P, Hoddinott P, Littlecott H, Moore L, Murphy S, et al. When and how do ‘effective’ interventions need to be adapted and/or re-evaluated in new contexts? The need for guidance. J Epidemiol Community Health. 2019;73(6):481–2.

Shoveller J. A critical examination of representations of context within research on population health interventions. Crit Public Health. 2016;26(5):487–500.

Treweek S, Zwarenstein M. Making trials matter: pragmatic and explanatory trials and the problem of applicability. Trials. 2009;10(1):37.

Rosengarten M, Savransky M. A careful biomedicine? Generalization and abstraction in RCTs. Crit Public Health. 2019;29(2):181–91.

Green J, Roberts H, Petticrew M, Steinbach R, Goodman A, Jones A, et al. Integrating quasi-experimental and inductive designs in evaluation: a case study of the impact of free bus travel on public health. Evaluation. 2015;21(4):391–406.

Canguilhem G. The normal and the pathological. New York: Zone Books; 1991. (1949).

Google Scholar  

Hawe P, Shiell A, Riley T. Theorising interventions as events in systems. Am J Community Psychol. 2009;43:267–76.

King G, Keohane RO, Verba S. Designing social inquiry: scientific inference in qualitative research: Princeton University Press; 1994.

Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):581–629.

Yin R. Enhancing the quality of case studies in health services research. Health Serv Res. 1999;34(5 Pt 2):1209.

CAS   PubMed   PubMed Central   Google Scholar  

Raine R, Fitzpatrick R, Barratt H, Bevan G, Black N, Boaden R, et al. Challenges, solutions and future directions in the evaluation of service innovations in health care and public health. Health Serv Deliv Res. 2016 [cited 2020 Jun 30];4(16). Available from: https://www.journalslibrary.nihr.ac.uk/hsdr/hsdr04160#/abstract .

Craig P, Di Ruggiero E, Frohlich KL, E M, White M, Group CCGA. Taking account of context in population health intervention research: guidance for producers, users and funders of research. NIHR Evaluation, Trials and Studies Coordinating Centre; 2018.

Grant RL, Hood R. Complex systems, explanation and policy: implications of the crisis of replication for public health research. Crit Public Health. 2017;27(5):525–32.

Mahoney J. Strategies of causal inference in small-N analysis. Sociol Methods Res. 2000;4:387–424.

Turner S. Major system change: a management and organisational research perspective. In: Rosalind Raine, Ray Fitzpatrick, Helen Barratt, Gywn Bevan, Nick Black, Ruth Boaden, et al. Challenges, solutions and future directions in the evaluation of service innovations in health care and public health. Health Serv Deliv Res. 2016;4(16) 2016. https://doi.org/10.3310/hsdr04160.

Ragin CC. Using qualitative comparative analysis to study causal complexity. Health Serv Res. 1999;34(5 Pt 2):1225.

Hanckel B, Petticrew M, Thomas J, Green J. Protocol for a systematic review of the use of qualitative comparative analysis for evaluative questions in public health research. Syst Rev. 2019;8(1):252.

Schneider CQ, Wagemann C. Set-theoretic methods for the social sciences: a guide to qualitative comparative analysis: Cambridge University Press; 2012. 369 p.

Flyvbjerg B. Five misunderstandings about case-study research. Qual Inq. 2006;12:219–45.

Tsoukas H. Craving for generality and small-N studies: a Wittgensteinian approach towards the epistemology of the particular in organization and management studies. Sage Handb Organ Res Methods. 2009:285–301.

Stake RE. The art of case study research. London: Sage Publications Ltd; 1995.

Mitchell JC. Typicality and the case study. Ethnographic research: A guide to general conduct. Vol. 238241. 1984.

Gerring J. What is a case study and what is it good for? Am Polit Sci Rev. 2004;98(2):341–54.

May C, Mort M, Williams T, F M, Gask L. Health technology assessment in its local contexts: studies of telehealthcare. Soc Sci Med 2003;57:697–710.

McGill E. Trading quality for relevance: non-health decision-makers’ use of evidence on the social determinants of health. BMJ Open. 2015;5(4):007053.

Greenhalgh T. We can’t be 100% sure face masks work – but that shouldn’t stop us wearing them | Trish Greenhalgh. The Guardian. 2020 [cited 2020 Jun 27]; Available from: https://www.theguardian.com/commentisfree/2020/jun/05/face-masks-coronavirus .

Hammersley M. So, what are case studies? In: What’s wrong with ethnography? New York: Routledge; 1992.

Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach. BMC Med Res Methodol. 2011;11(1):100.

Luck L, Jackson D, Usher K. Case study: a bridge across the paradigms. Nurs Inq. 2006;13(2):103–9.

Yin RK. Case study research and applications: design and methods: Sage; 2017.

Hyett N, A K, Dickson-Swift V. Methodology or method? A critical review of qualitative case study reports. Int J Qual Stud Health Well-Being. 2014;9:23606.

Carolan CM, Forbat L, Smith A. Developing the DESCARTE model: the design of case study research in health care. Qual Health Res. 2016;26(5):626–39.

Greenhalgh T, Annandale E, Ashcroft R, Barlow J, Black N, Bleakley A, et al. An open letter to the BMJ editors on qualitative research. Bmj. 2016;352.

Thomas G. A typology for the case study in social science following a review of definition, discourse, and structure. Qual Inq. 2011;17(6):511–21.

Lincoln YS, Guba EG. Judging the quality of case study reports. Int J Qual Stud Educ. 1990;3(1):53–9.

Riley DS, Barber MS, Kienle GS, Aronson JK, Schoen-Angerer T, Tugwell P, et al. CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol. 2017;89:218–35.

Download references

Acknowledgements

Not applicable

This work was funded by the Medical Research Council - MRC Award MR/S014632/1 HCS: Case study, Context and Complex interventions (TRIPLE C). SP was additionally funded by the University of Oxford's Higher Education Innovation Fund (HEIF).

Author information

Authors and affiliations.

Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK

Sara Paparini, Chrysanthi Papoutsi, Trish Greenhalgh & Sara Shaw

Wellcome Centre for Cultures & Environments of Health, University of Exeter, Exeter, UK

Judith Green

School of Health Sciences, University of East Anglia, Norwich, UK

Jamie Murdoch

Public Health, Environments and Society, London School of Hygiene & Tropical Medicin, London, UK

Mark Petticrew

Institute for Culture and Society, Western Sydney University, Penrith, Australia

Benjamin Hanckel

You can also search for this author in PubMed   Google Scholar

Contributions

JG, MP, SP, JM, TG, CP and SS drafted the initial paper; all authors contributed to the drafting of the final version, and read and approved the final manuscript.

Corresponding author

Correspondence to Sara Paparini .

Ethics declarations

Ethics approval and consent to participate, consent for publication, competing interests.

The authors declare that they have no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Paparini, S., Green, J., Papoutsi, C. et al. Case study research for better evaluations of complex interventions: rationale and challenges. BMC Med 18 , 301 (2020). https://doi.org/10.1186/s12916-020-01777-6

Download citation

Received : 03 July 2020

Accepted : 07 September 2020

Published : 10 November 2020

DOI : https://doi.org/10.1186/s12916-020-01777-6

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Qualitative
• Case studies
• Mixed-method
• Public health
• Health services research
• Interventions

BMC Medicine

ISSN: 1741-7015

• Submission enquiries: [email protected]
• General enquiries: [email protected]

Research Methodology in Bioscience and Biotechnology

Research Mindset • Best Practices • Integrity • Publications • Societal Impact

• © 2023
• Kian Mau Goh 0

Faculty of Science, Universiti Teknologi Malaysia, Johor, Malaysia

You can also search for this author in PubMed   Google Scholar

Provides an overview of good research practices and mindsets

Shortens the learning curve for beginners in science writing and presentation

Underline the importance of research integrity and ethics despite the KPI pressure

1926 Accesses

1 Altmetric

This is a preview of subscription content, log in via an institution to check access.

Access this book

• Available as EPUB and PDF
• Read on any device
• Instant download
• Own it forever
• Durable hardcover edition
• Dispatched in 3 to 5 business days
• Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Other ways to access

Licence this eBook for your library

Institutional subscriptions

About this book

This monograph offers a comprehensive guide to good research practices and mindsets, covering a wide range of topics across 8  chapters. Readers will find numerous themes and strategies that can help them develop their research skills and achieve their objectives, from effective proposal writing to stress management and upskilling. This book explains the purpose, process, tips, and mistakes of writing proposals, theses, articles, and reviews in clear and straightforward language, allowing readers to develop good research plans. By applying the advice and insights offered in this book, students and researchers can improve the quality of their work, cultivate research integrity, and develop good publication plans, write well, and reduce rejection rates. Research outputs will be more likely to be of high quality if students and researchers are encouraged to cultivate these pieces of advice. The focus of the book is not solely on the outcomes of research. Rather, it also delves into mindset, habits, adaptability, time management, stress management, recent tools for upskilling, planning, and execution. Throughout the book, the author seeks to instill a growth mindset in the readers, encouraging them to develop positive research habits and behaviors. KPIs, particularly publications, shall not be used as a reason to erode research integrity and ethnicity; therefore, plagiarism, self-citation, falsifying data, exaggerating findings, authorship in publications, the use of AI tools, CRediT, and COPE are discussed. This book contains interviews with high-profile researchers, top management at institutions, policy advisers, etc., whose opinions and advice the readers will find valuable. Overall, this all-in-one guide is an essential resource for postgraduate students, post-doctoral fellows, and academics who are struggling to find a survival strategy in the rapidly changing research environment. The book assists readers in developing right mindset, planning their research and publications, and in achieving their predetermined objectives.

• Research methodology
• Journal publication
• Research proposal
• Thesis writing
• Good research practice
• Research integrity

Table of contents (8 chapters)

Front matter, science and philosophy.

Kian Mau Goh

Student’s Proposal, Dissertation, or Thesis

Research integrity and publication ethics, good research practices, publication 101, improving writing and presentation skills, lessons learned from nature’s reports, success can be learned, back matter, authors and affiliations, about the author.

Kian Mau Goh obtained his Bachelor's degree in Chemical-Bioprocess Engineering from the esteemed engineering faculty in Universiti Teknologi Malaysia (UTM) in 2002. After graduation, he gained invaluable experience as a research scientist at A*STAR/National University of Singapore for two years before returning to UTM to complete his PhD in Protein Engineering in 2007. His team focuses on extremophiles, primarily thermophiles and halophiles, and his research interests include protein engineering, enzymology, metataxonomics, and metagenomics, as well as microbial comparative genomics and transcriptomics.

Bibliographic Information

Book Title : Research Methodology in Bioscience and Biotechnology

Book Subtitle : Research Mindset • Best Practices • Integrity • Publications • Societal Impact

Authors : Kian Mau Goh

DOI : https://doi.org/10.1007/978-981-99-2812-5

Publisher : Springer Singapore

eBook Packages : Biomedical and Life Sciences , Biomedical and Life Sciences (R0)

Copyright Information : The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023

Hardcover ISBN : 978-981-99-2811-8 Published: 29 July 2023

Softcover ISBN : 978-981-99-2814-9 Due: 12 August 2024

eBook ISBN : 978-981-99-2812-5 Published: 28 July 2023

Edition Number : 1

Number of Pages : XXIII, 241

Number of Illustrations : 1 b/w illustrations

Topics : Plant Sciences , Biological Techniques , Biotechnology

• Publish with us

Policies and ethics

• Find a journal
• Track your research

430+ Research Methodology (RM) Solved MCQs

• Open access
• Published: 18 June 2024

Engaging a community to focus on upper limb function in people with multiple sclerosis: the ThinkHand campaign case study

• Alison Thomson 1 ,
• Rachel Horne 2 ,
• Christine Chapman 2 ,
• Trishna Bharadia 2 ,
• Patrick Burke 2 ,
• Elizabeth Colwell 2 ,
• Mark Harrington 2 ,
• Bonnie Boskovic 2 ,
• Andrea Stennett 1 , 4 ,
• David Baker 3 ,
• Gavin Giovannoni 1 , 3 , 4 &
• Klaus Schmierer 3 , 4  

Research Involvement and Engagement volume  10 , Article number:  62 ( 2024 ) Cite this article

10 Altmetric

Metrics details

Background: Solving complex research challenges requires innovative thinking and alternative approaches to traditional methods. One such example is the problem of arm and hand, or upper limb function in multiple sclerosis (MS), a neurological condition affecting approximately 2.9 million people worldwide and more than 150,000 in the United Kingdom. Historically, clinical trials and research have focused on mobility and walking ability. This excludes a large number of patients who are wheelchair users, limiting their quality of life and restricting access to possibly helpful medications. To address this issue, the ThinkHand campaign was launched in 2016, aiming to raise awareness about the importance of upper limb function in MS and develop alternative ways to measure, record, and account for hand and arm function changes.

Main body: The campaign utilised innovative strategies at scientific conferences and online surveys to engage people affected by MS, healthcare professionals, charities, and researchers in discussing the importance of preserving upper limb function. Through co-design and interdisciplinary collaboration, the campaign developed new tools like the low-cost cardboard version of the Nine-Hole Peg Test, facilitating remote monitoring of hand function. Additionally, the campaign co-created the “Under & Over” rehabilitation tool, allowing individuals with advanced MS to participate in a remote rehabilitation program.

The impact of the ThinkHand campaign has been significant, helping to shift the focus of both academic and industry-supported trials, including the O’HAND and ChariotMS trials, both using upper limb function as their primary end point. The campaign’s patient-centred approach highlighted the importance of recognising patients’ perspectives in research and challenged established assumptions and practices. It demonstrated the effectiveness of interdisciplinary collaboration, systems thinking, and co-creation with stakeholders in tackling complex problems.

Conclusion: The ThinkHand campaign provides valuable insights for health research practices. By involving patients at all stages, researchers can gain a deeper understanding of the impact of disease on their lives, identify gaps and focus research on their needs. Experimentation and iteration can lead to innovative solutions, and openness to unconventional methods can drive widespread change. The ThinkHand campaign exemplifies the potential of patient-centred approaches to address complex research challenges and revolutionise the field of MS research and management. Embracing such approaches will contribute to more inclusive and impactful research in the future.

Plain English Summary

Solving complex research challenges requires creative thinking and new ways of doing things. One such challenge is understanding the problems with arm and hand function in multiple sclerosis (MS), a neurological condition that affects more than 150,000 in the United Kingdom. In the past, research focused mainly on walking ability, leaving out many people who use wheelchairs.

To tackle this issue, we created the ThinkHand campaign in 2016. Its goal was to raise awareness about the importance of hand and arm function for people with MS (pwMS) and find better ways to measure changes in these functions such that they can become outcomes in clinical trials. This could provide a pathway to better treatments for pwMS who cannot walk.

The campaign used various methods, including surveys, social media posts, exhibitions and music to involve pwMS, healthcare professionals, charities, and researchers in discussions about the issues. Working together, they created tools to support pwMS, particularly those at an advanced stage of the disease (pwAMS), to take part in research and measure their hand and arm function. Through our collaborative approach focusing on patients’ perspectives, the campaign challenged old ideas and deeply embedded practices. It showed that collaboration between different areas of expertise involving pwMS at all stages of research can help solve complex problems. This campaign teaches us valuable lessons for health research. When researchers listen to patients and try new things, they can better understand how a disease affects people’s lives and develop better solutions.

In conclusion, we show how embracing a patient-centred approach can address complex research challenges and improve how we study and manage MS and other conditions in the future.

Peer Review reports

Solving complex research challenges requires innovative thinking and alternative approaches to traditional methods. One such example is the problem of arm and hand, or upper limb function, in multiple sclerosis (MS), a neurological condition affecting approximately 2.9 million people worldwide and more than 150,000 in the United Kingdom (UK) [ 1 , 2 ]. The historical focus on mobility and walking ability, dominated by lower limb function, in clinical trials and research, has potentially negative implications on the quality of life of some individuals with MS, particularly in the more advanced stages. Indeed, there is also evidence to suggest that some newly diagnosed people with MS (pwMS) present with upper limb impairment which increases in severity over time [ 3 , 4 ]. Yet, the focus on lower limb function has meant that, historically, the vast majority of trials have excluded patients who are wheelchair users [ 5 ]. The main reason for this understanding was that treatment would not be beneficial given the nature of the condition in these individuals since its usefulness was being measured by improvement in lower limb function [ 6 ]. This means that to date, MS disease-modifying treatments (DMTs) had only been licensed if they improve walking ability. To address this problem, our group launched the ThinkHand campaign in 2016. The key aims were set out and made public to raise awareness about the importance of upper limb function in MS, the socioeconomic costs of losing upper limb function and to develop alternative ways to measure, record, and account for the change in hand and arm function in the everyday lives of people with MS.

The early and innovative contribution of people with MS in this project and the creative methods used, enabled the ThinkHand campaign to successfully bring this “wicked problem” to the fore, while having a long-lasting impact on the field of MS research and management. “Wicked” because of its (i) bias and exclusion of a large number of pwMS from MS research participation opportunities and (ii) complexity and interrelated causes and consequences. “Wicked problems”, a term coined by Rittel and Webber [ 7 ] describes complex social problems that are difficult to solve due to their interrelated causes and consequences, the lack of a clear problem definition, the presence of multiple stakeholders with conflicting values and goals, and the unpredictable nature of their evolution. These problems often defy traditional problem-solving approaches and require novel, innovative, and collaborative solutions that address the underlying systemic issues. In the case of the ThinkHand campaign, it also required pathophysiological underpinning, which was achieved through hypothesis-generating and supporting, preliminary evidence [ 8 , 9 , 10 ]. The multi-faceted and unpredictable nature of MS and its impact on upper limb function makes it difficult to measure and track effectively. This issue is also interconnected with other factors such as walking ability, cognition, quality of life, employability, and daily living activities, adding to its complexity. The lack of consensus among stakeholders, including patients, healthcare providers, researchers, and policymakers, on the most effective ways to measure and track upper limb function in MS also makes it challenging to find a comprehensive solution.

The aim of this case study is to document the impact of the ThinkHand campaign and demonstrate the potential for patient-centred approaches to address complex issues in health research. The article highlights the importance of recognising that traditional methods of knowledge dissemination and mobilisation within science and academia have limited reach and impact, and that alternative methods from disciplines such as art and design can open up a topic for debate, invite people with lived experience of MS to challenge assumptions and ultimately change clinical and research practice. The article also highlights the importance of actively involving patients, their families, and members of the public in the design, conduct, and dissemination of research activities, which is now considered best practice in the UK. This can take many forms, such as patient advisory groups, patient representatives on research teams, and patient-led research projects. The goal of patient and public involvement (PPI) in research is to ensure that the needs, concerns, and perspectives of patients and the public are taken into account in the research process. ThinkHand demonstrates how through involving patients and the public, researchers can gain a deeper understanding of the impact of disease on their lives and where they want research to focus. Further, it demonstrates how engaging people living with the conditions can help tackle “wicked problems” and in turn change a field of research.

The problem within the field

The decision to raise awareness about the importance of hand and arm function in MS stemmed from the realisation that clinical trials had shown that DMTs in individuals with advanced stages of MS can still delay the worsening of disability in hand function, despite having little to no impact on leg function. The effect on hand function was observed in trials where it had been employed as a secondary endpoint. This is a problem if the only outcome measure is around walking ability, as measured by the Expanded Disability Status Scale (EDSS) [ 11 , 12 ]. This observation has been reported in neurology literature dating back to the early 1990s but has not been acted on by the MS community. In light of this, the research team at QMUL and Barts Health NHS Trust revisited a model previously – and ironically – suggested by John Kurtzke [ 13 ], the inventor of the EDSS, to describe progressive MS as a “length-dependent central nervous system axonopathy” [ 8 ]. This model suggests that the longer the nerve fibres, the more likely they are affected to a functionally relevant degree by MS lesions and, ultimately, die off. This is why progressive MS symptoms are often seen first in the legs, as the nerve fibres supplying the legs are longer than those to the arms. This concept is key to testing whether people with advanced MS using wheelchairs can still expect improvements in hand and arm function.

Through responsive and meaningful patient involvement, the ThinkHand campaign aimed to raise awareness and initiate discussions among people with MS, clinicians, charities, pharmaceutical companies, and regulators about the importance of preserving upper limb function for people with more advanced MS. The campaign outlined specific goals to impact [ 1 ] trials in more advanced MS to include wheelchair users [ 2 ], regulators to accept the Nine-Hole Peg Test (9HPT) as a primary outcome measure for phase 3 trials [ 3 ], treatments for people with more advanced MS (wheelchair users) to protect arm and hand function and [ 4 ] evidence-based stopping criteria for DMTs.

How we addressed the issue

The method used in the campaign, shown in Fig.  1 , was a multi-pronged approach that involved online surveys, disruptive strategies at scientific conferences, awareness events, and co-design of outcome measurement and rehabilitation tools. The following provides further details of the methods used:

Online Surveys : Online surveys were conducted through The MS Research blog [ 14 ] to gather data on the importance of hand and arm function in daily life for individuals with advanced MS and the attitudes of healthcare professionals towards including such individuals in research studies.

Social Media : explanatory videos documenting the pathway to ChariotMS trial [ 15 ].

Innovative Strategies : To disseminate the knowledge obtained from the online surveys and encourage discussion around the issue, unconventional activities were employed at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) conference in 2016. These included researchers constructing their research poster out of cardboard using their own hands emphasising the importance of hand function and inviting people with MS to contribute to a “Burning Debate” session on the inclusion of wheelchair users in MS clinical trials.

Awareness Event : The campaign organised a ThinkHand awareness event in London, which celebrated the hand function of artists, musicians, and a renowned jewellery maker, all living with MS. The aim of the event was to highlight the impact of hand and arm function on self-expression, livelihood, creativity, and independence.

Low-Cost Assessment Tool : The 9HPT is an outcome measure used to measure finger dexterity and arm function and is considered the gold standard for assessing upper limb function in people with MS in clinical trials. Because the commercial apparatus, made of plastic, is quite expensive (around GBP105), we created a low-cost (GBP9.99), environmentally friendly version for people to use at home so they could monitor their arm and hand function themselves. The cardboard tool was exhibited at ECTRIMS 2017 and an academic publication detailing its validation was produced [ 16 ].

Co-Design of Rehabilitation Tool : The focus on patient-generated knowledge in the campaign led to the co-design of a hand rehabilitation tool “Under & Over” with individuals living with MS. A randomised controlled study was conducted to assess the delivery of a remote rehabilitation program to individuals with advanced MS [ 17 ].

Workflow diagram of the stages of the campaign

Role of patient engagement

The MS Research group at QMUL has a long-standing PPI group and a track record of engaging people at all stages of research development [ 18 , 19 , 20 , 21 ]. Clinical academics and researchers within the group successfully use a range of social media platforms within their PPI and engagement work, which became crucial in this campaign. The established PPI group, along with a number of other people with MS (co-authors on this paper and listed in the acknowledgements) contributed to the formulation of how to tackle the wicked problem, contributing their personal experiences and personal insights of the issue. For example, people were sharing experiences such as, “Now that I’m in a wheelchair, my hands have become my legs.”

Online survey

This led to the campaign initiating a series of online surveys [ 6 ]. These were conducted through The MS Research Blog, which had a daily readership of 9,000 individuals. The surveys invited people with advanced MS to share the importance of hand and arm function in their daily lives and healthcare professionals to share their attitudes towards including individuals with advanced MS in research studies. 360 people with MS and 43 MS Neurologists responded to the surveys. The findings revealed that 92% of respondents (321/349) placed greater importance on their upper limb function compared to lower limb function, and 95% (332/350) felt that pwMS using wheelchairs should not be excluded from DMT trials. At the same time, 75% of UK MS Neurologists (32/43) said that they regularly stop prescribing DMTs in pwMS who need a wheelchair, even though 61% (26/43) felt that currently available DMTs were likely still effective even at this stage of the disease. The results of these surveys focused the ThinkHand campaign efforts on changing perceptions of the problem. The team needed to go beyond traditional methods of communication and knowledge dissemination to illustrate the impact of these issues on a larger scale.

Innovative strategies and social media

The cardboard poster presented at ECTRIMS conference 2017, being made by poster authors by hand

To do this, they employed disruptive strategies at a clinical academic conference in 2017 to draw attention to the survey results and the wider issue. ECTRIMS is the largest worldwide conference dedicated to understanding and treating MS and is attended by thousands of MS specialist healthcare professionals, researchers, and pharmaceutical companies. The survey results were created by hand by the authors into a poster made of cardboard to emphasise the importance of hand function in daily life (Fig.  2 ). The team also hosted a “Burning Debate” on the inclusion of wheelchair users in clinical trials, utilising the survey data and with a backdrop of inflatable numbers (see Fig.  3 ) to support the argument. The balloons displayed the number “95%,” representing the data and indicating the percentage of survey respondents who believe that people with MS using wheelchairs should not be excluded from progressive trials. People with MS were invited to the conference debate through Twitter (now X), where they contributed comments on the discussion (see Fig.  3 ). These activities brought attention to the issue with conference participants engaging in these activities and reflecting on their own assumptions and approaches about managing and researching upper limb function for the people they research and treat. Unconventional elements such as balloons and handmade posters were used to creatively emphasise critical issues at the academic conference, disrupting traditional approaches. Additionally, involving people with MS in the debate through social media challenged assumptions and brought a fresh perspective to the discussion.

Professor Klaus Schmierer taking part in the Burning Debate and Twitter commentary from patients

Awareness event

The ThinkHand exhibition was crucial to raising awareness about the impact of hand and arm function on key aspects of life such as self-expression, livelihood, and creativity. The exhibition showcased work of artists, musicians, and a renowned jewellery maker who have MS. The aim was to communicate the human aspect of upper limb function and its link to one’s identity. It was held in London on February 22nd 2018 and engaged funders, regulators, and researchers to reflect on this issue. It was covered by the Evening Standard [ 22 ] and various multimedia channels within the MS community [ 23 , 24 , 25 , 26 ].

Low-cost assessment tool

The cardboard 9 Hole Peg Test. Image credit: The Agency of Design

The 9HPT is a widely used tool for evaluating upper limb function and is a standard method in MS clinical trials [ 27 , 28 ]. However, the standard 9HPT apparatus made of plastic is costly and the test usually administered by a clinician, limiting its access for patients to monitor their upper limb function themselves. To address these limitations, the ThinkHand campaign developed a low-cost cardboard version of the test (Fig.  4 ). This innovative measure was designed and produced by the campaign team, in collaboration with a design consultancy The Agency of Design, and was validated through an academic publication [ 16 ]. This low-cost and easily accessible cardboard 9HPT provides an alternative measure for upper limb function, making it more widely available to researchers and clinicians working in the field of MS. It was distributed to 12,000 delegates at the ECTRIMS conference and quickly became a success, receiving requests from around the world for its use in remote monitoring of hand function in patients and clinical and research teams.

Co-design of a rehabilitation tool

After the international distribution and use of the cardboard 9HPT, the team received feedback that patients were using the tool more regularly than intended. Some were using it multiple times a week to see if they could improve on their time, ultimately using it like a rehabilitation tool. This supported other patient feedback the team had received from earlier qualitative work, where people with MS used everyday activities and objects to monitor changes in their hand and arm function at home. Anecdotes of using the ability to scrape a yoghurt pot clean every morning at breakfast to varying degrees of success would tell one person what their hand and arm function was like that day. This became a design-led exploration of alternative ways to measure, record and account for people’s experiences of change in hand and arm function in everyday life. Key to this design process was reviewing existing upper limb rehabilitation tools for both MS and other conditions, then including insights from patients about how they engaged with the c9HPT tool at home (Fig.  5 ).

A photograph of the Under and Over rehabilitation tool. Image credit: The Agency of Design

The resulting tool, Under & Over, is a plastic board with two strings that people can thread to create a range of patterns. This tool was formally assessed in a remote study with a 12-week rehabilitation programme. The study found that a small, engaged, and motivated group of individuals with advanced MS were able to complete a remote rehabilitation program [ 17 ]. The study was the first fully remote study examining the effect of a targeted upper limb rehabilitation tool and demonstrates the feasibility and acceptability of delivering a remote program to individuals with advanced MS.

Campaign success

The ThinkHand campaign contributed to several notable outcomes in the field of MS research and management. The campaign received financial support from private donors, commercial and government agencies which allocated resources towards the study of upper limb function in people with MS. Our activities contributed to the development of two clinical trials with emphasis on people with more advanced MS with upper limb function measured using the nine-hole-peg test as their primary outcome measures. (i) An international trial to assess ocrelizumab in people with primary progressive MS (O’HAND Study, NCT04035005), of which one of the co-authors (Giovannoni) became the principal investigator. (ii) A UK-wide trial called ChariotMS (NCT04695080), which focusses entirely on pwMS who are wheelchair users. From its inception, ChariotMS has been co-created and managed with PPIE input. The trial, testing cladribine tablets in pwMS with an EDSS between 6.5 and 8.5 is being supported by three charities (MS Society UK, National MS Society US, Barts Charity), the National Institute for Health and Care Research (NIHR) EME-Programme, and an industry partner (Merck Healthcare). If successful, both ChariotMS and O’HAND could lead to the first MS drug(s) licensed to protect upper limb function, including in pwMS who have so far been completely excluded from participating in MS DMT trials. With two trials underway that were facilitated by our campaign, the team won in 2019 the Influence Award in the public engagement award ceremony of the QMUL Centre for Public Engagement.

While the ThinkHand campaign aimed to address an important unmet need in the MS community, some pwMS expressed resistance to being regularly reminded of the limitations imposed by their condition. Similarly, some researchers and professionals in the field of MS found the campaign’s approach to be challenging to established perspectives and dogmas. This type of resistance to new ideas and perspectives is not uncommon in any field of research, as new ideas often challenge established views and can take time to gain acceptance [ 29 ]. Despite the slightly mixed reception, the ThinkHand campaign has had a lasting impact on the field of MS research and management and has provided patients with an innovative and independent method for monitoring their upper limb function.

Learnings for practice

Through the experience of working with people with MS in creative practices of engagement and involvement, valuable insights emerge, offering significant learnings for practice that enable researchers to effectively tackle complex problems within clinical and research settings in new ways.

Interdisciplinary collaboration

The campaign was an interdisciplinary collaboration, harnessing the collective expertise of multiple fields to tackle the complex and multifaceted nature of the so-called wicked problem. For example, the project involved collaboration between experts in areas such as lived experience, medicine, clinical research, design research, and social sciences to address the challenge at hand. This interdisciplinary approach not only facilitated a holistic understanding of the issue but also promoted innovative and creative exploration. Unlike approaches confined to a single field, the campaign benefited from a range of accountabilities and was not bound by the constraints of any singular research methodology. This flexibility allowed the project to employ diverse methods from various disciplines, enabling a more creative and responsive process.

Systems thinking

The project used systems thinking to understand the interconnectedness of different components of the problem and how they influence each other. This approach was used to identify the root causes of lack of change in the field and design interventions that address these holistically. The impact of this has long lasting benefits for people with MS. For example, the cardboard 9HPT tool addressed health access issues brought about during the Covid-19 pandemic where the Neurology service at The Royal London Hospital used it as a remote test to monitor patients when they were unable to see them in person [ 30 , 31 ].

Co-creation with multiple stakeholders

The project involved co-creation with stakeholders, including people with MS, funders, charities, regulators, health care professionals and researchers to ensure that interventions were relevant and feasible. The project used participatory methods, such as co-design, to gather input and build engagement from these stakeholders. For example, the project engaged with people with advanced MS to understand exactly how they generate information on their hand function at home and used this to develop the Under & Over tool that could align with their needs and values.

Experimentation and iteration

The project used an experimental and iterative approach, testing and refining interventions based on reflections and feedback from multiple audiences. This approach allowed the project to learn from failures, improve upon successful ideas and approaches, and continuously adapt to changing circumstances. For example, the team kept a commentary of the campaign on the MS Research Blog, engaging readers on the development of the campaign and sharing problems, challenges and developments, such as the ChariotMS trial. The project did not follow a traditional research process. The team had a practical understanding of the problem that guided activities while responding to iterative feedback from people with MS. In this way, it was not restricted to a predetermined process that could have limited aspects of its responsiveness.

In summary, we have described the innovative approach undertaken by our team in the ThinkHand campaign, addressing the complex issue of upper limb function in pwMS. By actively involving patients in the process, the campaign not only raised awareness about the importance of upper limb function in MS but also contributed to the development of innovative ways to measure, record, and account for the change in hand and arm function in the everyday lives of people with MS. This has had a long-lasting influence on the field of MS research and management.

Moreover, the campaign underscores the immense potential of a patient-centred approach when grappling with complex issues in health research. By fostering openness, transparency, and honest discussions, patients were empowered to contribute and influence the trajectory of the project actively. This powerful impact of sustained patient engagement and involvement practices cannot be overstated.

The campaign’s realisation that traditional methods of communication and knowledge dissemination are inadequate for driving widespread change further emphasises the crucial lessons learned from involvement and engagement. Through these lessons, we recognise the necessity of working with more dynamic, engaging, and creative methods to comprehend the significance of this issue truly.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

Queen Mary University of London

patient public involvement

disease-modifying treatments

• Multiple Sclerosis

Nine-Hole Peg Test

Cardboard Nine-Hole Peg Test

European Committee for Treatment and Research in Multiple Sclerosis

Walton C, King R, Rechtman L, Kaye W, Leray E, Marrie RA, et al. Rising prevalence of multiple sclerosis worldwide: insights from the Atlas of MS, third edition. Mult Scler. 2020;26(14):1816–21.

Article   PubMed   PubMed Central   Google Scholar  

Society MS, MS Society. 2020 [cited 2020 Jun 22]. MS in the UK. www.mssociety.org.uk/what-we-do/our-work/our-evidence/ms-in-the-uk .

Kister I, Kantarci OH. Multiple sclerosis severity score: concept and applications. Mult Scler. 2020;26(5):548–53.

Article   PubMed   Google Scholar  

Corrini C, Gervasoni E, Perini G, Cosentino C, Putzolu M, Montesano A, et al. Mobility and balance rehabilitation in multiple sclerosis: a systematic review and dose-response meta-analysis. Multiple Scler Relat Disorders. 2023;69:104424.

Article   Google Scholar  

Leray E, Yaouanq J, Le Page E, Coustans M, Laplaud D, Oger J, et al. Evidence for a two-stage disability progression in multiple sclerosis. Brain. 2010;133(7):1900–13.

Dubuisson N, Baker D, Thomson A, Marta M, Gnanapavan S, Turner B, et al. Disease modification in advanced MS: focus on upper limb function. Mult Scler. 2017;23(14):1956–7.

Rittel HWJ, Webber MM. Dilemmas in a general theory of planning. Policy Sci. 1973;4(2):155–69.

Giovannoni G, Cutter G, Sormani MP, Belachew S, Hyde R, Koendgen H, et al. Is multiple sclerosis a length-dependent central axonopathy? The case for therapeutic lag and the asynchronous progressive MS hypotheses. Multiple Scler Relat Disorders. 2017;12:70–8.

Mao Z, Álvarez-González C, Allen-Philbey K, De Trane S, Yildiz O, Campion T, et al. Treating the ineligible: disease modification in people with multiple sclerosis beyond NHS England commissioning policies. Multiple Scler Relat Disorders. 2019;27:247–53.

Allen-Philbey K, De Trane S, Mao Z, Álvarez-González C, Mathews J, MacDougall A, et al. Subcutaneous cladribine to treat multiple sclerosis: experience in 208 patients. Ther Adv Neurol Disord. 2021;14:17562864211057661.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983;33(11):1444–1444.

Article   CAS   PubMed   Google Scholar  

Schwid SR, Goodman AD, Mattson DH, Mihai C, Donohoe KM, Petrie MD, et al. The measurement of ambulatory impairment in multiple sclerosis. Neurology. 1997;49(5):1419–24.

Kurtzke JF. On the origin of EDSS. Multiple Scler Relat Disorders. 2015;4(2):95–103.

Giovannoni G. ThinkHand: what iconic image captures hand function best? [Internet]. Barts MS Blog. 2016 [cited 2016 Feb 11]. http://multiple-sclerosis-research.blogspot.com/2016/07/thinkhand-what-iconic-image-captures.html .

#ChariotMS 6Aug2021 FIRST PATIENT IN [Internet]. 2021 [cited 2023 Nov 13]. https://www.youtube.com/watch?v=iefmYRH7vBg .

Dubuisson N, Bauer A, Buckley M, Gilbert R, Paterson A, Marta M, et al. Validation of an environmentally-friendly and affordable cardboard 9-hole peg test. Multiple Scler Relat Disorders. 2017;17:172–6.

Thomson A, Stennett A, Metin C, Bestwick J, Giovannoni G, Dobson R. Under & over: a randomised controlled study to develop an upper limb rehabilitation tool for people with multiple sclerosis. Multiple Scler Relat Disorders. 2024;85:105529.

Baker D, Pepper G, Yauner F, Giovannoni G. MSer – a new, neutral descriptor for someone with multiple sclerosis. Multiple Scler Relat Disorders. 2014;3(1):31–3.

Thomson A, Rivas C, Giovannoni G. Multiple sclerosis outpatient future groups: improving the quality of participant interaction and ideation tools within service improvement activities. BMC Health Serv Res. 2015;15(1):105.

Thomson A, Raciborska D, Baker D, Giovannoni G. How to start a blog. Pract Neurol. 2017;17(3):224–8.

Thomson A. Working with patient experience. In: The Routledge Companion to Design Research [Internet]. 2nd ed. London: Routledge; 2023 [cited 2023 Jul 20]. pp. 363–77. https://www.taylorfrancis.com/books/9781003182443/chapters/ https://doi.org/10.4324/9781003182443-32 .

Lydall R, Evening S. 2018 [cited 2023 Jul 22]. Lift drugs ban on MS patients who can no longer walk, say doctors | London Evening Standard | Evening Standard. https://www.standard.co.uk/news/health/lift-drugs-ban-on-ms-patients-who-can-no-longer-walk-say-doctors-a3772906.html .

Trust MS. MS Trust. 2018 [cited 2023 Aug 8]. Why we should be ‘thinking hand’. https://mstrust.org.uk/news/why-we-should-be-thinking-hand .

Staines Rpharmaphorum. 2018 [cited 2023 Aug 8]. #ThinkHand campaign aims to change MS perceptions. https://pharmaphorum.com/news/ms-drugs-needed-preserve-hand-function .

Official launch of the #ThinkHand campaign [Internet]. 2018 [cited 2023 Aug 8]. https://www.youtube.com/watch?v=U0HLSq3nzHQ .

Bharadia T. #ThinkHand campaign could be a game-changer [Internet]. talkhealth Blog. 2018 [cited 2023 Aug 8]. https://www.talkhealthpartnership.com/blog/2018/04/thinkhand-campaign-game-changer/ .

Oxford Grice K, Vogel KA, Le V, Mitchell A, Muniz S, Vollmer MA. Adult norms for a commercially available nine Hole Peg Test for finger dexterity. Am J Occup Ther. 2003;57(5):570–3.

Solaro C, Cattaneo D, Brichetto G, Castelli L, Tacchino A, Gervasoni E, et al. Clinical correlates of 9-hole peg test in a large population of people with multiple sclerosis. Mult Scler Relat Disord. 2019;30:1–8.

Rogers EM. Diffusion of innovations. 1st Edition. New York: The Free Press of Glencoe; 1962.

Google Scholar  

Kuri A, Jacobs BM, Leddy S, Schmierer K, Turner B, Allen-Philbey K, et al. Evaluation of remote assessments for multiple sclerosis in an in-home setting. Multiple Scler Relat Disorders. 2021;54:103125.

Stennett A, Allen-Philbey K, Begum T, Johnson A, Dobson R, Giovannoni G et al. An evaluation of remote monitoring in people with MS during the COVID-19 pandemic. Multiple Scler J. 2021;268–9.

Download references

Acknowledgements

We sincerely thank all PPI co-authors for their enthusiastic and invaluable contributions to this project and in shaping the manuscript with their valuable insights. Thank you to the Barts MS Patient Advisory Group members and The MS Research Blog readers for enriching our understanding through their shared experiences and thoughts. We greatly thank Christine Chapman for her exceptional dedication to the ChariotMS study and related activities.

We express our gratitude to Ondrej Rypacek, Kishon Khan, and Romilly Saumarez Smith for their active participation in the exhibition, significantly enhancing its impact. Finally, our sincere appreciation to go to the study participants in the Measurement on Our Terms, Under & Over and ChariotMS studies and the online survey respondents for their indispensable contributions to the campaign’s success.

The ThinkHand campaign and new upper limb patient-related outcome measure was funded by the Horne Family Foundation. The c9HPT and associated ECTRIMS 2016 stand was funded by Biogen. The Under & Over study, O’HAND study (NCT04035005) and the ECTRIMS 2018 booth were funded by Roche. ChariotMS (NCT04695080) is funded by the Efficacy and Mechanism Evaluation (EME) Programme, an MRC and NIHR partnership (project reference 17/145/09). The views expressed in this publication are those of the author(s) and not necessarily those of the MRC, NIHR or the Department of Health and Social Care. ChariotMS receives further support from the MS Society UK, US National MS Society, Barts Charity and Merck Healthcare. We are also grateful for support from the Morris-Saady Charitable Trust and Lipomed GmbH during the preparation stage of ChariotMS.

Author information

Authors and affiliations.

Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, UK

Alison Thomson, Andrea Stennett & Gavin Giovannoni

Patient Author, Barts MS Advisory Group, Queen Mary University of London, London, UK

Rachel Horne, Christine Chapman, Trishna Bharadia, Patrick Burke, Elizabeth Colwell, Mark Harrington & Bonnie Boskovic

The Blizard Institute, Centre for Neuroscience, Surgery and Trauma, Queen Mary University of London, London, UK

David Baker, Gavin Giovannoni & Klaus Schmierer

Clinical Board Medicine (Neuroscience), Barts Health NHS Trust, The Royal London Hospital, London, UK

Andrea Stennett, Gavin Giovannoni & Klaus Schmierer

You can also search for this author in PubMed   Google Scholar

Contributions

The project’s concept and design were developed collaboratively by AT, KS, DB, GG, and the PPI co-authors. The manuscript was primarily drafted by AT who actively incorporated valuable insights from PPI co-authors. Early drafts were reviewed and commented on by AS, KS, DB, and GG. PB, EC, MH, CC, TB, and RH played pivotal roles in reviewing and providing an overview of the lived experience aspect of the project. All authors contributed to and approved the manuscript in its present form.

Corresponding author

Correspondence to Alison Thomson .

Ethics declarations

Ethical approval and consent to participate.

Online survey respondents received a link to the online survey, which informed them that completion of the electronic questionnaire implied that they had consented to participate in the survey.

Consent for publication

Not applicable.

Competing interests

AT: AT has received research support from The UK MS Society, Roche and honoraria from Novartis and Merck. RH: RH is part of the Horne Family Foundation. CC: None.TB: None.PB: None.EC: None.MH: None.BB: None.AS: None.DB: DB has received honoraria for consultancy from Merck, Novartis, Teva and Sandoz.KS: KS has received research support, through Queen Mary University of London, from Biogen, Merck KGaA, and Novartis, Roche and Sanofi-Genzyme, speaking honoraria from, and/or served in an advisory role for, Biogen, EMD Serono, IGES UK, Merck KGaA, Novartis, Roche, and Sanofi-Genzyme and Teva; and remuneration for teaching activities from AcadeMe, Medscape and the Neurology Academy.GG: In the last two years, GG has received compensation for serving as a consultant or speaker for or has received research support from Aurinia Pharmaceuticals, Biogen, BMS-Celgene, GlaxoSmithKline, Janssens/J&J, Japanese Tobacco, Merck KGaA/EMD Serono, Moderna, Novartis, Sandoz, Sanofi and Roche/Genentech.

AT is a design researcher and Senior Lecturer in PPIE at Queen Mary University of London. AT established and leads the Barts MS Patient Advisory Group and was the PI of the Under & Over study.

TB is an MS patient advocate and thought leader who provided ongoing support and advice as an ambassador for the ThinkHand campaign, particularly around engagement with the MS community.

CC lives with MS and is an Honorary Research Fellow (clinical trials patient communications) at the Blizard Institute.

RH, PB, MH, EC and BB live with MS and contributed as members of the Barts MS Patient Advisory Group to the development of ThinkHand activities and writing of this manuscript.

AS is a research neuro-physiotherapist at Barts Health NHS Trust and Honorary Clinical Lecturer at Queen Mary University of London and was involved in the Under & Over study.

KS is a Professor of Neurology and consultant neurologist. He is a Deputy Director of Clinical Research at QMUL & Barts Health NHS Trust, the Neurology Research lead, and the clinical lead of BartsMS. KS is the chief investigator of ChariotMS.

DB is a Professor of Immunology at Queen Mary University of London and is a frequent author of The MS Research Blog.

GG is a Professor of Neurology and MS consultant neurologist and runs the MS Selfie website.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Thomson, A., Horne, R., Chapman, C. et al. Engaging a community to focus on upper limb function in people with multiple sclerosis: the ThinkHand campaign case study. Res Involv Engagem 10 , 62 (2024). https://doi.org/10.1186/s40900-024-00586-y

Download citation

Received : 16 November 2023

Accepted : 18 May 2024

Published : 18 June 2024

DOI : https://doi.org/10.1186/s40900-024-00586-y

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Patient public involvement
• Public engagement
• Clinical trials
• Patient-centred
• Co-creation

Research Involvement and Engagement

ISSN: 2056-7529

• General enquiries: [email protected]

Information

• Author Services

Initiatives

You are accessing a machine-readable page. In order to be human-readable, please install an RSS reader.

All articles published by MDPI are made immediately available worldwide under an open access license. No special permission is required to reuse all or part of the article published by MDPI, including figures and tables. For articles published under an open access Creative Common CC BY license, any part of the article may be reused without permission provided that the original article is clearly cited. For more information, please refer to https://www.mdpi.com/openaccess .

Feature papers represent the most advanced research with significant potential for high impact in the field. A Feature Paper should be a substantial original Article that involves several techniques or approaches, provides an outlook for future research directions and describes possible research applications.

Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive positive feedback from the reviewers.

Editor’s Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Editors select a small number of articles recently published in the journal that they believe will be particularly interesting to readers, or important in the respective research area. The aim is to provide a snapshot of some of the most exciting work published in the various research areas of the journal.

Original Submission Date Received: .

• Active Journals
• Find a Journal
• Proceedings Series
• For Authors
• For Reviewers
• For Editors
• For Librarians
• For Publishers
• For Societies
• For Conference Organizers
• Open Access Policy
• Institutional Open Access Program
• Special Issues Guidelines
• Editorial Process
• Research and Publication Ethics
• Article Processing Charges
• Testimonials
• Preprints.org
• SciProfiles
• Encyclopedia

Article Menu

• Subscribe SciFeed
• Recommended Articles
• Google Scholar
• on Google Scholar
• Table of Contents

Find support for a specific problem in the support section of our website.

Please let us know what you think of our products and services.

Visit our dedicated information section to learn more about MDPI.

JSmol Viewer

Location-routing optimization for two-echelon cold chain logistics of front warehouses based on a hybrid ant colony algorithm.

1. Introduction

2. mathematical models, 2.1. problem description, 2.2. problem assumptions and notations, 2.3. the model of two-echelon low-carbon location-routing problem, 2.3.1. operating cost, 2.3.2. total fixed cost, 2.3.3. total transportation cost, 2.3.4. refrigeration cost, 2.3.5. cargo damage cost, 2.3.6. comprehensive carbon emission cost, 3. design of haco algorithm, 3.1. elbow rule, 3.2. improved ant colony optimization algorithm, 3.2.1. original ant colony optimization algorithm, 3.2.2. dynamic adjustment mechanism, 3.2.3. deterministic selection, 3.2.4. random selection, 3.2.5. pheromone update rule, 3.3. steps of iaco algorithm, 4. case study, 4.1. parameter setting, 4.2. results, 5. discussion and conclusions.

• In this work, HACO successfully overcame the disadvantage that ACO would fall into the local optimal solution. During the mid-stage of the algorithm’s operation, ACO experienced stagnation for over 100 iterations. HACO used an adaptive hybrid selection strategy that effectively combined randomness with determinism, enhancing its search capabilities. This method enabled the algorithm to swiftly jump out of the local optimal and avoid stagnation;
• In terms of convergence speed, HACO demonstrated a significant advantage, requiring only 20 iterations to reach the optimal solution of the objective function. Furthermore, the comparative analysis indicated that HACO achieved up to a 99.9% reduction in execution time. This advantage was primarily attributable to the local pheromone updating strategy of HACO, which mitigated the impact of non-optimal solutions and rendered the algorithm more effective than the global pheromone updating strategy in terms of resource allocation and convergence speed;
• HACO outperformed in finding high-quality solutions by adapting its search strategy based on solution characteristics throughout the iteration process and applying the pheromone updating strategy. The balance between exploration and exploitation led to optimal outcomes, with a focus on discovering the best path planning solution;
• The results of the case study revealed that HACO, when compared with ACO, reduced total logistics cost, carbon emission cost, and execution time by 0.41%, 1.78%, and 99.9%, respectively. This indicated that HACO significantly outperformed the original ACO in balancing the environmental benefits and the logistics cost, thereby validated the efficacy of both the algorithm and the model.

Supplementary Materials

Author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest, abbreviations.

• Qu, P.; Zhang, M.; Fan, K.; Guo, Z. Microporous modified atmosphere packaging to extend shelf life of fresh foods: A review. Crit. Rev. Food Sci. Nutr. 2022 , 62 , 51–65. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Lin, J.; Li, T.; Guo, J. Factors influencing consumers’ continuous purchase intention on fresh food e-commerce platforms: An organic foods-centric empirical investigation. Electron. Commer. Res. Appl. 2021 , 50 , 101103. [ Google Scholar ] [ CrossRef ]
• Qin, G.; Tao, F.; Li, L. A Vehicle Routing Optimization Problem for Cold Chain Logistics Considering Customer Satisfaction and Carbon Emissions. Int. J. Environ. Res. Public Health 2019 , 16 , 576. [ Google Scholar ] [ CrossRef ]
• Han, J.W.; Zuo, M.; Zhu, W.Y.; Zuo, J.H.; Lü, E.L.; Yang, X.T. A comprehensive review of cold chain logistics for fresh agricultural products: Current status, challenges, and future trends. Trends Food Sci. Technol. 2021 , 109 , 536–551. [ Google Scholar ] [ CrossRef ]
• Liu, Z.; Huang, Y.Q.; Shang, W.L.; Zhao, Y.J.; Yang, Z.L.; Zhao, Z. Precooling energy and carbon emission reduction technology investment model in a fresh food cold chain based on a differential game. Appl. Energy 2022 , 326 , 119945. [ Google Scholar ] [ CrossRef ]
• Abbasi, S.; Moosivand, M.; Vlachos, I.; Talooni, M. Designing the Location–Routing Problem for a Cold Supply Chain Considering the COVID-19 Disaster. Sustainability 2023 , 15 , 15490. [ Google Scholar ] [ CrossRef ]
• Li, K.; Li, D.; Wu, D. Multi-objective Optimization for Location-Routing-Inventory Problem in Cold Chain Logistics Network with Soft Time Window Constraint. J. Eur. Des Systèmes Autom. 2020 , 53 , 803–809. [ Google Scholar ] [ CrossRef ]
• Wu, X. The Front Warehouse Model of the “Missfresh” E-commerce Company Under the Background of Artificial Intelligence. In Proceedings of the 3rd International Conference on Artificial Intelligence in Electronics Engineering, Bangkok, Thailand, 11–13 January 2022; pp. 49–54. [ Google Scholar ] [ CrossRef ]
• Li, Y.; Yang, J. The last-mile delivery vehicle routing problem with handling cost in the front warehouse mode. Comput. Ind. Eng. 2024 , 190 , 110076. [ Google Scholar ] [ CrossRef ]
• Wang, Y.; Sun, Y.; Guan, X.; Guo, Y. Two-Echelon Location-Routing Problem with Time Windows and Transportation Resource Sharing. J. Adv. Transp. 2021 , 2021 , 8280686. [ Google Scholar ] [ CrossRef ]
• Ziaei, Z.; Jabbarzadeh, A. A multi-objective robust optimization approach for green location-routing planning of multi-modal transportation systems under uncertainty. J. Clean. Prod. 2021 , 291 , 125293. [ Google Scholar ] [ CrossRef ]
• Saif-Eddine, A.S.; El-Beheiry, M.M.; El-Kharbotly, A.K. An improved genetic algorithm for optimizing total supply chain cost in inventory location routing problem. Ain Shams Eng. J. 2019 , 10 , 63–76. [ Google Scholar ] [ CrossRef ]
• Watson-Gandy, C.; Dohrn, P. Depot location with van salesmen—A practical approach. Omega 1973 , 1 , 321–329. [ Google Scholar ] [ CrossRef ]
• Gao, S.; Wang, Y.; Cheng, J.; Inazumi, Y.; Tang, Z. Ant colony optimization with clustering for solving the dynamic location routing problem. Appl. Math. Comput. 2016 , 285 , 149–173. [ Google Scholar ] [ CrossRef ]
• Xu, X.; Liu, W.; Jiang, M.; Lin, Z. A multi-cycle and multi-echelon location-routing problem for integrated reverse logistics. Ind. Manag. Data Syst. 2022 , 122 , 2237–2260. [ Google Scholar ] [ CrossRef ]
• Aghighi, A.; Goli, A.; Malmir, B.; Tirkolaee, E.B. The stochastic location-routing-inventory problem of perishable products with reneging and balking. J. Ambient Intell. Humaniz. Comput. 2023 , 14 , 6497–6516. [ Google Scholar ] [ CrossRef ]
• Tasouji Hassanpour, S.; Ke, G.Y.; Zhao, J.; Tulett, D.M. Infectious waste management during a pandemic: A stochastic location-routing problem with chance-constrained time windows. Comput. Ind. Eng. 2023 , 177 , 109066. [ Google Scholar ] [ CrossRef ]
• Jiaojiao, W.; Yueyu, L.; Congcong, C. Study on Location and Route Optimization of Distribution Center of a Digital Company Based on Clustering Algorithm and Ant Colony Algorithm Method. In Proceedings of the 2020 9th International Conference on Industrial Technology and Management (ICITM), Oxford, UK, 11–13 February 2020; pp. 202–205. [ Google Scholar ] [ CrossRef ]
• Leng, L.; Zhang, C.; Zhao, Y.; Wang, W.; Zhang, J.; Li, G. Biobjective low-carbon location-routing problem for cold chain logistics: Formulation and heuristic approaches. J. Clean. Prod. 2020 , 273 , 122801. [ Google Scholar ] [ CrossRef ]
• Sun, J.; Tang, J.; Fu, W.; Chen, Z.; Niu, Y. Construction of a multi-echelon supply chain complex network evolution model and robustness analysis of cascading failure. Comput. Ind. Eng. 2020 , 144 , 106457. [ Google Scholar ] [ CrossRef ]
• Dai, Z.; Aqlan, F.; Gao, K.; Zhou, Y. A two-phase method for multi-echelon location-routing problems in supply chains. Expert Syst. Appl. 2019 , 115 , 618–634. [ Google Scholar ] [ CrossRef ]
• Mirhedayatian, S.M.; Crainic, T.G.; Guajardo, M.; Wallace, S.W. A two-echelon location-routing problem with synchronisation. J. Oper. Res. Soc. 2021 , 72 , 145–160. [ Google Scholar ] [ CrossRef ]
• Fazayeli, S.; Eydi, A.; Kamalabadi, I.N. A model for distribution centers location-routing problem on a multimodal transportation network with a meta-heuristic solving approach. J. Ind. Eng. Int. 2018 , 14 , 327–342. [ Google Scholar ] [ CrossRef ]
• Darvish, M.; Archetti, C.; Coelho, L.C.; Speranza, M.G. Flexible two-echelon location routing problem. Eur. J. Oper. Res. 2019 , 277 , 1124–1136. [ Google Scholar ] [ CrossRef ]
• Chen, J.; Liao, W.; Yu, C. Route optimization for cold chain logistics of front warehouses based on traffic congestion and carbon emission. Comput. Ind. Eng. 2021 , 161 , 107663. [ Google Scholar ] [ CrossRef ]
• Wu, X. Optimization of Distribution Mode of the Fresh Food Logistics Front Warehouse from the Perspective of Intelligent Logistics. In Proceedings of the 2021 IEEE Conference on Telecommunications, Optics and Computer Science (TOCS), Shenyang, China, 10–11 December 2021; pp. 307–311. [ Google Scholar ] [ CrossRef ]
• Zhu, J.; Tian, X. Value of High-Quality Distribution in Front Warehouse Mode Retailing. Procedia Comput. Sci. 2022 , 199 , 110–117. [ Google Scholar ] [ CrossRef ]
• Tang, J.; Qi, C.; Wang, H. Integrated optimization of order splitting and distribution routing for the front warehouse mode e-retailing. Int. J. Prod. Res. 2023 , 62 , 1715–1736. [ Google Scholar ] [ CrossRef ]
• Chen, W.; Zhang, Y.; Zhou, Y. Integrated scheduling of zone picking and vehicle routing problem with time windows in the front warehouse mode. Comput. Ind. Eng. 2022 , 163 , 107823. [ Google Scholar ] [ CrossRef ]
• Wang, Y.; Peng, S.; Zhou, X.; Mahmoudi, M.; Zhen, L. Green logistics location-routing problem with eco-packages. Transp. Res. Part E Logist. Transp. Rev. 2020 , 143 , 102118. [ Google Scholar ] [ CrossRef ]
• Yingfei, Y.; Mengze, Z.; Zeyu, L.; Ki-Hyung, B.; Andriandafiarisoa Ralison Ny Avotra, A.; Nawaz, A. Green logistics performance and infrastructure on service trade and environment-Measuring firm’s performance and service quality. J. King Saud Univ. Sci. 2022 , 34 , 101683. [ Google Scholar ] [ CrossRef ]
• Dzwigo, H.; Trushkina, N.; Kwilinski, A. The Organizational and Economic Mechanism of Implementing the Concept of Green Logistics. Virtual Econ. 2021 , 4 , 41–75. [ Google Scholar ] [ CrossRef ]
• Yao, X.; Cheng, Y.; Song, M. Assessment of collaboration in city logistics: From the aspects of profit and CO 2 emissions. Int. J. Logist. Res. Appl. 2019 , 22 , 576–591. [ Google Scholar ] [ CrossRef ]
• Zhang, S.; Chen, N.; She, N.; Li, K. Location optimization of a competitive distribution central for urban cold chain logistics in terms of low-carbon emissions. Comput. Ind. Eng. 2021 , 154 , 107120. [ Google Scholar ] [ CrossRef ]
• Wang, Z.; Leng, L.; Wang, S.; Li, G.; Zhao, Y. A Hyperheuristic Approach for Location-Routing Problem of Cold Chain Logistics considering Fuel Consumption. Comput. Intell. Neurosci. 2020 , 2020 , 8395754. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Dukkanci, O.; Kara, B.Y.; Bektaş, T. The green location-routing problem. Comput. Oper. Res. 2019 , 105 , 187–202. [ Google Scholar ] [ CrossRef ]
• Zhang, C.; Zhao, Y.; Leng, L. A Hyper-Heuristic Algorithm for Time-Dependent Green Location Routing Problem With Time Windows. IEEE Access 2020 , 8 , 83092–83104. [ Google Scholar ] [ CrossRef ]
• Li, Y.; Lim, M.K.; Hu, J.; Tseng, M.L. Investigating the effect of carbon tax and carbon quota policy to achieve low carbon logistics operations. Resour. Conserv. Recycl. 2020 , 154 , 104535. [ Google Scholar ] [ CrossRef ]
• Wang, S.; Tao, F.; Shi, Y. Optimization of Location–Routing Problem for Cold Chain Logistics Considering Carbon Footprint. Int. J. Environ. Res. Public Health 2018 , 15 , 86. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Taptich, M.N.; Scown, C.D.; Piscopo, K.; Horvath, A. Drop-in biofuels offer strategies for meeting California’s 2030 climate mandate. Environ. Res. Lett. 2018 , 13 , 094018. [ Google Scholar ] [ CrossRef ]
• Grahn, M.; Azar, C.; Williander, M.I.; Anderson, J.E.; Mueller, S.A.; Wallington, T.J. Fuel and Vehicle Technology Choices for Passenger Vehicles in Achieving Stringent CO 2 Targets: Connections between Transportation and Other Energy Sectors. Environ. Sci. Technol. 2009 , 43 , 3365–3371. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Bonsu, N.O. Towards a circular and low-carbon economy: Insights from the transitioning to electric vehicles and net zero economy. J. Clean. Prod. 2020 , 256 , 120659. [ Google Scholar ] [ CrossRef ]
• Dall-Orsoletta, A.; Ferreira, P.; Gilson Dranka, G. Low-carbon technologies and just energy transition: Prospects for electric vehicles. Energy Convers. Manag. X 2022 , 16 , 100271. [ Google Scholar ] [ CrossRef ]
• Nilsson, M.; Nykvist, B. Governing the electric vehicle transition – Near term interventions to support a green energy economy. Appl. Energy 2016 , 179 , 1360–1371. [ Google Scholar ] [ CrossRef ]
• Wu, T.; Li, Z.; Wang, G.; Zhang, X.; Qiu, J. Low-Carbon Charging Facilities Planning for Electric Vehicles Based on a Novel Travel Route Choice Model. IEEE Trans. Intell. Transp. Syst. 2023 , 24 , 5908–5922. [ Google Scholar ] [ CrossRef ]
• Almouhanna, A.; Quintero-Araujo, C.L.; Panadero, J.; Juan, A.A.; Khosravi, B.; Ouelhadj, D. The location routing problem using electric vehicles with constrained distance. Comput. Oper. Res. 2020 , 115 , 104864. [ Google Scholar ] [ CrossRef ]
• Çatay, B.; Sadati, İ. An improved matheuristic for solving the electric vehicle routing problem with time windows and synchronized mobile charging/battery swapping. Comput. Oper. Res. 2023 , 159 , 106310. [ Google Scholar ] [ CrossRef ]
• Lee, C. An exact algorithm for the electric-vehicle routing problem with nonlinear charging time. J. Oper. Res. Soc. 2021 , 72 , 1461–1485. [ Google Scholar ] [ CrossRef ]
• Chen, Y.; Li, D.; Zhang, Z.; Wahab, M.; Jiang, Y. Solving the battery swap station location-routing problem with a mixed fleet of electric and conventional vehicles using a heuristic branch-and-price algorithm with an adaptive selection scheme. Expert Syst. Appl. 2021 , 186 , 115683. [ Google Scholar ] [ CrossRef ]
• Wang, M.; Miao, L.; Zhang, C. A branch-and-price algorithm for a green location routing problem with multi-type charging infrastructure. Transp. Res. Part E Logist. Transp. Rev. 2021 , 156 , 102529. [ Google Scholar ] [ CrossRef ]
• Arslan, O.; Karaşan, O.E.; Mahjoub, A.R.; Yaman, H. A Branch-and-Cut Algorithm for the Alternative Fuel Refueling Station Location Problem with Routing. Transp. Sci. 2019 , 53 , 1107–1125. [ Google Scholar ] [ CrossRef ]
• Bao, Z.; Xie, C. Optimal station locations for en-route charging of electric vehicles in congested intercity networks: A new problem formulation and exact and approximate partitioning algorithms. Transp. Res. Part C Emerg. Technol. 2021 , 133 , 103447. [ Google Scholar ] [ CrossRef ]
• Christensen, T.R.L.; Klose, A. A fast exact method for the capacitated facility location problem with differentiable convex production costs. Eur. J. Oper. Res. 2021 , 292 , 855–868. [ Google Scholar ] [ CrossRef ]
• Rafie-Majd, Z.; Pasandideh, S.H.R.; Naderi, B. Modelling and solving the integrated inventory-location-routing problem in a multi-period and multi-perishable product supply chain with uncertainty: Lagrangian relaxation algorithm. Comput. Chem. Eng. 2018 , 109 , 9–22. [ Google Scholar ] [ CrossRef ]
• Biuki, M.; Kazemi, A.; Alinezhad, A. An integrated location-routing-inventory model for sustainable design of a perishable products supply chain network. J. Clean. Prod. 2020 , 260 , 120842. [ Google Scholar ] [ CrossRef ]
• De Oliveira, S.M.; Bezerra, L.C.; Stützle, T.; Dorigo, M.; Wanner, E.F.; De Souza, S.R. A computational study on ant colony optimization for the traveling salesman problem with dynamic demands. Comput. Oper. Res. 2021 , 135 , 105359. [ Google Scholar ] [ CrossRef ]
• Dewantoro, R.W.; Sihombing, P. The Combination of Ant Colony Optimization (ACO) and Tabu Search (TS) Algorithm to Solve the Traveling Salesman Problem (TSP). In Proceedings of the 2019 3rd International Conference on Electrical, Telecommunication and Computer Engineering (ELTICOM), Medan, Indonesia, 16–17 September 2019; pp. 160–164. [ Google Scholar ] [ CrossRef ]
• Tuani, A.F.; Keedwell, E.; Collett, M. Heterogenous Adaptive Ant Colony Optimization with 3-opt local search for the Travelling Salesman Problem. Appl. Soft Comput. 2020 , 97 , 106720. [ Google Scholar ] [ CrossRef ]
• Jia, Y.H.; Mei, Y.; Zhang, M. A Bilevel Ant Colony Optimization Algorithm for Capacitated Electric Vehicle Routing Problem. IEEE Trans. Cybern. 2022 , 52 , 10855–10868. [ Google Scholar ] [ CrossRef ]
• Xiang, X.; Qiu, J.; Xiao, J.; Zhang, X. Demand coverage diversity based ant colony optimization for dynamic vehicle routing problems. Eng. Appl. Artif. Intell. 2020 , 91 , 103582. [ Google Scholar ] [ CrossRef ]
• Cao, R.; Li, S.; Ji, Y.; Zhang, Z.; Xu, H.; Zhang, M.; Li, M.; Li, H. Task assignment of multiple agricultural machinery cooperation based on improved ant colony algorithm. Comput. Electron. Agric. 2021 , 182 , 105993. [ Google Scholar ] [ CrossRef ]
• Deng, W.; Xu, J.; Zhao, H. An Improved Ant Colony Optimization Algorithm Based on Hybrid Strategies for Scheduling Problem. IEEE Access 2019 , 7 , 20281–20292. [ Google Scholar ] [ CrossRef ]
• Guan, B.; Zhao, Y.; Li, Y. An improved ant colony optimization with an automatic updating mechanism for constraint satisfaction problems. Expert Syst. Appl. 2021 , 164 , 114021. [ Google Scholar ] [ CrossRef ]
• Wang, M.; Ma, T.; Li, G.; Zhai, X.; Qiao, S. Ant Colony Optimization With an Improved Pheromone Model for Solving MTSP With Capacity and Time Window Constraint. IEEE Access 2020 , 8 , 106872–106879. [ Google Scholar ] [ CrossRef ]
• Jiang, J.; Yu, N.; Ye, J.; Bai, W. Vehicle logistics path optimization based on ant colony and particle hybrid algorithm. J. Phys. Conf. Ser. 2021 , 1865 , 042086. [ Google Scholar ] [ CrossRef ]
• Shi, K.; Huang, L.; Jiang, D.; Sun, Y.; Tong, X.; Xie, Y.; Fang, Z. Path Planning Optimization of Intelligent Vehicle Based on Improved Genetic and Ant Colony Hybrid Algorithm. Front. Bioeng. Biotechnol. 2022 , 10 , 905983. [ Google Scholar ] [ CrossRef ]
• Wang, Y.; Wang, L.; Chen, G.; Cai, Z.; Zhou, Y.; Xing, L. An Improved Ant Colony Optimization algorithm to the Periodic Vehicle Routing Problem with Time Window and Service Choice. Swarm Evol. Comput. 2020 , 55 , 100675. [ Google Scholar ] [ CrossRef ]
• Di Caprio, D.; Ebrahimnejad, A.; Alrezaamiri, H.; Santos-Arteaga, F.J. A novel ant colony algorithm for solving shortest path problems with fuzzy arc weights. Alex. Eng. J. 2022 , 61 , 3403–3415. [ Google Scholar ] [ CrossRef ]
• Goel, R.; Maini, R. A hybrid of ant colony and firefly algorithms (HAFA) for solving vehicle routing problems. J. Comput. Sci. 2018 , 25 , 28–37. [ Google Scholar ] [ CrossRef ]
• Hou, W.; Xiong, Z.; Wang, C.; Chen, H. Enhanced ant colony algorithm with communication mechanism for mobile robot path planning. Robot. Auton. Syst. 2022 , 148 , 103949. [ Google Scholar ] [ CrossRef ]
• Li, Y.; Soleimani, H.; Zohal, M. An improved ant colony optimization algorithm for the multi-depot green vehicle routing problem with multiple objectives. J. Clean. Prod. 2019 , 227 , 1161–1172. [ Google Scholar ] [ CrossRef ]
• He, M.; Wei, Z.; Wu, X.; Peng, Y. An Adaptive Variable Neighborhood Search Ant Colony Algorithm for Vehicle Routing Problem With Soft Time Windows. IEEE Access 2021 , 9 , 21258–21266. [ Google Scholar ] [ CrossRef ]
• Liang, S.; Jiao, T.; Du, W.; Qu, S. An improved ant colony optimization algorithm based on context for tourism route planning. PLoS ONE 2021 , 16 , e0257317. [ Google Scholar ] [ CrossRef ]
• Guo, K.; Hu, S.; Zhu, H.; Tan, W. Industrial information integration method to vehicle routing optimization using grey target decision. J. Ind. Inf. Integr. 2022 , 27 , 100336. [ Google Scholar ] [ CrossRef ]
• Wang, X.; Zhan, L.; Zhang, Y.; Fei, T.; Tseng, M.L. Environmental cold chain distribution central location model in the semiconductor supply chain: A hybrid arithmetic whale optimization algorithm. Comput. Ind. Eng. 2024 , 187 , 109773. [ Google Scholar ] [ CrossRef ]
• Horvat, M.; Jović, A.; Burnik, K. Assessing the Robustness of Cluster Solutions in Emotionally-Annotated Pictures Using Monte-Carlo Simulation Stabilized K-Means Algorithm. Mach. Learn. Knowl. Extr. 2021 , 3 , 435–452. [ Google Scholar ] [ CrossRef ]
• Zheng, F.; Meng, X.; Wang, L.; Zhang, N. Operation Optimization Method of Distribution Network with Wind Turbine and Photovoltaic Considering Clustering and Energy Storage. Sustainability 2023 , 15 , 2184. [ Google Scholar ] [ CrossRef ]
• Zhao, B.; Gui, H.; Li, H.; Xue, J. Cold Chain Logistics Path Optimization via Improved Multi-Objective Ant Colony Algorithm. IEEE Access 2020 , 8 , 142977–142995. [ Google Scholar ] [ CrossRef ]
• Chen, A.; Tan, H.; Zhu, Y. Ant colony optimization algorithm and its application. In Proceedings of the 2nd International Conference on Applied Mathematics, Modelling, and Intelligent Computing (CAMMIC 2022), Kunming, China, 25–27 March 2022; p. 265. [ Google Scholar ] [ CrossRef ]
• Ebadinezhad, S. DEACO: Adopting dynamic evaporation strategy to enhance ACO algorithm for the traveling salesman problem. Eng. Appl. Artif. Intell. 2020 , 92 , 103649. [ Google Scholar ] [ CrossRef ]
• Wu, H.; Gao, Y.; Wang, W.; Zhang, Z. A hybrid ant colony algorithm based on multiple strategies for the vehicle routing problem with time windows. Complex Intell. Syst. 2023 , 9 , 2491–2508. [ Google Scholar ] [ CrossRef ]
• Chen, J.; Gui, P.; Ding, T.; Na, S.; Zhou, Y. Optimization of Transportation Routing Problem for Fresh Food by Improved Ant Colony Algorithm Based on Tabu Search. Sustainability 2019 , 11 , 6584. [ Google Scholar ] [ CrossRef ]
• Wu, L.; Huang, X.; Cui, J.; Liu, C.; Xiao, W. Modified adaptive ant colony optimization algorithm and its application for solving path planning of mobile robot. Expert Syst. Appl. 2023 , 215 , 119410. [ Google Scholar ] [ CrossRef ]
• Liu, J.; Liu, J. Applying multi-objective ant colony optimization algorithm for solving the unequal area facility layout problems. Appl. Soft Comput. 2019 , 74 , 167–189. [ Google Scholar ] [ CrossRef ]
• Yi, N.; Xu, J.; Yan, L.; Huang, L. Task optimization and scheduling of distributed cyber–physical system based on improved ant colony algorithm. Future Gener. Comput. Syst. 2020 , 109 , 134–148. [ Google Scholar ] [ CrossRef ]
• Agramanisti Azdy, R.; Darnis, F. Use of Haversine Formula in Finding Distance Between Temporary Shelter and Waste End Processing Sites. J. Phys. Conf. Ser. 2020 , 1500 , 012104. [ Google Scholar ] [ CrossRef ]
• Dauni, P.; Firdaus, M.D.; Asfariani, R.; Saputra, M.I.N.; Hidayat, A.A.; Zulfikar, W.B. Implementation of Haversine formula for school location tracking. J. Phys. Conf. Ser. 2019 , 1402 , 077028. [ Google Scholar ] [ CrossRef ]

Click here to enlarge figure

Share and Cite

Zhang, X.; Wang, Y.; Zhang, D. Location-Routing Optimization for Two-Echelon Cold Chain Logistics of Front Warehouses Based on a Hybrid Ant Colony Algorithm. Mathematics 2024 , 12 , 1851. https://doi.org/10.3390/math12121851

Zhang X, Wang Y, Zhang D. Location-Routing Optimization for Two-Echelon Cold Chain Logistics of Front Warehouses Based on a Hybrid Ant Colony Algorithm. Mathematics . 2024; 12(12):1851. https://doi.org/10.3390/math12121851

Zhang, Xuya, Yue Wang, and Dongqing Zhang. 2024. "Location-Routing Optimization for Two-Echelon Cold Chain Logistics of Front Warehouses Based on a Hybrid Ant Colony Algorithm" Mathematics 12, no. 12: 1851. https://doi.org/10.3390/math12121851

Article Metrics

Article access statistics, supplementary material.

ZIP-Document (ZIP, 8 KiB)

Further Information

Mdpi initiatives, follow mdpi.

Subscribe to receive issue release notifications and newsletters from MDPI journals