how to write a case study in public health

Organizing Your Social Sciences Research Assignments

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

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

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

How to Approach Writing a Case Study Research Paper

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

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

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

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

Structure and Writing Style

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

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

I. Introduction

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

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

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

II. Literature Review

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

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

III. Method

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

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

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

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

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

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

IV. Discussion

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

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

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

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

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

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

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

V. Conclusion

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

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

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

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

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

Problems to Avoid

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

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

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

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

Writing Tip

At Least Five Misconceptions about Case Study Research

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

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

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

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

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Oomph library resources: phw 250/250b epidemiologic methods: epidemiologic case study resources.

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Epidemiologic Case Studies

Epidemiologic Case Studies (US CDC) These case studies are interactive exercises developed to teach epidemiologic principles and practices. They are based on real-life outbreaks and public health problems and were developed in collaboration with the original investigators and experts from the Centers for Disease Control and Prevention (CDC). The case studies require students to apply their epidemiologic knowledge and skills to problems confronted by public health practitioners at the local, state, and national level every day.
Case Studies (WHO) From "Strengthening health security by implementing the International Health Regulations," each case has learning objectives and documentation.
Case Studies in Social Medicine A series of Perspective articles from the New England Journal of Medicine that highlight the importance of social concepts and social context in clinical medicine. The series uses discussions of real clinical cases to translate theories and methods for understanding social processes into terms that can readily be used in medical education, clinical practice, and health system planning.
African Case Studies in Public Heath Case study exercises based on real events in African contexts and written by experienced Africa-based public health trainers and practitioners. These case studies represent the most up-to-date and context-appropriate case study exercises for African public health training programs. These exercises are designed to reinforce and instill competencies for addressing health threats in the future leaders of public health in Africa.
Case Consortium @ Columbia University: Public Health Cases The case collection includes "teaching" cases. Nearly all the cases are multimedia and based on original research; a few are written from secondary sources. All cases are offered free of charge.
Epi Teams Training: Case Studies From the North Carolina Institute for Public Health, this curriculum includes several interactive case studies designed be used by the Epi Team as a group. These case studies are based on actual outbreaks that have occurred in North Carolina and elsewhere.
National Center for Case Study Teaching in Science The mission of the NCCSTS at the University at Buffalo is to promote the development and dissemination of materials and practices for case teaching in the sciences. Our website provides access to an award-winning collection of peer-reviewed case studies. We offer a five-day summer workshop and a two-day fall conference to train faculty in the case method of teaching science. In addition, we are actively engaged in educational research to assess the impact of the case method on student learning. "Case Collection" includes over 100 public health cases.

Books of Case Studies

how to write a case study in public health

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Cases Studies in Public Health Available Online

First study of mers animal host in saudi arabia.

Case studies aren’t just for business schools anymore. Columbia University’s Mailman School of Public Health has been using the case method to teach MPH students as part of the new Columbia Public Health Curriculum. Now, six of the School’s public health cases have been published online, making them available to classrooms anywhere.

“The case method can be a powerful tool for learning public health. It gives students the opportunity to gain experience making decisions in the face of uncertainty, much as they will have to do every day when they graduate and leave us to work in their chosen field,” says Melissa Begg, ScD , Vice Dean for Education at the Mailman School, who is leading the implementation of the new MPH curriculum.

Each case study tells a detailed story which stops mid-action, asking students to imagine themselves into the shoes of a decision-maker facing a tough call. One case developed with the help of David Abramson, PhD , assistant professor of Sociomedical Sciences, looks at the decision of whether to evacuate two hospitals during Superstorm Sandy. Another looks at how to win a community’s trust, as told through the experience of Mailman scientists conducting a federally-funded study of arsenic-tainted water in Bangladesh.

Classroom discussions are lively, and most important, there isn’t a single right answer. “Students practice taking positions and defending them based on the available evidence, while developing communication and critical thinking skills,” explains Dr. Begg. “They learn to argue persuasively for their points of view.

The Mailman School case studies are available through Columbia University’s Case Consortium website, which also features cases by Columbia’s Journalism School and the School for International and Public Affairs (SIPA). They are available free (after registration) to educators and at a nominal cost to students, professionals, and other interested parties.

“While most existing case curriculum remains paper-based, the Mailman School cases are online and multimedia, meeting students where they live in the digital media world,” says Kirsten Lundberg, MPA, director of the Case Consortium @ Columbia.

The “discussion-based” case study approach has historic roots reaching back to Socrates, and was popularized in the 20th century by business schools. To see the cases, please visit Case Consortium and click on Cases.

Public Health Case Studies

Voluntary or Regulated? The Trans Fat Campaign in New York City

This case takes students behind the scenes in the world of public health policymaking. Students follow the New York City Department of Health and Mental Hygiene, and the process it went through to craft a policy to reduce public consumption of trans fats in restaurants. In 2005, after considerable internal negotiations, the department’s Bureau of Chronic Disease Prevention and Control elected to launch a public awareness campaign aimed equally at consumers, restaurants and their suppliers. But after a year, the awareness campaign had not budged the rate of trans fat use in restaurants. In 2006, the department decided to resort to regulation, despite the risks of triggering protests of a “nanny state,” not to mention pushback from industry.

When BEST Intentions Go Awry: Arsenic Mitigation in Bangladesh

This case is about a public health response to the widespread arsenic contamination of groundwater in Bangladesh. It examines the lead-up to a 2008 media crisis that confronted a Columbia University clinical trial of a potential treatment for arsenic poisoning. The case raises for discussion the challenges of conducting research in rural, less developed and culturally insular communities. It also asks how to help communities while studying them—complicated by funding restrictions and a possible skewing of results.

Community Savings, or Community Threat? California Policy for Ill and Elderly Inmates

This case looks at the challenges that confront public health professionals who work in a corrections environment. By 2011, a court-appointed Receiver had made progress in fixing a broken system of medical care for prisoners in California. But costs spiraled ever higher for elderly and ailing inmates. Public health officials had to balance competing public priorities: save taxpayer dollars while treating patients. A new law allowed the sickest prisoners to move to community-based care—but now public health doctors had to decide: who qualified for medical parole?

Credible Voice: WHO-Beijing and the SARS Crisis

This case study takes students into the Beijing office of the World Health Organization as it dealt with the SARS crisis in early 2003. The WHO serves as the world’s monitor of disease outbreak and control. It is able to mobilize legions of the world’s best scientists to analyze, diagnose, prescribe treatments for and contain diseases. However, it depends on the cooperation of the countries experiencing an epidemic. What happens when that cooperation is limited or nonexistent?

The Elusive Tuberculosis Case: The CDC and Andrew Speaker

This case explores the ethical and logistical challenges that doctors face when an infectious disease patient does not cooperate with advice to stay out of public spaces in order to protect the general welfare. In April 2007, a young Atlanta lawyer, Andrew Speaker, was diagnosed with active tuberculosis. Initially cooperative, Speaker departs without notice for Greece and his scheduled wedding even though it is clear that his strain of TB is more lethal and difficult-to-treat than anticipated.

Evacuate or Stay? Northshore LIJ and Hurricane Sandy

This case examines the pros and cons of evacuating medical facilities in the face of a looming natural disaster. In October 2012, the North Shore-Long Island Jewish Hospitals (North Shore-LIJ) network braced—together with rest of the East coast—for the advent of Hurricane Sandy. Weather forecasters painted a grim picture, and North Shore-LIJ had three hospitals in low-lying areas. Vice President of Protective Services James Romagnoli and COO Mark Solazzo had seen this scenario only a year earlier, when in August 2011 they evacuated hospitals in advance of Hurricane Irene. But Irene had, at the last moment, spared New York City. With that unnecessary evacuation fresh in their minds, the two officials had to decide what to do as Sandy approached.

Health Case Studies

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Glynda Rees, British Columbia Institute of Technology

Rob Kruger, British Columbia Institute of Technology

Janet Morrison, British Columbia Institute of Technology

Publisher: BCcampus

Language: English

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Reviewed by Jessica Sellars, Medical assistant office instructor, Blue Mountain Community College on 10/11/23

Comprehensiveness rating: 5 see less

This is a book of compiled and very well organized patient case studies. The author has broken it up by disease patient was experiencing and even the healthcare roles that took place in this patients care. There is a well thought out direction and plan. There is an appendix to refer to as well if you are needing to find something specific quickly. I have been looking for something like this to help my students have a base to do their project on. This is the most comprehensive version I have found on the subject.

Content Accuracy rating: 5

This is a book compiled of medical case studies. It is very accurate and can be used to learn from great care and mistakes.

Relevance/Longevity rating: 5

This material is very relevant in this context. It also has plenty of individual case studies to utilize in many ways in all sorts of medical courses. This is a very useful textbook and it will continue to be useful for a very long time as you can still learn from each study even if medicine changes through out the years.

Clarity rating: 5

The author put a lot of thought into the ease of accessibility and reading level of the target audience. There is even a "how to use this resource" section which could be extremely useful to students.

Consistency rating: 5

The text follows a very consistent format throughout the book.

Modularity rating: 5

Each case study is individual broken up and in a group of similar case studies. This makes it extremely easy to utilize.

Organization/Structure/Flow rating: 5

The book is very organized and the appendix is through. It flows seamlessly through each case study.

Interface rating: 5

I had no issues navigating this book, It was clearly labeled and very easy to move around in.

Grammatical Errors rating: 5

I did not catch any grammar errors as I was going through the book

Cultural Relevance rating: 5

This is a challenging question for any medical textbook. It is very culturally relevant to those in medical or medical office degrees.

I have been looking for something like this for years. I am so happy to have finally found it.

Reviewed by Cindy Sun, Assistant Professor, Marshall University on 1/7/23

Interestingly, this is not a case of ‘you get what you pay for’. Instead, not only are the case studies organized in a fashion for ease of use through a detailed table of contents, the authors have included more support for both faculty and students. For faculty, the introduction section titled ‘How to use this resource’ and individual notes to educators before each case study contain application tips. An appendix overview lists key elements as issues / concepts, scenario context, and healthcare roles for each case study. For students, learning objectives are presented at the beginning of each case study to provide a framework of expectations.

The content is presented accurately and realistic.

The case studies read similar to ‘A Day In the Life of…’ with detailed intraprofessional communications similar to what would be overheard in patient care areas. The authors present not only the view of the patient care nurse, but also weave interprofessional vantage points through each case study by including patient interaction with individual professionals such as radiology, physician, etc.

In addition to objective assessment findings, the authors integrate standard orders for each diagnosis including medications, treatments, and tests allowing the student to incorporate pathophysiology components to their assessments.

Each case study is arranged in the same framework for consistency and ease of use.

This compilation of eight healthcare case studies focusing on new onset and exacerbation of prevalent diagnoses, such as heart failure, deep vein thrombosis, cancer, and chronic obstructive pulmonary disease advancing to pneumonia.

Each case study has a photo of the ‘patient’. Simple as this may seem, it gives an immediate mental image for the student to focus.

Interface rating: 4

As noted by previous reviewers, most of the links do not connect active web pages. This may be due to the multiple options for accessing this resource (pdf download, pdf electronic, web view, etc.).

Grammatical Errors rating: 4

A minor weakness that faculty will probably need to address prior to use is regarding specific term usages differences between Commonwealth countries and United States, such as lung sound descriptors as ‘quiet’ in place of ‘diminished’ and ‘puffers’ in place of ‘inhalers’.

The authors have provided a multicultural, multigenerational approach in selection of patient characteristics representing a snapshot of today’s patient population. Additionally, one case study focusing on heart failure is about a middle-aged adult, contrasting to the average aged patient the students would normally see during clinical rotations. This option provides opportunities for students to expand their knowledge on risk factors extending beyond age.

This resource is applicable to nursing students learning to care for patients with the specific disease processes presented in each case study or for the leadership students focusing on intraprofessional communication. Educators can assign as a supplement to clinical experiences or as an in-class application of knowledge.

Reviewed by Stephanie Sideras, Assistant Professor, University of Portland on 8/15/22

The eight case studies included in this text addressed high frequency health alterations that all nurses need to be able to manage competently. While diabetes was not highlighted directly, it was included as a potential comorbidity. The five overarching learning objectives pulled from the Institute of Medicine core competencies will clearly resonate with any faculty familiar with Quality and Safety Education for Nurses curriculum.

The presentation of symptoms, treatments and management of the health alterations was accurate. Dialogue between the the interprofessional team was realistic. At times the formatting of lab results was confusing as they reflected reference ranges specific to the Canadian healthcare system but these occurrences were minimal and could be easily adapted.

The focus for learning from these case studies was communication - patient centered communication and interprofessional team communication. Specific details, such as drug dosing, was minimized, which increases longevity and allows for easy individualization of the case data.

While some vocabulary was specific to the Canadian healthcare system, overall the narrative was extremely engaging and easy to follow. Subjective case data from patient or provider were formatted in italics and identified as 'thoughts'. Objective and behavioral case data were smoothly integrated into the narrative.

The consistency of formatting across the eight cases was remarkable. Specific learning objectives are identified for each case and these remain consistent across the range of cases, varying only in the focus for the goals for each different health alterations. Each case begins with presentation of essential patient background and the progress across the trajectory of illness as the patient moves from location to location encountering different healthcare professionals. Many of the characters (the triage nurse in the Emergency Department, the phlebotomist) are consistent across the case situations. These consistencies facilitate both application of a variety of teaching methods and student engagement with the situated learning approach.

Case data is presented by location and begins with the patient's first encounter with the healthcare system. This allows for an examination of how specific trajectories of illness are manifested and how care management needs to be prioritized at different stages. This approach supports discussions of care transitions and the complexity of the associated interprofessional communication.

The text is well organized. The case that has two levels of complexity is clearly identified

The internal links between the table of contents and case specific locations work consistently. In the EPUB and the Digital PDF the external hyperlinks are inconsistently valid.

The grammatical errors were minimal and did not detract from readability

Cultural diversity is present across the cases in factors including race, ethnicity, socioeconomic status, family dynamics and sexual orientation.

The level of detail included in these cases supports a teaching approach to address all three spectrums of learning - knowledge, skills and attitudes - necessary for the development of competent practice. I also appreciate the inclusion of specific assessment instruments that would facilitate a discussion of evidence based practice. I will enjoy using these case to promote clinical reasoning discussions of data that is noticed and interpreted with the resulting prioritizes that are set followed by reflections that result from learner choices.

Reviewed by Chris Roman, Associate Professor, Butler University on 5/19/22

It would be extremely difficult for a book of clinical cases to comprehensively cover all of medicine, and this text does not try. Rather, it provides cases related to common medical problems and introduces them in a way that allows for various... read more

Comprehensiveness rating: 4 see less

The narrative form of the cases is less subject to issues of accuracy than a more content-based book would be. That said, the cases are realistic and reasonable, avoiding being too mundane or too extreme.

These cases are narrative and do not include many specific mentions of drugs, dosages, or other aspects of clinical care that may grow/evolve as guidelines change. For this reason, the cases should be “evergreen” and can be modified to suit different types of learners.

Clarity rating: 4

The text is written in very accessible language and avoids heavy use of technical language. Depending on the level of learner, this might even be too simplistic and omit some details that would be needed for physicians, pharmacists, and others to make nuanced care decisions.

The format is very consistent with clear labeling at transition points.

The authors point out in the introductory materials that this text is designed to be used in a modular fashion. Further, they have built in opportunities to customize each cases, such as giving dates of birth at “19xx” to allow for adjustments based on instructional objectives, etc.

The organization is very easy to follow.

I did not identify any issues in navigating the text.

The text contains no grammatical errors, though the language is a little stiff/unrealistic in some cases.

Cases involve patients and members of the care team that are of varying ages, genders, and racial/ethnic backgrounds

Reviewed by Trina Larery, Assistant Professor, Pittsburg State University on 4/5/22

The book covers common scenarios, providing allied health students insight into common health issues. The information in the book is thorough and easily modified if needed to include other scenarios not listed. The material was easy to understand... read more

Content Accuracy rating: 4

The treatments were explained and rationales were given, which can be very helpful to facilitate effective learning for a nursing student or novice nurse. The case studies were accurate in explanation. The DVT case study incorrectly identifies the location of the clot in the popliteal artery instead of in the vein.

The content is relevant to a variety of different types of health care providers and due to the general nature of the cases, will remain relevant over time. Updates should be made annually to the hyperlinks and to assure current standard of practice is still being met.

Clear, simple and easy to read.

Consistent with healthcare terminology and framework throughout all eight case studies.

The text is modular. Cases can be used individually within a unit on the given disease process or relevant sections of a case could be used to illustrate a specific point providing great flexibility. The appendix is helpful in locating content specific to a certain diagnosis or a certain type of health care provider.

The book is well organized, presenting in a logical clear fashion. The appendix allows the student to move about the case study without difficulty.

The interface is easy and simple to navigate. Some links to external sources might need to be updated regularly since those links are subject to change based on current guidelines. A few hyperlinks had "page not found".

Few grammatical errors were noted in text.

The case studies include people of different ethnicities, socioeconomic status, ages, and genders to make this a very useful book.

I enjoyed reading the text. It was interesting and relevant to today's nursing student. There are roughly 25 broken online links or "pages not found", care needs to be taken to update at least annually and assure links are valid and utilizing the most up to date information.

Reviewed by Benjamin Silverberg, Associate Professor/Clinician, West Virginia University on 3/24/22

Comprehensiveness rating: 3 see less

The appendix reviews the "key roles" and medical venues found in all 8 cases, but is fairly spartan on medical content. The table of contents at the beginning only lists the cases and locations of care. It can be a little tricky to figure out what is going on where, especially since each case is largely conversation-based. Since this presents 8 cases (really 7 with one being expanded upon), there are many medical topics (and venues) that are not included. It's impossible to include every kind of situation, but I'd love to see inclusion of sexual health, renal pathology, substance abuse, etc.

Though there are differences in how care can be delivered based on personal style, changing guidelines, available supplies, etc, the medical accuracy seems to be high. I did not detect bias or industry influence.

Relevance/Longevity rating: 4

Medications are generally listed as generics, with at least current dosing recommendations. The text gives a picture of what care looks like currently, but will be a little challenging to update based on new guidelines (ie, it can be hard to find the exact page in which a medication is dosed/prescribed). Even if the text were to be a little out of date, an instructor can use that to point out what has changed (and why).

Clear text, usually with definitions of medical slang or higher-tier vocabulary. Minimal jargon and there are instances where the "characters" are sorting out the meaning as well, making it accessible for new learners, too.

Overall, the style is consistent between cases - largely broken up into scenes and driven by conversation rather than descriptions of what is happening.

There are 8 (well, again, 7) cases which can be reviewed in any order. Case #2 builds upon #1, which is intentional and a good idea, though personally I would have preferred one case to have different possible outcomes or even a recurrence of illness. Each scene within a case is reasonably short.

Organization/Structure/Flow rating: 4

These cases are modular and don't really build on concepts throughout. As previously stated, case #2 builds upon #1, but beyond that, there is no progression. (To be sure, the authors suggest using case #1 for newer learners and #2 for more advanced ones.) The text would benefit from thematic grouping, a longer introduction and debriefing for each case (there are learning objectives but no real context in medical education nor questions to reflect on what was just read), and progressively-increasing difficulty in medical complexity, ethics, etc.

I used the PDF version and had no interface issues. There are minimal photographs and charts. Some words are marked in blue but those did not seem to be hyperlinked anywhere.

No noticeable errors in grammar, spelling, or formatting were noted.

I appreciate that some diversity of age and ethnicity were offered, but this could be improved. There were Canadian Indian and First Nations patients, for example, as well as other characters with implied diversity, but there didn't seem to be any mention of gender diverse or non-heterosexual people, or disabilities. The cases tried to paint family scenes (the first patient's dog was fairly prominently mentioned) to humanize them. Including more cases would allow for more opportunities to include sex/gender minorities, (hidden) disabilities, etc.

The text (originally from 2017) could use an update. It could be used in conjunction with other Open Texts, as a compliment to other coursework, or purely by itself. The focus is meant to be on improving communication, but there are only 3 short pages at the beginning of the text considering those issues (which are really just learning objectives). In addition to adding more cases and further diversity, I personally would love to see more discussion before and after the case to guide readers (and/or instructors). I also wonder if some of the ambiguity could be improved by suggesting possible health outcomes - this kind of counterfactual comparison isn't possible in real life and could be really interesting in a text. Addition of comprehension/discussion questions would also be worthwhile.

Reviewed by Danielle Peterson, Assistant Professor, University of Saint Francis on 12/31/21

This text provides readers with 8 case studies which include both chronic and acute healthcare issues. Although not comprehensive in regard to types of healthcare conditions, it provides a thorough look at the communication between healthcare workers in acute hospital settings. The cases are primarily set in the inpatient hospital setting, so the bulk of the clinical information is basic emergency care and inpatient protocol: vitals, breathing, medication management, etc. The text provides a table of contents at opening of the text and a handy appendix at the conclusion of the text that outlines each case’s issue(s), scenario, and healthcare roles. No index or glossary present.

Although easy to update, it should be noted that the cases are taking place in a Canadian healthcare system. Terms may be unfamiliar to some students including “province,” “operating theatre,” “physio/physiotherapy,” and “porter.” Units of measurement used include Celsius and meters. Also, the issue of managed care, health insurance coverage, and length of stay is missing for American students. These are primary issues that dictate much of the healthcare system in the US and a primary job function of social workers, nurse case managers, and medical professionals in general. However, instructors that wish to add this to the case studies could do so easily.

The focus of this text is on healthcare communication which makes it less likely to become obsolete. Much of the clinical information is stable healthcare practice that has been standard of care for quite some time. Nevertheless, given the nature of text, updates would be easy to make. Hyperlinks should be updated to the most relevant and trustworthy sources and checked frequently for effectiveness.

The spacing that was used to note change of speaker made for ease of reading. Although unembellished and plain, I expect students to find this format easy to digest and interesting, especially since the script is appropriately balanced with ‘human’ qualities like the current TV shows and songs, the use of humor, and nonverbal cues.

A welcome characteristic of this text is its consistency. Each case is presented in a similar fashion and the roles of the healthcare team are ‘played’ by the same character in each of the scenarios. This allows students to see how healthcare providers prioritize cases and juggle the needs of multiple patients at once. Across scenarios, there was inconsistency in when clinical terms were hyperlinked.

The text is easily divisible into smaller reading sections. However, since the nature of the text is script-narrative format, if significant reorganization occurs, one will need to make sure that the communication of the script still makes sense.

The text is straightforward and presented in a consistent fashion: learning objectives, case history, a script of what happened before the patient enters the healthcare setting, and a script of what happens once the patient arrives at the healthcare setting. The authors use the term, “ideal interactions,” and I would agree that these cases are in large part, ‘best case scenarios.’ Due to this, the case studies are well organized, clear, logical, and predictable. However, depending on the level of student, instructors may want to introduce complications that are typical in the hospital setting.

The interface is pleasing and straightforward. With exception to the case summary and learning objectives, the cases are in narrative, script format. Each case study supplies a photo of the ‘patient’ and one of the case studies includes a link to a 3-minute video that introduces the reader to the patient/case. One of the highlights of this text is the use of hyperlinks to various clinical practices (ABG, vital signs, transfer of patient). Unfortunately, a majority of the links are broken. However, since this is an open text, instructors can update the links to their preference.

Although not free from grammatical errors, those that were noticed were minimal and did not detract from reading.

Cultural Relevance rating: 4

Cultural diversity is visible throughout the patients used in the case studies and includes factors such as age, race, socioeconomic status, family dynamics, and sexual orientation. A moderate level of diversity is noted in the healthcare team with some stereotypes: social workers being female, doctors primarily male.

As a social work instructor, I was grateful to find a text that incorporates this important healthcare role. I would have liked to have seen more content related to advance directives, mediating decision making between the patient and care team, emotional and practical support related to initial diagnosis and discharge planning, and provision of support to colleagues, all typical roles of a medical social worker. I also found it interesting that even though social work was included in multiple scenarios, the role was only introduced on the learning objectives page for the oncology case.

Reviewed by Crystal Wynn, Associate Professor, Virginia State University on 7/21/21

The text covers a variety of chronic diseases within the cases; however, not all of the common disease states were included within the text. More chronic diseases need to be included such as diabetes, cancer, and renal failure. Not all allied health care team members are represented within the case study. Key terms appear throughout the case study textbook and readers are able to click on a hyperlink which directs them to the definition and an explanation of the key term.

Content is accurate, error-free and unbiased.

The content is up-to-date, but not in a way that will quickly make the text obsolete within a short period of time. The text is written and/or arranged in such a way that necessary updates will be relatively easy and straightforward to implement.

The text is written in lucid, accessible prose, and provides adequate context for any jargon/technical terminology used

The text is internally consistent in terms of terminology and framework.

The text is easily and readily divisible into smaller reading sections that can be assigned at different points within the course. Each case can be divided into a chronic disease state unit, which will allow the reader to focus on one section at a time.

Organization/Structure/Flow rating: 3

The topics in the text are presented in a logical manner. Each case provides an excessive amount of language that provides a description of the case. The cases in this text reads more like a novel versus a clinical textbook. The learning objectives listed within each case should be in the form of questions or activities that could be provided as resources for instructors and teachers.

Interface rating: 3

There are several hyperlinks embedded within the textbook that are not functional.

The text contains no grammatical errors.

Cultural Relevance rating: 3

The text is not culturally insensitive or offensive in any way. More examples of cultural inclusiveness is needed throughout the textbook. The cases should be indicative of individuals from a variety of races and ethnicities.

Reviewed by Rebecca Hillary, Biology Instructor, Portland Community College on 6/15/21

This textbook consists of a collection of clinical case studies that can be applicable to a wide range of learning environments from supplementing an undergraduate Anatomy and Physiology Course, to including as part of a Medical or other health care program. I read the textbook in E-reader format and this includes hyperlinks that bring the students to subsequent clinical study if the book is being used in a clinical classroom. This book is significantly more comprehensive in its approach from other case studies I have read because it provides a bird’s eye view of the many clinicians, technicians, and hospital staff working with one patient. The book also provides real time measurements for patients that change as they travel throughout the hospital until time of discharge.

Each case gave an accurate sense of the chaos that would be present in an emergency situation and show how the conditions affect the practitioners as well as the patients. The reader gets an accurate big picture--a feel for each practitioner’s point of view as well as the point of view of the patient and the patient’s family as the clock ticks down and the patients are subjected to a number of procedures. The clinical information contained in this textbook is all in hyperlinks containing references to clinical skills open text sources or medical websites. I did find one broken link on an external medical resource.

The diseases presented are relevant and will remain so. Some of the links are directly related to the Canadian Medical system so they may not be applicable to those living in other regions. Clinical links may change over time but the text itself will remain relevant.

Each case study clearly presents clinical data as is it recorded in real time.

Each case study provides the point of view of several practitioners and the patient over several days. While each of the case studies covers different pathology they all follow this same format, several points of view and data points, over a number of days.

The case studies are divided by days and this was easy to navigate as a reader. It would be easy to assign one case study per body system in an Anatomy and Physiology course, or to divide them up into small segments for small in class teaching moments.

The topics are presented in an organized way showing clinical data over time and each case presents a large number of view points. For example, in the first case study, the patient is experiencing difficulty breathing. We follow her through several days from her entrance to the emergency room. We meet her X Ray Technicians, Doctor, Nurses, Medical Assistant, Porter, Physiotherapist, Respiratory therapist, and the Lab Technicians running her tests during her stay. Each practitioner paints the overall clinical picture to the reader.

I found the text easy to navigate. There were not any figures included in the text, only clinical data organized in charts. The figures were all accessible via hyperlink. Some figures within the textbook illustrating patient scans could have been helpful but I did not have trouble navigating the links to visualize the scans.

I did not see any grammatical errors in the text.

The patients in the text are a variety of ages and have a variety of family arrangements but there is not much diversity among the patients. Our seven patients in the eight case studies are mostly white and all cis gendered.

Some of the case studies, for example the heart failure study, show clinical data before and after drug treatments so the students can get a feel for mechanism in physiological action. I also liked that the case studies included diet and lifestyle advice for the patients rather than solely emphasizing these pharmacological interventions. Overall, I enjoyed reading through these case studies and I plan to utilize them in my Anatomy and Physiology courses.

Reviewed by Richard Tarpey, Assistant Professor, Middle Tennessee State University on 5/11/21

As a case study book, there is no index or glossary. However, medical and technical terms provide a useful link to definitions and explanations that will prove useful to students unfamiliar with the terms. The information provided is appropriate for entry-level health care students. The book includes important health problems, but I would like to see coverage of at least one more chronic/lifestyle issue such as diabetes. The book covers adult issues only.

Content is accurate without bias

The content of the book is relevant and up-to-date. It addresses conditions that are prevalent in today's population among adults. There are no pediatric cases, but this does not significantly detract from the usefulness of the text. The format of the book lends to easy updating of data or information.

The book is written with clarity and is easy to read. The writing style is accessible and technical terminology is explained with links to more information.

Consistency is present. Lack of consistency is typically a problem with case study texts, but this book is consistent with presentation, format, and terminology throughout each of the eight cases.

The book has high modularity. Each of the case studies can be used independently from the others providing flexibility. Additionally, each case study can be partitioned for specific learning objectives based on the learning objectives of the course or module.

The book is well organized, presenting students conceptually with differing patient flow patterns through a hospital. The patient information provided at the beginning of each case is a wonderful mechanism for providing personal context for the students as they consider the issues. Many case studies focus on the problem and the organization without students getting a patient's perspective. The patient perspective is well represented in these cases.

The navigation through the cases is good. There are some terminology and procedure hyperlinks within the cases that do not work when accessed. This is troubling if you intend to use the text for entry-level health care students since many of these links are critical for a full understanding of the case.

There are some non-US variants of spelling and a few grammatical errors, but these do not detract from the content of the messages of each case.

The book is inclusive of differing backgrounds and perspectives. No insensitive or offensive references were found.

I like this text for its application flexibility. The book is useful for non-clinical healthcare management students to introduce various healthcare-related concepts and terminology. The content is also helpful for the identification of healthcare administration managerial issues for students to consider. The book has many applications.

Reviewed by Paula Baldwin, Associate Professor/Communication Studies, Western Oregon University on 5/10/21

The different case studies fall on a range, from crisis care to chronic illness care. read more

The different case studies fall on a range, from crisis care to chronic illness care.

The contents seems to be written as they occurred to represent the most complete picture of each medical event's occurence.

These case studies are from the Canadian medical system, but that does not interfere with it's applicability.

It is written for a medical audience, so the terminology is mostly formal and technical.

Some cases are shorter than others and some go in more depth, but it is not problematic.

The eight separate case studies is the perfect size for a class in the quarter system. You could combine this with other texts, videos or learning modalities, or use it alone.

As this is a case studies book, there is not a need for a logical progression in presentation of topics.

No problems in terms of interface.

I have not seen any grammatical errors.

I did not see anything that was culturally insensitive.

I used this in a Health Communication class and it has been extraordinarily successful. My studies are analyzing the messaging for the good, the bad, and the questionable. The case studies are widely varied and it gives the class insights into hospital experiences, both front and back stage, that they would not normally be able to examine. I believe that because it is based real-life medical incidents, my students are finding the material highly engaging.

Reviewed by Marlena Isaac, Instructor, Aiken Technical College on 4/23/21

This text is great to walk through patient care with entry level healthcare students. The students are able to take in the information, digest it, then provide suggestions to how they would facilitate patient healing. Then when they are faced with... read more

The case studies provided accurate information that relates to the named disease.

It is relevant to health care studies and the development of critical thinking.

Cases are straightforward with great clinical information.

Clinical information is provided concisely.

Appropriate for clinical case study.

Presented to facilitate information gathering.

Takes a while to navigate in the browser.

Cultural Relevance rating: 1

Text lacks adequate representation of minorities.

Reviewed by Kim Garcia, Lecturer III, University of Texas Rio Grande Valley on 11/16/20

The book has 8 case studies, so obviously does not cover the whole of medicine, but the cases provided are descriptive and well developed. Cases are presented at different levels of difficulty, making the cases appropriate for students at different levels of clinical knowledge. The human element of both patient and health care provider is well captured. The cases are presented with a focus on interprofessional interaction and collaboration, more so than teaching medical content.

Content is accurate and un-biased. No errors noted. Most diagnostic and treatment information is general so it will remain relevant over time. The content of these cases is more appropriate for teaching interprofessional collaboration and less so for teaching the medical care for each diagnosis.

The content is relevant to a variety of different types of health care providers (nurses, radiologic technicians, medical laboratory personnel, etc) and due to the general nature of the cases, will remain relevant over time.

Easy to read. Clear headings are provided for sections of each case study and these section headings clearly tell when time has passed or setting has changed. Enough description is provided to help set the scene for each part of the case. Much of the text is written in the form of dialogue involving patient, family and health care providers, making it easy to adapt for role play. Medical jargon is limited and links for medical terms are provided to other resources that expound on medical terms used.

The text is consistent in structure of each case. Learning objectives are provided. Cases generally start with the patient at home and move with the patient through admission, testing and treatment, using a variety of healthcare services and encountering a variety of personnel.

The text is modular. Cases could be used individually within a unit on the given disease process or relevant sections of a case could be used to illustrate a specific point. The appendix is helpful in locating content specific to a certain diagnosis or a certain type of health care provider.

Each case follows a patient in a logical, chronologic fashion. A clear table of contents and appendix are provided which allows the user to quickly locate desired content. It would be helpful if the items in the table of contents and appendix were linked to the corresponding section of the text.

The hyperlinks to content outside this book work, however using the back arrow on your browser returns you to the front page of the book instead of to the point at which you left the text. I would prefer it if the hyperlinks opened in a new window or tab so closing that window or tab would leave you back where you left the text.

No grammatical errors were noted.

The text is culturally inclusive and appropriate. Characters, both patients and care givers are of a variety of races, ethnicities, ages and backgrounds.

I enjoyed reading the cases and reviewing this text. I can think of several ways in which I will use this content.

Reviewed by Raihan Khan, Instructor/Assistant Professor, James Madison University on 11/3/20

The book contains several important health issues, however still missing some chronic health issues that the students should learn before they join the workforce, such as diabetes-related health issues suffered by the patients. read more

The health information contained in the textbook is mostly accurate.

I think the book is written focusing on the current culture and health issues faced by the patients. To keep the book relevant in the future, the contexts especially the culture/lifestyle/health care modalities, etc. would need to be updated regularly.

The language is pretty simple, clear, and easy to read.

There is no complaint about consistency. One of the main issues of writing a book, consistency was well managed by the authors.

The book is easy to explore based on how easy the setup is. Students can browse to the specific section that they want to read without much hassle of finding the correct information.

The organization is simple but effective. The authors organized the book based on what can happen in a patient's life and what possible scenarios students should learn about the disease. From that perspective, the book does a good job.

The interface is easy and simple to navigate. Some links to external sources might need to be updated regularly since those links are subject to change that is beyond the author's control. It's frustrating for the reader when the external link shows no information.

The book is free of any major language and grammatical errors.

The book might do a little better in cultural competency. e.g. Last name Singh is mainly for Sikh people. In the text Harj and Priya Singh are Muslim. the authors can consult colleagues who are more familiar with those cultures and revise some cultural aspects of the cases mentioned in the book.

The book is a nice addition to the open textbook world. Hope to see more health issues covered by the book.

Reviewed by Ryan Sheryl, Assistant Professor, California State University, Dominguez Hills on 7/16/20

This text contains 8 medical case studies that reflect best practices at the time of publication. The text identifies 5 overarching learning objectives: interprofessional collaboration, client centered care, evidence-based practice, quality improvement, and informatics. While the case studies do not cover all medical conditions or bodily systems, the book is thorough in conveying details of various patients and medical team members in a hospital environment. Rather than an index or glossary at the end of the text, it contains links to outside websites for more information on medical tests and terms referenced in the cases.

The content provided is reflective of best practices in patient care, interdisciplinary collaboration, and communication at the time of publication. It is specifically accurate for the context of hospitals in Canada. The links provided throughout the text have the potential to supplement with up-to-date descriptions and definitions, however, many of them are broken (see notes in Interface section).

The content of the case studies reflects the increasingly complex landscape of healthcare, including a variety of conditions, ages, and personal situations of the clients and care providers. The text will require frequent updating due to the rapidly changing landscape of society and best practices in client care. For example, a future version may include inclusive practices with transgender clients, or address ways medical racism implicitly impacts client care (see notes in Cultural Relevance section).

The text is written clearly and presents thorough, realistic details about working and being treated in an acute hospital context.

The text is very straightforward. It is consistent in its structure and flow. It uses consistent terminology and follows a structured framework throughout.

Being a series of 8 separate case studies, this text is easily and readily divisible into smaller sections. The text was designed to be taken apart and used piece by piece in order to serve various learning contexts. The parts of each case study can also be used independently of each other to facilitate problem solving.

The topics in the case studies are presented clearly. The structure of each of the case studies proceeds in a similar fashion. All of the cases are set within the same hospital so the hospital personnel and service providers reappear across the cases, giving a textured portrayal of the experiences of the various service providers. The cases can be used individually, or one service provider can be studied across the various studies.

The text is very straightforward, without complex charts or images that could become distorted. Many of the embedded links are broken and require updating. The links that do work are a very useful way to define and expand upon medical terms used in the case studies.

Grammatical errors are minimal and do not distract from the flow of the text. In one instance the last name Singh is spelled Sing, and one patient named Fred in the text is referred to as Frank in the appendix.

The cases all show examples of health care personnel providing compassionate, client-centered care, and there is no overt discrimination portrayed. Two of the clients are in same-sex marriages and these are shown positively. It is notable, however, that the two cases presenting people of color contain more negative characteristics than the other six cases portraying Caucasian people. The people of color are the only two examples of clients who smoke regularly. In addition, the Indian client drinks and is overweight, while the First Nations client is the only one in the text to have a terminal diagnosis. The Indian client is identified as being Punjabi and attending a mosque, although there are only 2% Muslims in the Punjab province of India. Also, the last name Singh generally indicates a person who is a Hindu or Sikh, not Muslim.

Reviewed by Monica LeJeune, RN Instructor, LSUE on 4/24/20

Has comprehensive unfolding case studies that guide the reader to recognize and manage the scenario presented. Assists in critical thinking process. read more

Has comprehensive unfolding case studies that guide the reader to recognize and manage the scenario presented. Assists in critical thinking process.

Accurately presents health scenarios with real life assessment techniques and patient outcomes.

Relevant to nursing practice.

Clearly written and easily understood.

Consistent with healthcare terminology and framework

Has a good reading flow.

Topics presented in logical fashion

Easy to read.

No grammatical errors noted.

Text is not culturally insensitive or offensive.

Good book to have to teach nursing students.

Reviewed by april jarrell, associate professor, J. Sargeant Reynolds Community College on 1/7/20

The text is a great case study tool that is appropriate for nursing school instructors to use in aiding students to learn the nursing process. read more

The text is a great case study tool that is appropriate for nursing school instructors to use in aiding students to learn the nursing process.

The content is accurate and evidence based. There is no bias noted

The content in the text is relevant, up to date for nursing students. It will be easy to update content as needed because the framework allows for addition to the content.

The text is clear and easy to understand.

Framework and terminology is consistent throughout the text; the case study is a continual and takes the student on a journey with the patient. Great for learning!

The case studies can be easily divided into smaller sections to allow for discussions, and weekly studies.

The text and content progress in a logical, clear fashion allowing for progression of learning.

No interface issues noted with this text.

No grammatical errors noted in the text.

No racial or culture insensitivity were noted in the text.

I would recommend this text be used in nursing schools. The use of case studies are helpful for students to learn and practice the nursing process.

Reviewed by Lisa Underwood, Practical Nursing Instructor, NTCC on 12/3/19

The text provides eight comprehensive case studies that showcase the different viewpoints of the many roles involved in patient care. It encompasses the most common seen diagnoses seen across healthcare today. Each case study comes with its own set of learning objectives that can be tweaked to fit several allied health courses. Although the case studies are designed around the Canadian Healthcare System, they are quite easily adaptable to fit most any modern, developed healthcare system.

Content Accuracy rating: 3

Overall, the text is quite accurate. There is one significant error that needs to be addressed. It is located in the DVT case study. In the study, a popliteal artery clot is mislabeled as a DVT. DVTs are located in veins, not in arteries. That said, the case study on the whole is quite good. This case study could be used as a learning tool in the classroom for discussion purposes or as a way to test student understanding of DVTs, on example might be, "Can they spot the error?"

At this time, all of the case studies within the text are current. Healthcare is an ever evolving field that rests on the best evidence based practice. Keeping that in mind, educators can easily adapt the studies as the newest evidence emerges and changes practice in healthcare.

All of the case studies are well written and easy to understand. The text includes several hyperlinks and it also highlights certain medical terminology to prompt readers as a way to enhance their learning experience.

Across the text, the language, style, and format of the case studies are completely consistent.

The text is divided into eight separate case studies. Each case study may be used independently of the others. All case studies are further broken down as the focus patient passes through each aspect of their healthcare system. The text's modularity makes it possible to use a case study as individual work, group projects, class discussions, homework or in a simulation lab.

The case studies and the diagnoses that they cover are presented in such a way that educators and allied health students can easily follow and comprehend.

The book in itself is free of any image distortion and it prints nicely. The text is offered in a variety of digital formats. As noted in the above reviews, some of the hyperlinks have navigational issues. When the reader attempts to access them, a "page not found" message is received.

There were minimal grammatical errors. Some of which may be traced back to the differences in our spelling.

The text is culturally relevant in that it includes patients from many different backgrounds and ethnicities. This allows educators and students to explore cultural relevance and sensitivity needs across all areas in healthcare. I do not believe that the text was in any way insensitive or offensive to the reader.

By using the case studies, it may be possible to have an open dialogue about the differences noted in healthcare systems. Students will have the ability to compare and contrast the Canadian healthcare system with their own. I also firmly believe that by using these case studies, students can improve their critical thinking skills. These case studies help them to "put it all together".

Reviewed by Melanie McGrath, Associate Professor, TRAILS on 11/29/19

The text covered some of the most common conditions seen by healthcare providers in a hospital setting, which forms a solid general base for the discussions based on each case. read more

The text covered some of the most common conditions seen by healthcare providers in a hospital setting, which forms a solid general base for the discussions based on each case.

I saw no areas of inaccuracy

As in all healthcare texts, treatments and/or tests will change frequently. However, everything is currently up-to-date thus it should be a good reference for several years.

Each case is written so that any level of healthcare student would understand. Hyperlinks in the text is also very helpful.

All of the cases are written in a similar fashion.

Although not structured as a typical text, each case is easily assigned as a stand-alone.

Each case is organized clearly in an appropriate manner.

I did not see any issues.

I did not see any grammatical errors

The text seemed appropriately inclusive. There are no pediatric cases and no cases of intellectually-impaired patients, but those types of cases introduce more advanced problem-solving which perhaps exceed the scope of the text. May be a good addition to the text.

I found this text to be an excellent resource for healthcare students in a variety of fields. It would be best utilized in inter professional courses to help guide discussion.

Reviewed by Lynne Umbarger, Clinical Assistant Professor, Occupational Therapy, Emory and Henry College on 11/26/19

While the book does not cover every scenario, the ones in the book are quite common and troublesome for inexperienced allied health students. The information in the book is thorough enough, and I have found the cases easy to modify for educational purposes. The material was easily understood by the students but challenging enough for classroom discussion. There are no mentions in the book about occupational therapy, but it is easy enough to add a couple words and make inclusion simple.

Very nice lab values are provided in the case study, making it more realistic for students.

These case studies focus on commonly encountered diagnoses for allied health and nursing students. They are comprehensive, realistic, and easily understood. The only difference is that the hospital in one case allows the patient's dog to visit in the room (highly unusual in US hospitals).

The material is easily understood by allied health students. The cases have links to additional learning materials for concepts that may be less familiar or should be explored further in a particular health field.

The language used in the book is consistent between cases. The framework is the same with each case which makes it easier to locate areas that would be of interest to a particular allied health profession.

The case studies are comprehensive but well-organized. They are short enough to be useful for class discussion or a full-blown assignment. The students seem to understand the material and have not expressed that any concepts or details were missing.

Each case is set up like the other cases. There are learning objectives at the beginning of each case to facilitate using the case, and it is easy enough to pull out material to develop useful activities and assignments.

There is a quick chart in the Appendix to allow the reader to determine the professions involved in each case as well as the pertinent settings and diagnoses for each case study. The contents are easy to access even while reading the book.

As a person who attends carefully to grammar, I found no errors in all of the material I read in this book.

There are a greater number of people of different ethnicities, socioeconomic status, ages, and genders to make this a very useful book. With each case, I could easily picture the person in the case. This book appears to be Canadian and more inclusive than most American books.

I was able to use this book the first time I accessed it to develop a classroom activity for first-year occupational therapy students and a more comprehensive activity for second-year students. I really appreciate the links to a multitude of terminology and medical lab values/issues for each case. I will keep using this book.

Reviewed by Cindy Krentz, Assistant Professor, Metropolitan State University of Denver on 6/15/19

The book covers eight case studies of common inpatient or emergency department scenarios. I appreciated that they had written out the learning objectives. I liked that the patient was described before the case was started, giving some understanding of the patient's background. I think it could benefit from having a glossary. I liked how the authors included the vital signs in an easily readable bar. I would have liked to see the labs also highlighted like this. I also felt that it would have been good written in a 'what would you do next?' type of case study.

The book is very accurate in language, what tests would be prudent to run and in the day in the life of the hospital in all cases. One inaccuracy is that the authors called a popliteal artery clot a DVT. The rest of the DVT case study was great, though, but the one mistake should be changed.

The book is up to date for now, but as tests become obsolete and new equipment is routinely used, the book ( like any other health textbook) will need to be updated. It would be easy to change, however. All that would have to happen is that the authors go in and change out the test to whatever newer, evidence-based test is being utilized.

The text is written clearly and easy to understand from a student's perspective. There is not too much technical jargon, and it is pretty universal when used- for example DVT for Deep Vein Thrombosis.

The book is consistent in language and how it is broken down into case studies. The same format is used for highlighting vital signs throughout the different case studies. It's great that the reader does not have to read the book in a linear fashion. Each case study can be read without needing to read the others.

The text is broken down into eight case studies, and within the case studies is broken down into days. It is consistent and shows how the patient can pass through the different hospital departments (from the ER to the unit, to surgery, to home) in a realistic manner. The instructor could use one or more of the case studies as (s)he sees fit.

The topics are eight different case studies- and are presented very clearly and organized well. Each one is broken down into how the patient goes through the system. The text is easy to follow and logical.

The interface has some problems with the highlighted blue links. Some of them did not work and I got a 'page not found' message. That can be frustrating for the reader. I'm wondering if a glossary could be utilized (instead of the links) to explain what some of these links are supposed to explain.

I found two or three typos, I don't think they were grammatical errors. In one case I think the Canadian spelling and the United States spelling of the word are just different.

This is a very culturally competent book. In today's world, however, one more type of background that would merit delving into is the trans-gender, GLBTQI person. I was glad that there were no stereotypes.

I enjoyed reading the text. It was interesting and relevant to today's nursing student. Since we are becoming more interprofessional, I liked that we saw what the phlebotomist and other ancillary personnel (mostly different technicians) did. I think that it could become even more interdisciplinary so colleges and universities could have more interprofessional education- courses or simulations- with the addition of the nurse using social work, nutrition, or other professional health care majors.

Reviewed by Catherine J. Grott, Interim Director, Health Administration Program, TRAILS on 5/5/19

The book is comprehensive but is specifically written for healthcare workers practicing in Canada. The title of the book should reflect this. read more

The book is comprehensive but is specifically written for healthcare workers practicing in Canada. The title of the book should reflect this.

The book is accurate, however it has numerous broken online links.

Relevance/Longevity rating: 3

The content is very relevant, but some links are out-dated. For example, WHO Guidelines for Safe Surgery 2009 (p. 186) should be updated.

The book is written in clear and concise language. The side stories about the healthcare workers make the text interesting.

The book is consistent in terms of terminology and framework. Some terms that are emphasized in one case study are not emphasized (with online links) in the other case studies. All of the case studies should have the same words linked to online definitions.

Modularity rating: 3

The book can easily be parsed out if necessary. However, the way the case studies have been written, it's evident that different authors contributed singularly to each case study.

The organization and flow are good.

Interface rating: 1

There are numerous broken online links and "pages not found."

The grammar and punctuation are correct. There are two errors detected: p. 120 a space between the word "heart" and the comma; also a period is needed after Dr (p. 113).

I'm not quite sure that the social worker (p. 119) should comment that the patient and partner are "very normal people."

There are roughly 25 broken online links or "pages not found." The BC & Canadian Guidelines (p. 198) could also include a link to US guidelines to make the text more universal . The basilar crackles (p. 166) is very good. Text could be used compare US and Canadian healthcare. Text could be enhanced to teach "soft skills" and interdepartmental communication skills in healthcare.

Reviewed by Lindsey Henry, Practical Nursing Instructor, Fletcher on 5/1/19

I really appreciated how in the introduction, five learning objectives were identified for students. These objectives are paramount in nursing care and they are each spelled out for the learner. Each Case study also has its own learning... read more

As a seasoned nurse, I believe that the content regarding pathophysiology and treatments used in the case studies were accurate. I really appreciated how many of the treatments were also explained and rationales were given, which can be very helpful to facilitate effective learning for a nursing student or novice nurse.

The case studies are up to date and correlate with the current time period. They are easily understood.

I really loved how several important medical terms, including specific treatments were highlighted to alert the reader. Many interventions performed were also explained further, which is great to enhance learning for the nursing student or novice nurse. Also, with each scenario, a background and history of the patient is depicted, as well as the perspectives of the patient, patients family member, and the primary nurse. This really helps to give the reader a full picture of the day in the life of a nurse or a patient, and also better facilitates the learning process of the reader.

These case studies are consistent. They begin with report, the patient background or updates on subsequent days, and follow the patients all the way through discharge. Once again, I really appreciate how this book describes most if not all aspects of patient care on a day to day basis.

Each case study is separated into days. While they can be divided to be assigned at different points within the course, they also build on each other. They show trends in vital signs, what happens when a patient deteriorates, what happens when they get better and go home. Showing the entire process from ER admit to discharge is really helpful to enhance the students learning experience.

The topics are all presented very similarly and very clearly. The way that the scenarios are explained could even be understood by a non-nursing student as well. The case studies are very clear and very thorough.

The book is very easy to navigate, prints well on paper, and is not distorted or confusing.

I did not see any grammatical errors.

Each case study involves a different type of patient. These differences include race, gender, sexual orientation and medical backgrounds. I do not feel the text was offensive to the reader.

I teach practical nursing students and after reading this book, I am looking forward to implementing it in my classroom. Great read for nursing students!

Reviewed by Leah Jolly, Instructor, Clinical Coordinator, Oregon Institute of Technology on 4/10/19

Good variety of cases and pathologies covered. read more

Good variety of cases and pathologies covered.

Content Accuracy rating: 2

Some examples and scenarios are not completely accurate. For example in the DVT case, the sonographer found thrombus in the "popliteal artery", which according to the book indicated presence of DVT. However in DVT, thrombus is located in the vein, not the artery. The patient would also have much different symptoms if located in the artery. Perhaps some of these inaccuracies are just typos, but in real-life situations this simple mistake can make a world of difference in the patient's course of treatment and outcomes.

Good examples of interprofessional collaboration. If only it worked this way on an every day basis!

Clear and easy to read for those with knowledge of medical terminology.

Good consistency overall.

Broken up well.

Topics are clear and logical.

Would be nice to simply click through to the next page, rather than going through the table of contents each time.

Minor typos/grammatical errors.

No offensive or insensitive materials observed.

Reviewed by Alex Sargsyan, Doctor of Nursing Practice/Assistant Professor , East Tennessee State University on 10/8/18

Because of the case study character of the book it does not have index or glossary. However it has summary for each health case study outlining key elements discussed in each case study. read more

Because of the case study character of the book it does not have index or glossary. However it has summary for each health case study outlining key elements discussed in each case study.

Overall the book is accurately depicting the clinical environment. There are numerous references to external sites. While most of them are correct, some of them are not working. For example Homan’s test link is not working "404 error"

Book is relevant in its current version and can be used in undergraduate and graduate classes. That said, the longevity of the book may be limited because of the character of the clinical education. Clinical guidelines change constantly and it may require a major update of the content.

Cases are written very clearly and have realistic description of an inpatient setting.

The book is easy to read and consistent in the language in all eight cases.

The cases are very well written. Each case is subdivided into logical segments. The segments reflect different setting where the patient is being seen. There is a flow and transition between the settings.

Book has eight distinct cases. This is a great format for a book that presents distinct clinical issues. This will allow the students to have immersive experiences and gain better understanding of the healthcare environment.

Book is offered in many different formats. Besides the issues with the links mentioned above, overall navigation of the book content is very smooth.

Book is very well written and has no grammatical errors.

Book is culturally relevant. Patients in the case studies come different cultures and represent diverse ethnicities.

Reviewed by Justin Berry, Physical Therapist Assistant Program Director, Northland Community and Technical College, East Grand Forks, MN on 8/2/18

This text provides eight patient case studies from a variety of diagnoses, which can be utilized by healthcare students from multiple disciplines. The cases are comprehensive and can be helpful for students to determine professional roles, interprofessional roles, when to initiate communication with other healthcare practitioners due to a change in patient status, and treatment ideas. Some additional patient information, such as lab values, would have been beneficial to include.

Case study information is accurate and unbiased.

Content is up to date. The case studies are written in a way so that they will not be obsolete soon, even with changes in healthcare.

The case studies are well written, and can be utilized for a variety of classroom assignments, discussions, and projects. Some additional lab value information for each patient would have been a nice addition.

The case studies are consistently organized to make it easy for the reader to determine the framework.

The text is broken up into eight different case studies for various patient diagnoses. This design makes it highly modular, and would be easy to assign at different points of a course.

The flow of the topics are presented consistently in a logical manner. Each case study follows a patient chronologically, making it easy to determine changes in patient status and treatment options.

The text is free of interface issues, with no distortion of images or charts.

The text is not culturally insensitive or offensive in any way. Patients are represented from a variety of races, ethnicities, and backgrounds

This book would be a good addition for many different health programs.

Reviewed by Ann Bell-Pfeifer, Instructor/Program Director, Minnesota State Community and Technical College on 5/21/18

The book gives a comprehensive overview of many types of cases for patient conditions. Emergency Room patients may arrive with COPD, heart failure, sepsis, pneumonia, or as motor vehicle accident victims. It is directed towards nurses, medical laboratory technologists, medical radiology technologists, and respiratory therapists and their roles in caring for patients. Most of the overview is accurate. One suggestion is to provide an embedded radiologist interpretation of the exams which are performed which lead to the patients diagnosis.

Overall the book is accurate. Would like to see updates related to the addition of direct radiography technology which is commonly used in the hospital setting.

Many aspects of medicine will remain constant. The case studies seem fairly accurate and may be relevant for up to 3 years. Since technology changes so quickly in medicine, the CT and x-ray components may need minor updates within a few years.

The book clarity is excellent.

The case stories are consistent with each scenario. It is easy to follow the structure and learn from the content.

The book is quite modular. It is easy to break it up into cases and utilize them individually and sequentially.

The cases are listed by disease process and follow a logical flow through each condition. They are easy to follow as they have the same format from the beginning to the end of each case.

The interface seems seamless. Hyperlinks are inserted which provide descriptions and references to medical procedures and in depth definitions.

The book is free of most grammatical errors. There is a place where a few words do not fit the sentence structure and could be a typo.

The book included all types of relationships and ethnic backgrounds. One type which could be added is a transgender patient.

I think the book was quite useful for a variety of health care professionals. The authors did an excellent job of integrating patient cases which could be applied to the health care setting. The stories seemed real and relevant. This book could be used to teach health care professionals about integrated care within the emergency department.

Reviewed by Shelley Wolfe, Assistant Professor, Winona State University on 5/21/18

This text is comprised of comprehensive, detailed case studies that provide the reader with multiple character views throughout a patient’s encounter with the health care system. The Table of Contents accurately reflected the content. It should be noted that the authors include a statement that conveys that this text is not like traditional textbooks and is not meant to be read in a linear fashion. This allows the educator more flexibility to use the text as a supplement to enhance learning opportunities.

The content of the text appears accurate and unbiased. The “five overarching learning objectives” provide a clear aim of the text and the educator is able to glean how these objectives are captured into each of the case studies. While written for the Canadian healthcare system, this text is easily adaptable to the American healthcare system.

Overall, the content is up-to-date and the case studies provide a variety of uses that promote longevity of the text. However, not all of the blue font links (if using the digital PDF version) were still in working order. I encountered links that led to error pages or outdated “page not found” websites. While the links can be helpful, continued maintenance of these links could prove time-consuming.

I found the text easy to read and understand. I enjoyed that the viewpoints of all the different roles (patient, nurse, lab personnel, etc.) were articulated well and allowed the reader to connect and gain appreciation of the entire healthcare team. Medical jargon was noted to be appropriate for the intended audience of this text.

The terminology and organization of this text is consistent.

The text is divided into 8 case studies that follow a similar organizational structure. The case studies can further be divided to focus on individual learning objectives. For example, the case studies could be looked at as a whole for discussing communication or could be broken down into segments to focus on disease risk factors.

The case studies in this text follow a similar organizational structure and are consistent in their presentation. The flow of individual case studies is excellent and sets the reader on a clear path. As noted previously, this text is not meant to be read in a linear fashion.

This text is available in many different forms. I chose to review the text in the digital PDF version in order to use the embedded links. I did not encounter significant interface issues and did not find any images or features that would distract or confuse a reader.

No significant grammatical errors were noted.

The case studies in this text included patients and healthcare workers from a variety of backgrounds. Educators and students will benefit from expanding the case studies to include discussions and other learning opportunities to help develop culturally-sensitive healthcare providers.

I found the case studies to be very detailed, yet written in a way in which they could be used in various manners. The authors note a variety of ways in which the case studies could be employed with students; however, I feel the authors could also include that the case studies could be used as a basis for simulated clinical experiences. The case studies in this text would be an excellent tool for developing interprofessional communication and collaboration skills in a variety healthcare students.

Reviewed by Darline Foltz, Assistant Professor, University of Cincinnati - Clermont College on 3/27/18

This book covers all areas listed in the Table of Contents. In addition to the detailed patient case studies, there is a helpful section of "How to Use this Resource". I would like to note that this resource "aligns with the open textbooks... read more

The book appears to be accurate. Although one of the learning outcomes is as follows: "Demonstrate an understanding of the Canadian healthcare delivery system.", I did not find anything that is ONLY specific to the Canadian healthcare delivery system other than some of the terminology, i.e. "porter" instead of "transporter" and a few french words. I found this to make the book more interesting for students rather than deter from it. These are patient case studies that are relevant in any country.

The content is up-to-date. Changes in medical science may occur, i.e. a different test, to treat a diagnosis that is included in one or more of the case studies, however, it would be easy and straightforward to implement these changes.

This book is written in lucid, accessible prose. The technical/medical terminology that is used is appropriate for medical and allied health professionals. Something that would improve this text would to provide a glossary of terms for the terms in blue font.

This book is consistent with current medical terminology

This text is easily divided into each of the 6 case studies. The case studies can be used singly according to the body system being addressed or studied.

Because this text is a collection of case studies, flow doesn't pertain, however the organization and structure of the case studies are excellent as they are clear and easy to read.

There are no distractions in this text that would distract or confuse the reader.

I did not identify any grammatical errors.

This text is not culturally insensitive or offensive in any way and uses patients and healthcare workers that are of a variety of races, ethnicities and backgrounds.

I believe that this text would not only be useful to students enrolled in healthcare professions involved in direct patient care but would also be useful to students in supporting healthcare disciplines such as health information technology and management, medical billing and coding, etc.

Introduction

Case Study #1: Chronic Obstructive Pulmonary Disease (COPD)

Learning Objectives
Patient: Erin Johns
Emergency Room

Case Study #2: Pneumonia

Day 0: Emergency Room
Day 1: Emergency Room
Day 1: Medical Ward
Day 2: Medical Ward
Day 3: Medical Ward
Day 4: Medical Ward

Case Study #3: Unstable Angina (UA)

Patient: Harj Singh

Case Study #4: Heart Failure (HF)

Patient: Meryl Smith
In the Supermarket
Day 0: Medical Ward

Case Study #5: Motor Vehicle Collision (MVC)

Patient: Aaron Knoll
Crash Scene
Operating Room
Post Anaesthesia Care Unit (PACU)
Surgical Ward

Case Study #6: Sepsis

Patient: George Thomas
Sleepy Hollow Care Facility

Case Study #7: Colon Cancer

Patient: Fred Johnson
Two Months Ago
Pre-Surgery Admission

Case Study #8: Deep Vein Thrombosis (DVT)

Patient: Jamie Douglas

Appendix: Overview About the Authors

Ancillary Material

About the book.

Health Case Studies is composed of eight separate health case studies. Each case study includes the patient narrative or story that models the best practice (at the time of publishing) in healthcare settings. Associated with each case is a set of specific learning objectives to support learning and facilitate educational strategies and evaluation.

The case studies can be used online in a learning management system, in a classroom discussion, in a printed course pack or as part of a textbook created by the instructor. This flexibility is intentional and allows the educator to choose how best to convey the concepts presented in each case to the learner.

Because these case studies were primarily developed for an electronic healthcare system, they are based predominantly in an acute healthcare setting. Educators can augment each case study to include primary healthcare settings, outpatient clinics, assisted living environments, and other contexts as relevant.

About the Contributors

Glynda Rees teaches at the British Columbia Institute of Technology (BCIT) in Vancouver, British Columbia. She completed her MSN at the University of British Columbia with a focus on education and health informatics, and her BSN at the University of Cape Town in South Africa. Glynda has many years of national and international clinical experience in critical care units in South Africa, the UK, and the USA. Her teaching background has focused on clinical education, problem-based learning, clinical techniques, and pharmacology.

Glynda‘s interests include the integration of health informatics in undergraduate education, open accessible education, and the impact of educational technologies on nursing students’ clinical judgment and decision making at the point of care to improve patient safety and quality of care.

Faculty member in the critical care nursing program at the British Columbia Institute of Technology (BCIT) since 2003, Rob has been a critical care nurse for over 25 years with 17 years practicing in a quaternary care intensive care unit. Rob is an experienced educator and supports student learning in the classroom, online, and in clinical areas. Rob’s Master of Education from Simon Fraser University is in educational technology and learning design. He is passionate about using technology to support learning for both faculty and students.

Part of Rob’s faculty position is dedicated to providing high fidelity simulation support for BCIT’s nursing specialties program along with championing innovative teaching and best practices for educational technology. He has championed the use of digital publishing and was the tech lead for Critical Care Nursing’s iPad Project which resulted in over 40 multi-touch interactive textbooks being created using Apple and other technologies.

Rob has successfully completed a number of specialist certifications in computer and network technologies. In 2015, he was awarded Apple Distinguished Educator for his innovation and passionate use of technology to support learning. In the past five years, he has presented and published abstracts on virtual simulation, high fidelity simulation, creating engaging classroom environments, and what the future holds for healthcare and education.

Janet Morrison is the Program Head of Occupational Health Nursing at the British Columbia Institute of Technology (BCIT) in Burnaby, British Columbia. She completed a PhD at Simon Fraser University, Faculty of Communication, Art and Technology, with a focus on health information technology. Her dissertation examined the effects of telehealth implementation in an occupational health nursing service. She has an MA in Adult Education from St. Francis Xavier University and an MA in Library and Information Studies from the University of British Columbia.

Janet’s research interests concern the intended and unintended impacts of health information technologies on healthcare students, faculty, and the healthcare workforce.

She is currently working with BCIT colleagues to study how an educational clinical information system can foster healthcare students’ perceptions of interprofessional roles.

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Systems Thinking for Public Health: A Case Study Using U.S. Public Education

ABSTRACT | The initial response to the COVID-19 pandemic in the United States largely focused on addressing the immediate health consequences from the emergent pathogen. This initial focus often ignored the related impacts from the pandemic and from mitigation measures, including how existing social determinants of health compounded physical, social, and economic impacts on individuals who have historically been marginalized. The consequences of decisions around closing and reopening primary and secondary (K–12 in the United States) public schools exemplify the complex impacts of pandemic mitigation measures. Ongoing COVID-19 mitigation and recovery efforts have gradually begun addressing indirect consequences, but these efforts were slow to be identified and adopted through much of the acute phase of the pandemic, mirroring the decades-long neglect of contributors to the overall health and well-being of populations that have been made to be vulnerable.

A systems approach for decision-making and problem solving holistically considers the effects of complex interacting factors. Taking a systems approach at the start of the next health emergency could encourage response strategies that consider various competing public health needs throughout different sectors of society, account for existing disparities, and preempt undesirable consequences before and during response implementation. There is a need to understand how a systems approach can be better integrated into decision-making to improve future responses to public health emergencies. A wide range of stakeholders should contribute expertise to these models, and these partnerships should be formed in advance of a public health emergency.

Introduction

In September 2021 the National Academies of Sciences, Engineering, and Medicine hosted a workshop titled “Towards a Post-Pandemic World: Lessons from COVID-19 for Now and the Future.” (NASEM, 2022) In this article, select workshop participants further explore the application of systems thinking in evaluating COVID-19 mitigation measures.

Systems Thinking in Public Health

A systems science approach to outbreak response planning is a useful tool for broadening strategic thinking to consider critical factors driving the short- and long-term consequences of crisis response measures, including how such decisions will impact health disparities (Bradley et al., 2020). A conceptual framework, systems thinking accounts for the relationship between individual factors within a scenario as well as their contributions to the whole, and can facilitate the synthesis of response plans that match the scale and complexity of the problem at hand (Trochim et al., 2006).

Specifically for public health, a systems approach “applies scientific insights to understand the elements that influence health outcomes; models the relationships between those elements; and alters design, processes or policies based on the resultant knowledge” (Kaplan et al., 2013). Complex and interconnected risk factors collectively influenced health outcomes in the COVID-19 pandemic. Response to an evolving public health emergency requires a systems approach that can weigh disparate needs and account for systemic inequities to quickly generate solutions while remaining adaptable as new data emerges.

In this article, we use the issue of K–12 public school closures in the United States to illustrate the need for systems approaches in public health situations. Mapping tools, such as causal loop diagrams, can show the complexity of interconnected factors and their use should be prioritized to guide evidence-based decisions in complex and evolving circumstances. This article argues for the adoption of a systems science approach to outbreak decision-making that:

addresses the inherent complexity of societal impacts during public health emergencies,
accounts for social determinants of health, and
includes perspectives from a wide range of stakeholders

COVID-19 Decision-Making and Unintended Consequences

At the start of the COVID-19 pandemic, policy decisions and responses were enacted quickly to contain the spread of disease. However, the public health implications of COVID-19 extend beyond the disease itself, as the pandemic exacerbated disparities in health outcomes closely correlated with social determinants of health and structural inequalities (Karmakar et al., 2021; Liao and De Maio 2021; Webb Hooper et al., 2020). While strong infection control measures, such as lockdowns and school closures, were considered essential when COVID-19 was an emergent disease, these responses resulted in unintended consequences that were not prioritized in the early decision-making process (Turcotte-Tremblay et al., 2021).

This trade-off may have been necessary at the time, given the rapid disease spread and lack of data about the disease to guide initial decisions. However, as the potential for containment or eradication of COVID-19 dimmed, decision-makers were slow to update mitigation measures based on evolving knowledge and accounting for the broader population health needs. The COVID-19 response stemmed largely from concern about acute infections, reflecting a mindset that was more focused on medical response than broader public health impacts.

Biological factors (e.g., age or comorbidities such as hypertension, diabetes, lung disease, or immunodeficiencies) and social determinants of health (e.g., disparities stemming from marginalized socioeconomic status, lack of access to housing and transportation, race and ethnicity, and language and literacy barriers) interact to affect health and well-being (WHO, 2023; Gao et al., 2021). While awareness of biological risk factors for severe illness grew rapidly and mitigation measures were enacted to protect individuals at risk, consideration for social risk factors in COVID response plans were not equally prioritized (Laylavi, 2021).

For example, while the federal government heavily invested in the development of vaccines and anti-viral treatments early in the pandemic (Lalani et al., 2023), expanded unemployment support to address pandemic-related job losses and educational support for students during school closures were deprioritized and debated at length in government. This inaction slowed critical support for populations disproportionately impacted by pandemic spread-related closures.

The neglect of programs that would create a social safety net for the populations most marginalized is not specific to the pandemic, but is an exacerbation of systematic neglect over decades (Mody et al., 2022; Dorn et al., 2020; Saenz and Sparks, 2020). Even when educational support programs were rolled out, they were implemented inconsistently and did not specifically consider the additional needs of populations that have been made to be vulnerable and that were more likely to be disproportionately impacted by school closures and loss of income due to pandemic restrictions (Wright, 2021).

Officials did not give significant attention to the secondary impacts of the COVID-19 pandemic as the pandemic progressed. While these social disparities existed before the onset of COVID-19, decisions made in response to the pandemic widened many of these gaps.

There have been earlier calls to apply a systems approach to improve public health outcomes, and many examples exist to illustrate the strength of a systems approach in successfully addressing complex public health challenges (Kaplan et al., 2013; Honoré et al., 2011). The example of public school closures demonstrates how the social impacts of mitigation measures widened existing disparities. The example also highlights the need for holistic, systems-based approaches in addressing future public health crises.

Public School Closures and Remote Learning: A Case for Applying Systems Thinking to Improve Health Outcomes during Future Disease Outbreaks

The issue of school closures during the pandemic serves as a case study for how factors affecting health were not holistically considered during decision-making. School closures can exacerbate social and health disparities, with long-lasting consequences (NASEM, 2020). Many students rely on school systems for adequate nutrition, safety, supervision, and socioemotional and cognitive development (Van Lancker and Parolin, 2020). In addition, substantial evidence shows that remote learning is an inadequate and unequitable substitute for in-person learning and does not completely mitigate learning losses during school closures (Agostinelli et al., 2022; Engzell et al., 2021; Bettinger and Loeb, 2017).

Furthermore, school closures may have a greater impact on students in underserved communities. Systemically disadvantaged students (e.g., those who are experiencing poverty or are from racial or ethnic minority communities) are less likely to have access to the technology or broadband internet that is necessary for remote learning. They are less likely to have parents who are able to work from home and supervise them and often encounter other barriers to achieving learning goals (Smith and Reeves, 2020). Students with special educational needs have had disproportionate learning losses and have limited access to other supportive resources otherwise provided through schools while schools are closed (Hurwitz et al., 2021; Nelson and Murakami, 2020).

Importantly, education access and achievement are associated with improved health outcomes, and the above-mentioned educational disparities may translate to worsened health disparities among the different communities (Dorn et al., 2021; Zajacova and Lawrence, 2018).

The decision-making surrounding school closures is complex (Allen, 2021; World Bank Group Education, 2020). While decision makers now know that K–12 public school children have reduced physical risk to severe disease outcomes from COVID-19 compared to adults, school closures were implemented early in the pandemic, when this risk was unknown and there was limited time for decision-making. Students experienced related impacts from pandemic mitigation measures, and some have suffered mentally, emotionally, and developmentally as a direct result of school closures specifically (Viner et al., 2022; Engzell et al., 2021).

However, decisions about school closures and transitions to remote learning at the start of the COVID-19 pandemic generally focused on physical health risk factors (e.g., preventing transmission and mortality) rather than holistic evaluations of children’s multifaceted developmental needs (e.g., socialization in cognitive and emotional development; Viner et al., 2022). Factors such as public fear and parental pressure may have also affected decisions both to close and reopen schools. Many under-resourced schools may have also had limited ability to facilitate a safe return to in-person learning. The many factors affecting school closure decisions further demonstrates the overall need for a systematic, context-specific model for decision-making in future emergencies.

Widespread school closures lasted well into 2021, despite early and repeated warnings about the potential costs to student well-being (Allen, 2021; Kaffenberger, 2021; Balingit and Meckler, 2020) and evidence that with adequate interventions, in-person schooling could be made safe (Alonso et al., 2022; Rotevatn et al., 2022; Head et al., 2021).

Furthermore, school closures were experienced unequally. A nationwide study by Parolin and Lee (2021) found a correlation between school closures in fall 2021 and the racial and ethnic composition of the student body, with nearly 70 percent in-person attendance in schools with a high majority of White students and more than 70 percent closure among schools with large proportions of non-White students. This difference was observed across the United States and within local metro areas.

For example, in Los Angeles County, schools with the highest proportion of racial and ethnic minority students stayed closed at higher rates and for longer durations than schools with the highest proportion of White students (see Figure 1 ). Many factors could have contributed to this observation, including governance, demographic distribution in urban and suburban areas, differences in resource availability in public schools (including school health services), and differences in transmission rates due to population density.

A separate study by Grossmann et al. (2021) also suggested that other outside factors, such as political pressure and strength of teachers unions, may have had significant influence over school closure decisions. A diversity of factors impact student well-being; thus, a systems approach would support informed decision-making in school closure policies.

Multiple factors must also be accounted for in remediation plans, not just initial decision-making, in response to a public health crisis. In July 2021, the Center on Reinventing Public Education (CRPE, 2022) evaluated published plans from 100 major US school districts on spending the more than $43 billion allocated from the Elementary and Secondary School Emergency Relief Fund. While most districts included learning loss and social, emotional, and mental health as key target areas for remediation, only about 30 percent of schools accounted for special needs, equity, and community engagement in their remediation plans (see Figure 2 ). This data revealed that many school districts have attempted to address pandemic-related health outcomes, but these efforts can be further improved with a more holistic approach to decision-making regarding public education and student health.

Students’ well-being and long-term health outcomes are not the only considerations in deciding when best to resume in-person learning. Plans for safe and sustainable resumption of in-person learning also need to consider the needs and concerns of other stakeholders, such as parents, school staff (including nurses and health human resources), and public officials. For example, federal school reopening strategies included practices to safeguard the well-being of educators and other school staff (Department of Education, 2021). Other concerns include the need for data to understand and mitigate transmission dynamics within classrooms and in the local community, especially with the emergence of new viral variants (Honein et al., 2021). These complexities further underline the need for a holistic decision-making strategy that accounts for different needs and dynamics as information unfolds during a public health emergency such as the COVID-19 pandemic.

Using Systems Thinking to Redefine Strategies for Public Health Preparedness

Implementing a systems approach to public health planning requires tools, trained experts, and collaboration with stakeholders. Causal loop diagrams (CLDs) are analytical tools used to map a complex set of factors and forces in a system. They can be used to analyze interplay between factors or develop response strategies. CLDs are gaining attention in public health spheres and can be developed for various purposes, including for influencing policy and practice and for system dynamics modeling (Baugh Littlejohns et al., 2021).

Several CLDs have been developed to demonstrate the variety and interconnectedness of issues related to COVID-19, including mitigation measures. In a series of workshops, Sahin et al. (2020) gathered a group of subject matter experts in various fields (e.g., public health, social science, systems thinking) to develop a CLD that maps the unintended impacts of COVID-19 mitigation measures on socioeconomic systems (see Figure 3 ). One of the loops shows that social distancing will likely decrease virus transmission but also has negative, lasting mental health consequences (loop B3). Sahin et al. (2020) note there is a “a high risk of catastrophic social order demise” if enacted policies do not account for impacts on society.

Tools such as CLDs can facilitate understanding of varying factors within a public health system, a view that is needed to enact holistic solutions. This model captures the severity of social consequences, which were largely overlooked throughout the pandemic.

To further demonstrate their potential, we have created an example CLD that highlights components that could inform a more complex CLD addressing public education issues for children (see Figure 4 ). This illustrative CLD integrates several of the factors that have been discussed in this article (e.g., children’s physical health, mental and emotional health, family stressors). While not developed with the intent of immediate application, this example CLD could be modified and used for decision-making.

An analysis of COVID-19 CLDs by Strelkovskii and Rovenskaya (2021) concluded that these tools can “draw the attention of policy makers to areas where unintended and unwanted effects may be anticipated”; they identified CLDs as useful tools for highlighting the diverse impacts of the pandemic. Their analysis also found that, while there have been numerous calls to apply systems thinking approaches to the impacts of COVID-19, there are few examples of practical applications. The authors highlighted that there have been relatively few examples of CLDs developed for COVID-19, and these have been developed for purposes other than influencing decision-making.

As with many aspects of the COVID-19 pandemic, there is an opportunity to develop tools, such as CLDs, that are more actionable and policy related. The means of developing the CLD are also critical to its use. Such development should include an interdisciplinary group of experts to capture the multiple layers of a complex system. Stakeholder and community participation in developing CLDs represent a step toward developing tools that are more comprehensive and that may be more actionable from a policy standpoint (Baugh Littlejohns et al., 2021). Collaborative groups that include experts, community members, and policy makers can be better poised to develop a dynamic model that can be useful in depicting complex social, physical, and economic relationships. These nuanced models could serve as critical tools for weighing the impacts of mitigation measures in a public health emergency, and developing system models in advance will facilitate immediate action at the onset of an emergency. While providing substantial benefits, developing CLDs also presents challenges. Because systems are inherently complex, it is difficult to capture all relevant factors in a diagram while maintaining the detail that is needed to be useful. Also, translating a CLD into action can be challenging, as evidenced by the lack of actionable CLDs that address the impacts of the COVID-19 pandemic. Despite these challenges, CLDs remain a useful tool for providing a decision-making framework in complex situations with interconnected factors.

The U.S. response strategy to the COVID-19 pandemic suffered from a lack of a holistic and systems-oriented approach to decision-making. This paper outlines the complexities that should have been considered in making the shift to fully remote learning inK–12 schools during COVID-19. There is a need to integrate diverse perspectives from interdisciplinary experts, stakeholders, and community members in developing models that influence decision-making. In the example of school closures, educators, parents, school health leaders, and community leaders are relevant stakeholders for public health decisions that affect health outcomes in schools.

Systems approaches facilitate more comprehensive assessments to inform decision-making, and CLDs are a valuable tool that can be used for response planning. Time is of the essence in a public health emergency, especially when there is minimal information about an emerging threat. Systems models can be built to respond to an emerging threat and developed as information is gained.

We assert that using CLDs as part of a systems approach can improve the transparency, inclusiveness, and credibility of the decision-making process during future public health emergencies. Systems thinking, and tools such as CLDs, should be prioritized in future public health emergencies.

Despite the widely acknowledged usefulness of CLDs, there are few examples of CLDs that were applied during the COVID-19 pandemic to influence decision-making. Partnerships between public health experts and decision-makers should be developed in advance of public health emergencies, so they will be poised to respond immediately. Further, perspectives from the economic and social sectors should also be sought, to understand the complex impact of emergencies, including the impacts of mitigation measures. Increased stakeholder engagement can result in tools that are more actionable and effective.

A commitment to incorporate systems thinking will require broadening the preparedness planning approach for public health decision-making, emphasizing the inclusion of physical and related impacts, and securing buy-in from decision-makers (Zięba, 2021; Klement, 2020). This type of thinking would also require training, so the public health workforce can learn to design and implement these methods.

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Wright, A. 2021. “It’s patchwork”: Rural teachers struggle to connect in pandemic. Stateline , March 3. Available at: https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2021/03/03/its-patchwork-rural-teachers-struggle-to-connect-in-pandemic (accessed October 17, 2023).
Zajacova, A., and E. M. Lawrence. 2018. The relationship between education and health: Reducing disparities through a contextual approach. Annual Review of Public Health 39(1):273–289. https://doi.org/10.1146/annurev-publhealth-031816-044628.
Zięba, K. 2021. How can systems thinking help us in the COVID-19 crisis? Knowledge and Process Management 29(3):221–230. https://doi.org/https://doi.org/10.1002/kpm.1680.

https://doi.org/10.31478/202311a

Suggested Citation

Ashby, E., C. Minicucci, J. Liao, D. Buonsenso, S. González- Dambrauskas, R. Obregón, M. Zahn, W. Hallman, and C. John. 2023. Systems thinking for public health: A case study using U.S. public education. NAM Perspectives . Discussion Paper, National Academy of Medicine, Washington, DC. https://doi.org/10.31478/202311a .

Author Information

Elizabeth Ashby, MS, is Associate Program Officer, National Academies of Sciences, Engineering, and Medicine. Charlie Minicucci, BS, is Research Associate, National Academies of Sciences, Engineering, and Medicine. Julie Liao, PhD, is Program Officer, National Academies of Sciences, Engineering, and Medicine. Danilo Buonsenso, MD, PhD, is Pediatric Infectious Disease Physician, Department of Woman & Child Health & Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS. Sebastián González-Dambrauskas, MD, is Founder and Chair, LARed: Red Colaborativa Pediátrica de Latinoamérica and Adjunct Professor, Departamento de Pediatría y Unidad de Cuidados Intensivos de Niños, Universidad de la República. Rafael Obregón, PhD, is Country Representative, Paraguay, UNICEF. Matt Zahn, MD, is Pediatric Infectious Disease Physician, Children’s Hospital of Orange County. William Hallman, PhD, is Professor and Chair, Department of Human Ecology, School of Environmental and Biological Sciences, Rutgers University. Chandy John, MD, MS, is Professor of Pediatrics, Indiana University School of Medicine.

Acknowledgments

Charlie Minicucci and Elizabeth Ashby contributed equally to this work.

This manuscript benefited from the thoughtful input of Jessica G. Burke , University of Pittsburgh; Erin D. Maughan , George Mason University; and Carol Walsh , National Association of School Nurses.

Conflict-of-Interest Disclosures

Danilo Buonsenso reports funding from Pfizer outside the submitted work.

Correspondence

Questions or comments about this paper should be directed to Charlie Minicucci at [email protected].

The views expressed in this paper are those of the authors and not necessarily of the authors’ organizations, the National Academy of Medicine (NAM), or the National Academies of Sciences, Engineering, and Medicine (the National Academies). The paper is intended to help inform and stimulate discussion. It is not a report of the NAM or the National Academies. Copyright by the National Academy of Sciences. All rights reserved.

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Welcome To Open Case Studies

Connecting you with real-world public health data.

The Open Case Studies project showcases the possibilities of what can be achieved when working with real-world data.

Housed in a freely accessible GitHub repository, the project’s self-contained and experiential guides demonstrate the data analysis process and the use of various data science methods, tools, and software in the context of messy, real-world data.

These case studies will empower current and future data scientists to leverage real-world data to solve leading public health challenges.

Who Are Open Case Studies For?

Your experiential guide to the power of data analysis.

The Open Case Studies project provides insights about gathering and working with data for students, instructors, and those with experience in data science or statistical methods at nonprofit organizations and public sector agencies.

Each case study in the project focuses on an important public health topic and introduces methods to provide users with the skills and knowledge for greater legibility, reproducibility, rigor, and flexibility in their own data analyses.

Case Study Bank Overview

Real data on ten public health challenges in the U.S.

The following in-depth case studies use real data and focus on five areas of public health that are particularly pressing in the United States.

Vaping Behaviors in American Youth

This case study explores the trends of tobacco product usage among American youths surveyed in the National Youth Tobacco Survey (NYTS) from 2015-2019. It demonstrates how to use survey data and code books and provides an introduction to writing functions to wrangle similar but slightly different data repetitively. The case study introduces packages for using survey weighting and survey design to perform an analysis to compare vaping product usage among different groups, and covers how to use a logistic regression to compare groups for a variable that is binary (such as true or false — in this case it was using vaping products or not). This case study also covers how to make visualizations of multiple groups over time with confidence interval error bars.

Opioids in the United States

This case study examines the number of opioid pills (specifically oxycodone and hydrocodone, as they are the top two misused opioids) shipped to pharmacies and practitioners at the county-level around the United States from 2006 to 2014 using data from the Drug Enforcement Administration (DEA). This case study demonstrates how to get data from a source called an application programming interface (API). It explores why and how to normalize data, as well as why and how to potentially stratify or redefine groups. It also shows how to compare two independent groups when the data is not normally distributed using a test called the Wilcoxon rank sum test (also called the Mann Whitney U test) and how to add confidence intervals to plots (using a method called bootstrapping).

Disparities in Youth Disconnection

This case study focuses on rates of youth (people between 16-24) disconnection (those who are neither working nor in school) among different racial, ethnic and gender subgroups to identify subgroups that may be particularly vulnerable. It demonstrates that deeper inspection of subgroups yields some differences that are not otherwise discernable, how to import data from a PDF using screenshots of sections of the PDF, and how to use the Mann-Kendall trend test to test for the presence of a consistent direction in the relationship of disconnection rates with time. This case study also shows how to make a visualization that stylistically matches that of an existing report, how to add images to plots, and how to create effective bar plots for multiple comparisons across several groups.

Mental Health of American Youth

This case study investigates how the rate of self-reported symptoms of major depressive episodes (MDE) has changed over time among American youth (age 12-17) from 2004-2018. It describes the impact of self-reporting bias in surveys, how to get data directly from a website, as well as how to compare changes in the frequency of a variable between two groups using a chi-squared test to determine if two variables are independent (in this case if the sex of the students influenced the frequency of reported MDE symptoms in 2004 and 2018). This case study also demonstrates how to create direct labels on visualizations with many groups across time, as well as how to create an animated gif.

Exploring CO2 Emissions Across Time

This case study investigates how CO2 emissions have changed since the 1700s and how the level of emissions has compared for different countries around the world. It explores how yearly average temperature and the number of natural disasters in the United States has changed over time and provides an introduction for examining if two sets of data are correlated with one another. This case study also goes into great detail about how to make what are called heatmaps and other plots to visualize multiple groups over time. This includes adding labels directly to lines on plots with multiple lines.

Predicting Annual Air Pollution

This case study uses machine learning methods to predict annual air pollution levels spatially within the United States based on data about population density, urbanization, road density, as well as satellite pollution data and chemical modeling data among other predictors. Machine learning methods are used to predict air pollution levels when traditional monitoring systems are not available in a particular area or when there is not enough spatial granularity with current monitoring systems. The case study also demonstrates how to visualize data using maps.

Exploring Global Patterns of Obesity Across Rural and Urban Regions

This case study compares average Body Mass Index measurements for males and females from rural and urban regions from over 200 countries around the world, with a particular emphasis on the United States. It provides a thorough introduction to wrangling data from a PDF, how to compare two paired groups using the t test and the nonparametric Wilcoxon signed-rank test using R programming, and how to make visualizations of group comparisons that emphasize a particular subset of the data.

Exploring Global Patterns of Dietary Behaviors Associated with Health Risk

This case study investigates the consumption of dietary factors associated with health risk among males and females from over 200 countries around the world, with a particular emphasis on the United States. It demonstrates how to wrangle data from a PDF; how to combine data from two different sources; how to compare two paired groups and multiple paired groups using t-tests, ANOVA, and linear regression; and how to create visualizations of several groups and how to combine plots together with very different scales.

Influence of Multicollinearity on Measured Impact of Right-To-Carry Gun Laws

This case study focuses on two well-known studies that evaluated the influence of right-to-carry gun laws on violent crime rates. It demonstrates a phenomenon called multicollinearity, where explanatory variables that can predict one another can lead to aberrant and unstable findings; how to make visualizations with labels, such as arrows or equations; and how to combine multiple plots together.

School Shootings in the United States

This case study illustrates ways to communicate trends in a dataset about the number and characteristics of school shooting events for students in grades K-12 in the United States since 1970. It demonstrates how to create a dashboard, which is a website that shows patterns in a dataset in a concise manner; how to import data from a Google Sheets document; how to create interactive tables and maps; and how to properly calculate percentages for data when there are missing values.

Which Case Study Is Right For Me?

Connecting with the public health data you need.

The Open Case Studies project approaches data in many different ways. The guide below will help connect you with a case study:

Data science projects often start with a question. Here, you may look for case studies that explore a question that is similar to one you are interested in investigating with your data.

How does something change over time?

Investigating how a variable has changed over time can help identify consistent trends.

How do survey responses compare for different groups over time?

Survey data requires special care and attention to the survey design.

How do groups compare?

Public health researchers are often interested to know if one group is more vulnerable than another or if two or more groups are actually different from one another.

How do groups compare over time?

Comparing several groups over time can provide insight into if the change over time is different for different groups.

How do paired groups compare?

Paired groups are those that are not independent in some way. Perhaps you want to know how data from the same person over time compares with that of another person over time, or perhaps you are interested in how something changed in a city before and after an intervention, or perhaps you want to compare groups using data that has structure where there is coupling or matching of data values across samples.

Are certain groups or possibly subgroups more vulnerable?

Understand how to compare subpopulations at a deeper level.

How does something compare across regions?

Often it is useful to investigate if data differs by region, as many environmental, cultural, and political differences can influence public health outcomes.

How can I predict outcomes for new data?

Learn how the data might look next year or for locations that you don’t have data about.

Does this influence my data?

Analyze how a variable influences another variable.

Are these two variables related to one another?

Understand how two variables are related and how strongly they are related to one another.

How can I display this data for others to find and interpret and use easily?

Make it easy for others to find your data, see the major trends in your data, or search for specific values in your data.

Data can come from many different sources, from the more obvious like an excel file to the less obvious like an image or a website. These case studies demonstrate how to use data from a variety of possible sources.

Using data from a PDF or just parts of a PDF can be challenging. You could type the data into a new excel file, but this can result in mistakes and it is difficult to reproduce.

Data are often in CSV files and it is typically easy to import data and work with data in this form. However, sometimes it can be difficult if, for example, the first few lines are structured differently or if you have unusual missing value indicators.

If you find data on a website that doesn’t allow you to download in a convenient way, you can actually directly import the data into R programming language.

This is one of the most common data forms, and it is typically easy to import data and work with data in this form. However, sometimes it can be challenging, especially if you have many files.

You can extract text from image files. This can be useful if, for example, you want to only use certain parts of a PDF.

It is possible to find the data that you need to use from an application programming interface (API).

Google Sheet

You can download data from a Google Sheet, copy and paste it into Excel, or directly import the data into R programming language.

Survey data/Code books

Working with survey data requires special care and attention, and you can do this directly with R programming language.

Multiple files

If you find that you need to import data from multiple files, there is a more efficient way to do so without importing each one by one.

Data wrangling is the process of organizing your data in a more useful format. These case studies explore how to clean, rearrange, reshape, modify, filter, combine, or join your data.

Extracting data from a PDF

Extracting and organizing data from a PDF will make it easier to use.

Geocoding data

The process of assigning relevant latitude and longitude coordinates to data values is called geocoding. This can be helpful (although not always necessary) to create a map of your data.

Recoding data

If you have data values that are confusing and could be changed to something better, or if you want to convert your data to true or false, you might want to consider recoding these values.

Methods of joining data

Sometimes, you obtain data from multiple sources that need to be combined together.

Filtering data

Perhaps you need to filter your data for only specific values for given variables. In other words, you might want to filter census employment data to only values for females who are also Black and live in Connecticut.

Modifying data (normalizing, transforming, scaling etc.)

Sometimes it is difficult to know when or how to normalize data.

Working with text

You can work with, remove, replace, or change words, phrases, letters, numbers, or punctuation marks in your data.

Reshaping data

Sometimes it is useful to shape your data so that you have many columns (for example, when performing certain analyses), however it can be useful at other times (for example, when creating plots) to collapse multiple columns into fewer columns with more rows.

Repetitive process

Sometimes you need to wrangle multiple datasets from different sources in a similar manner.

A picture is worth a thousand words, particularly when it comes to interpreting data. These case studies demonstrate how to make effective visualizations in various contexts. The first ten represent basic visualizations while 11-22 are more advanced.

A table that is easy to interpret

Adding colors or simple graphics can make tables easier to interpret.

Scatter plot

Scatter plots can be a strong option for evaluating the relationship between variables, and especially for evaluating changes in a variable over time.

Line plots are often useful for evaluating changes over time.

Bar plots are a good choice if you want to compare data to a threshold.

Box plots are particularly useful for comparing groups with many data values. They provide information about the spread of the data.

Pie chart/waffle plot

Pie charts or waffle plots can be a strong option when comparing relative percentages.

It can be difficult to visualize multiple groups at simultaneously. In these situations, heat maps can be a great option.

Correlation plots

If you have many variables and need to know if they are correlated to one another, there are methods to efficiently check this.

Visualize missing data

It can be helpful to quickly identify how much of your data is missing (has NA values).

Create a map of your data

Often the best way to interpret regional differences in data is to make a map.

Advanced Visualizations

Matching a style

If you are working with collaborators, you can make your visualizations match the style of their figures.

Faceted plots allow you to quickly create multiple plots at once

It can be difficult to visualize multiple groups at the same time, so faceted plots are a great option in this situation.

Adding labels directly to plots with many different groups

If you compare many groups over time, for example, it can be difficult to see which line corresponds to which group. Adding labels directly to these lines can be very helpful and negates the need for an overcomplicated legend.

Emphasize a particular group

Sometimes you will have several different groups and you want to highlight a specific group.

Adding annotations to plots

Adding labels, such as thresholds, arrows, or equations, can make it easier for people to interpret your plot.

Add error bars to your plot

Adding error bars can help convey information about the confidence of the estimates in your plots.

Combine multiple plots together

Sometimes it is useful to put a variety of plots together and add text to explain what the plot shows.

Create an interactive plot when you have too many groups to label

If you compare a very large number of groups, it can be difficult to tell what is happening. Often it can help to make the plot interactive so that the user can hover over points or lines to see what they indicate.

Create an interactive map of your data

Sometimes it is easiest to see regional differences by interacting with and exploring an interactive map.

Create an interactive table of your data

Sometimes you might want to be able to search through your data or allow others to easily do so.

Add images to your figures

Including images to a plot, such as a logo, can be a helpful addition.

Create an interactive dashboard/website for your data

Dashboards can quickly convey major trends in a dataset, and they can also allow users to interact with the data to choose what aspects about the data they wish to explore.

To better understand data, it is helpful to use statistical tests. These case studies demonstrate a variety of statistical tests and concepts.

Are two groups different?

Correlation

Are two variables related to one another?

Are multiple groups different?

Linear regression

Would you like to compare groups?

Chi-squared test of independence

Do the frequencies of two groups suggest that they are independent?

Mann-Kendall Trend test

Is there a consistent change over time?

Machine learning

Would you like to predict data?

Calculate percentages with missing data?

Would you like to calculate percentages, but you are missing some data?

About The Project

Learn about the team behind the Open Case Studies project.

As part of the larger Open Case Studies project (OCS) at opencasestudies.org , these case studies were developed for and funded by the Bloomberg American Health Initiative. The OCS project is made up of a team of researchers at the Johns Hopkins Bloomberg School of Public Health (JHSPH).

Let us know how the Open Case Studies project has enhanced your educational curriculum or ability to tackle tough data-rich research projects.

JHSPH Faculty Contributors

Jessica Fanzo, PhD

Brendan Saloner, PhD

Megan Latshaw, PhD, MHS

Renee M. Johnson, PhD, MPH

Daniel Webster, ScD, MPH

Elizabeth Stuart, PhD

Bloomberg American Health Initiative

Joshua M. Sharfstein, MD – Director, Bloomberg American Health Initiative

Michelle Spencer, MS – Associate Director, Bloomberg American Health Initiative

Paulani Mui, MPH – Special Projects Officer, Bloomberg American Health Initiative

Other Contributors

Aboozar Hadavand, PhD, MA, MS, Minerva University

Roger Peng, PhD, MS, Johns Hopkins Bloomberg School of Public Health

Kirsten Koehler, PhD, MS, Johns Hopkins Bloomberg School of Public Health

Alex McCourt, PhD, JD, MPH, Johns Hopkins Bloomberg School of Public Health

Ashkan Afshin, MD, ScD, MPH, MSc, University of Washington and Institute for Health Metrics and Evaluation (IHME)

Erin Mullany, BA, Institute for Health Metrics and Evaluation (IHME)

External Review Panel

Leslie Myint, PhD, Macalester College

Shannon E. Ellis, PhD, University of California – San Diego

Christina Knudson, PhD, University of St. Thomas

Michael Love, PhD, University of North Carolina

Nicholas Horton, ScD, Amherst College

Mine Çetinkaya-Rundel, PhD, University of Edinburgh, Duke University, RStudio

Let Us Know How You're Using Open Case Studies

As the Open Case Studies project expands, we learn from you. Tell us what data you'd like to see, how you're using the data, or anything we can do to improve the project.

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Harvard T.H. Chan School of Public Health Case-Based Teaching & Learning Initiative

Teaching cases & active learning resources for public health education, case writing.

An overview of the case planning and writing process, by experienced case-writer and CBTL workshop leader Kirsten Lundberg.

2019. The Case Centre . Visit website A non-profit clearing house for materials on the case method, the Case Centre holds a large and diverse collection of cases, articles, book chapters and teaching materials, including the collections of leading business schools across the globe.

Austin, J. , 1993. Teaching Notes: Communicating the Teacher's Wisdom , Harvard Business School Publishing. Publisher's Version "Provides guidance for the preparation of teaching notes. Sets forth the rationale for teaching notes, what they should contain and why, and how they can be prepared. Based on the experiences of Harvard Business School faculty."

Abell, D. , 1997. What makes a good case? . ECCHO–The Newsletter of the European Case Clearing House , 17 (1) , pp. 4-7. Read online "Case writing is both art and science. There are few, if any, specific prescriptions or recipes, but there are key ingredients that appear to distinguish excellent cases from the run-of-the-mill. This technical note lists ten ingredients to look for if you are teaching somebody else''s case - and to look out for if you are writing it yourself."

Roberts, M.J. , 2001. Developing a teaching case (abridged) , Harvard Business School Publishing. Publisher's Version A straightforward and comprehensive overview of how to write a teaching case, including sections on what makes a good case; sources for and types of cases; and steps in writing a case.

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“How to Write Case Studies: A Comprehensive Guide”

Case studies are essential for marketing and research, offering in-depth insights into successes and problem-solving methods. This blog explains how to write case studies, including steps for creating them, tips for analysis, and case study examples. You'll also find case study templates to simplify the process. Effective case studies establish credibility, enhance marketing efforts, and provide valuable insights for future projects.

Case studies are detailed examinations of subjects like businesses, organizations, or individuals. They are used to highlight successes and problem-solving methods. They are crucial in marketing, education, and research to provide concrete examples and insights.

This blog will explain how to write case studies and their importance. We will cover different applications of case studies and a step-by-step process to create them. You’ll find tips for conducting case study analysis, along with case study examples and case study templates.

Effective case studies are vital. They showcase success stories and problem-solving skills, establishing credibility. This guide will teach you how to create a case study that engages your audience and enhances your marketing and research efforts.

What are Case Studies?

1. Definition and Purpose of a Case Study

Case studies are in-depth explorations of specific subjects to understand dynamics and outcomes. They provide detailed insights that can be generalized to broader contexts.

2. Different Types of Case Studies

Exploratory: Investigates an area with limited information.
Explanatory: Explains reasons behind a phenomenon.
Descriptive: Provides a detailed account of the subject.
Intrinsic : Focuses on a unique subject.
Instrumental: Uses the case to understand a broader issue.

3. Benefits of Using Case Studies

Case studies offer many benefits. They provide real-world examples to illustrate theories or concepts. Businesses can demonstrate the effectiveness of their products or services. Researchers gain detailed insights into specific phenomena. Educators use them to teach through practical examples. Learning how to write case studies can enhance your marketing and research efforts.

Understanding how to create a case study involves recognizing these benefits. Case study examples show practical applications. Using case study templates can simplify the process.

5 Steps to Write a Case Study

1. Identifying the Subject or Case

Choose a subject that aligns with your objectives and offers valuable insights. Ensure the subject has a clear narrative and relevance to your audience. The subject should illustrate key points and provide substantial learning opportunities. Common subjects include successful projects, client stories, or significant business challenges.

2. Conducting Thorough Research and Data Collection

Gather comprehensive data from multiple sources. Conduct interviews with key stakeholders, such as clients, team members, or industry experts. Use surveys to collect quantitative data. Review documents, reports, and any relevant records. Ensure the information is accurate, relevant, and up-to-date. This thorough research forms the foundation for how to write case studies that are credible and informative.

3. Structuring the Case Study

Organize your case study into these sections:

Introduction: Introduce the subject and its significance. Provide an overview of what will be covered.
Background: Provide context and background information. Describe the subject’s history, environment, and any relevant details.
Case Presentation: Detail the case, including the problem or challenge faced. Discuss the actions taken to address the issue.
Analysis: Analyze the data and discuss the findings. Highlight key insights, patterns, and outcomes.
Conclusion: Summarize the outcomes and key takeaways. Reflect on the broader implications and lessons learned.

4. Writing a Compelling Introduction

The introduction should grab the reader’s attention. Start with a hook, such as an interesting fact, quote, or question. Provide a brief overview of the subject and its importance. Explain why this case is relevant and worth studying. An engaging introduction sets the stage for how to create a case study that keeps readers interested.

5. Providing Background Information and Context

Give readers the necessary background to understand the case. Include details about the subject’s history, environment, and any relevant circumstances. Explain the context in which the case exists, such as the industry, market conditions, or organizational culture. Providing a solid foundation helps readers grasp the significance of the case and enhances the credibility of your study.

Understanding how to write a case study involves meticulous research and a clear structure. Utilizing case study examples and templates can guide you through the process, ensuring you present your findings effectively. These steps are essential for writing informative, engaging, and impactful case studies.

How to Write Case Study Analysis

1. Analyzing the Data Collected

Examine the data to identify patterns, trends, and key findings. Use qualitative and quantitative methods to ensure a comprehensive analysis. Validate the data’s accuracy and relevance to the subject. Look for correlations and causations that can provide deeper insights.

2. Identifying Key Issues and Problems

Pinpoint the main issues or challenges faced by the subject. Determine the root causes of these problems. Use tools like SWOT analysis (Strengths, Weaknesses, Opportunities, Threats) to get a clear picture. Prioritize the issues based on their impact and urgency.

3. Discussing Possible Solutions and Their Implementation

Explore various solutions that address the identified issues. Compare the potential effectiveness of each solution. Discuss the steps taken to implement the chosen solutions. Highlight the decision-making process and the rationale behind it. Include any obstacles faced during implementation and how they were overcome.

4. Evaluating the Results and Outcomes

Assess the outcomes of the implemented solutions. Use metrics and KPIs (Key Performance Indicators) to measure success. Compare the results with the initial objectives and expectations. Discuss any deviations and their reasons. Provide evidence to support your evaluation, such as before-and-after data or testimonials.

5. Providing Insights and Lessons Learned

Reflect on the insights gained from the case study. Discuss what worked well and what didn’t. Highlight lessons that can be applied to similar situations. Provide actionable recommendations for future projects. This section should offer valuable takeaways for the readers, helping them understand how to create a case study that is insightful and practical.

Mastering how to write case studies involves understanding each part of the analysis. Use case study examples to see how these elements are applied. Case study templates can help you structure your work. Knowing how to make a case study analysis will make your findings clear and actionable.

Case Study Examples and Templates

1. Showcasing Successful Case Studies

Georgia tech athletics increase season ticket sales by 80%.

Georgia Tech Athletics aimed to enhance their season ticket sales and engagement with fans. Their initial strategy involved multiple outbound phone calls without targeting. They partnered with Salesloft to improve their sales process with a more structured inbound approach. This allowed sales reps to target communications effectively. As a result, Georgia Tech saw an 80% increase in season ticket sales, with improved employee engagement and fan relationships.

WeightWatchers Revamps Enterprise Sales Process with HubSpot

WeightWatchers sought to improve their sales efficiency. Their previous system lacked automation, requiring extensive manual effort. By adopting HubSpot’s CRM, WeightWatchers streamlined their sales process. The automation capabilities of HubSpot allowed them to manage customer interactions more effectively. This transition significantly enhanced their operational efficiency and sales performance.

2. Breakdown of What Makes These Examples Effective

These case study examples are effective due to their clear structure and compelling storytelling. They:

Identify the problem: Each case study begins by outlining the challenges faced by the client.
Detail the solution: They explain the specific solutions implemented to address these challenges.
Showcase the results: Quantifiable results and improvements are highlighted, demonstrating the effectiveness of the solutions.
Use visuals and quotes: Incorporating images, charts, and client testimonials enhances engagement and credibility.

3. Providing Case Study Templates

To assist in creating your own case studies, here are some recommended case study templates:

1. General Case Study Template

Suitable for various industries and applications.
Includes sections for background, problem, solution, and results.
Helps provide a structured narrative for any case study.

2. Data-Driven Case Study Template

Focuses on presenting metrics and data.
Ideal for showcasing quantitative achievements.
Structured to highlight significant performance improvements and achievements.

3. Product-Specific Case Study Template

Emphasizes customer experiences and satisfaction with a specific product.
Highlights benefits and features of the product rather than the process.

4. Tips for Customizing Templates to Fit Your Needs

When using case study templates, tailor them to match the specific context of your study. Consider the following tips:

Adapt the language and tone: Ensure it aligns with your brand voice and audience.
Include relevant visuals: Add charts, graphs, and images to support your narrative.
Personalize the content: Use specific details about the subject to make the case study unique and relatable.

Utilizing these examples and templates will guide you in how to write case studies effectively. They provide a clear framework for how to create a case study that is engaging and informative. Learning how to make a case study becomes more manageable with these resources and examples.

Tips for Creating Compelling Case Studies

1. Using Storytelling Techniques to Engage Readers

Incorporate storytelling techniques to make your case study engaging. A compelling narrative holds the reader’s attention.

2. Including Quotes and Testimonials from Participants

Add quotes and testimonials to add credibility. Participant feedback enhances the authenticity of your study.

3. Visual Aids: Charts, Graphs, and Images to Support Your Case

Use charts, graphs, and images to illustrate key points. Visual aids help in better understanding and retention.

4. Ensuring Clarity and Conciseness in Writing

Write clearly and concisely to maintain reader interest. Avoid jargon and ensure your writing is easy to follow.

5. Highlighting the Impact and Benefits

Emphasize the positive outcomes and benefits. Show how the subject has improved or achieved success.

Understanding how to write case studies involves using effective storytelling and visuals. Case study examples show how to engage readers, and case study templates help organize your content. Learning how to make a case study ensures that it is clear and impactful.

Benefits of Using Case Studies

1. Establishing Authority and Credibility

How to write case studies can effectively establish your authority. Showcasing success stories builds credibility in your field.

2. Demonstrating Practical Applications of Your Product or Service

Case study examples demonstrate how your product or service solves real-world problems. This practical evidence is convincing for potential clients.

3. Enhancing Marketing and Sales Efforts

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Case studies for PHN residency

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Case studies for phn residents and preceptors.

Public health case studies provide the preceptor and resident an opportunity to discuss key public health nursing issues and provide orientation to broader public health topics.

These case studies are designed to explore the professional practice of public health nursing by integrating PHN practice with the Quad Council PHN competencies .

Each case study has two versions: the preceptor version, and the resident version.

The preceptor version provides the suggested responses for each scenario. Ideally, the preceptor and the resident review the case studies together, which provides an opportunity for discussion and development of clinical judgment.

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Child maltreatment

Suggested: Month 6

Resident version: Child maltreatment (PDF) Preceptor version: Child maltreatment (PDF)

Concepts covered: Legal responsibility of reporting, assessment, referral, safety, and completing a child protection report/process

Culturally sensitive care

Suggested: Month 5

Resident version: Culturally sensitive care (PDF) Preceptor version: Culturally sensitive care (PDF)

Concepts covered: Cultural practices, communication, stereotyping vs. cultural awareness, awareness of personal culture, resources, evidence-based practice

Culture, religion, and tuberculosis care

Resident version: Culture, religion, and tuberculosis care (PDF) Preceptor version: Culture, religion, and tuberculosis care (PDF)

Concepts covered: Knowledge of and organizational barriers to the accommodation of work, lifestyle, religious, or cultural factors that impact client care; directly observed therapy; medication non-adherence; mandated services; adapting nursing interventions to meet client needs

Depression and parenting

Suggested: Month 3

Resident version: Depression and parenting (PDF) Preceptor version: Depression and parenting (PDF)

Concepts covered: Caring for clients with mental health concerns, communication, nonjudgmental care, safety planning, resources, referral

Intimate partner violence

Suggested: Month 4

Resident version: Intimate partner violence (PDF) Preceptor version: Intimate partner violence (PDF)

Concepts covered: Mandated reporting, assessment, vulnerable adult, referral resources, non-judgmental care, safety planning, trauma-informed care, evidence-based practice

Outbreak investigation

Suggested: Month 7

Resident version: Outbreak investigation (PDF) Preceptor version: Outbreak investigation (PDF)

Concepts covered: Epidemiology, outbreak investigation process, primary prevention, risk communication, incidence rates

Trauma-informed care

Suggested: Month 8

Resident version: Trauma-informed care (PDF) Preceptor version: Trauma-informed care (PDF)

Concepts covered: Professional boundary-setting, building trust with clients, adverse childhood experiences (ACEs), evidence-based practice, components of trauma-informed care and establishing a trauma-informed approach, PHN resilience

Vulnerable adults

Resident version: Vulnerable adults (PDF) Preceptor version: Vulnerable adults (PDF)

Concepts covered: Elderly vulnerable adults (including reporting), resources, safety assessment, referral, financial support, and right of self-determination

public health practice

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Public health 2: case studies in public health practice.

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Conducting Research - Finding Books & eBooks
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Research Librarian for the Health Sciences, Medicine, Pharmaceutical Sciences, Pharmacology, Public Health

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Author(s) - last name, first name, MI, - [include multiple authors if noted] (date), Title of article. Source of Article/Title of Journal. volume #, (issue #): pages. If it is only an electronic publication with no reference to print pages, then you cite the DOI - Digital Object Identifier and the date last visited.

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PMC10709868

Challenges and strategies for conducting research in primary health care practice: an integrative review

Daiana bonfim.

1 Hospital Israelita Albert Einstein - Albert Einstein Center for Studies, Research, and Practices in Primary Health Care and Networks, Sao Paulo, Brazil

Lorrayne Belotti

Leticia yamawaka de almeida, ilana eshriqui, sofia rafaela maito velasco, camila nascimento monteiro, adelson guaraci jantsch.

2 Executive Secretariat of Organization Open University of the Unified Health System (UNASUS), Brasilia, Brazil

Associated Data

All data generated or analyzed during this study are included in this published article.

Providing accessible and high-quality patient-centered healthcare remains a challenge in many countries, despite global efforts to strengthen primary health care (PHC). Research and knowledge management are integral to enhancing PHC, facilitating the implementation of successful strategies, and promoting the use of evidence-based practices. Practice-based research in primary care (PC-PBR) has emerged as a valuable approach, with its external validity to diverse PHC settings, making it an effective means of translating research findings into professional practice.

To identify challenges and strategies for conducting practice-based research in primary health care services.

An integrative literature review was conducted by searching the PubMed, Embase, Scopus, Web of Science, and Lilacs databases. The research question, guided by the PICo framework, directed the execution of study selection and data extraction. Data analysis followed the RAdAR method's three phases: pre-analysis, data analysis, and interpretation of results.

Out of 440 initially identified articles, 26 met the inclusion criteria. Most studies were conducted in high-income countries, primarily the United States. The challenges and strategies for PC-PBR were categorized into six themes: research planning, infrastructure, engagement of healthcare professionals, knowledge translation, the relationship between universities and health services, and international collaboration. Notable challenges included research planning complexities, lack of infrastructure, difficulties in engaging healthcare professionals, and barriers to knowledge translation. Strategies underscore the importance of adapting research agendas to local contexts, providing research training, fostering stakeholder engagement, and establishing practice-based research networks.

The challenges encountered in PC-PBR are consistent across various contexts, highlighting the need for systematic, long-term actions involving health managers, decision-makers, academics, diverse healthcare professionals, and patients. This approach is essential to transform primary care, especially in low- and middle-income countries, into an innovative, comprehensive, patient-centered, and accessible healthcare system. By addressing these challenges and implementing the strategies, PC-PBR can play a pivotal role in bridging the gap between research and practice, ultimately improving patient care and population health.

Introduction

Despite global efforts toward strengthening primary health care (PHC) in the last 40 years, providing accessible and good quality patient-centered health care is still a challenge to most countries. Recently, the report Operational Framework for Primary Health Care (2020) released by the World Health Organization reinforced the principles of the Astana Declaration highlighting 14 levers that must be simultaneously pulled to promote PHC across the world [ 1 ].

One of those 14 “operational levers” describes the importance of conducting research that is meaningful for PHC: “ Research and knowledge management, including dissemination of lessons learned, as well as the use of knowledge to accelerate the scale-up of successful strategies to strengthen PHC ” [ 1 ] . Although conducting research that meets these premises is not simple, primary care practice-based research (PC-PBR) has become an important vehicle for the development of science in the real world, because of its external validity to other PHC settings and contexts, making knowledge translation easier to put evidence into professional practice [ 2 ].

PC-PBR occurs in the context of patient health care in the community, according to Dolor et al. (2015), resulting in the research questions being primarily generated by the health services to respond to the needs of their territory [ 3 ]. PHC is responsible for serving as the first point of contact for patients, through which all health issues should be addressed. It serves as an ideal setting for conducting practice-based research, encompassing the implementation of innovations and studies aimed at enhancing the quality of care for various health conditions. These conditions span across diverse areas, including mental health [ 4 ] and chronic kidney disease [ 5 ]. Furthermore, it is also pertinent in the context of public health emergencies, such as the COVID-19 pandemic [ 6 ].

One solution to foster this type of research is creating practice-based research networks (PBRNs). Their aim is to bring healthcare professionals, researchers, health managers, and academic institutions together, facilitating partnerships, and providing structure and technical support to healthcare professionals to carry out research projects that are developed and conducted in PHC settings to tackle important aspects of PHC [ 7 , 8 ]. They also help on the job of acquiring funding, capacity building, organizing the necessary logistics to put a research project in place and all sorts of tasks from study design to publication [ 3 , 9 ]. In this way, PBRNs seek to promote a culture of scientific research in an environment originally dedicated to health care [ 10 ] and to answer relevant questions about the local health needs of PHC services. According to Bodenheimer et al. (2005), PBRNs are increasingly seen as institutions that can simultaneously conduct research efficiently and leverage changes in practice [ 11 ], serving as laboratories for approaching important challenges to PHC.

However, a preview study [ 9 ] developed in Canada described some lessons learned to engage PBRLNs present aspects related to the need for continuity in ethics, regular team meetings, enhancing levels of engagement with stakeholders, the need for structural support and recognizing differences in data sharing across provinces.

Even though the literature on PC-PBR is growing, “How to implement a PBRN and how to scale PC-PBR?” and “How can a healthcare service become a setting for knowledge and innovation production?” are two questions still unanswered. Moreover, scenarios with incipient PHC could benefit from evidence-oriented policies and practice-oriented research. To answer these two questions, available information from places that already run PC-PBR projects needs to be systematized around the challenges, obstacles and solutions found by other researchers. Aiming to help researchers from low- and middle-income countries that are willing to produce research in primary care, we performed an integrative review identifying the challenges and strategies for carrying out PC-PBR.

An integrative literature review was performed based on the methodology proposed by Whittemore & Knafl (2005) [ 12 ] that includes (a) identification of the problem, (b) literature search, (c) evaluation, (d) analysis and (e) presentation of results. Differently from a systematic review, the broader focus of an integrative review enables the inclusion of studies using different methodologies (qualitative, quantitative and mixed) in the analysis and supplies the methodological rigor necessary for a broader understanding of one specific phenomenon [ 13 , 14 ].

Literature search

The research question was developed using the PICo framework (Population, Interest and Context). The elements were organized by P - Primary health care (PHC); I - Challenges and Strategies; Co - Practice-based research (PBR); resulting in the guiding question: “What are the challenges and strategies to carry out PBR in PHC?”. Data were collected in February 2022 by a librarian affiliated with the authors' institution from the databases PubMed, Embase, Scopus, Web of Science, and Lilacs. The database selection was conducted to ensure comprehensive coverage of relevant literature, encompassing multidisciplinary and geographical perspectives related to practice-based research in primary care. The search utilized descriptions and keywords from the Medical Subject Headings (MeSH) and Health Science Descriptors (DeCS), combined with the Boolean operators 'AND' and 'OR' (Table (Table1 1 ).

Search strategies, according to the database and Boolean operators

Study selection

Articles in English, Spanish and Portuguese were included, regardless of their publication year. Review studies, essays, letters to the editor, studies conducted in non-PHC settings (e.g., emergency services), and those focused on specific health problems were excluded.

Two researchers independently screened the articles by title and abstract (SRMV e AGJ), and the disagreements were resolved through discussion and mediation by a third author (LB). Following this stage, the studies were read in their entirety by the same two authors. During this phase, any remaining disagreements regarding the final inclusion were examined and decided by the authors. In the study selection phase, the software Rayyan was employed as a tool for managing and screening research articles.

Data extraction

Information was systematically extracted from the selected articles and organized using a custom-designed spreadsheet, enabling the identification of key aspects essential for addressing the research question. These included author names, publication year, study type, study location, research objectives, methodologies employed, study populations, primary internal and external challenges encountered in operationalizing research within primary healthcare, and strategies offered for its effective implementation.

Data synthesis

The review followed a deductive approach that prioritized the extraction and summarization of studies included as the primary objective of the review and synthesis [ 15 ]. This process entails extracting the results from each included paper and categorizing them according to common themes or meanings. These categories are subsequently further organized, allowing for a summary that yields synthesized findings: practical and actionable guidelines suitable for informing policy and formulating strategies [ 16 ].

To achieve this, the data analysis followed the steps established by the three distinct phases of the RADaR method: pre-analysis, data analysis, and interpretation of the results [ 17 ]. In the pre-analysis stage, each article was read, and its information was extracted and stored in a spreadsheet created to summarize all articles included in the study. In the data analysis stage, the content was categorized according to the similarities of the barriers and challenges identified. Finally, in the interpretation of the results, a reflective and critical analysis of the content was conducted, summarizing the content into themes for analysis [ 17 ].

A total of 440 publications were identified in the databases. After excluding duplicate studies ( n =120) and those that did not answer the guiding question ( n =283), 37 studies were read in their entirety. Out of these, 11 were excluded as they did not meet the eligibility criteria. The final sample consisted of 26 studies (Fig. 1 ), with the majority being published in the past two decades and conducted in high-income countries (HICs), primarily in the United States of America ( n =13). Furthermore, a significant proportion of these studies were case studies focused on the medical profession (Table (Table2 2 ).

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Flowchart of study selection

Description of the primary studies included in the integrative literature review according to the lead author, year, country, objective, population, and type of study

NR Not Reported

During the data analysis, six overarching themes and 15 subthemes related to the challenges of carrying out PC-PBR emerged. Among these challenges, difficulties regarding research planning were noteworthy, with issues ranging from excessive bureaucracy to challenges in planning and developing a research project. The Engagement of health professionals in research was recognized as one theme encompassing four different subthemes: lack of training and experience in scientific writing; difficulties with foreign languages; previous negative research experiences; and fears of negative impacts on the healthcare team, patients and productivity. Challenges regarding knowledge translation detail the difficulties in applying the knowledge acquired from one article to a change in daily work. Infrastructure issues are related to the location of the health services and how dispersed they can be in one area, the lack of technological tools and the little access to funding resources to sponsor more robust and long-term projects. Finally, a weak relationship between universities and health services can lead to little – or even no – collaboration between research institutes and PHC practices. The lack of international partnerships is finally presented as one main challenge for low- and middle-income countries (LMICs) since such collaborations could be helpful in building capacity for young research centers to address pressing issues in contexts where PHC is still very incipient (Table (Table3 3 ).

Summary of findings on challenges for conducting PC-PBR

The strategies listed in the articles included in this review were organized according to the challenges described in the previous section. The following were highlighted: suggestions related to creating a research agenda adapted to each reality; training strategies to develop research skills; sharing the results with all stakeholders involved, from participants to health managers and decision-makers; and the importance of creating networks for practice-based research (Table (Table4 4 ).

Strategies for conducting PC-PBR

Challenges and strategies for conducting PC-PBR

Research planning.

In this domain, a series of challenges related to designing a research plan are combined, such as developing and refining a research question, designing a strategy for data collection and data analysis, writing and submitting a proposal to the ethics board committee and the amount of time it takes to obtain the approval to start the project [ 8 , 9 , 11 , 18 , 30 , 32 , 35 ]. The time needed to carry out and conclude a study is often very different from the amount of time needed to make decisions in health care. Conducting a study with the length of time necessary to meet the needs for the transformation of health services is a difficult task, since managers and decision-makers may have more immediate expectations and hope for quick solutions to their problems [ 8 ]. To overcome this limitation, it is important that all stakeholders (managers, patients, health professionals, and researchers) are involved in the study, mainly to facilitate the understanding of the steps that one study needs to go through until its publication [ 9 , 18 , 38 ].

Engagement of health professionals in research

Some decision-makers and health managers fear that a research project can cause trouble in the way that a health facility is used to operate, impairing its productivity or even hindering the patients’ trust in the health service [ 8 , 18 , 21 , 30 , 31 , 35 , 36 ]. In addition, many managers see research projects as less important than practice, without acknowledging the possible benefits of research on patient care [ 28 ]. Researchers must bring these issues into debate with health managers and decision-makers so that barriers such as a lack of time dedicated to research, high caseloads limiting the time dedicated to research, and the need for institutional approval to allow professionals to participate in research projects can be overcome [ 26 ]. If this is not done, it will be difficult to create a routine of knowledge production and innovative research that integrates healthcare professionals, patients and researchers to create robust scientific evidence with an impact on the workplace, patient care and the quality of the services provided.

Knowledge translation

This theme, which is known as integrated knowledge translation in the current literature [ 39 ], involves the processes of generating, sharing, and applying knowledge, not necessarily in that specific order [ 8 , 32 ]. In theory, carrying out PC-PBR is a powerful resource to make knowledge translation happen, since research questions are created to answer local needs, relying on the participation of professionals – and sometimes the patients – in practice [ 32 ].

However, one of the barriers to knowledge translation lies in the difficulty of adapting the knowledge to contexts that are distinct from those where one study was held, e.g., results from HIC being translated to LMICs. This reinforces the need to involve all stakeholders in the stages of designing the project to describe the aspects of the context where the research will be held, outlining this information in the discussion section of the article as well, making it easier for the reader to understand its external validity [ 2 , 8 , 30 , 38 ].

The long time span for the publication of the study results in scientific journals, in addition to the high rejection rate, are factors that further delay the process of knowledge translation. Considering the dynamic nature of primary care services, studies should have a broad plan to disseminate results, to implement the evidence in a timely manner [ 30 ].

Infrastructure

Challenges related to infrastructure are frequently found in PC-PBR studies, from the distance between primary care services in rural settings and the difficulty of reaching some services to the often lack of technology resources, such as internet access, and patients’ electronic records [ 8 , 9 , 20 , 23 , 32 , 35 ].

The lack of reliable, sustainable, and systematic funding for PC-PBR research activities is the main obstacle to overcoming these infrastructure limitations and promoting the creation of PC-PBR [ 8 , 10 , 19 , 23 , 27 , 31 , 35 ]. Like every research initiative, PC-PBR needs to be supported with adequate and constant funding. For that reason, researchers must remain attentive and updated to identify funding opportunities [ 18 ].

Healthcare services produce a large volume of data every day. Information about healthcare procedures, prescriptions, patient profile, and all sorts of interactions between the patient and their healthcare providers. However, the quality of the information input and the way it is stored can limit its use [ 9 ]. It is essential for managers and stakeholders to verify how these data have been used, not only how practitioners use them for patient management but also for research, surveillance, and accountability [ 19 , 23 ].

Confidential information should be strictly and safely handled so that no patient information becomes public, allowing its use for research with no harm to the patient or for the practice [ 34 ]. For this purpose, all parties using these data must agree to a common commitment across the PC-PBR network to develop and implement research programs. Ideally, the research priorities should be established by the researchers and managers, with a clear evaluation of the capabilities of each practice, the information systems available and the whole network. When used appropriately, these real-world data can generate new knowledge from practice to improve patient care [ 18 ].

Relationship between universities and health services

Some studies highlighted the strains of integrating universities and health services [ 8 , 18 , 21 ]. The distance between these two scenarios can be explained by several factors: (a) the fact that academic priorities may not reflect the needs of the communities [ 8 ]; (b) weak connections between academia and primary care services [ 19 ]; (c) the lack of a mutual agenda between them combining common interests [ 25 ]; (d) the distance between researchers and health professionals [ 8 ]; and (e) the restricted access to specific research training courses run by universities, apart from formal master’s and doctorate courses [ 21 ]. Such training courses are usually offered during workdays, which limits the participation of those who work full-time as health care providers. Offering postgraduate courses in research aimed at health professionals that take advantage of the students’ experience to generate relevant research questions and new knowledge for healthcare could be transformative both for universities and health services. However, gathering individuals who traditionally work in different sectors is not easy. In addition, creating organizational structures that support primary care-based studies can demand financial resources, time, and people, which are not easily available [ 29 ].

Among the strategies found in the articles to overcome this challenge, it is important that the research questions arise from practice and that the roles of researchers, academics and health professionals are well-defined within the group. In addition, it is important to select a coordinator responsible for managing the research project and the tasks that need to be executed [ 30 , 34 ].

Implementing PC-PBR can bring results both for practice and academia, bringing together different professionals to achieve a common goal of improving patient care. Strengthening the interaction between academia and primary care services can help to promote the sustainable development of research projects in which health professionals can develop innovations in health care that can be studied and tested, creating a virtuous cycle beginning with raising questions from practice, conducting experiments, finding results and producing evidence that can serve the purpose of improving patient care and the health of the population [ 19 ].

Partnerships between countries

Despite this being a topic addressed in only two of the articles under analysis, promoting international partnerships can be a solution to many of the challenges mentioned here. However, such collaborations are not yet a reality for many countries. There is a shortage of international initiatives to promote research courses and training to bring together mentors from HIC and young researchers from LMICs and provide direction for conducting studies in contexts with few resources [ 8 ].

In addition, many professionals from LMICs who are involved in studies or education abroad end up migrating to other countries, contributing to the so-called “brain drain” of skilled professionals and worsening the inequality in scientific production between HICs and LMICs.

Addressing research projects within the local context and exploring opportunities for international collaboration is important enough to foster PBR and guide health professionals in places where universities and research institutes are not yet established. Moreover, it is important to consider the epidemiological profile, cultural aspects, and social determinants of health in every scenario involved when an international collaboration is planned. The different contexts of practice can enrich the research and establish comparisons that can be decisive for international scientific advancement [ 8 ].

The challenges and strategies for the implementation of PC-PBR indicate operational, structural, and political issues. One of the key aspects learned about planning a PC-PBR study is to identify and include all stakeholders (patients, employees, doctors and administration) in the development phase of the project, allowing for discussions about the study design and its implementation phases. This approach must become an integral part of the study, being comprehensive to addressing barriers to participation, obtain data, analyze and interpret the results and, finally, discuss its findings and implications. Additionally, planning data collection that demands little effort from health professionals can strengthen the study’s realization and the involvement of everyone.

In this context, it is important to emphasize that all challenges are even more pronounced in LMICs. In this regard, efforts are being made towards decolonization [ 40 ], encouraging research that validates the context and perspectives of local thinkers, thereby expanding the discussion to generate and incorporate evidence into real scenarios that value the knowledge of communities, healthcare professionals, policymakers, and researchers in LMICs. Therefore, the present study aimed to synthesize the challenges and strategies that underlie this discussion, but a gap was identified in terms of the production of this discussion in LMICs.

To address the issue of limited international collaborations in LMICs, it is crucial to explore targeted implications and strategies to surmount this constraint. Some viable strategies involve providing training and education in cultural sensitivity, thereby enhancing the efficacy of these partnerships. While international collaboration typically prioritizes partnerships with high-income countries, LMICs can also explore collaborations with other LMICs. Sharing knowledge, best practices and resources with neighboring countries facing similar challenges can result in mutually advantageous outcomes.

PC-PBR only happens if the professionals who are directly involved in patient care and health service management are integrated as part of the team of researchers, not just as the subjects of the research [ 8 , 36 ]. Although it is a great challenge, training healthcare professionals to conduct research in primary care is fundamental for the success of these projects [ 23 , 24 ].

Alternative research approaches, such as implementation research, have advanced and grown as new strategies to reduce the gap between research and practice, mainly because they systematically approach the factors that contribute to this gap, understanding the context and identifying barriers and solutions for delivering sustainable and effective health care [ 41 ]. Thus, to make progress in overcoming these structural barriers it is important to understand the essential pieces of the research process, without which a project will likely die prematurely. One of these elements is the minimal infrastructure needed for PC-PBR research projects to be long-lasting and sustainable [ 9 , 23 ].

The studies under analysis point out that the most promising way for this to happen is through collaboration between primary care services, universities, and research institutes. In addition, these collaborations can provide training in research skills for health professionals, creating an environment conducive to exchanging experiences, ideas, and questions about the practice. All these suggestions will help to create a research agenda oriented toward solving real issues related to taking care of patients in primary care, which is the main objective of conducting PC-PBR [ 8 ].

The distance between universities and primary care settings is recurrently cited. This issue reinforces the idea that there is a place where knowledge is produced (universities and academia) that is different from the places where health care occurs. In other words, primary care is seen as a place where scientific evidence produced by academia is put into practice.

Conducting scientific research within primary care practices is innovative and can create ruptures and conflicts when it affects the way the job is done or when it takes people out of their comfort zones. By placing health professionals—and at times, patients—as agents of research production, PC-PBR can change the way new knowledge is produced. If knowledge is traditionally produced in academia and then taken as a truth by the place where patient care occurs, PC-PBR can not only generate new knowledge to change professional practice but also bring new evidence to change the way academia works, guiding new research that is better aligned with reality [ 34 ].

In some countries, a more horizontal construction of new evidence and knowledge translation can be seen between academia and healthcare practice. In Australia, for example, PBR protocols are designed to build a sustainable collaboration between a PBRN and an Advanced Center of Research and Translation in Health to build a research platform for planning, conducting and translating research evidence to improve care across the healthcare spectrum [ 42 ].

Aligned with the need for partnership between universities and practices, international collaborations are also an opportunity to guide professionals in places where universities and research institutes are not yet established. Cases such as Australia and New Zealand, where two PBR networks were established to encourage research in the area of osteopathy, show that PBRN has the potential to facilitate the access of professional researchers and clinics that are interested in collaborating with clinical tests and, thus, offer the scientific community an opportunity to conduct research with different methodologies in diverse contexts [ 42 ].

Regarding the difficulties in engaging health professionals in PC-PBR, some examples listed in the articles were little experience in scientific writing, difficulties reading articles in foreign languages, limited self-trust and lack of training to start and conduct studies. Thus, studies recommend that universities and research institutes organize training courses to develop research skills and exchange experiences to determine shared research priorities [ 8 ].

Although essential, the development of research skills is not enough for professionals to engage with and incorporate studies into their places of practice. For PC-PBR projects to advance, leadership is necessary to influence policymakers and managers and advocate for studies to be directly connected with the practice where health care happens.

The majority of the selected studies highlighted the medical category in the discussion about PBR. However, it is important to expand the professional composition of PC-PBR beyond and consider other categories to organize more participative and multidisciplinary studies. All health professionals must be invited to interact and collaborate with scientific activities and implement new projects. The inclusion of all health professionals, including community health workers, nursing assistants, and dental hygienists, who are commonly found in LMICs, can improve the development of research projects that will better take into consideration the patients’ and the territory’s needs [ 8 ].

Implementing PC-PBR goes beyond research production, since the results of the studies produced by researchers, health professionals, users and managers, in addition to the lessons learned, are shared with the health service where the study was held, bringing greater transparency to the entire process and motivating more health professionals to actively participate in future research projects [ 38 ].

Limitations

This review was limited to the literature that reported lessons learned and experiences conducting PC-PBR since few empirical studies with primary data from practice were found. Additionally, there is little representation from LMICs. This limits the conclusions of this review to the contexts described herein, i.e., HIC, where PHC already has a solid structure and a robust research production. Exploring studies performed in PC-PBR networks and identifying their strengths and weaknesses would be a step forward in this sense, but it would demand greater operational efforts. However, this is the first review that is necessary for the advancement of primary care research mainly in LMIC.

The challenges for implementing PBR are similar in the contexts analyzed, showing that turning one place that was originally designed for delivering primary care into a place of knowledge production is not a trivial task. The benefits depicted in the studies show that transforming the traditional methods of knowledge production and translation through PC-PBR can generate a virtuous cycle, providing criticism and reflection about the practice and generating innovations and new knowledge to improve healthcare and patients’ health and well-being.

Additionally, the found strategies point to the need for lasting and systemic actions involving health managers, decision-makers, academics, different types of health professionals and patients, aiming to transform PHC practice in the long term. Despite being more the exception than the rule, PC-PBR has the potential to transform a PHC system that is still under development into an innovative, socially accountable, more comprehensive, accessible, and patient-centered healthcare approach. Furthermore, recognizing the transformative potential of PC-PBR, it becomes imperative to explore strategies for scaling these practices and approaches, ultimately having a broader and more profound impact on the entire primary healthcare system.

Acknowledgment

Not applicable.

Authors’ contributions

Conception and planning of the study: DB and AGJ. Writing the main manuscript text: DB, LB, LYA, IEO, SRMV, CNM, AGJ. Analysis and interpretation: DB, LB, LYA, IEO, SRMV, CNM, AGJ. All the authors read and gave final approval for the final version to be published and agreed to be accountable for all aspects of the work.

The study received no funding.

Availability of data and materials

Declarations.

The authors declare no competing interests.

Publisher's Note

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

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Miller B. Labeling accuracy of cannabidiol extracts sold online. JAMA. 2017;318:1708.
FDA approves first drug compromised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy. U.S. Food and Drug Administration. https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm611046.htm. Accessed Nov. 20, 2018.
State medical marijuana laws. National Conference of State Legislatures. http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx#2. Accessed Nov. 27, 2018.
Devinsky O, et al. Effect of cannabidiol on drop seizures in the Lennox-Gastaut Syndrome. The New England Journal of Medicine. 2018;378:1888.
Cannabidiol. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Nov. 5, 2018.
Cannabidiol. Facts & Comparisons eAnswers. http://www.wolterskluwercdi.com/facts-comparisons-online/. Accessed Nov. 5, 2018.
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