qualitative case study guidelines

Designing and Conducting Case Studies

This guide examines case studies, a form of qualitative descriptive research that is used to look at individuals, a small group of participants, or a group as a whole. Researchers collect data about participants using participant and direct observations, interviews, protocols, tests, examinations of records, and collections of writing samples. Starting with a definition of the case study, the guide moves to a brief history of this research method. Using several well documented case studies, the guide then looks at applications and methods including data collection and analysis. A discussion of ways to handle validity, reliability, and generalizability follows, with special attention to case studies as they are applied to composition studies. Finally, this guide examines the strengths and weaknesses of case studies.

Definition and Overview

Case study refers to the collection and presentation of detailed information about a particular participant or small group, frequently including the accounts of subjects themselves. A form of qualitative descriptive research, the case study looks intensely at an individual or small participant pool, drawing conclusions only about that participant or group and only in that specific context. Researchers do not focus on the discovery of a universal, generalizable truth, nor do they typically look for cause-effect relationships; instead, emphasis is placed on exploration and description.

Case studies typically examine the interplay of all variables in order to provide as complete an understanding of an event or situation as possible. This type of comprehensive understanding is arrived at through a process known as thick description, which involves an in-depth description of the entity being evaluated, the circumstances under which it is used, the characteristics of the people involved in it, and the nature of the community in which it is located. Thick description also involves interpreting the meaning of demographic and descriptive data such as cultural norms and mores, community values, ingrained attitudes, and motives.

Unlike quantitative methods of research, like the survey, which focus on the questions of who, what, where, how much, and how many, and archival analysis, which often situates the participant in some form of historical context, case studies are the preferred strategy when how or why questions are asked. Likewise, they are the preferred method when the researcher has little control over the events, and when there is a contemporary focus within a real life context. In addition, unlike more specifically directed experiments, case studies require a problem that seeks a holistic understanding of the event or situation in question using inductive logic--reasoning from specific to more general terms.

In scholarly circles, case studies are frequently discussed within the context of qualitative research and naturalistic inquiry. Case studies are often referred to interchangeably with ethnography, field study, and participant observation. The underlying philosophical assumptions in the case are similar to these types of qualitative research because each takes place in a natural setting (such as a classroom, neighborhood, or private home), and strives for a more holistic interpretation of the event or situation under study.

Unlike more statistically-based studies which search for quantifiable data, the goal of a case study is to offer new variables and questions for further research. F.H. Giddings, a sociologist in the early part of the century, compares statistical methods to the case study on the basis that the former are concerned with the distribution of a particular trait, or a small number of traits, in a population, whereas the case study is concerned with the whole variety of traits to be found in a particular instance" (Hammersley 95).

Case studies are not a new form of research; naturalistic inquiry was the primary research tool until the development of the scientific method. The fields of sociology and anthropology are credited with the primary shaping of the concept as we know it today. However, case study research has drawn from a number of other areas as well: the clinical methods of doctors; the casework technique being developed by social workers; the methods of historians and anthropologists, plus the qualitative descriptions provided by quantitative researchers like LePlay; and, in the case of Robert Park, the techniques of newspaper reporters and novelists.

Park was an ex-newspaper reporter and editor who became very influential in developing sociological case studies at the University of Chicago in the 1920s. As a newspaper professional he coined the term "scientific" or "depth" reporting: the description of local events in a way that pointed to major social trends. Park viewed the sociologist as "merely a more accurate, responsible, and scientific reporter." Park stressed the variety and value of human experience. He believed that sociology sought to arrive at natural, but fluid, laws and generalizations in regard to human nature and society. These laws weren't static laws of the kind sought by many positivists and natural law theorists, but rather, they were laws of becoming--with a constant possibility of change. Park encouraged students to get out of the library, to quit looking at papers and books, and to view the constant experiment of human experience. He writes, "Go and sit in the lounges of the luxury hotels and on the doorsteps of the flophouses; sit on the Gold Coast settees and on the slum shakedowns; sit in the Orchestra Hall and in the Star and Garter Burlesque. In short, gentlemen [sic], go get the seats of your pants dirty in real research."

But over the years, case studies have drawn their share of criticism. In fact, the method had its detractors from the start. In the 1920s, the debate between pro-qualitative and pro-quantitative became quite heated. Case studies, when compared to statistics, were considered by many to be unscientific. From the 1930's on, the rise of positivism had a growing influence on quantitative methods in sociology. People wanted static, generalizable laws in science. The sociological positivists were looking for stable laws of social phenomena. They criticized case study research because it failed to provide evidence of inter subjective agreement. Also, they condemned it because of the few number of cases studied and that the under-standardized character of their descriptions made generalization impossible. By the 1950s, quantitative methods, in the form of survey research, had become the dominant sociological approach and case study had become a minority practice.

Educational Applications

The 1950's marked the dawning of a new era in case study research, namely that of the utilization of the case study as a teaching method. "Instituted at Harvard Business School in the 1950s as a primary method of teaching, cases have since been used in classrooms and lecture halls alike, either as part of a course of study or as the main focus of the course to which other teaching material is added" (Armisted 1984). The basic purpose of instituting the case method as a teaching strategy was "to transfer much of the responsibility for learning from the teacher on to the student, whose role, as a result, shifts away from passive absorption toward active construction" (Boehrer 1990). Through careful examination and discussion of various cases, "students learn to identify actual problems, to recognize key players and their agendas, and to become aware of those aspects of the situation that contribute to the problem" (Merseth 1991). In addition, students are encouraged to "generate their own analysis of the problems under consideration, to develop their own solutions, and to practically apply their own knowledge of theory to these problems" (Boyce 1993). Along the way, students also develop "the power to analyze and to master a tangled circumstance by identifying and delineating important factors; the ability to utilize ideas, to test them against facts, and to throw them into fresh combinations" (Merseth 1991).

In addition to the practical application and testing of scholarly knowledge, case discussions can also help students prepare for real-world problems, situations and crises by providing an approximation of various professional environments (i.e. classroom, board room, courtroom, or hospital). Thus, through the examination of specific cases, students are given the opportunity to work out their own professional issues through the trials, tribulations, experiences, and research findings of others. An obvious advantage to this mode of instruction is that it allows students the exposure to settings and contexts that they might not otherwise experience. For example, a student interested in studying the effects of poverty on minority secondary student's grade point averages and S.A.T. scores could access and analyze information from schools as geographically diverse as Los Angeles, New York City, Miami, and New Mexico without ever having to leave the classroom.

The case study method also incorporates the idea that students can learn from one another "by engaging with each other and with each other's ideas, by asserting something and then having it questioned, challenged and thrown back at them so that they can reflect on what they hear, and then refine what they say" (Boehrer 1990). In summary, students can direct their own learning by formulating questions and taking responsibility for the study.

Types and Design Concerns

Researchers use multiple methods and approaches to conduct case studies.

Types of Case Studies

Under the more generalized category of case study exist several subdivisions, each of which is custom selected for use depending upon the goals and/or objectives of the investigator. These types of case study include the following:

Illustrative Case Studies These are primarily descriptive studies. They typically utilize one or two instances of an event to show what a situation is like. Illustrative case studies serve primarily to make the unfamiliar familiar and to give readers a common language about the topic in question.

Exploratory (or pilot) Case Studies These are condensed case studies performed before implementing a large scale investigation. Their basic function is to help identify questions and select types of measurement prior to the main investigation. The primary pitfall of this type of study is that initial findings may seem convincing enough to be released prematurely as conclusions.

Cumulative Case Studies These serve to aggregate information from several sites collected at different times. The idea behind these studies is the collection of past studies will allow for greater generalization without additional cost or time being expended on new, possibly repetitive studies.

Critical Instance Case Studies These examine one or more sites for either the purpose of examining a situation of unique interest with little to no interest in generalizability, or to call into question or challenge a highly generalized or universal assertion. This method is useful for answering cause and effect questions.

Identifying a Theoretical Perspective

Much of the case study's design is inherently determined for researchers, depending on the field from which they are working. In composition studies, researchers are typically working from a qualitative, descriptive standpoint. In contrast, physicists will approach their research from a more quantitative perspective. Still, in designing the study, researchers need to make explicit the questions to be explored and the theoretical perspective from which they will approach the case. The three most commonly adopted theories are listed below:

Individual Theories These focus primarily on the individual development, cognitive behavior, personality, learning and disability, and interpersonal interactions of a particular subject.

Organizational Theories These focus on bureaucracies, institutions, organizational structure and functions, or excellence in organizational performance.

Social Theories These focus on urban development, group behavior, cultural institutions, or marketplace functions.

Two examples of case studies are used consistently throughout this chapter. The first, a study produced by Berkenkotter, Huckin, and Ackerman (1988), looks at a first year graduate student's initiation into an academic writing program. The study uses participant-observer and linguistic data collecting techniques to assess the student's knowledge of appropriate discourse conventions. Using the pseudonym Nate to refer to the subject, the study sought to illuminate the particular experience rather than to generalize about the experience of fledgling academic writers collectively.

For example, in Berkenkotter, Huckin, and Ackerman's (1988) study we are told that the researchers are interested in disciplinary communities. In the first paragraph, they ask what constitutes membership in a disciplinary community and how achieving membership might affect a writer's understanding and production of texts. In the third paragraph they state that researchers must negotiate their claims "within the context of his sub specialty's accepted knowledge and methodology." In the next paragraph they ask, "How is literacy acquired? What is the process through which novices gain community membership? And what factors either aid or hinder students learning the requisite linguistic behaviors?" This introductory section ends with a paragraph in which the study's authors claim that during the course of the study, the subject, Nate, successfully makes the transition from "skilled novice" to become an initiated member of the academic discourse community and that his texts exhibit linguistic changes which indicate this transition. In the next section the authors make explicit the sociolinguistic theoretical and methodological assumptions on which the study is based (1988). Thus the reader has a good understanding of the authors' theoretical background and purpose in conducting the study even before it is explicitly stated on the fourth page of the study. "Our purpose was to examine the effects of the educational context on one graduate student's production of texts as he wrote in different courses and for different faculty members over the academic year 1984-85." The goal of the study then, was to explore the idea that writers must be initiated into a writing community, and that this initiation will change the way one writes.

The second example is Janet Emig's (1971) study of the composing process of a group of twelfth graders. In this study, Emig seeks to answer the question of what happens to the self as a result educational stimuli in terms of academic writing. The case study used methods such as protocol analysis, tape-recorded interviews, and discourse analysis.

In the case of Janet Emig's (1971) study of the composing process of eight twelfth graders, four specific hypotheses were made:

Twelfth grade writers engage in two modes of composing: reflexive and extensive.
These differences can be ascertained and characterized through having the writers compose aloud their composition process.
A set of implied stylistic principles governs the writing process.
For twelfth grade writers, extensive writing occurs chiefly as a school-sponsored activity, or reflexive, as a self-sponsored activity.

In this study, the chief distinction is between the two dominant modes of composing among older, secondary school students. The distinctions are:

The reflexive mode, which focuses on the writer's thoughts and feelings.
The extensive mode, which focuses on conveying a message.

Emig also outlines the specific questions which guided the research in the opening pages of her Review of Literature , preceding the report.

Designing a Case Study

After considering the different sub categories of case study and identifying a theoretical perspective, researchers can begin to design their study. Research design is the string of logic that ultimately links the data to be collected and the conclusions to be drawn to the initial questions of the study. Typically, research designs deal with at least four problems:

What questions to study
What data are relevant
What data to collect
How to analyze that data

In other words, a research design is basically a blueprint for getting from the beginning to the end of a study. The beginning is an initial set of questions to be answered, and the end is some set of conclusions about those questions.

Because case studies are conducted on topics as diverse as Anglo-Saxon Literature (Thrane 1986) and AIDS prevention (Van Vugt 1994), it is virtually impossible to outline any strict or universal method or design for conducting the case study. However, Robert K. Yin (1993) does offer five basic components of a research design:

A study's questions.
A study's propositions (if any).
A study's units of analysis.
The logic that links the data to the propositions.
The criteria for interpreting the findings.

In addition to these five basic components, Yin also stresses the importance of clearly articulating one's theoretical perspective, determining the goals of the study, selecting one's subject(s), selecting the appropriate method(s) of collecting data, and providing some considerations to the composition of the final report.

Conducting Case Studies

To obtain as complete a picture of the participant as possible, case study researchers can employ a variety of approaches and methods. These approaches, methods, and related issues are discussed in depth in this section.

Method: Single or Multi-modal?

To obtain as complete a picture of the participant as possible, case study researchers can employ a variety of methods. Some common methods include interviews , protocol analyses, field studies, and participant-observations. Emig (1971) chose to use several methods of data collection. Her sources included conversations with the students, protocol analysis, discrete observations of actual composition, writing samples from each student, and school records (Lauer and Asher 1988).

Berkenkotter, Huckin, and Ackerman (1988) collected data by observing classrooms, conducting faculty and student interviews, collecting self reports from the subject, and by looking at the subject's written work.

A study that was criticized for using a single method model was done by Flower and Hayes (1984). In this study that explores the ways in which writers use different forms of knowing to create space, the authors used only protocol analysis to gather data. The study came under heavy fire because of their decision to use only one method.

Participant Selection

Case studies can use one participant, or a small group of participants. However, it is important that the participant pool remain relatively small. The participants can represent a diverse cross section of society, but this isn't necessary.

For example, the Berkenkotter, Huckin, and Ackerman (1988) study looked at just one participant, Nate. By contrast, in Janet Emig's (1971) study of the composition process of twelfth graders, eight participants were selected representing a diverse cross section of the community, with volunteers from an all-white upper-middle-class suburban school, an all-black inner-city school, a racially mixed lower-middle-class school, an economically and racially mixed school, and a university school.

Often, a brief "case history" is done on the participants of the study in order to provide researchers with a clearer understanding of their participants, as well as some insight as to how their own personal histories might affect the outcome of the study. For instance, in Emig's study, the investigator had access to the school records of five of the participants, and to standardized test scores for the remaining three. Also made available to the researcher was the information that three of the eight students were selected as NCTE Achievement Award winners. These personal histories can be useful in later stages of the study when data are being analyzed and conclusions drawn.

Data Collection

There are six types of data collected in case studies:

Archival records.
Interviews.
Direct observation.
Participant observation.

In the field of composition research, these six sources might be:

A writer's drafts.
School records of student writers.
Transcripts of interviews with a writer.
Transcripts of conversations between writers (and protocols).
Videotapes and notes from direct field observations.
Hard copies of a writer's work on computer.

Depending on whether researchers have chosen to use a single or multi-modal approach for the case study, they may choose to collect data from one or any combination of these sources.

Protocols, that is, transcriptions of participants talking aloud about what they are doing as they do it, have been particularly common in composition case studies. For example, in Emig's (1971) study, the students were asked, in four different sessions, to give oral autobiographies of their writing experiences and to compose aloud three themes in the presence of a tape recorder and the investigator.

In some studies, only one method of data collection is conducted. For example, the Flower and Hayes (1981) report on the cognitive process theory of writing depends on protocol analysis alone. However, using multiple sources of evidence to increase the reliability and validity of the data can be advantageous.

Case studies are likely to be much more convincing and accurate if they are based on several different sources of information, following a corroborating mode. This conclusion is echoed among many composition researchers. For example, in her study of predrafting processes of high and low-apprehensive writers, Cynthia Selfe (1985) argues that because "methods of indirect observation provide only an incomplete reflection of the complex set of processes involved in composing, a combination of several such methods should be used to gather data in any one study." Thus, in this study, Selfe collected her data from protocols, observations of students role playing their writing processes, audio taped interviews with the students, and videotaped observations of the students in the process of composing.

It can be said then, that cross checking data from multiple sources can help provide a multidimensional profile of composing activities in a particular setting. Sharan Merriam (1985) suggests "checking, verifying, testing, probing, and confirming collected data as you go, arguing that this process will follow in a funnel-like design resulting in less data gathering in later phases of the study along with a congruent increase in analysis checking, verifying, and confirming."

It is important to note that in case studies, as in any qualitative descriptive research, while researchers begin their studies with one or several questions driving the inquiry (which influence the key factors the researcher will be looking for during data collection), a researcher may find new key factors emerging during data collection. These might be unexpected patterns or linguistic features which become evident only during the course of the research. While not bearing directly on the researcher's guiding questions, these variables may become the basis for new questions asked at the end of the report, thus linking to the possibility of further research.

Data Analysis

As the information is collected, researchers strive to make sense of their data. Generally, researchers interpret their data in one of two ways: holistically or through coding. Holistic analysis does not attempt to break the evidence into parts, but rather to draw conclusions based on the text as a whole. Flower and Hayes (1981), for example, make inferences from entire sections of their students' protocols, rather than searching through the transcripts to look for isolatable characteristics.

However, composition researchers commonly interpret their data by coding, that is by systematically searching data to identify and/or categorize specific observable actions or characteristics. These observable actions then become the key variables in the study. Sharan Merriam (1988) suggests seven analytic frameworks for the organization and presentation of data:

The role of participants.
The network analysis of formal and informal exchanges among groups.
Historical.
Thematical.
Ritual and symbolism.
Critical incidents that challenge or reinforce fundamental beliefs, practices, and values.

There are two purposes of these frameworks: to look for patterns among the data and to look for patterns that give meaning to the case study.

As stated above, while most researchers begin their case studies expecting to look for particular observable characteristics, it is not unusual for key variables to emerge during data collection. Typical variables coded in case studies of writers include pauses writers make in the production of a text, the use of specific linguistic units (such as nouns or verbs), and writing processes (planning, drafting, revising, and editing). In the Berkenkotter, Huckin, and Ackerman (1988) study, for example, researchers coded the participant's texts for use of connectives, discourse demonstratives, average sentence length, off-register words, use of the first person pronoun, and the ratio of definite articles to indefinite articles.

Since coding is inherently subjective, more than one coder is usually employed. In the Berkenkotter, Huckin, and Ackerman (1988) study, for example, three rhetoricians were employed to code the participant's texts for off-register phrases. The researchers established the agreement among the coders before concluding that the participant used fewer off-register words as the graduate program progressed.

Composing the Case Study Report

In the many forms it can take, "a case study is generically a story; it presents the concrete narrative detail of actual, or at least realistic events, it has a plot, exposition, characters, and sometimes even dialogue" (Boehrer 1990). Generally, case study reports are extensively descriptive, with "the most problematic issue often referred to as being the determination of the right combination of description and analysis" (1990). Typically, authors address each step of the research process, and attempt to give the reader as much context as possible for the decisions made in the research design and for the conclusions drawn.

This contextualization usually includes a detailed explanation of the researchers' theoretical positions, of how those theories drove the inquiry or led to the guiding research questions, of the participants' backgrounds, of the processes of data collection, of the training and limitations of the coders, along with a strong attempt to make connections between the data and the conclusions evident.

Although the Berkenkotter, Huckin, and Ackerman (1988) study does not, case study reports often include the reactions of the participants to the study or to the researchers' conclusions. Because case studies tend to be exploratory, most end with implications for further study. Here researchers may identify significant variables that emerged during the research and suggest studies related to these, or the authors may suggest further general questions that their case study generated.

For example, Emig's (1971) study concludes with a section dedicated solely to the topic of implications for further research, in which she suggests several means by which this particular study could have been improved, as well as questions and ideas raised by this study which other researchers might like to address, such as: is there a correlation between a certain personality and a certain composing process profile (e.g. is there a positive correlation between ego strength and persistence in revising)?

Also included in Emig's study is a section dedicated to implications for teaching, which outlines the pedagogical ramifications of the study's findings for teachers currently involved in high school writing programs.

Sharan Merriam (1985) also offers several suggestions for alternative presentations of data:

Prepare specialized condensations for appropriate groups.
Replace narrative sections with a series of answers to open-ended questions.
Present "skimmer's" summaries at beginning of each section.
Incorporate headlines that encapsulate information from text.
Prepare analytic summaries with supporting data appendixes.
Present data in colorful and/or unique graphic representations.

Issues of Validity and Reliability

Once key variables have been identified, they can be analyzed. Reliability becomes a key concern at this stage, and many case study researchers go to great lengths to ensure that their interpretations of the data will be both reliable and valid. Because issues of validity and reliability are an important part of any study in the social sciences, it is important to identify some ways of dealing with results.

Multi-modal case study researchers often balance the results of their coding with data from interviews or writer's reflections upon their own work. Consequently, the researchers' conclusions become highly contextualized. For example, in a case study which looked at the time spent in different stages of the writing process, Berkenkotter concluded that her participant, Donald Murray, spent more time planning his essays than in other writing stages. The report of this case study is followed by Murray's reply, wherein he agrees with some of Berkenkotter's conclusions and disagrees with others.

As is the case with other research methodologies, issues of external validity, construct validity, and reliability need to be carefully considered.

Commentary on Case Studies

Researchers often debate the relative merits of particular methods, among them case study. In this section, we comment on two key issues. To read the commentaries, choose any of the items below:

Strengths and Weaknesses of Case Studies

Most case study advocates point out that case studies produce much more detailed information than what is available through a statistical analysis. Advocates will also hold that while statistical methods might be able to deal with situations where behavior is homogeneous and routine, case studies are needed to deal with creativity, innovation, and context. Detractors argue that case studies are difficult to generalize because of inherent subjectivity and because they are based on qualitative subjective data, generalizable only to a particular context.

Flexibility

The case study approach is a comparatively flexible method of scientific research. Because its project designs seem to emphasize exploration rather than prescription or prediction, researchers are comparatively freer to discover and address issues as they arise in their experiments. In addition, the looser format of case studies allows researchers to begin with broad questions and narrow their focus as their experiment progresses rather than attempt to predict every possible outcome before the experiment is conducted.

Emphasis on Context

By seeking to understand as much as possible about a single subject or small group of subjects, case studies specialize in "deep data," or "thick description"--information based on particular contexts that can give research results a more human face. This emphasis can help bridge the gap between abstract research and concrete practice by allowing researchers to compare their firsthand observations with the quantitative results obtained through other methods of research.

Inherent Subjectivity

"The case study has long been stereotyped as the weak sibling among social science methods," and is often criticized as being too subjective and even pseudo-scientific. Likewise, "investigators who do case studies are often regarded as having deviated from their academic disciplines, and their investigations as having insufficient precision (that is, quantification), objectivity and rigor" (Yin 1989). Opponents cite opportunities for subjectivity in the implementation, presentation, and evaluation of case study research. The approach relies on personal interpretation of data and inferences. Results may not be generalizable, are difficult to test for validity, and rarely offer a problem-solving prescription. Simply put, relying on one or a few subjects as a basis for cognitive extrapolations runs the risk of inferring too much from what might be circumstance.

High Investment

Case studies can involve learning more about the subjects being tested than most researchers would care to know--their educational background, emotional background, perceptions of themselves and their surroundings, their likes, dislikes, and so on. Because of its emphasis on "deep data," the case study is out of reach for many large-scale research projects which look at a subject pool in the tens of thousands. A budget request of $10,000 to examine 200 subjects sounds more efficient than a similar request to examine four subjects.

Ethical Considerations

Researchers conducting case studies should consider certain ethical issues. For example, many educational case studies are often financed by people who have, either directly or indirectly, power over both those being studied and those conducting the investigation (1985). This conflict of interests can hinder the credibility of the study.

The personal integrity, sensitivity, and possible prejudices and/or biases of the investigators need to be taken into consideration as well. Personal biases can creep into how the research is conducted, alternative research methods used, and the preparation of surveys and questionnaires.

A common complaint in case study research is that investigators change direction during the course of the study unaware that their original research design was inadequate for the revised investigation. Thus, the researchers leave unknown gaps and biases in the study. To avoid this, researchers should report preliminary findings so that the likelihood of bias will be reduced.

Concerns about Reliability, Validity, and Generalizability

Merriam (1985) offers several suggestions for how case study researchers might actively combat the popular attacks on the validity, reliability, and generalizability of case studies:

Prolong the Processes of Data Gathering on Site: This will help to insure the accuracy of the findings by providing the researcher with more concrete information upon which to formulate interpretations.
Employ the Process of "Triangulation": Use a variety of data sources as opposed to relying solely upon one avenue of observation. One example of such a data check would be what McClintock, Brannon, and Maynard (1985) refer to as a "case cluster method," that is, when a single unit within a larger case is randomly sampled, and that data treated quantitatively." For instance, in Emig's (1971) study, the case cluster method was employed, singling out the productivity of a single student named Lynn. This cluster profile included an advanced case history of the subject, specific examination and analysis of individual compositions and protocols, and extensive interview sessions. The seven remaining students were then compared with the case of Lynn, to ascertain if there are any shared, or unique dimensions to the composing process engaged in by these eight students.
Conduct Member Checks: Initiate and maintain an active corroboration on the interpretation of data between the researcher and those who provided the data. In other words, talk to your subjects.
Collect Referential Materials: Complement the file of materials from the actual site with additional document support. For example, Emig (1971) supports her initial propositions with historical accounts by writers such as T.S. Eliot, James Joyce, and D.H. Lawrence. Emig also cites examples of theoretical research done with regards to the creative process, as well as examples of empirical research dealing with the writing of adolescents. Specific attention is then given to the four stages description of the composing process delineated by Helmoltz, Wallas, and Cowley, as it serves as the focal point in this study.
Engage in Peer Consultation: Prior to composing the final draft of the report, researchers should consult with colleagues in order to establish validity through pooled judgment.

Although little can be done to combat challenges concerning the generalizability of case studies, "most writers suggest that qualitative research should be judged as credible and confirmable as opposed to valid and reliable" (Merriam 1985). Likewise, it has been argued that "rather than transplanting statistical, quantitative notions of generalizability and thus finding qualitative research inadequate, it makes more sense to develop an understanding of generalization that is congruent with the basic characteristics of qualitative inquiry" (1985). After all, criticizing the case study method for being ungeneralizable is comparable to criticizing a washing machine for not being able to tell the correct time. In other words, it is unjust to criticize a method for not being able to do something which it was never originally designed to do in the first place.

Annotated Bibliography

Armisted, C. (1984). How Useful are Case Studies. Training and Development Journal, 38 (2), 75-77.

This article looks at eight types of case studies, offers pros and cons of using case studies in the classroom, and gives suggestions for successfully writing and using case studies.

Bardovi-Harlig, K. (1997). Beyond Methods: Components of Second Language Teacher Education . New York: McGraw-Hill.

A compilation of various research essays which address issues of language teacher education. Essays included are: "Non-native reading research and theory" by Lee, "The case for Psycholinguistics" by VanPatten, and "Assessment and Second Language Teaching" by Gradman and Reed.

Bartlett, L. (1989). A Question of Good Judgment; Interpretation Theory and Qualitative Enquiry Address. 70th Annual Meeting of the American Educational Research Association. San Francisco.

Bartlett selected "quasi-historical" methodology, which focuses on the "truth" found in case records, as one that will provide "good judgments" in educational inquiry. He argues that although the method is not comprehensive, it can try to connect theory with practice.

Baydere, S. et. al. (1993). Multimedia conferencing as a tool for collaborative writing: a case study in Computer Supported Collaborative Writing. New York: Springer-Verlag.

The case study by Baydere et. al. is just one of the many essays in this book found in the series "Computer Supported Cooperative Work." Denley, Witefield and May explore similar issues in their essay, "A case study in task analysis for the design of a collaborative document production system."

Berkenkotter, C., Huckin, T., N., & Ackerman J. (1988). Conventions, Conversations, and the Writer: Case Study of a Student in a Rhetoric Ph.D. Program. Research in the Teaching of English, 22, 9-44.

The authors focused on how the writing of their subject, Nate or Ackerman, changed as he became more acquainted or familiar with his field's discourse community.

Berninger, V., W., and Gans, B., M. (1986). Language Profiles in Nonspeaking Individuals of Normal Intelligence with Severe Cerebral Palsy. Augmentative and Alternative Communication, 2, 45-50.

Argues that generalizations about language abilities in patients with severe cerebral palsy (CP) should be avoided. Standardized tests of different levels of processing oral language, of processing written language, and of producing written language were administered to 3 male participants (aged 9, 16, and 40 yrs).

Bockman, J., R., and Couture, B. (1984). The Case Method in Technical Communication: Theory and Models. Texas: Association of Teachers of Technical Writing.

Examines the study and teaching of technical writing, communication of technical information, and the case method in terms of those applications.

Boehrer, J. (1990). Teaching With Cases: Learning to Question. New Directions for Teaching and Learning, 42 41-57.

This article discusses the origins of the case method, looks at the question of what is a case, gives ideas about learning in case teaching, the purposes it can serve in the classroom, the ground rules for the case discussion, including the role of the question, and new directions for case teaching.

Bowman, W. R. (1993). Evaluating JTPA Programs for Economically Disadvantaged Adults: A Case Study of Utah and General Findings . Washington: National Commission for Employment Policy.

"To encourage state-level evaluations of JTPA, the Commission and the State of Utah co-sponsored this report on the effectiveness of JTPA Title II programs for adults in Utah. The technique used is non-experimental and the comparison group was selected from registrants with Utah's Employment Security. In a step-by-step approach, the report documents how non-experimental techniques can be applied and several specific technical issues can be addressed."

Boyce, A. (1993) The Case Study Approach for Pedagogists. Annual Meeting of the American Alliance for Health, Physical Education, Recreation and Dance. (Address). Washington DC.

This paper addresses how case studies 1) bridge the gap between teaching theory and application, 2) enable students to analyze problems and develop solutions for situations that will be encountered in the real world of teaching, and 3) helps students to evaluate the feasibility of alternatives and to understand the ramifications of a particular course of action.

Carson, J. (1993) The Case Study: Ideal Home of WAC Quantitative and Qualitative Data. Annual Meeting of the Conference on College Composition and Communication. (Address). San Diego.

"Increasingly, one of the most pressing questions for WAC advocates is how to keep [WAC] programs going in the face of numerous difficulties. Case histories offer the best chance for fashioning rhetorical arguments to keep WAC programs going because they offer the opportunity to provide a coherent narrative that contextualizes all documents and data, including what is generally considered scientific data. A case study of the WAC program, . . . at Robert Morris College in Pittsburgh demonstrates the advantages of this research method. Such studies are ideal homes for both naturalistic and positivistic data as well as both quantitative and qualitative information."

---. (1991). A Cognitive Process Theory of Writing. College Composition and Communication. 32. 365-87.

No abstract available.

Cromer, R. (1994) A Case Study of Dissociations Between Language and Cognition. Constraints on Language Acquisition: Studies of Atypical Children . Hillsdale: Lawrence Erlbaum Associates, 141-153.

Crossley, M. (1983) Case Study in Comparative and International Education: An Approach to Bridging the Theory-Practice Gap. Proceedings of the 11th Annual Conference of the Australian Comparative and International Education Society. Hamilton, NZ.

Case study research, as presented here, helps bridge the theory-practice gap in comparative and international research studies of education because it focuses on the practical, day-to-day context rather than on the national arena. The paper asserts that the case study method can be valuable at all levels of research, formation, and verification of theories in education.

Daillak, R., H., and Alkin, M., C. (1982). Qualitative Studies in Context: Reflections on the CSE Studies of Evaluation Use . California: EDRS

The report shows how the Center of the Study of Evaluation (CSE) applied qualitative techniques to a study of evaluation information use in local, Los Angeles schools. It critiques the effectiveness and the limitations of using case study, evaluation, field study, and user interview survey methodologies.

Davey, L. (1991). The Application of Case Study Evaluations. ERIC/TM Digest.

This article examines six types of case studies, the type of evaluation questions that can be answered, the functions served, some design features, and some pitfalls of the method.

Deutch, C. E. (1996). A course in research ethics for graduate students. College Teaching, 44, 2, 56-60.

This article describes a one-credit discussion course in research ethics for graduate students in biology. Case studies are focused on within the four parts of the course: 1) major issues, 2 )practical issues in scholarly work, 3) ownership of research results, and 4) training and personal decisions.

DeVoss, G. (1981). Ethics in Fieldwork Research. RIE 27p. (ERIC)

This article examines four of the ethical problems that can happen when conducting case study research: acquiring permission to do research, knowing when to stop digging, the pitfalls of doing collaborative research, and preserving the integrity of the participants.

Driscoll, A. (1985). Case Study of a Research Intervention: the University of Utah’s Collaborative Approach . San Francisco: Far West Library for Educational Research Development.

Paper presented at the annual meeting of the American Association of Colleges of Teacher Education, Denver, CO, March 1985. Offers information of in-service training, specifically case studies application.

Ellram, L. M. (1996). The Use of the Case Study Method in Logistics Research. Journal of Business Logistics, 17, 2, 93.

This article discusses the increased use of case study in business research, and the lack of understanding of when and how to use case study methodology in business.

Emig, J. (1971) The Composing Processes of Twelfth Graders . Urbana: NTCE.

This case study uses observation, tape recordings, writing samples, and school records to show that writing in reflexive and extensive situations caused different lengths of discourse and different clusterings of the components of the writing process.

Feagin, J. R. (1991). A Case For the Case Study . Chapel Hill: The University of North Carolina Press.

This book discusses the nature, characteristics, and basic methodological issues of the case study as a research method.

Feldman, H., Holland, A., & Keefe, K. (1989) Language Abilities after Left Hemisphere Brain Injury: A Case Study of Twins. Topics in Early Childhood Special Education, 9, 32-47.

"Describes the language abilities of 2 twin pairs in which 1 twin (the experimental) suffered brain injury to the left cerebral hemisphere around the time of birth and1 twin (the control) did not. One pair of twins was initially assessed at age 23 mo. and the other at about 30 mo.; they were subsequently evaluated in their homes 3 times at about 6-mo intervals."

Fidel, R. (1984). The Case Study Method: A Case Study. Library and Information Science Research, 6.

The article describes the use of case study methodology to systematically develop a model of online searching behavior in which study design is flexible, subject manner determines data gathering and analyses, and procedures adapt to the study's progressive change.

Flower, L., & Hayes, J. R. (1984). Images, Plans and Prose: The Representation of Meaning in Writing. Written Communication, 1, 120-160.

Explores the ways in which writers actually use different forms of knowing to create prose.

Frey, L. R. (1992). Interpreting Communication Research: A Case Study Approach Englewood Cliffs, N.J.: Prentice Hall.

The book discusses research methodologies in the Communication field. It focuses on how case studies bridge the gap between communication research, theory, and practice.

Gilbert, V. K. (1981). The Case Study as a Research Methodology: Difficulties and Advantages of Integrating the Positivistic, Phenomenological and Grounded Theory Approaches . The Annual Meeting of the Canadian Association for the Study of Educational Administration. (Address) Halifax, NS, Can.

This study on an innovative secondary school in England shows how a "low-profile" participant-observer case study was crucial to the initial observation, the testing of hypotheses, the interpretive approach, and the grounded theory.

Gilgun, J. F. (1994). A Case for Case Studies in Social Work Research. Social Work, 39, 4, 371-381.

This article defines case study research, presents guidelines for evaluation of case studies, and shows the relevance of case studies to social work research. It also looks at issues such as evaluation and interpretations of case studies.

Glennan, S. L., Sharp-Bittner, M. A. & Tullos, D. C. (1991). Augmentative and Alternative Communication Training with a Nonspeaking Adult: Lessons from MH. Augmentative and Alternative Communication, 7, 240-7.

"A response-guided case study documented changes in a nonspeaking 36-yr-old man's ability to communicate using 3 trained augmentative communication modes. . . . Data were collected in videotaped interaction sessions between the nonspeaking adult and a series of adult speaking."

Graves, D. (1981). An Examination of the Writing Processes of Seven Year Old Children. Research in the Teaching of English, 15, 113-134.

Hamel, J. (1993). Case Study Methods . Newbury Park: Sage. .

"In a most economical fashion, Hamel provides a practical guide for producing theoretically sharp and empirically sound sociological case studies. A central idea put forth by Hamel is that case studies must "locate the global in the local" thus making the careful selection of the research site the most critical decision in the analytic process."

Karthigesu, R. (1986, July). Television as a Tool for Nation-Building in the Third World: A Post-Colonial Pattern, Using Malaysia as a Case-Study. International Television Studies Conference. (Address). London, 10-12.

"The extent to which Television Malaysia, as a national mass media organization, has been able to play a role in nation building in the post-colonial period is . . . studied in two parts: how the choice of a model of nation building determines the character of the organization; and how the character of the organization influences the output of the organization."

Kenny, R. (1984). Making the Case for the Case Study. Journal of Curriculum Studies, 16, (1), 37-51.

The article looks at how and why the case study is justified as a viable and valuable approach to educational research and program evaluation.

Knirk, F. (1991). Case Materials: Research and Practice. Performance Improvement Quarterly, 4 (1 ), 73-81.

The article addresses the effectiveness of case studies, subject areas where case studies are commonly used, recent examples of their use, and case study design considerations.

Klos, D. (1976). Students as Case Writers. Teaching of Psychology, 3.2, 63-66.

This article reviews a course in which students gather data for an original case study of another person. The task requires the students to design the study, collect the data, write the narrative, and interpret the findings.

Leftwich, A. (1981). The Politics of Case Study: Problems of Innovation in University Education. Higher Education Review, 13.2, 38-64.

The article discusses the use of case studies as a teaching method. Emphasis is on the instructional materials, interdisciplinarity, and the complex relationships within the university that help or hinder the method.

Mabrito, M. (1991, Oct.). Electronic Mail as a Vehicle for Peer Response: Conversations of High and Low Apprehensive Writers. Written Communication, 509-32.

McCarthy, S., J. (1955). The Influence of Classroom Discourse on Student Texts: The Case of Ella . East Lansing: Institute for Research on Teaching.

A look at how students of color become marginalized within traditional classroom discourse. The essay follows the struggles of one black student: Ella.

Matsuhashi, A., ed. (1987). Writing in Real Time: Modeling Production Processes Norwood, NJ: Ablex Publishing Corporation.

Investigates how writers plan to produce discourse for different purposes to report, to generalize, and to persuade, as well as how writers plan for sentence level units of language. To learn about planning, an observational measure of pause time was used" (ERIC).

Merriam, S. B. (1985). The Case Study in Educational Research: A Review of Selected Literature. Journal of Educational Thought, 19.3, 204-17.

The article examines the characteristics of, philosophical assumptions underlying the case study, the mechanics of conducting a case study, and the concerns about the reliability, validity, and generalizability of the method.

---. (1988). Case Study Research in Education: A Qualitative Approach San Francisco: Jossey Bass.

Merry, S. E., & Milner, N. eds. (1993). The Possibility of Popular Justice: A Case Study of Community Mediation in the United States . Ann Arbor: U of Michigan.

". . . this volume presents a case study of one experiment in popular justice, the San Francisco Community Boards. This program has made an explicit claim to create an alternative justice, or new justice, in the midst of a society ordered by state law. The contributors to this volume explore the history and experience of the program and compare it to other versions of popular justice in the United States, Europe, and the Third World."

Merseth, K. K. (1991). The Case for Cases in Teacher Education. RIE. 42p. (ERIC).

This monograph argues that the case method of instruction offers unique potential for revitalizing the field of teacher education.

Michaels, S. (1987). Text and Context: A New Approach to the Study of Classroom Writing. Discourse Processes, 10, 321-346.

"This paper argues for and illustrates an approach to the study of writing that integrates ethnographic analysis of classroom interaction with linguistic analysis of written texts and teacher/student conversational exchanges. The approach is illustrated through a case study of writing in a single sixth grade classroom during a single writing assignment."

Milburn, G. (1995). Deciphering a Code or Unraveling a Riddle: A Case Study in the Application of a Humanistic Metaphor to the Reporting of Social Studies Teaching. Theory and Research in Education, 13.

This citation serves as an example of how case studies document learning procedures in a senior-level economics course.

Milley, J. E. (1979). An Investigation of Case Study as an Approach to Program Evaluation. 19th Annual Forum of the Association for Institutional Research. (Address). San Diego.

The case study method merged a narrative report focusing on the evaluator as participant-observer with document review, interview, content analysis, attitude questionnaire survey, and sociogram analysis. Milley argues that case study program evaluation has great potential for widespread use.

Minnis, J. R. (1985, Sept.). Ethnography, Case Study, Grounded Theory, and Distance Education Research. Distance Education, 6.2.

This article describes and defines the strengths and weaknesses of ethnography, case study, and grounded theory.

Nunan, D. (1992). Collaborative language learning and teaching . New York: Cambridge University Press.

Included in this series of essays is Peter Sturman’s "Team Teaching: a case study from Japan" and David Nunan’s own "Toward a collaborative approach to curriculum development: a case study."

Nystrand, M., ed. (1982). What Writers Know: The Language, Process, and Structure of Written Discourse . New York: Academic Press.

Owenby, P. H. (1992). Making Case Studies Come Alive. Training, 29, (1), 43-46. (ERIC)

This article provides tips for writing more effective case studies.

---. (1981). Pausing and Planning: The Tempo of Writer Discourse Production. Research in the Teaching of English, 15 (2),113-34.

Perl, S. (1979). The Composing Processes of Unskilled College Writers. Research in the Teaching of English, 13, 317-336.

"Summarizes a study of five unskilled college writers, focusing especially on one of the five, and discusses the findings in light of current pedagogical practice and research design."

Pilcher J. and A. Coffey. eds. (1996). Gender and Qualitative Research . Brookfield: Aldershot, Hants, England.

This book provides a series of essays which look at gender identity research, qualitative research and applications of case study to questions of gendered pedagogy.

Pirie, B. S. (1993). The Case of Morty: A Four Year Study. Gifted Education International, 9 (2), 105-109.

This case study describes a boy from kindergarten through third grade with above average intelligence but difficulty in learning to read, write, and spell.

Popkewitz, T. (1993). Changing Patterns of Power: Social Regulation and Teacher Education Reform. Albany: SUNY Press.

Popkewitz edits this series of essays that address case studies on educational change and the training of teachers. The essays vary in terms of discipline and scope. Also, several authors include case studies of educational practices in countries other than the United States.

---. (1984). The Predrafting Processes of Four High- and Four Low Apprehensive Writers. Research in the Teaching of English, 18, (1), 45-64.

Rasmussen, P. (1985, March) A Case Study on the Evaluation of Research at the Technical University of Denmark. International Journal of Institutional Management in Higher Education, 9 (1).

This is an example of a case study methodology used to evaluate the chemistry and chemical engineering departments at the University of Denmark.

Roth, K. J. (1986). Curriculum Materials, Teacher Talk, and Student Learning: Case Studies in Fifth-Grade Science Teaching . East Lansing: Institute for Research on Teaching.

Roth offers case studies on elementary teachers, elementary school teaching, science studies and teaching, and verbal learning.

Selfe, C. L. (1985). An Apprehensive Writer Composes. When a Writer Can't Write: Studies in Writer's Block and Other Composing-Process Problems . (pp. 83-95). Ed. Mike Rose. NMY: Guilford.

Smith-Lewis, M., R. and Ford, A. (1987). A User's Perspective on Augmentative Communication. Augmentative and Alternative Communication, 3, 12-7.

"During a series of in-depth interviews, a 25-yr-old woman with cerebral palsy who utilized augmentative communication reflected on the effectiveness of the devices designed for her during her school career."

St. Pierre, R., G. (1980, April). Follow Through: A Case Study in Metaevaluation Research . 64th Annual Meeting of the American Educational Research Association. (Address).

The three approaches to metaevaluation are evaluation of primary evaluations, integrative meta-analysis with combined primary evaluation results, and re-analysis of the raw data from a primary evaluation.

Stahler, T., M. (1996, Feb.) Early Field Experiences: A Model That Worked. ERIC.

"This case study of a field and theory class examines a model designed to provide meaningful field experiences for preservice teachers while remaining consistent with the instructor's beliefs about the role of teacher education in preparing teachers for the classroom."

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

This book examines case study research in education and case study methodology.

Stiegelbauer, S. (1984) Community, Context, and Co-curriculum: Situational Factors Influencing School Improvements in a Study of High Schools. Presented at the annual meeting of the American Educational Research Association, New Orleans, LA.

Discussion of several case studies: one looking at high school environments, another examining educational innovations.

Stolovitch, H. (1990). Case Study Method. Performance And Instruction, 29, (9), 35-37.

This article describes the case study method as a form of simulation and presents guidelines for their use in professional training situations.

Thaller, E. (1994). Bibliography for the Case Method: Using Case Studies in Teacher Education. RIE. 37 p.

This bibliography presents approximately 450 citations on the use of case studies in teacher education from 1921-1993.

Thrane, T. (1986). On Delimiting the Senses of Near-Synonyms in Historical Semantics: A Case Study of Adjectives of 'Moral Sufficiency' in the Old English Andreas. Linguistics Across Historical and Geographical Boundaries: In Honor of Jacek Fisiak on the Occasion of his Fiftieth Birthday . Berlin: Mouton de Gruyter.

United Nations. (1975). Food and Agriculture Organization. Report on the FAO/UNFPA Seminar on Methodology, Research and Country: Case Studies on Population, Employment and Productivity . Rome: United Nations.

This example case study shows how the methodology can be used in a demographic and psychographic evaluation. At the same time, it discusses the formation and instigation of the case study methodology itself.

Van Vugt, J. P., ed. (1994). Aids Prevention and Services: Community Based Research . Westport: Bergin and Garvey.

"This volume has been five years in the making. In the process, some of the policy applications called for have met with limited success, such as free needle exchange programs in a limited number of American cities, providing condoms to prison inmates, and advertisements that depict same-sex couples. Rather than dating our chapters that deal with such subjects, such policy applications are verifications of the type of research demonstrated here. Furthermore, they indicate the critical need to continue community based research in the various communities threatened by acquired immuno-deficiency syndrome (AIDS) . . . "

Welch, W., ed. (1981, May). Case Study Methodology in Educational Evaluation. Proceedings of the Minnesota Evaluation Conference. Minnesota. (Address).

The four papers in these proceedings provide a comprehensive picture of the rationale, methodology, strengths, and limitations of case studies.

Williams, G. (1987). The Case Method: An Approach to Teaching and Learning in Educational Administration. RIE, 31p.

This paper examines the viability of the case method as a teaching and learning strategy in instructional systems geared toward the training of personnel of the administration of various aspects of educational systems.

Yin, R. K. (1993). Advancing Rigorous Methodologies: A Review of 'Towards Rigor in Reviews of Multivocal Literatures.' Review of Educational Research, 61, (3).

"R. T. Ogawa and B. Malen's article does not meet its own recommended standards for rigorous testing and presentation of its own conclusions. Use of the exploratory case study to analyze multivocal literatures is not supported, and the claim of grounded theory to analyze multivocal literatures may be stronger."

---. (1989). Case Study Research: Design and Methods. London: Sage Publications Inc.

This book discusses in great detail, the entire design process of the case study, including entire chapters on collecting evidence, analyzing evidence, composing the case study report, and designing single and multiple case studies.

Professional regulation in the digital era: A qualitative case study of three professions in Ontario, Canada

Roles Conceptualization, Formal analysis, Funding acquisition, Methodology, Project administration, Supervision, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada

Roles Data curation, Formal analysis, Writing – original draft, Writing – review & editing

Affiliations Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada, School of Sociological and Anthropological Studies, University of Ottawa, Ottawa, Ontario, Canada

Roles Data curation, Formal analysis, Writing – review & editing

Roles Formal analysis, Writing – original draft, Writing – review & editing

Affiliation Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada

Roles Validation, Writing – review & editing

Affiliation School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada

Roles Conceptualization, Visualization, Writing – review & editing

Affiliation Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada

Roles Conceptualization, Formal analysis, Validation, Writing – review & editing

Affiliation Department of Sociology, Western University, London, Ontario, Canada

Kathleen Leslie,
Sophia Myles,
Abeer A. Alraja,
Patrick Chiu,
Catharine J. Schiller,
Sioban Nelson,
Tracey L. Adams

Published: May 10, 2024
https://doi.org/10.1371/journal.pone.0303192
Reader Comments

Technology is transforming service delivery and practice in many regulated professions, altering required skills, scopes of practice, and the organization of professional work. Professional regulators face considerable pressure to facilitate technology-enabled work while adapting to digital changes in their practices and procedures. However, our understanding of how regulators are responding to technology-driven risks and the impact of technology on regulatory policy is limited. To examine the impact of technology and digitalization on regulation, we conducted an exploratory case study of the regulatory bodies for nursing, law, and social work in Ontario, Canada. Data were collected over two phases. First, we collected documents from the regulators’ websites and regulatory consortiums. Second, we conducted key informant interviews with two representatives from each regulator. Data were thematically analyzed to explore the impact of technological change on regulatory activities and policies and to compare how regulatory structure and field shape this impact. Five themes were identified in our analysis: balancing efficiency potential with risks of certain technological advances; the potential for improving regulation through data analytics; considering how to regulate a technologically competent workforce; recalibrating pandemic emergency measures involving technology; and contemplating the future of technology on regulatory policy and practice. Regulators face ongoing challenges with providing equity-based approaches to regulating virtual practice, ensuring practitioners are technologically competent, and leveraging regulatory data to inform decision-making. Policymakers and regulators across Canada and internationally should prioritize risk-balanced policies, guidelines, and practice standards to support professional practice in the digital era.

Citation: Leslie K, Myles S, Alraja AA, Chiu P, Schiller CJ, Nelson S, et al. (2024) Professional regulation in the digital era: A qualitative case study of three professions in Ontario, Canada. PLoS ONE 19(5): e0303192. https://doi.org/10.1371/journal.pone.0303192

Editor: Sascha Köpke, University Hospital Cologne: Uniklinik Koln, GERMANY

Received: December 15, 2023; Accepted: April 20, 2024; Published: May 10, 2024

Copyright: © 2024 Leslie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The minimum data needed to replicate the study are within the paper and its Supporting information files. However, the raw interview transcripts cannot be made publicly available for ethical reasons because they may contain identifiable or sensitive data. Excerpts from interviews are presented in the paper and additional excerpts can be made available upon reasonable request to the Athabasca University Research Ethics Board (email: [email protected] , phone: 780.213.2033).

Funding: This project was funded by an Insight Development Grant (File # 430-2021-00407) from the Social Sciences and Humanities Research Council of Canada (Principal Investigator KL). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Funder URL: https://www.sshrc-crsh.gc.ca/ .

Competing interests: The authors have declared that no competing interests exist.

Introduction

Technology is rapidly transforming service delivery across regulated professions, altering required skills, scopes of practice, and the organization of professional work [ 1 – 5 ]. Regulatory bodies that govern these professions are under immense pressure to adapt their practices and procedures to facilitate technology-enabled work, while also upholding their mandate to protect the public interest. This urgency has been magnified by the COVID-19 pandemic, which expedited the shift towards virtual practice [ 6 – 8 ] and the scrutiny of professionals’ social media behaviour [ 9 , 10 ]. Regulators must evolve alongside technological advancements to mitigate emerging risks and ensure that new technologies do not negatively impact professional practice or services provided to the public.

Research exploring the impact of digitalization, artificial intelligence (AI), and other technological changes on professional work is emerging [ 11 – 15 ]. This literature has explored the interplay between traditional professional practice and digital innovation [ 16 , 17 ], the organizational changes induced by digital development [ 13 , 15 , 18 , 19 ], and the emerging digital competencies required by professionals [ 20 , 21 ]. Our previous research has also identified challenges that accompany the expansion of virtual practice, including uncertainty about professional standards, breaches of privacy law and other legal requirements, and concerns about equity and professional ethics [ 6 , 22 , 23 ]. Furthermore, while AI technology has the potential to deliver more efficient and data-driven professional services, the associated risks are just beginning to be explored [ 24 , 25 ]. Notably, the burgeoning use of AI raises issues around privacy, equity, and the integrity of professional practice, all of which have implications for professional regulators. Already there are cases where regulators have needed to respond to the inappropriate use of AI in professional practice [ 26 ]. Technology with the potential to profoundly affect professional practice calls for regulatory practices that are responsive to the changing sociotechnical landscape, including the associated risks, inequities, and uncertainties.

Despite emerging research on digitalization’s impact on professional work, our understanding of how regulatory bodies are responding to technology-driven risks and opportunities remains limited. Responses to these challenges have varied, with some regulators imposing a duty of technological competence [ 27 ], while others have refrained from setting formal tech-centric standards. Standards for virtual practice also vary significantly between regulators, even for the same profession [ 6 ]. In addition to how regulators are working to support registrants in the digital era, regulators may be adopting technology to improve their own regulatory practices. To varying extents, professional regulators are digitizing processes related to registration, complaints management, continuing competence, and discipline. However, the way that professional regulators may be using technology to enhance their own work has received little research attention.

This research aims to address these research gaps by examining how regulatory practices and policies are evolving in response to digitalization, and how regulators can support professionals through significant workplace changes while upholding the public interest. Building on our team’s recent work, including a knowledge synthesis of existing academic and grey literature [ 22 , 23 ] and a review of regulatory guidance around virtual care [ 6 ], this study provides foundational insights into the challenges and opportunities of regulating in a digital era. Understanding these challenges and opportunities can inform professional regulators across various sectors and jurisdictions and guide the development of risk-appropriate policies, guidelines, and standards for modern professional regulation.

We aimed to examine the impact of technology and digitalization on three regulatory bodies in Ontario, Canada through a qualitative comparative case study approach. Our specific objectives were to:

Explore approaches and policies that these regulators have enacted to address the challenges and opportunities presented by the digital era;
Describe the effects of technological change on regulatory activities at these regulatory bodies; and
Compare the regulatory responses to technological change across these regulators.

Our study was guided by Yin’s [ 28 ] structured approach to exploratory case study research, which is well suited to understanding new or less studied areas where the researcher has little or no control over the phenomenon of interest. Case study designs in professional regulatory research can produce comprehensive analyses for examining regulatory reforms and innovations [ 29 ]. In this study, we compared how three professional regulators in Ontario, Canada approached regulating in the public interest in the digital era.

Participants

Participating regulators were the Ontario College of Social Workers and Social Service Workers (OCSW), the Law Society of Ontario (LSO), and the College of Nurses of Ontario (CNO). As an exploratory case study, we sought a variety of professional sectors; law, nursing, and social work offered a diversity of regulatory and professional contexts. These three regulators are each under separate legislative frameworks but share the common context of a single jurisdiction of Ontario. Further, the nature of the professional work being regulated is different, and we expected that technology may be impacting these different work contexts in unique ways. In this way, we could distinguish between issues specific to each regulatory body and cross-cutting themes present across the professional, legislative, and workforce factors that vary between them. Our selection of these three regulatory bodies was thus aimed at achieving what Flyvbjerg [ 30 ] called maximum variation in case study research and is appropriate for exploratory work that can be built upon by examining other professions in more jurisdictions in future projects. A brief description of these regulatory bodies is provided in Table 1 .

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https://doi.org/10.1371/journal.pone.0303192.t001

Data collection

We conducted data collection over two phases. The first phase involved gathering publicly available documents relevant to our research objectives and the second phase involved semi-structured interviews. We started with documents to gain a foundational understanding of how technology intersected with regulatory policy and practice for these three professions, and our interviews provided further insight and contextualization to deepen our understanding.

In the first phase, we identified relevant documents by searching regulators’ websites. We conducted our initial searches between May 2022 and September 2022, reviewing documents back to 2015. The date of 2015 was chosen to capture pre-COVID responses while being feasible given our research funding timeline. We also anticipated limited applicability and availability of older regulatory documents given the rapid change of technology in the past decade. The search was updated in January 2023.

We searched each regulator’s website for keywords based on concepts that fit with our research objectives (e.g., digital, tele*, virtual, tech*) and then specific documents were reviewed in full, including minutes from council meetings, regulatory publications for registrants and the public such as newsletters, and strategic plans. We reviewed each retrieved document for references to other regulatory documents, webpages, or resources that were directly relevant to the impact of technology on the regulator’s policies or practices. In this iterative way, we retrieved regulatory updates and news releases; frequently-asked-questions; policies and policy briefs; council briefing reports and minutes; and practice statements, standards, directives, guidance, and guidelines. We identified 34 documents (nine from the CNO, 15 from the LSO, and ten from the OCSW; see S1 File ) that met our inclusion criteria of relating to our research objectives and being published between 2015 and 2022. Document information was organized in a spreadsheet and copies of all included documents were saved as PDFs to keep a record in case websites changed during analysis. These documents allowed us to identify pivotal milestones and policies related to regulatory responses to technology that were used to inform the development of our interview guide. All documents were publicly available.

In the second phase, we emailed the executive director or registrar from each of the three regulators to explain the study and request an interview with individuals familiar with the regulator’s response to technology and relevant policies and practices. Each executive director agreed to an interview and designated two individuals (total n = 6) from their regulatory body to participate and with whom the research team communicated directly by email. Our sampling strategy was purposive and required study participants to have knowledge about the impact of technology on regulatory practice and policy at their organization, appropriate for our case study research design.

We developed a semi-structured interview guide and shared this with our participants prior to the interview (see S2 File ). The semi-structured interview guide was developed collaboratively by the research team based on our previous research in the field, our recent scoping review on a similar topic, and our preliminary analysis of the Phase 1 documents. The first author (KL, she/her) is an early career researcher with experience conducting qualitative interviews in regulatory research who was supported by senior career qualitative researchers (TLA, SN). Interviews were conducted between 1 January 2023 and 31 March 2023 by the first author (KL), and at least one other research team member attended and took detailed notes (TLA, AA, SM). At the beginning of each interview, the first author (KL) provided participants with background information and reiterated the study purpose and objectives. Interviews were conducted by videoconference software (Microsoft Teams) and lasted approximately 60 minutes. Each interview was recorded and transcribed verbatim.

Data analysis

Following data collection, we analyzed all data (documents, interview transcripts, and field notes) using thematic data analysis [ 31 , 32 ]. In this flexible but rigourous approach to data analysis, the researchers play a key role in knowledge production through prolonged engagement with the data [ 32 ]. Three research team members (KL, AA, SM) independently read all documents, transcripts, and field notes to develop a coding framework, using the categories and concepts from the documents and semi-structured interview guide as a basis. Two research team members (KL, PC) with experience in qualitative data analysis and regulatory research then coded all transcripts independently by hand using colour-coded highlighting. KL and PC collaborated throughout regular discussions to develop themes. Extracts from transcripts were brought together for each theme as it was developed, and information from the documents was used to augment and triangulate these findings. As results were developed for each regulator, we compared and contrasted findings across the cases to identify themes and develop rich descriptions. Finally, we returned to the original transcripts and audio recordings to ensure the identified themes and selected quotes accurately reflected the data. We also identified documentary data from Phase 1 that could be included to support the findings and add context, depth, and breadth to the interview data. Findings were regularly reviewed and refined with the research team throughout the analysis.

Trustworthiness

To ensure the credibility of our findings, we used a multifaceted approach. Data collection and analysis were carried out in a systematic way, including extensive engagement with the transcripts and generating a careful audit trail. Using multiple data sources provides enhanced validity with our findings supported by more than one source of evidence [ 28 , 33 ]. We met regularly as a research team to discuss and verify our analysis; we included thick descriptions of our findings and verbatim quotes to support each theme. The diversity of our team, which includes research and clinical backgrounds in professional regulation, political science, nursing, law, and sociology, provided a range of analytical perspectives to aid in interpreting results. We followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) [ 34 ] to guide the transparent reporting of our methods and findings (see S3 File ).

Ethical considerations

The Athabasca University Research Ethics Board approved the study (File #24794). Each regulatory body contacted agreed to participate and informed written consent was obtained from all interview participants. No one withdrew their participation and only participants and research team members were present during the interviews. The study posed minimal risk to participants as they provided information in their professional capacity and no personal information was collected. To protect participant confidentiality, quotes in the findings are attributed to the regulatory bodies and the professions they represent without using names or position titles. As each regulator represents a single case, we have not differentiated between participants representing the same regulator.

While some research team members are members of the profession of participating regulators, they do not have established relationships with interviewees (prior to study commencement or since study completion), and interviewees were aware of the principal investigator’s (KL) background as a registered nurse and lawyer.

We identified five themes in our analysis of the interview and document data: 1) balancing efficiency potential with risks of certain technological advances; 2) the potential for improving regulation through data analytics; 3) considering how to regulate a technologically competent workforce; 4) recalibrating pandemic emergency measures involving technology; and 5) contemplating the future of technology on regulatory policy and practice. Descriptions of these themes, along with illustrative regulatory responses and quotes, are provided in Table 2 . We also review these themes in detail below, providing context from regulatory documents and quotes from interview transcripts. Quotations have been very lightly edited for grammar.

https://doi.org/10.1371/journal.pone.0303192.t002

Theme 1: Balancing efficiency potential with risks of technological advances

Participants recognized that technological advances may enable regulators to work more efficiently; however, they believed the risks associated with new technologies necessitated a cautious approach. This caution meant that many changes were incorporated slowly, and participants emphasized that even seemingly simple changes, such as online registration processes, were being approached carefully. A participant from the LSO noted that “historically, we’ve been very paper-based, so people would fill out paper applications and they would mail those into us” but the pandemic “accelerated changes that were being considered prior to that, and certainly desired prior to that, and so the application process has moved online.” Similarly, a participant from OCSW described their desire to move away from printing out physical certificates for all registrants, noting “we’re hoping we can transition out of it because it’s a very manual, expensive process that we do across the board for everyone.” However, the potential efficiency gain of digital certificates also came with risk, with the participant noting “then technology comes into play, because how do we ensure that it’s not fraudulent? … There’s always the ability to tamper with it” (OCSW).

Participants also discussed the importance of carefully considering the contexts in which technology should be used to facilitate regulatory operations. Participants from all three regulatory bodies discussed opportunities to automate tasks to free up staff and to improve their response times to registrants, especially for low-risk activities. For example, inquiries related to registration renewals are often straightforward and may not require human interaction. Participants from the CNO and OCSW discussed how technology can create opportunities for registrants to better engage with regulatory bodies and increase the accessibility of standards and guidelines at the point of care.

At the same time, all participants emphasized the need to consider the full context of each situation to assess the appropriate use of technology. One commonality between regulators was the recognition that not everything should be digitalized because regulation also involves a relational component. This requirement for human interaction is especially relevant when dealing with registrants and the public in higher-stakes situations (e.g., investigations and discipline processes). A participant from OCSW noted that technological interactions were appropriate for the “benign stuff” such as registration renewals, but that “there is a balance and if a regulator wants to be sort of relevant, they have to ensure that they are meeting that sort of human need.” A participant from the LSO responded similarly:

I think , probably the answer is that where processes that don’t really require a human touch , so for instance , handing an application in–we can eliminate the human touch there and move those types of things increasingly online . But I think maintaining those sorts of areas where having someone to talk to where you’re having an ethical issue , having a CPD program that you can attend that speaks specifically to your practice area and there are other colleagues there as well , those types of things . I think , that’s probably–to my mind at least–where the balance is . You beef up those areas where [human interaction] is important , and you try to gain those efficiencies in areas where perhaps it’s not so important that you do something in person ( LSO )

Participants’ responses highlighted the value regulators place on using a risk-based approach to carefully assess the suitability and feasibility of integrating technology into regulatory processes: “I think increasingly, as we try to move into new areas with technology, that ensuring that we’re approaching things from a risk-based perspective is very important” (LSO).

The potential of technology to improve efficiency was valued by participants who noted the complexity and resource-intensity of regulatory processes were increasing; however, the risk-adverse nature of regulation meant currently these gains have not yet been fully realized as participants focused more on the potential efficiency gains, should risks be appropriately managed.

Theme 2: The potential for improving regulation through data analytics

In addition to potential efficiency gains, participants highlighted where data could be leveraged to guide decision-making and potentially improve regulatory processes and outcomes. Similar to the cautious approach regulators were taking to the incorporation of new technologies more generally, the discussion of data analytics focused primarily on potential, rather than realized, benefits.

Participants from the CNO discussed the development of a new Insights Engine [ 35 ] that focused on data analytics but was in the very early stages of being used. This new system is meant to provide “more real-time data” that would allow the regulator to “specifically tag pieces of information…where they are coming from, from whom, and that informs how we also develop resources for members” (CNO). A CNO participant noted that the regulator had “lots and lots of data inputs” but these were “not accessible in a way that is as meaningful as we would like them to be in order to drive…our projects or the things that we need to improve or change.” The CNO participant described this as important not only to inform decision-making but to “prioritize our projects, where we kind of put our resources and our people, kind of focus our work so I think that will make us more efficient.”

A participant from the OCSW also noted a change in their current data systems that could, in the future, support data analytics for decision-making:

We’re changing over from our current legacy software into a new CRM [customer relationship management system] this year…we are hoping [the new CRM] will be able to mine the data in that way and be able to identify trends . So even when we’re looking at complaints , registrants , investigations or even something simple like [continuing competence program] completion rates . We have a pretty high completion rate , but let’s say we do have a situation where we have lower completion rates , we can look to see if there are certain regions that have individuals that are not participating as much or things like that . Currently , we can’t do that as simply , but in a future state , we’d want to . So , we have the questions we want to ask . ( OCSW )

In addition to regulators’ plans to use data analytics to improve regulation, we also heard that regulators were using existing data to identify practitioners at risk. As a participant from the LSO noted, “I think we always use data that’s available to us to sort of assess risk and try to get ahead of things and understand where problems exist”. For example, existing data have “clearly shown for many years that the sole practitioners are at the highest risk of being the subject of complaints” and “the causes of this are usually skills-related, not knowledge of the law” (LSO). Using this data, the regulator developed a new competence framework to support the implementation of a practice essentials course to support sole practitioners; at the time of our data collection, this was almost ready to be rolled out.

Theme 3: Considering how to regulate a technologically competent workforce

Beyond considering how to incorporate technology to improve regulatory operations, participants also discussed how to support and regulate their registrants in an increasingly digitalized world. Participants from all three regulatory bodies discussed the factors that have influenced their regulatory approaches as technology changes how their registrants practiced. Participants discussed the importance of assessing the most appropriate level of regulation to balance their mandate of protecting the public while ensuring that they do not create barriers in practice. This is sometimes termed right touch or risk-based regulation.

One key consideration was the legislative framework under which regulatory bodies operate and how this impacted regulators’ ability to respond nimbly. A participant from the LSO described their broad bylaw-making power under the Law Society Act and the way it allowed the regulator “quite a bit of flexibility…[to] be fairly nimble when we need to be…basically to allow access to justice to continue when no one could meet in person” during the pandemic. For example, the LSO facilitated emergency Orders in Council to allow virtual execution and witnessing of wills [ 36 ] provided legislative interpretation regarding virtual client identification [ 37 ], and guided registrants about requirements for virtual notarizing and commissioning [ 38 ].

Other factors influencing regulators’ decision-making included their existing strategies for modernizing standards and the influence of collaborative work between regulators. Participants from the CNO highlighted pre-pandemic work that was done in collaboration with other regulators to develop guidelines and competencies for compassion in the digital healthcare age. This work informed their ongoing reforms for technology-enabled practice and virtual care as the regulator worked to modernize practice standards [ 39 ].

Similarly, a participant from the LSO spoke about the influence of the Federation of Law Societies of Canada on discussions around technological competence. In 2019, this Federation added commentary to the duty of competency in its Model Code of Professional Conduct; this commentary required lawyers to have an understanding of and ability to use technology relevant to the nature and area of the lawyer’s practice and responsibility [ 40 ]. The commentary further required that lawyers understand the risks and benefits associated with relevant technology. Different legal regulators across Canada began to adopt this duty of technological competence, and the LSO adopted it in 2022. As one LSO participant described:

In general , we try and stay fairly close to [the model code] , certainly with the basics , because , you know , that’s what a national model code is supposed to do . And in this one , we were actually slow to adopt it because we had a technological taskforce…And then we also had a competence taskforce—the competence taskforce was intended to look at if our competence standards and programs were suitable for the next 20 years…the tech competence requirement was part of that report…So that was the impetus for this particular change to our rules . ( LSO )

An important element of this commentary to the competence rule is that legal professionals must understand technology relevant to their area of practice. One participant from the LSO discussed the importance of this approach given the nuances in different law practice areas. This participant noted that the regulator was not assessing technological competence because “depending on practice area, it’s often not entirely clear how we would assess it anyway” since some areas of legal practice required uses of very specific technologies (e.g., the Ontario Teranet system to transfer title in real estate law) “whereas there are other areas of law where, in theory at least, you could probably still get by with a typewriter and dictaphone” (LSO).

In contrast to the LSO’s specific inclusion of technology in its commentary to the duty of competence, the OCSW and CNO described how their current standards were broad enough to generally cover technological competence. The Council of the OCSW specifically decided not to adopt the model technology guidelines for social work published by the Association of Social Work Boards in 2015 [ 41 ], opting “instead to produce resources to help support members in their practice and to apply those standards to technology or any other issue” (OCSW). One participant from the OCSW described how this decision was made:

I think one of the convincing reasons for that was the current edition of our standards of practice refers to diskettes , which is such a great example of why you don’t want standards of practice to be too specific , because they’ll be out of date before the ink dries , I guess . And so I think that has been the approach that our college has taken—that technology competence and technology really doesn’t warrant its own standalone standard because it applies to other standards such as record keeping boundaries , competence and integrity , and confidentiality . ( OCSW )

Despite differences in approaches to technological competence, participants from all three regulatory bodies spoke about their role in supporting their registrants’ professional practice by developing guidance around technology and virtual practice. In deciding what practice resources were needed, regulators responded based on registrant inquiries and the level of perceived risk. For example, a participant from the LSO discussed how they use inquiries from their practice management helpline to inform their continuing professional development offerings and regulatory resources.

Participants from the OCSW discussed how they encourage registrants to identify learning needs associated with technology when completing their continuing professional development program. Our review of OCSW newsletters showed ongoing encouragement of members to review resources on topics such as using communication technology in practice, selecting online platforms for virtual services, and practice standard considerations for navigating COVID-19 [ 42 – 46 ]. Participants from the OCSW also highlighted measures they took to ensure social workers from other Canadian jurisdictions were registered with OCSW before providing virtual services to clients in Ontario. This enabled the regulator to address issues related to professional conduct since “we can’t minimize the risks involved in electronic practice—they’re huge…so it is probably extra important that those people be registered in Ontario” (OCSW).

In developing practice support and guidance, participants discussed whether they had a role in providing guidance on specific technologies. There were differences in perspectives between regulators. For example, participants from the CNO discussed that it was not within their mandate to endorse or provide guidance on specific technologies:

Questions about which [technology platform] I should be using—we don’t regulate that , right ? We don’t say one thing is better than the other . We don’t endorse certain products . So that also becomes a challenge as well , what do we tell them in order to assess what is appropriate ? It goes back to your accountabilities . Does it meet those standards that you’re obligated to follow in order to assess whether this application or technology is appropriate and is safe for you to use ? ( CNO )

Participants from the LSO spoke about their technology resource centre [ 47 ] that provided guidance on selecting technology for practice, technology use, data protection, cybersecurity, cloud computing, and working remotely. While this was a departure from the level of guidance provided historically, this participant felt it was necessary to guide legal professionals on what was required to meet the standard of professional competence.

We’ve also tried to sort of help people along , in terms of what was created at the Technology Resource Centre…that was sort of a bit of a departure for us , because we got into really looking at specific products and…even suggesting to people that these are products that you can use in certain areas to help facilitate your practice . And traditionally , that hadn’t been our approach . Our approach was much more of satisfy yourself—go out there and see what’s out there kind of approach . So , we’ve tried to help nudge people in the right direction and give them a better idea of what we mean by technological competence . But that has certainly been a challenge . ( LSO )

Thus, while all three regulators operate within the same province, their approach to regulating a technologically competent workforce differed, creating differences in standards and resources provided to registrants regarding technology.

Theme 4: Recalibrating pandemic emergency measures involving technology

In many ways, the COVID-19 pandemic accelerated the use of virtual technologies and impacted various aspects of regulatory operations, including entry-to-practice, registration, continuing competence, and complaints and discipline proceedings. Different perspectives emerged about whether specific regulatory functions should remain virtual or return to pre-pandemic in-person norms. A recurring theme was the need to strike a balance between both modalities.

I think through all of this , whether it’s hearings or discipline or entry to practice , I think there’s increasingly this feeling that… some form of hybrid is probably where the sweet spot is , and I think we need to figure out where that is , and figure out what’s going to stay online , what’s going to stay remote and what should be in-person . And I suspect it’ll take some time to really figure that out . ( LSO )

Since a core function of regulatory bodies is to ensure that applicants meet the required entry-to-practice competencies, regulators found themselves grappling with the consequences of changes to the delivery of education and practicums during the pandemic. Participants from the CNO discussed how the lack of evidence on the outcomes of simulated clinical experiences created challenges for ensuring graduates were prepared competently:

Is there a break point in terms of safety ? And there is research out there [but] none of it is conclusive . There certainly are some jurisdictions that have gone the route of saying , you know , 50% of your clinical can be simulation . We haven’t designated a percentage yet . ( CNO )

Participants from the LSO also experienced challenges as education, placements and articling shifted online. In some cases, applicants were called to the bar after completing their legal education and training remotely. While these changes were necessary due to the pandemic, participants discussed the need to re-assess to determine the best approach going forward.

The pandemic also meant that some regulators shifted to online entry-to-practice exams, but this raised risks related to the security of exams and the appropriateness of the testing environment. The CNO did not adopt remote proctoring and participants noted they “weren’t comfortable at the time with the kind of research that’s out there in terms of security and the whole process around remote proctoring. And we are well aware that there are other regulators—both nursing and outside of nursing—that are doing it. So it’s something we’re exploring” (CNO). The LSO was one of the regulators that adopted remote proctoring and experienced an “exam cheating scandal…where we received information and materials to suggest that there had been cheating involved in some of our licensing examinations…And we’re now no longer doing testing online.” While the OCSW does not currently require an entry-to-practice exam, participants spoke about their interest in exploring how digitalization might impact future exam requirements that were being considered.

In considering the use of technology to increase efficiencies during the licensure process, one participant from the LSO identified the need to attend to equity considerations:

I think the other place where you really see that tension playing out is in the equity space … for , particularly , students who are going through the licensing process . If you are in one of these marginalized groups , you can … face more barriers , you can become more anxious about dealing with what feels like the behemoth , the impersonal behemoth , of the Law Society … So that’s a tension and because efficiency is highly valued … I think , how we are trying to deal with that is to have a personal engagement as needed . The trick is to determine when it’s needed . I don’t think it’s hard to find a sympathetic ear actually at the Law Society , but to know when that intervention is required—that’s , I think , the real challenge . ( LSO )

In addition to changes to entry-to-practice and registration/licensure, regulators’ investigation, discipline, and conduct processes were significantly disrupted by the pandemic as many of these shifted from in-person to virtual formats. This shift to virtual formats provided some advantages that participants described, such as “levelling the playing field” (CNO) for those who lived far from the regulatory body and potentially easing anxiety to facilitate more open conversations.

Participants from the CNO and LSO highlighted the potential negative consequences of virtual hearings such as increased ‘Zoom fatigue’, perceptions of informality, and barriers for individuals who live in areas with unreliable internet access. A participant from the CNO mentioned concerns about whether virtual hearings would have the same level of seriousness as an in-person meeting. These concerns were shared by those at the LSO:

When you walk into a courtroom , and you see that the judge sitting up there and there’s a sense of formality to it , versus getting on a Zoom call with a bunch of heads from shoulders up . That may not feel like you’re getting the same hearing that you might have in person . So , I think there’s definitely a balance there . ( LSO )

In general, regulators seemed to be striving for a balanced approach to post-pandemic recalibrations. Advantages, disadvantages, and risks associated with in-person and virtual modalities are becoming clearer and are helping inform this recalibration process.

Theme 5: Contemplating the future of technology in regulatory policy and practice

Participants described their curiosity in wanting to learn more about the impact on public protection as technologies like AI continue to evolve and become more commonplace. Participants described specific areas they were watching to learn more about how technology was impacting professional practice, such as how the therapeutic relationship might “look different when practicing in a more technological environment” (CNO). A participant from the LSO was interested in exploring “whether virtual proceedings have impacted incarceration rates, and release versus bail, or other outcomes” and whether digital products such as online “will kits” help people in the way they are intended.

Participants highlighted opportunities for increased collaboration between regulators to streamline and harmonize processes and to share data to support evidence-based regulatory policy across professions. For example, one participant from the CNO said “I think there’s always been that collaboration amongst different regulators, but having data, I think, provides this objective piece as well, which I think will be helpful for sure.” A participant from the OCSW described the importance of working together given the similarities in regulatory functions and services, especially across health profession regulators:

In essence , even though we’re regulating different professions , we’re all regulating . So , when you’re thinking of technology and the use of social media and some of the expectations we have from our professionals , specifically health , it would be good if those regulatory bodies could come together and say , you know , here’s the spectrum of our expectations . Here’s how we’ve been monitoring this spectrum . Let’s talk about it as a unit…We may be regulating different professionals , but we’re all running organizations . The operations of each of these organizations are extremely similar and overlap . ( OCSW )

A participant from OCSW expressed a desire for regulation to become more forward-thinking around technology: “Often regulators are sort of the last ones around the corner with a lot of the updates……there’s no reason the regulator can’t be the cutting edge in some of this.” One more innovative approach to staying on top of technological changes was the LSO’s Access to Innovation program which created a regulatory sandbox for innovative technological legal services [ 48 ]. While, at the time of our interview, this sandbox did not yet have evaluation data available, this way of providing a safe space to support innovative technology is meant to provide insight into new risks and opportunities related to technology.

Technology can potentially revolutionize professional work and the regulation of that work. However, technological change has simultaneously created tensions around the application of AI, data analytics, technological competence, social media use, and other dimensions of professional practice and regulation [ 49 ]. The results of our study have underscored the wide-ranging implications of technology on regulatory practices, with changes to entry-to-practice and registration/licensing, practice standards and guidance, practitioner support, continuing professional development, and disciplinary practices and procedures. Regulators are grappling with how to respond to technological changes in the practice of the professionals they regulate, while simultaneously experiencing technologically mediated changes to internal processes.

Concerns about risk may slow progress

Our findings illustrate that regulators are in the early stages of exploring the opportunities and risks that technology has on daily operations. Although regulators from different sectors have adopted technology at varied paces, the literature suggests that many have begun exploring the potential value of technology, including AI, in supporting regulatory operations and decision-making [ 50 – 55 ]. Regulation is becoming increasingly complex and resource-intensive, and our findings suggest that participants are hopeful that integrating technology into regulatory operations will provide a means to enhance efficiency. While participants noted that there are areas where technology can be integrated more easily, they also highlighted the importance of carefully studying the impacts of technology on functions that carry a greater risk of producing undesirable outcomes. This finding aligns with research by van der Gaag et al. that found regulators were concerned that AI could introduce errors and biases, jeopardize public trust, and perpetuate systemic inequities [ 56 ]. Our participants noted a need to take a risk-based approach to the advantages and disadvantages of adopting technology to support decision-making. While risk aversion may be necessary for higher-stakes regulatory processes, it may slow progress in adopting technological enhancements that could drive needed efficiency gains in increasingly resource-constrained environments.

Ensuring an equity-based approach to virtual practice and processes

The rapid expansion of virtual services influenced our participants’ responses to regulating technology use among professionals. In the context of the health and social care sectors, the pandemic accelerated the proliferation of virtual care options. In the context of law, evidence from before the pandemic suggests that, increasingly, lawyers are operating virtual legal offices rather than those of traditional brick-and-mortar [ 57 ]. Technology use in practice raises important questions about privacy, confidentiality, boundaries, informed consent, continuity of services, and new complexities for addressing malpractice and complaints [ 6 , 57 – 59 ]. While our participants discussed that technology does not necessarily require the development of unique standards of practice, this is an area that regulators will be required to re-evaluate as new risks and challenges emerge.

The introduction of virtual practice also raises unique equity concerns, potentially expanding access but in unequal ways [ 60 ]. Regulators have a role in ensuring that regulatory decisions do not perpetuate systemic inequities [ 61 ]. Our previous research on for-profit virtual care in Canada found that equity has not been adequately considered within standards from medical regulators [ 6 , 22 ]. Equity considerations must be embedded in regulatory decision-making as technology continues to evolve, and many of these considerations apply to regulatory policies and practices (e.g., virtual discipline hearings) as well as regulating virtual practice.

Our participants also described varied approaches to virtual training experiences and entry-to-practice exams, and this was an area where participants noted disparate approaches were common even across regulators in the same field. A growing body of literature across various professions suggests that there are advantages and lessons to be learned from virtual training models, including virtual reality. More evidence is needed to support informed regulatory decision-making in this evolving area of technology-enabled training and assessing entry-to-practice competency. For nursing, social work, and law, training usually requires hands-on, practical experience that may be difficult to gain in a virtual or simulated setting; however, there may be advantages to innovative virtual training models [ 62 ]. There may also be lessons that can be learned from professions, such as paramedicine, that use training via virtual reality to help establish competence [ 63 – 65 ].

Varied approaches to ensuring technologically competent professionals

As regulators work to strike a balanced approach for enabling professionals to deliver virtual services, practitioners themselves must build technological competence. As discussed by our participants, regulators expect registrants to have the required knowledge and skills related to technology but the approaches regulators have taken to ensure that registrants have this competence differed. Scholars have explored the knowledge needs and competencies that members of their professions require to function in an increasingly digitalized world [ 59 , 66 , 67 ]. As discussed by our participants, technological competence will look different depending on each practice setting. However, with growing interprofessional collaboration, regulators within and across sectors have an opportunity to work together to share evidence and explore how competencies can be harmonized to ensure greater consistency amongst professionals.

Aside from being competent in using technology to deliver professional services, social media introduces implications for how regulated professionals interact with the public to maintain public trust. Many professional regulators have developed standards of practice to outline responsibilities and accountabilities due to increased complaints and findings of unprofessional conduct centred on inappropriate social media use [ 9 , 68 – 71 ]. High-profile conduct cases have sparked considerable debate about the need to balance professionals’ freedom of expression and speech with their obligations to maintain public trust. Social media can be a powerful platform for fostering professional networks, continuing education, and advocacy to encourage system improvements. At the same time, it can potentially cause significant social harm. Regulators will continue to need to evaluate how they approach registrants who use social media in ways that push the boundaries of conventional views of professionalism.

Opportunities to leverage regulatory data

Participants discussed the opportunities that technology can bring in facilitating better use of regulatory data to inform decision-making, though many challenges–including adequate knowledge and resources, addressing privacy concerns, and ensuring data platform interoperability–remain to realize this potential. Beyond the use of data analytics to inform internal regulatory policies and processes, regulators have an opportunity to leverage data to inform broader social goals such as workforce planning. Within the health and social care sectors, the importance of standardized health workforce data for integrated workforce planning has been recognized by scholars [ 72 – 74 ] and has become a priority for federal, provincial, and territorial governments in Canada [ 75 – 77 ]. Promising practices exist in other jurisdictions such as the United States and Australia where national databases and datasets are used, and Canada has recently announced pan-Canadian databases for physician and nursing data [ 75 , 78 ]. These data support inter-jurisdictional labour mobility and awareness of registration status and malpractice or disciplinary histories. The collection of standardized data can also provide meaningful input on issues such as the mental health of the workforce, a priority mentioned by all our participants. In addition, equity must be a priority, and the collection of enhanced demographic data could facilitate better understanding of the diversity of the workforce and the inequities that exist to inform policy and research needs.

Limitations and future research

The transferability of these findings should be interpreted carefully when applying to other regulatory contexts within and outside of Canada. Our participant sample was small and meant to provide foundational insights into how regulators are navigating an increasingly digitalized world. Members of our team are currently engaged in two funded research projects that build on this foundational work, one that expands the current study to survey and interview regulators across Canada, and one examining whether ethical codes and guidelines from regulators provide sufficient guidance for practitioners when they encounter challenges related to technology in practice. The implications of technology on professional regulation will require monitoring and evaluation over time to examine how technological innovations impact all facets of regulation and professional work.

Our case study explored how three Ontario professional regulators operating within different legislative frameworks are navigating technology in the digital era. Cross-sectoral participants provided theoretical and pragmatic insights for regulating in the digital era and the role regulators can and should play in digitally enabled professional practice. These insights provided an understanding of how these regulatory bodies are responding to the challenges of upholding their mandate to regulate in the public interest during rapid digital evolution. Our analysis identified five themes: balancing efficiency potential with risks of certain technological advances; the potential for improving regulation through data analytics; considering how to regulate a technologically competent workforce; recalibrating pandemic emergency measures involving technology; and contemplating the future of technology on regulatory policy and practice. Regulators will continue to grapple with considerations about technology used to facilitate regulatory functions, balancing consumer demands amid emerging risks posed by technology, producing technologically competent workforces, and informing workforce planning via regulatory data. Policymakers and regulators across Canada and internationally should prioritize risk-balanced policies, guidelines, and practice standards for modern professional regulation.

Supporting information

S1 file. description of regulatory documents..

https://doi.org/10.1371/journal.pone.0303192.s001

S2 File. Semi-structured interview guide.

https://doi.org/10.1371/journal.pone.0303192.s002

S3 File. COREQ checklist.

Consolidated criteria for reporting qualitative studies (COREQ): 32-item checklist.

https://doi.org/10.1371/journal.pone.0303192.s003

Acknowledgments

We gratefully acknowledge and thank our interview participants for generously sharing their time and insights with us.

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Editorial: the qualitative case study

The International Journal of Logistics Management

ISSN : 0957-4093

Article publication date: 13 November 2017

Gammelgaard, B. (2017), "Editorial: the qualitative case study", The International Journal of Logistics Management , Vol. 28 No. 4, pp. 910-913. https://doi.org/10.1108/IJLM-09-2017-0231

Emerald Publishing Limited

IJLM receives many submissions based on case studies. That is positive as the journal is highly interested in empirical research not the least based on qualitative enquiry. However, in general there seems to be a lack of knowledge on what a qualitative case study is and how to conduct it in a way that makes a research manuscript suitable for a scientific journal. This editorial seeks to give the present IJLM community and future authors some guidelines on the requirements to a qualitative case study in order to pass the initial screening and eventually be accepted by the reviewers. The guidelines are formulated with initial “check questions” for you when you design and write up a qualitative case study.

Is your study really qualitative? Qualitative studies entail many research methods; this editorial focuses on the qualitative case study. First of all, the term qualitative needs to be defined as qualitative research is still struggling to find its way into scientific logistics and supply chain management (SCM) journals (e.g. Frankel et al. , 2005 ; Pedrosa et al. , 2012 ). Here, Ketokivi and Choi’s (2014) seminal article on the renaissance of case research as a scientific method is helpful. They state that the term qualitative in relation to research indicates an examination of concepts and their meaning and interpretations in specific contexts of enquiry (p. 233). In line with this statement, Fawcett et al. (2014 , p. 6) say in their trail guide to success in publishing that “qualitative research as scientific inquiry relies on storytelling to make sense of real-world dilemmas.” The first issue in relation to qualitative research is to make sure that it is actually qualitative. With recent years’ intense focus on the quantification of study results and refinement of statistical methods and test, it is easy to forget about the qualities found in a study and then start quantifying the results on a wrong background ( Ketokivi and Choi, 2014 ).

What is the aim of your case study? Case studies are often used for inductive exploration of yet unknown phenomena, i.e. theory generation. But also deductive theory testing by analytical generalization has been proposed, most prominently by Yin (2013) . A third category of case study is proposed by Ketokivi and Choi (2014) , suggesting that theory elaboration is also a valid purpose of case studies. This type of case studies uses both induction and deduction and to an equal extent. One important aspect, which qualifies for all three types of case studies, is what the two authors call the duality criterion. This means that while the case study context is always unique, the empirical examination must always be balanced with a more general theoretical examination. Depending on the aim of the case study, a different research design should be set up.

How did you select your cases? Accounting for selection of case(s) for a study, is necessary. While it is often a question of access – that may be hard to get – this account must always reflect on the appropriateness of the case(s) selected for a specific study. Flyvbjerg (2006) outlines a list of selection criteria for case studies in social science that is also useful for logistics and SCM case research. He emphasizes that cases in general should be selected for their expected information thickness rather than generalization properties. Firstly, there are extreme or deviant cases that highlight special circumstances that can point at special problems or the opposite. A single case study can be appropriate for this purpose. Next, a maximum variation case selection can be chosen for selection. For instance, if a study critically investigates a specific taken for granted concept in the discipline, a selection of cases covering big and small units of analysis, cases on developed and emergent economics etc. could be a good selection strategy. The third strategy proposed is a selection of critical case(s). The argument here would be that if the expected findings are valid for these cases, logically they are valid for all other cases within a segment. Last but no least is the paradigmatic cases that seek to create new understandings of where the discipline is heading and to create new schools or lines of thought within the discipline. From this, it should be obvious, that it is not per se the number of cases that are important for a potential publication but the captured information and analysis of it. A further note is that it is important to make the case clear as a unit of analysis. A company’s supply chain, for example, is not necessarily a case; here more information of what it is, more specifically, that the empirical study is focusing on is needed.

What is the quality of your case study research? Pedrosa et al. (2012) suggest that case-based research should be evaluated not only on results (validity and reliability) but on the entire research process that first and foremost must be transparent to the audience. The overall three criteria should, according to these authors, be fulfilled by case-based research, namely transferability, truth value and traceability. Transferability has to do with the general theoretical aim and interest of the study and that the study’s result can be analytically generalized as also suggested by Ketokivi and Choi (2014) and Yin (2013) as mentioned above. Information about unit of analysis, case selection, and number of cases also belong into this criterion. Second, truth values are established by information about coding procedures, comparisons, iteration and refutation. Finally, traceability has to do with openness about research protocol and sometimes even data base, data-collection guidelines, informant selection and number of informants within the case study. In qualitative case studies, reliability in the original meaning of the term is not possible because new insights are often created through qualitative methods such as interviews ( Kvale, 1983 ), openness about the research process is of utmost importance for quality assessment. Apart from taking these criteria into account, a good qualitative case study will furthermore reflect on its adherence to these criteria.

What is epistemological foundation of your case research? Aastrup and Halldórsson (2008) point to a lack of epistemological foundation and discussion of the case study in logistics and SCM. They find that strict cause-effect relations sought after in positivistic research are only possible in an understanding of logistics and SCM as closed systems. As very few supply chains these days are actually closed systems, an open system view is more appropriate. Applying this approach together with a critical realist epistemology, they find that not only can and should concrete logistics and SCM systems be investigated, they also include social and meaning structures that comprehend actors’ intentionality. In this way, generative mechanisms underlying logistics and SCM performance are revealed.

Is an interpretivist or social constructivist approach suitable for your case research? In respect to Aastrup and Halldórsson’s (2008) request for establishing an epistemological foundation for case studies, Gammelgaard (2004) goes one step further in suggesting that there may be more than one foundation represented by three different schools of logistics research. Here, she points to the case study as the most appropriate research method in logistics research taking a systems approach. However, a pure systems approach that considers identification and description of new system parts as well as identifying new system boundaries, theory; this is not very commonly seen in the discipline. Most often, research is drawn toward a more objective ontology and epistemology such as positivism. Only rarely, are interpretivist and social constructivist approaches applied openly in logistics and SCM. These approaches are, however, very well suited to qualitative case studies where meanings, interpretations, managerial dilemmas and storytelling play a pre-dominant role. Fawcett and Magnan’s (2002) article on rhetoric and reality of supply chain integration is one good example of a case study that revealed that the interpretation of SCM differed depending on function and hierarchical level leading to difficulties in implementation of SCM. More research of this kind and maybe even with a more critical (in the academic sense of the word) stance through social constructivism may enrich the discipline tremendously. Also worth noting is Storey’s (2002) claims that from a general management perspective, the socially constructed nature of supply chain practices, processes and process innovations are under-researched. I think that this is still the case and sincerely hope that IJLM will break new grounds with research along these lines. See also Houé and Murphy’s (2017) arguments for applying a social constructivist approach to studying logistics networks.

What is the story you want to tell? Last but not least, there is the question of storytelling. It is hard to write up qualitative case studies in a short and compelling way as such studies go into depth and details of a phenomenon. Fawcett et al. (2014) suggest that you should use interview quotes in the storytelling and recommend a balance between “power quotes” to emphasize parts of your analysis and “proof quotes” where a link between data and analysis should be clearly established. Åhlström (2007) also emphasizes the link between data and theory as mandatory to convince and persuade the general audience about the qualities of your case analysis but reviewers in particular. However, the individual researchers/research team’s capacity of theoretical sensitivity will vary and a certain amount of “conceptual leap” in a qualitative analysis – highly depending on researchers’ theoretical and research process capacities – will always be present; especially so where high levels of research expertise exist ( Klag and Langley, 2013 ).

I sincerely hope that these guidelines are helpful for your case research. However, they are only overall guidelines and you will most likely need to study a good deal of the used references in detail. I strongly encourage you to do so not at least as it may open up a whole new perspective of scientific inquiry and an intensified conversation about viable research methods in logistics and SCM.

Good luck with your case research!

Aastrup , J. and Halldórsson , A. ( 2008 ), “ Epistemological role of case studies in logistics. A critical realist perspective ”, International Journal of Physical Distribution & Logistics Management , Vol. 38 No. 10 , pp. 746 - 763 .

Åhlström , P. ( 2007 ), “ Presenting qualitative research: convincing through illustrating the analysis process ”, Journal of Purchasing & Supply Management , Vol. 13 No. 3 , pp. 216 - 218 .

Fawcett , S.E. , Waller , M. , Miller , J.W. , Schwieterman , M.A. , Hazen , B.T. and Overstreet , R.E. ( 2014 ), “ A trail guide to publishing success. Tips on writing influential conceptual, qualitative and survey research ”, Journal of Business Logistics , Vol. 35 No. 1 , pp. 1 - 16 .

Fawcett , S.E. and Magnan , G.M. ( 2002 ), “ The rhetoric and reality of supply chain integration ”, International Journal of Physical Distribution & Logistics Management , Vol. 32 No. 5 , pp. 339 - 361 .

Flyvbjerg , B. ( 2006 ), “ Five misunderstandings about case-study research ”, Qualitative Inquiry , Vol. 12 No. 2 , pp. 219 - 245 .

Frankel , R. , Naslund , D. and Bolumole , Y.Y. ( 2005 ), “ The ‘white space’ of logistics research: a look at the role of methods usage ”, Journal of Business Logistics , Vol. 26 No. 2 , pp. 185 - 209 .

Gammelgaard , B. ( 2004 ), “ Schools in logistics research? A methodology framework for analysis of the discipline ”, International Journal of Physical Distribution & Logistics Management , Vol. 34 No. 6 , pp. 479 - 491 .

Houé , T. and Murphy , E. ( 2017 ), “ A study of logistics networks: the value of a qualitative approach ”, European Management Journal , Vol. 14 No. 1 , pp. 13 - 18 .

Ketokivi , M. and Choi , T. ( 2014 ), “ Renaissance of case research as a scientific method ”, Journal of Operations Management , Vol. 32 No. 5 , pp. 232 - 240 .

Klag , M. and Langley , A. ( 2013 ), “ Approaching the conceptual leap in qualitative research ”, International Journal of Management Reviews , Vol. 15 No. 2 , pp. 149 - 166 .

Kvale , S. ( 1983 ), “ The qualitative research interview: a phenomenological and a hermeneutical mode of understanding ”, Journal of Phenomenological Psychology , Vol. 14 No. 2 , pp. 171 - 196 .

Pedrosa , A.M. , Näslund , D. and Jasmand , C. ( 2012 ), “ Logistics case study based research: towards higher quality ”, International Journal of Physical Distribution and Logistics Management , Vol. 42 No. 3 , pp. 275 - 295 .

Storey , J. ( 2002 ), “ What are the key general manager issues in ‘supply chain management’? ”, Journal of General Management , Vol. 27 No. 4 , pp. 15 - 28 .

Yin , R. ( 2013 ), Case Study Research: Design and Methods , 5th ed. , Sage Publications , Thousand Oaks, CA .

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Exploring variations in the implementation of a health system level policy intervention to improve maternal and child health outcomes in resource limited settings: A qualitative multiple case study from Uganda

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Background Despite growing literature, few studies have explored the implementation of policy interventions to reduce maternal and perinatal mortality in low- and middle-income countries (LMICs). Even fewer studies explicitly articulate the theoretical approaches used to understand contextual influences on policy implementation. This under-use of theory may account for the limited understanding of the variations in implementation processes and outcomes. We share findings from a study exploring how a health system-level policy intervention was implemented to improve maternal and child health outcomes in a resource limited LMIC.

Methods Our qualitative multiple case study was informed by the Normalization Process Theory (NPT). It was conducted across eight districts and among ten health facilities in Uganda, with 48 purposively selected participants. These included health care workers located at each of the case sites, policy makers from the Ministry of Health, and from agencies and professional associations. Data were collected using semi-structured, in-depth interviews to understand uptake and use of Uganda’s maternal and perinatal death surveillance and response (MPDSR) policy and were inductively and deductively analyzed using NPT constructs and subconstructs.

Results We identified six broad themes that may explain the observed variations in the implementation of the MPDSR policy. These include: 1) perception of the implementation of the policy, 2) leadership of the implementation process, 3) structural arrangements and coordination, 4) extent of management support and adequacy of resources, 5) variations in appraisal and reconfiguration efforts and 6) variations in barriers to implementation of the policy.

Conclusion and recommendations The variations in sense making and relational efforts, especially perceptions of the implementation process and leadership capacity, had ripple effects across operational and appraisal efforts. Adopting theoretically informed approaches to assessing the implementation of policy interventions is crucial, especially within resource limited settings.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study was undertaken with no funding.

Author Declarations

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

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

Ethics approval for this study was sought from the Health Sciences Research Ethics Board (HSREB, IRB 00000940) Delegated Review of the University of Western Ontario. Additional ethical approval was sought from the School of Medicine Research and Ethics Committee, Makerere University College of Health Sciences (REC REF No. 2018-018), the Uganda National Council for Science and Technology (HS 2393) and the Ugandan Ministry of Health (ADM 130/313/05). Participation in the study was completely voluntary and written informed consent was sought at all times. Study participants were assured of privacy and confidentiality and approved the use of information for improving public health, clinical practices and policy implementation. The manuscript does not include details, images, or videos relating to individual participants.

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

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

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

Data Availability

The datasets generated and/or analysed during the current study are not publicly available because it was a qualitative study but are available from the corresponding author on reasonable request.

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(PDF) Qualitative Case Study Guidelines
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Case Study Methodology of Qualitative Research: Key Attributes and
A case study is one of the most commonly used methodologies of social research. This article attempts to look into the various dimensions of a case study research strategy, the different epistemological strands which determine the particular case study type and approach adopted in the field, discusses the factors which can enhance the effectiveness of a case study research, and the debate ...
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Qualitative case studies guidelines. The Qualitative Report, 19(40), 1-25. 25 Pages Posted: 4 Feb 2015. See all articles by Sasa Baskarada Sasa Baskarada. Defence Science and Technology Organisation. Date Written: October 19, 2014. Abstract. Although widely used, the qualitative case study method is not well understood. Due to conflicting ...
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Qualitative Case Study Guidelines Executive Summary The case study is rapidly gaining acceptance in many diverse scientific domains. Despite the fact thatit has often been viewed as a soft research method, it is actually remarkably difficult to execute well in practice. Accordingly, having a set of clear and succinct
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Qualitative Case Study Guidelines . Abstract . Although widely used, the qualitative case study method is not well understood. Due to conflicting epistemological presuppositions and the complexity inherent in qualitative case-based studies, scientific rigor can be difficult to demonstrate, and any resulting findings can be difficult tojustify.
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Abstract. Although widely used, the qualitative case study method is not well understood. Due to conflicting epistemological presuppositions and the complexity inherent in qualitative case-based studies, scientific rigor can be difficult to demonstrate, and any resulting findings can be difficult tojustify. For that reason, this paper discusses ...
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Guide: Designing and Conducting Case Studies
Designing and Conducting Case Studies. This guide examines case studies, a form of qualitative descriptive research that is used to look at individuals, a small group of participants, or a group as a whole. Researchers collect data about participants using participant and direct observations, interviews, protocols, tests, examinations of ...
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In addition, qualitative case study research is still subject to unresolved disputes about its worth, credibility, and trustworthiness from some advocates within the positivist domain, but this is not confined to case study research (Merriam, 1998). Positivists argue that qualitative case study research is difficult to generalize from the findings.
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bility to accommodate various paradigms, approaches, and methods. Method The authors identified guidelines, reporting standards, and critical appraisal criteria for qualitative research by searching PubMed, Web of Science, and Google through July 2013; reviewing the reference lists of retrieved sources; and contacting experts. Specifically, two authors reviewed a sample of sources to generate ...
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First is to provide a step-by-step guideline to research students for conducting case study. Second, an analysis of authors' multiple case studies is presented in order to provide an application of step-by-step guideline. This article has been divided into two sections. First section discusses a checklist with four phases that are vital for ...
Qualitative research
Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. 3. Consolidated criteria for reporting qualitative research (COREQ) : a 32-item checklist for interviews and focus groups. 4. The RETRIEVE Checklist for Studies Reporting the Elicitation of Stated Preferences for Child Health -Related Quality of Life.
Professional regulation in the digital era: A qualitative case study of
Squires A, Dorsen C. Qualitative research in nursing and health professions regulation. J Nurs Regul. 2018;9: 15-26. View Article Google Scholar 30. Flyvbjerg B. Five misunderstandings about case-study research. Qual Inq. 2006;12: 219-245. View Article Google Scholar 31.
Guidelines for Designing an Interpretive Case
These best practice guidelines emerged from a synthesis of leading research work on case studies and, in particular, interpretive case studies. The guidelines are organised into a comprehensive framework that considers key design aspects, such as the research problem, philosophical perspectives, qualitative approaches, case study strategy ...
Guidelines for Using a Case Study Approach in Construction Culture
The guidelines help novice researchers identify critical steps in designing qualitative case studies in cultural research, and future research could deductively and quantitatively test the theories developed in this paper to confirm validity.
Editorial: the qualitative case study
Qualitative studies entail many research methods; this editorial focuses on the qualitative case study. First of all, the term qualitative needs to be defined as qualitative research is still struggling to find its way into scientific logistics and supply chain management (SCM) journals (e.g. Frankel et al., 2005; Pedrosa et al., 2012 ).
Standards for reporting qualitative research: a synthesis of
Reporting guideline provided for? (i.e. exactly what the authors state in the paper) Reporting of qualitative research studies. Full bibliographic reference: O'Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9):1245-1251. Language: English: PubMed ...
Exploring variations in the implementation of a health system level
Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. ... Methods Our qualitative multiple case study was informed by the Normalization Process Theory (NPT). It was conducted across eight districts and among ten health ...
Barriers to routine screening for intimate partner violence during
The purpose of this study is to identify and describe midwives' perspectives of the barriers in conducting routine screening of IPV for pregnant women in northern Nigeria. A case study qualitative descriptive design was used to collect data from ten midwives in the antenatal clinic of a tertiary hospital.