quantitative case study analysis

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

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

Research question

• Conceptual framework
• Conceptual vs. theoretical framework

Data collection

• Qualitative research methods
• Focus groups
• Observational research

What is a case study?

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

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

Case studies

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

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

Definition of a case study

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

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

Characteristics of case studies

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

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

The role of case studies in research

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

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

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

What is the purpose of a case study?

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

Why use case studies in qualitative research?

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

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

The explanatory, exploratory, and descriptive roles of case studies

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

The impact of case studies on knowledge development

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

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

Types of case studies

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

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

Exploratory case studies

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

Descriptive case studies

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

Explanatory case studies

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

Intrinsic, instrumental, and collective case studies

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

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

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

Critical information systems research

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

Health research

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

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

Asthma research studies

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

Other fields

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

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

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

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

Propositions

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

Units of analysis

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

Argumentation

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

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

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

Defining the research question

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

Selecting and defining the case

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

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

Developing a detailed case study protocol

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

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

Collecting data

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

Analyzing and interpreting data

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

Writing the case study report

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

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

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

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

Observations

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

Documents and artifacts

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

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

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

Ensuring the quality of data collection

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

Data analysis

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

Organizing the data

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

Categorizing and coding the data

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

Identifying patterns and themes

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

Interpreting the data

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

Verification of the data

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

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

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

Benefits include the following:

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

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

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

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

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• Case Study | Definition, Examples & Methods

Case Study | Definition, Examples & Methods

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

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

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

Table of contents

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Quantitative study designs: Case Studies/ Case Report/ Case Series

Quantitative study designs.

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Case Study / Case Report / Case Series

Some famous examples of case studies are John Martin Marlow’s case study on Phineas Gage (the man who had a railway spike through his head) and Sigmund Freud’s case studies, Little Hans and The Rat Man. Case studies are widely used in psychology to provide insight into unusual conditions.

A case study, also known as a case report, is an in depth or intensive study of a single individual or specific group, while a case series is a grouping of similar case studies / case reports together.

A case study / case report can be used in the following instances:

• where there is atypical or abnormal behaviour or development
• an unexplained outcome to treatment
• an emerging disease or condition

The stages of a Case Study / Case Report / Case Series

Which clinical questions does Case Study / Case Report / Case Series best answer?

Emerging conditions, adverse reactions to treatments, atypical / abnormal behaviour, new programs or methods of treatment – all of these can be answered with case studies /case reports / case series. They are generally descriptive studies based on qualitative data e.g. observations, interviews, questionnaires, diaries, personal notes or clinical notes.

What are the advantages and disadvantages to consider when using Case Studies/ Case Reports and Case Series ?

What are the pitfalls to look for.

One pitfall that has occurred in some case studies is where two common conditions/treatments have been linked together with no comprehensive data backing up the conclusion. A hypothetical example could be where high rates of the common cold were associated with suicide when the cohort also suffered from depression.

Critical appraisal tools 

To assist with critically appraising Case studies / Case reports / Case series there are some tools / checklists you can use.

JBI Critical Appraisal Checklist for Case Series

JBI Critical Appraisal Checklist for Case Reports

Real World Examples

Some Psychology case study / case report / case series examples

Capp, G. (2015). Our community, our schools : A case study of program design for school-based mental health services. Children & Schools, 37(4), 241–248. A pilot program to improve school based mental health services was instigated in one elementary school and one middle / high school. The case study followed the program from development through to implementation, documenting each step of the process.

Cowdrey, F. A. & Walz, L. (2015). Exposure therapy for fear of spiders in an adult with learning disabilities: A case report. British Journal of Learning Disabilities, 43(1), 75–82. One person was studied who had completed a pre- intervention and post- intervention questionnaire. From the results of this data the exposure therapy intervention was found to be effective in reducing the phobia. This case report highlighted a therapy that could be used to assist people with learning disabilities who also suffered from phobias.

Li, H. X., He, L., Zhang, C. C., Eisinger, R., Pan, Y. X., Wang, T., . . . Li, D. Y. (2019). Deep brain stimulation in post‐traumatic dystonia: A case series study. CNS Neuroscience & Therapeutics. 1-8. Five patients were included in the case series, all with the same condition. They all received deep brain stimulation but not in the same area of the brain. Baseline and last follow up visit were assessed with the same rating scale.

References and Further Reading  

Greenhalgh, T. (2014). How to read a paper: the basics of evidence-based medicine. (5th ed.). New York: Wiley.

Heale, R. & Twycross, A. (2018). What is a case study? Evidence Based Nursing, 21(1), 7-8.

Himmelfarb Health Sciences Library. (2019). Study design 101: case report. Retrieved from https://himmelfarb.gwu.edu/tutorials/studydesign101/casereports.cfm

Hoffmann T., Bennett S., Mar C. D. (2017). Evidence-based practice across the health professions. Chatswood, NSW: Elsevier.

Robinson, O. C., & McAdams, D. P. (2015). Four functional roles for case studies in emerging adulthood research. Emerging Adulthood, 3(6), 413-420.

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Writing a Case Study

What is a case study?

A Case study is: 

• An in-depth research design that primarily uses a qualitative methodology but sometimes​​ includes quantitative methodology.
• Used to examine an identifiable problem confirmed through research.
• Used to investigate an individual, group of people, organization, or event.
• Used to mostly answer "how" and "why" questions.

What are the different types of case studies?

Note: These are the primary case studies. As you continue to research and learn

about case studies you will begin to find a robust list of different types. 

Who are your case study participants?

What is triangulation ? 

Validity and credibility are an essential part of the case study. Therefore, the researcher should include triangulation to ensure trustworthiness while accurately reflecting what the researcher seeks to investigate.

How to write a Case Study?

When developing a case study, there are different ways you could present the information, but remember to include the five parts for your case study.

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• Published: 27 June 2011

The case study approach

• Sarah Crowe 1 ,
• Kathrin Cresswell 2 ,
• Ann Robertson 2 ,
• Guro Huby 3 ,
• Anthony Avery 1 &
• Aziz Sheikh 2  

BMC Medical Research Methodology volume  11 , Article number:  100 ( 2011 ) Cite this article

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

Peer Review reports

Introduction

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

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

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

What is a case study?

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

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

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

What are case studies used for?

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

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

How are case studies conducted?

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

Defining the case

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

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

Selecting the case(s)

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

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

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

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

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

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

Collecting the data

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

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

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

Analysing, interpreting and reporting case studies

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

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

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

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

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

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

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

Conclusions

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

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Acknowledgements

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

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

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Crowe, S., Cresswell, K., Robertson, A. et al. The case study approach. BMC Med Res Methodol 11 , 100 (2011). https://doi.org/10.1186/1471-2288-11-100

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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.

Related Links

Consider the following list of related Web sites for more information on the topic of case study research. Note: although many of the links cover the general category of qualitative research, all have sections that address issues of case studies.

• Sage Publications on Qualitative Methodology: Search here for a comprehensive list of new books being published about "Qualitative Methodology" http://www.sagepub.co.uk/
• The International Journal of Qualitative Studies in Education: An on-line journal "to enhance the theory and practice of qualitative research in education." On-line submissions are welcome. http://www.tandf.co.uk/journals/tf/09518398.html
• Qualitative Research Resources on the Internet: From syllabi to home pages to bibliographies. All links relate somehow to qualitative research. http://www.nova.edu/ssss/QR/qualres.html

Becker, Bronwyn, Patrick Dawson, Karen Devine, Carla Hannum, Steve Hill, Jon Leydens, Debbie Matuskevich, Carol Traver, & Mike Palmquist. (2005). Case Studies. Writing@CSU . Colorado State University. https://writing.colostate.edu/guides/guide.cfm?guideid=60

• First Online: 27 October 2022

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

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Home » Quantitative Research – Methods, Types and Analysis

Quantitative Research – Methods, Types and Analysis

Table of Contents

Quantitative Research

Quantitative research is a type of research that collects and analyzes numerical data to test hypotheses and answer research questions . This research typically involves a large sample size and uses statistical analysis to make inferences about a population based on the data collected. It often involves the use of surveys, experiments, or other structured data collection methods to gather quantitative data.

Quantitative Research Methods

Quantitative Research Methods are as follows:

Descriptive Research Design

Descriptive research design is used to describe the characteristics of a population or phenomenon being studied. This research method is used to answer the questions of what, where, when, and how. Descriptive research designs use a variety of methods such as observation, case studies, and surveys to collect data. The data is then analyzed using statistical tools to identify patterns and relationships.

Correlational Research Design

Correlational research design is used to investigate the relationship between two or more variables. Researchers use correlational research to determine whether a relationship exists between variables and to what extent they are related. This research method involves collecting data from a sample and analyzing it using statistical tools such as correlation coefficients.

Quasi-experimental Research Design

Quasi-experimental research design is used to investigate cause-and-effect relationships between variables. This research method is similar to experimental research design, but it lacks full control over the independent variable. Researchers use quasi-experimental research designs when it is not feasible or ethical to manipulate the independent variable.

Experimental Research Design

Experimental research design is used to investigate cause-and-effect relationships between variables. This research method involves manipulating the independent variable and observing the effects on the dependent variable. Researchers use experimental research designs to test hypotheses and establish cause-and-effect relationships.

Survey Research

Survey research involves collecting data from a sample of individuals using a standardized questionnaire. This research method is used to gather information on attitudes, beliefs, and behaviors of individuals. Researchers use survey research to collect data quickly and efficiently from a large sample size. Survey research can be conducted through various methods such as online, phone, mail, or in-person interviews.

Quantitative Research Analysis Methods

Here are some commonly used quantitative research analysis methods:

Statistical Analysis

Statistical analysis is the most common quantitative research analysis method. It involves using statistical tools and techniques to analyze the numerical data collected during the research process. Statistical analysis can be used to identify patterns, trends, and relationships between variables, and to test hypotheses and theories.

Regression Analysis

Regression analysis is a statistical technique used to analyze the relationship between one dependent variable and one or more independent variables. Researchers use regression analysis to identify and quantify the impact of independent variables on the dependent variable.

Factor Analysis

Factor analysis is a statistical technique used to identify underlying factors that explain the correlations among a set of variables. Researchers use factor analysis to reduce a large number of variables to a smaller set of factors that capture the most important information.

Structural Equation Modeling

Structural equation modeling is a statistical technique used to test complex relationships between variables. It involves specifying a model that includes both observed and unobserved variables, and then using statistical methods to test the fit of the model to the data.

Time Series Analysis

Time series analysis is a statistical technique used to analyze data that is collected over time. It involves identifying patterns and trends in the data, as well as any seasonal or cyclical variations.

Multilevel Modeling

Multilevel modeling is a statistical technique used to analyze data that is nested within multiple levels. For example, researchers might use multilevel modeling to analyze data that is collected from individuals who are nested within groups, such as students nested within schools.

Applications of Quantitative Research

Quantitative research has many applications across a wide range of fields. Here are some common examples:

• Market Research : Quantitative research is used extensively in market research to understand consumer behavior, preferences, and trends. Researchers use surveys, experiments, and other quantitative methods to collect data that can inform marketing strategies, product development, and pricing decisions.
• Health Research: Quantitative research is used in health research to study the effectiveness of medical treatments, identify risk factors for diseases, and track health outcomes over time. Researchers use statistical methods to analyze data from clinical trials, surveys, and other sources to inform medical practice and policy.
• Social Science Research: Quantitative research is used in social science research to study human behavior, attitudes, and social structures. Researchers use surveys, experiments, and other quantitative methods to collect data that can inform social policies, educational programs, and community interventions.
• Education Research: Quantitative research is used in education research to study the effectiveness of teaching methods, assess student learning outcomes, and identify factors that influence student success. Researchers use experimental and quasi-experimental designs, as well as surveys and other quantitative methods, to collect and analyze data.
• Environmental Research: Quantitative research is used in environmental research to study the impact of human activities on the environment, assess the effectiveness of conservation strategies, and identify ways to reduce environmental risks. Researchers use statistical methods to analyze data from field studies, experiments, and other sources.

Characteristics of Quantitative Research

Here are some key characteristics of quantitative research:

• Numerical data : Quantitative research involves collecting numerical data through standardized methods such as surveys, experiments, and observational studies. This data is analyzed using statistical methods to identify patterns and relationships.
• Large sample size: Quantitative research often involves collecting data from a large sample of individuals or groups in order to increase the reliability and generalizability of the findings.
• Objective approach: Quantitative research aims to be objective and impartial in its approach, focusing on the collection and analysis of data rather than personal beliefs, opinions, or experiences.
• Control over variables: Quantitative research often involves manipulating variables to test hypotheses and establish cause-and-effect relationships. Researchers aim to control for extraneous variables that may impact the results.
• Replicable : Quantitative research aims to be replicable, meaning that other researchers should be able to conduct similar studies and obtain similar results using the same methods.
• Statistical analysis: Quantitative research involves using statistical tools and techniques to analyze the numerical data collected during the research process. Statistical analysis allows researchers to identify patterns, trends, and relationships between variables, and to test hypotheses and theories.
• Generalizability: Quantitative research aims to produce findings that can be generalized to larger populations beyond the specific sample studied. This is achieved through the use of random sampling methods and statistical inference.

Examples of Quantitative Research

Here are some examples of quantitative research in different fields:

• Market Research: A company conducts a survey of 1000 consumers to determine their brand awareness and preferences. The data is analyzed using statistical methods to identify trends and patterns that can inform marketing strategies.
• Health Research : A researcher conducts a randomized controlled trial to test the effectiveness of a new drug for treating a particular medical condition. The study involves collecting data from a large sample of patients and analyzing the results using statistical methods.
• Social Science Research : A sociologist conducts a survey of 500 people to study attitudes toward immigration in a particular country. The data is analyzed using statistical methods to identify factors that influence these attitudes.
• Education Research: A researcher conducts an experiment to compare the effectiveness of two different teaching methods for improving student learning outcomes. The study involves randomly assigning students to different groups and collecting data on their performance on standardized tests.
• Environmental Research : A team of researchers conduct a study to investigate the impact of climate change on the distribution and abundance of a particular species of plant or animal. The study involves collecting data on environmental factors and population sizes over time and analyzing the results using statistical methods.
• Psychology : A researcher conducts a survey of 500 college students to investigate the relationship between social media use and mental health. The data is analyzed using statistical methods to identify correlations and potential causal relationships.
• Political Science: A team of researchers conducts a study to investigate voter behavior during an election. They use survey methods to collect data on voting patterns, demographics, and political attitudes, and analyze the results using statistical methods.

How to Conduct Quantitative Research

Here is a general overview of how to conduct quantitative research:

• Develop a research question: The first step in conducting quantitative research is to develop a clear and specific research question. This question should be based on a gap in existing knowledge, and should be answerable using quantitative methods.
• Develop a research design: Once you have a research question, you will need to develop a research design. This involves deciding on the appropriate methods to collect data, such as surveys, experiments, or observational studies. You will also need to determine the appropriate sample size, data collection instruments, and data analysis techniques.
• Collect data: The next step is to collect data. This may involve administering surveys or questionnaires, conducting experiments, or gathering data from existing sources. It is important to use standardized methods to ensure that the data is reliable and valid.
• Analyze data : Once the data has been collected, it is time to analyze it. This involves using statistical methods to identify patterns, trends, and relationships between variables. Common statistical techniques include correlation analysis, regression analysis, and hypothesis testing.
• Interpret results: After analyzing the data, you will need to interpret the results. This involves identifying the key findings, determining their significance, and drawing conclusions based on the data.
• Communicate findings: Finally, you will need to communicate your findings. This may involve writing a research report, presenting at a conference, or publishing in a peer-reviewed journal. It is important to clearly communicate the research question, methods, results, and conclusions to ensure that others can understand and replicate your research.

When to use Quantitative Research

Here are some situations when quantitative research can be appropriate:

• To test a hypothesis: Quantitative research is often used to test a hypothesis or a theory. It involves collecting numerical data and using statistical analysis to determine if the data supports or refutes the hypothesis.
• To generalize findings: If you want to generalize the findings of your study to a larger population, quantitative research can be useful. This is because it allows you to collect numerical data from a representative sample of the population and use statistical analysis to make inferences about the population as a whole.
• To measure relationships between variables: If you want to measure the relationship between two or more variables, such as the relationship between age and income, or between education level and job satisfaction, quantitative research can be useful. It allows you to collect numerical data on both variables and use statistical analysis to determine the strength and direction of the relationship.
• To identify patterns or trends: Quantitative research can be useful for identifying patterns or trends in data. For example, you can use quantitative research to identify trends in consumer behavior or to identify patterns in stock market data.
• To quantify attitudes or opinions : If you want to measure attitudes or opinions on a particular topic, quantitative research can be useful. It allows you to collect numerical data using surveys or questionnaires and analyze the data using statistical methods to determine the prevalence of certain attitudes or opinions.

Purpose of Quantitative Research

The purpose of quantitative research is to systematically investigate and measure the relationships between variables or phenomena using numerical data and statistical analysis. The main objectives of quantitative research include:

• Description : To provide a detailed and accurate description of a particular phenomenon or population.
• Explanation : To explain the reasons for the occurrence of a particular phenomenon, such as identifying the factors that influence a behavior or attitude.
• Prediction : To predict future trends or behaviors based on past patterns and relationships between variables.
• Control : To identify the best strategies for controlling or influencing a particular outcome or behavior.

Quantitative research is used in many different fields, including social sciences, business, engineering, and health sciences. It can be used to investigate a wide range of phenomena, from human behavior and attitudes to physical and biological processes. The purpose of quantitative research is to provide reliable and valid data that can be used to inform decision-making and improve understanding of the world around us.

Advantages of Quantitative Research

There are several advantages of quantitative research, including:

• Objectivity : Quantitative research is based on objective data and statistical analysis, which reduces the potential for bias or subjectivity in the research process.
• Reproducibility : Because quantitative research involves standardized methods and measurements, it is more likely to be reproducible and reliable.
• Generalizability : Quantitative research allows for generalizations to be made about a population based on a representative sample, which can inform decision-making and policy development.
• Precision : Quantitative research allows for precise measurement and analysis of data, which can provide a more accurate understanding of phenomena and relationships between variables.
• Efficiency : Quantitative research can be conducted relatively quickly and efficiently, especially when compared to qualitative research, which may involve lengthy data collection and analysis.
• Large sample sizes : Quantitative research can accommodate large sample sizes, which can increase the representativeness and generalizability of the results.

Limitations of Quantitative Research

There are several limitations of quantitative research, including:

• Limited understanding of context: Quantitative research typically focuses on numerical data and statistical analysis, which may not provide a comprehensive understanding of the context or underlying factors that influence a phenomenon.
• Simplification of complex phenomena: Quantitative research often involves simplifying complex phenomena into measurable variables, which may not capture the full complexity of the phenomenon being studied.
• Potential for researcher bias: Although quantitative research aims to be objective, there is still the potential for researcher bias in areas such as sampling, data collection, and data analysis.
• Limited ability to explore new ideas: Quantitative research is often based on pre-determined research questions and hypotheses, which may limit the ability to explore new ideas or unexpected findings.
• Limited ability to capture subjective experiences : Quantitative research is typically focused on objective data and may not capture the subjective experiences of individuals or groups being studied.
• Ethical concerns : Quantitative research may raise ethical concerns, such as invasion of privacy or the potential for harm to participants.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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Maben J, Griffiths P, Penfold C, et al. Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation. Southampton (UK): NIHR Journals Library; 2015 Feb. (Health Services and Delivery Research, No. 3.3.)

Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation.

Chapter 5 case study quantitative data findings.

• Introduction

This chapter provides the results of the analysis of quantitative data from three different sources:

• Staff activity: task time distribution. Observations of staff activities were undertaken in each study ward to understand the types of tasks undertaken by staff and the proportion of time spent on each. Staff were shadowed by a researcher who logged their activities.
• Staff travel distances. These were collected by staff wearing pedometers. These data were collected before and after the shadowing sessions.
• Staff experience surveys. Staff surveys on each ward were conducted before and after the move to the new hospital and these data provide a comparison of perceptions of the ward environment in the old and new wards.

The survey probed perceptions of many aspects of the ward environment before and after the move. As discussed in Chapter 3 , the trust, the designers and stakeholders held various expectations about the benefits of the 100% single room design. We examined whether or not these expectations (or hypotheses about the effect of the move) were fulfilled. Specifically, the new hospital was designed to increase patient comfort, prevent infections, reduce numbers of patient falls, reduce patient stress, increase patient-centred care and increase the time spent by nurses on direct care (see Appendix 16 ). Concerns were raised about the possible reduction in staff observing and monitoring patients, increased travel distances and patient isolation.

This chapter primarily addresses the following two research questions:

• What are the advantages and disadvantages of a move to all single rooms for staff?
• Does the move to all single rooms affect staff experience and well-being and their ability to deliver effective and high-quality care?
• Staff activity: task time distribution results

Preliminary analysis showed that five activity categories accounted for 78% of observation data before the move and 83% of observation data after the move. This meant that numbers in the remaining categories were too low for analysis, so all subsequent analyses were confined to these five categories: direct care, indirect care, professional communication, medication tasks and ward-related activities. Proportion of time was derived by calculating the duration of each event from its start and end time, and then aggregating duration by activity for each observation session. The number of events for each activity was also counted ( Table 23 ).

Observations (events) per session before and after new build

Proportion of time spent in each type of activity was analysed using a general linear model with proportion of time as the dependent variable. The first model consisted of a single independent variable for before and after the new build and was used to ascertain the effect of the move to a new build, prior to adjusting for other variables. To this model were added ward (maternity, surgical, older people, AAU), staff group (midwife, RN, HCA) and day of the week. This second model was used to ascertain the effect of the move to the new build having adjusted for these variables.

Events were defined as a switch of activity (either to a new activity or to continue a previously interrupted activity) and were captured by a new entry in the PDA. The number of events (new or continuation of a previous activity) per hour was modelled in the same way except that a generalised linear model with a Poisson distribution and shift length in hours specified as offset (equivalent to modelling the hourly rate) was fitted to the data. An unadjusted analysis (before and after the new build only) and adjusted analysis (before and after the new build, ward, staff group and day of week) were performed.

Analysis of medication tasks was confined to RNs only. The fact that RMs work only on the postnatal ward means that it would not be possible to interpret whether any obtained results were due to the effect of the professional group or the ward. Therefore, staff group (i.e. midwives) was dropped from this model. On average the number of events (either new or continuations of previous activities) observed per session was higher before the move than after (177 vs. 153).

However, the move to the new build did not result in a significant change to the proportion of time spent on different activities ( Table 24 ). Although there was an increase in the proportion of direct care, indirect care, professional communication and medication tasks and a decrease in ward-related activities such as cleaning, bed making and stocking the utility room in adjusted analyses, none of these changes was statistically significant (see Table 24 ).

Mean proportion of time spent in each type of activity before and after move

Table 25 shows results for the analysis of the number of events per hour. The adjusted number of recorded events per hour decreased significantly for direct care ( p  = 0.039) and professional communication ( p  = 0.002), and increased significantly for medication tasks. A decrease in the number of events per hour for an activity, and no change in the proportion of time spent on that activity, suggests that there were fewer interruptions during these tasks and work was, therefore, less fragmented. This interpretation is supported by qualitative data showing that nurses could focus on direct care and communication tasks more easily in the single room environment. Staff had difficulty locating each other and also felt reluctant to interrupt a colleague providing direct care in a single room, and there were more frequent structured opportunities for professional communication within the small nursing teams.

Number of events per hour by type of activity before and after move

The number of events per hour increased significantly for medication tasks ( p  = 0.001), showing increased fragmentation for this task. Again, this interpretation is supported by the qualitative data showing that when staff entered a patient room to administer medication they were likely to engage in other direct care activities; thus medication administration was not carried out in a single medication round, but integrated into patient care activities generally.

We also assessed the changes in patients’ contact time per patient-day to check if nurses spent more time with the patient instead of doing other activities. The analysis draws on day shift observation data (based on 118.5 hours of staff shadowing before the move and 254.5 hours after the move). The proportion of contact time was applied to the total NHPPD to provide an estimate of the patients’ contact time per patient-day (see Table 26 ).

Patients’ contact time per patient-day before and after move in the case study wards

After the move, the contact time per patient-days increased in all units, apart from surgery, where there was a decrease in direct care and an increase in indirect care activities, for example medication activities and professional communication, and essential ward/patient care activities.

These changes are the result of a combination of two factors: a change in the proportion of care (i.e. an increase/decrease in the time spent with the patient) and a change in NHPPD (i.e. an increase/decrease in the number of nurses working full-time during a day).

• Staff travel distances results

Statistical analysis

The data were analysed using a repeated measures general linear mixed model (GLMM) with steps per hour as the dependent variable and pre/post new build, ward (maternity, surgical, older people, AAU), observation session (repeated measure), staff group (midwife, RN, HCA) and day of the week as independent variables. The first GLMM analysis investigated the main effects of ward, pre/post move, staff group and day of the week. The second GLMM analysis investigated the interactions between pre/post move and ward, and between pre/post move and staff group. Because midwives were employed only on the maternity ward, there was potential confounding between the effects of ward and staff type. Initial analyses confirmed that removing maternity from the analyses improved the fit of the models. The first sensitivity analysis added a variable to the model that indicated whether or not a member of staff contributed to both the pre- and post-build samples. Only five staff contributed to both. The effect on the overall results was minor. A second sensitivity analysis fitted a model to first observation session data only, but allowed data to repeat across individual staff before and after the build. We report the results below, including where sensitivity analyses identified differences.

The data set contains information on 140 sessions collected on 53 staff (49%) prior to and 56 staff (51%) after the new build. A number of staff contributed more than one observation session: 85 provided one session, 18 provided two sessions, five provided three sessions and one provided four sessions. There were 73 sessions (52%) collected prior to the new build and 67 sessions (48%) after the new build. The average numbers of sessions per member of staff were 1.38 and 1.20, respectively. A small number of staff ( n  = 5, 4%) were observed at both times (one RN and four HCAs). Table 27 shows descriptive data for ward and staff group.

Steps per hour before and after new build

The unadjusted means (see Table 27 ) show an increase in the number of steps per hour for all wards and staff groups. Staff working on the older people’s ward (from 664 to 845) and RNs (from 639 to 827) have seen the biggest increases.

Table 28 shows results for the main effects of ward, pre/post move, staff group and day of the week. The number of steps per hour increased significantly from a mean of 715 before the move to a mean of 839 [ F (1,83) = 10.36; p  = 0.002] after the move. HCAs took significantly more steps per hour than nurses [ F (1,83) = 8.01; p  = 0.006]. There were also significant differences between days of the week [ F (4,21) = 3.40; p  = 0.027]. There was no significant difference between wards in the distances travelled ( Table 29 ).

F -tests on main effects

Mean steps per hour by wards, pre-/post move, staff group and day of the week

Table 30 shows results for the interactions between pre/post move and ward, and between pre/post move and staff group. Neither of the two interactions was statistically significant.

F -tests on interaction effects

The estimated marginal means ( Table 31 ) showed that there was an increase from pre to post build across all wards. Although the size of this increase did not differ significantly between wards, the increases in the surgical and older people’s wards were larger than for the AAU. RNs experienced a larger increase (from 624 to 811) in the number of steps per hour (from 3.74 to 4.86 miles) than HCAs (from 828 to 862 steps; from 4.96 to 5.17 miles).

Mean steps per hour for the interactions

The estimated marginal means from the second sensitivity analysis suggested a decrease in the number of steps per hour for the AAU from 901 to 836 and for HCAs from 876 to 855, rather than an increase as shown in Table 31 . The change in means for the remaining two wards and for RNs, from pre to post build, were in the same direction, and of the same order of magnitude (see Table 31 ).

• Staff experience survey

Because of staff leave, shift patterns and staff turnover during the course of the study, it was not possible to use a completely within-subjects design, in which the pre- and post-move surveys were completed by the same people. Despite this, 19 participants did complete surveys at both times, which meant a mixed within- and between-subjects design. One potential problem with this is that the subgroup who completed both surveys could have been sensitised to the research questions and, therefore, could have been more likely to report differences after the move than those who completed only one survey; that would bias our results. We addressed this by treating the design as a between-subjects design and checking for bias by comparing the results of our analyses for the whole group with separate within-subjects analyses on the subgroup who completed both surveys. The results were identical except for a small difference: perceptions of the effect of the accommodation on the delivery of care approached significance (0.099) in the within-subjects analysis whereas for the whole group this effect was significant (0.011). This can be attributed to lack of power in the subsample of 19. On this basis we proceeded with the analysis by treating the ‘before’ and ‘after’ samples as independent groups.

There were 152 items in the staff survey. Our approach to analysis was multifaceted. First, we explored the potential for grouping questions into subscales that would summarise a topic area. We thematically analysed the questions to determine those that were likely to be measuring attitudes to related aspects of the ward design, and then tested these subscales using statistical reliability analysis. Where reliability was not adequate we revised the items in the subscales until we had identified coherent subscales. These were then analysed using independent sample t -tests to determine if post-move responses were significantly different from the pre-move scores for each subscale. Similar analyses were undertaken for the teamwork and safety climate scales. Qualitative open-ended questions were analysed thematically using a content analytic approach. The well-being and stress items were compared before and after the move using the Pearson chi-squared test and Fisher’s exact test when expected frequencies were less than 5.

One of the aims of the study was to investigate if there were differences between the case study wards in their perceptions of the positives and negatives of the new single room accommodation. However, the relatively small number of staff in each of the case study wards meant that it was not possible to explore this question statistically. We therefore used correspondence analysis and perceptual mapping to examine the interaction between ward attributes and case study wards. Correspondence analysis is an exploratory mapping tool that allows visualisation of relationships in the data that would be difficult to identify if presented in a table. 114 It is related to other techniques such as factor analysis and multidimensional scaling. It does not rely on significance testing and is best viewed as an exploratory technique that provides insights into the similarities and differences between two variables. 115 Correspondence analysis does not address questions of whether or not there were differences in ratings between the attributes (e.g. whether or not privacy for patients was rated more highly than staff teamwork). Instead, it focuses on the differences between case study wards and the interaction between ratings and wards. It allows an examination of to what extent which wards are associated with particular ratings. In this way it allows us to qualitatively explore the quantitative data.

Ward environment survey subscales

Ten reliable subscales were formed. Table 32 shows the subscales and example items from each.

Description of subscales

Appendix 19 contains a complete list of all items used for each subscale.

Table 33 summarises the statistical analysis of the subscales showing means, Cronbach’s alpha and the number of items for each subscale before and after the move. According to accepted criteria, 115 alpha above 0.60 is acceptable for exploratory analyses, above 0.70 is acceptable for confirmatory purposes and above 0.80 is good for confirmatory purposes. Obtained coefficients were generally good, ranging mostly between 0.67 and 0.92. The lowest alpha, of 0.53, was obtained for the family/visitors subscale after the move, suggesting that this subscale is not internally consistent. However, the pre-move alpha was good (0.70), so it was decided to retain this subscale for exploratory purposes.

Mean subscale scores and reliability analysis before and after the move

Table 34 shows the results of independent sample t -tests comparing subscale scores before and after the move. Staff perceived significant improvements in the efficiency of the physical environment, the patient amenity, the effect of the environment on infection control, patient privacy, and family and visitors. The largest increases were found for perceptions of infection control and patient privacy. Perceptions of the effect of the ward environment on teamwork and care delivery were significantly more negative after the move. There were no significant differences in staff perceptions of staff facilities, patient safety and staff safety.

Results of t -tests comparing perceptions of the ward environment before and after the move

Although all subscales showed moderate to very good reliability, changes were not uniform for all items in every subscale; there were some exceptions to the overall trend. Overall ratings for the subscale ‘efficiency of physical environment’ increased, but ratings for the item ‘ward design/layout minimises walking distances for staff’ decreased. These perceptions were confirmed by our findings from the analysis of travel distances showing that staff took significantly more steps after than before the move. Some aspects of the design increased the amenity of the ward for staff but others did not. For example, staff toilet facilities, locker facilities and space at staff bases were rated more highly but ratings for social interaction and natural light decreased. These positive and negative aspects meant there was no significant difference in staff amenity before and after the move. The new ward was rated as much more positive for patients but there were reduced scores for three items after the move: social contact between patients, ability of patients to see staff and way finding. All aspects of teamwork and training were rated less positively, except for the item ‘discussing patient care with colleagues’, which increased. This finding is supported by our analysis of observation data showing that professional communication activities were less fragmented.

Although there were no significant differences in the effect of the ward layout on perceptions of patient safety, examination of the items showed that ratings for two items increased (‘minimising risk to patients of physical/verbal abuse from other patients/visitors’ and ‘minimising the risk of medication errors’) while ratings for two items decreased (‘responding to patient calls for assistance’ and ‘minimising the risk of falls/injury to patients’). This suggests that, although staff thought some risks to safety were reduced, they perceived an increased risk of falls and delays in responding to calls for assistance. Staff perceptions of a rise in risk of falls are detailed in Chapter 6 . Staff also reported being unable to hear calls for assistance when in a single room with a patient.

There were five items that did not fit into any of the subscales. These items were analysed singly using Fisher’s exact test and the results are shown in Table 35 . There was a significant relationship between the move and ratings for the number and location of hand basins, ease of keeping patient areas clean and quiet, and the overall comfort of patients, which all increased after the move. There was no relationship between the move and judgements of whether or not the location of the dirty utility room (where bedpans are stored and disposed of) reduces cross-contamination.

Results of single-item analyses

The distribution of responses for the four significant items showed that significantly more staff rated these aspects of single room accommodation as more positive after the move than before ( Tables 36 – 39 ).

Distribution of responses for the item ‘Number and location of CHWBs supports good hand hygiene’

Distribution of responses for the item ‘Easy to keep patient care areas clean’

Distribution of responses for the item ‘Overall comfort of patients’

Distribution of responses for the item ‘Easy to keep patient care areas quiet’

Expectations before the move and reality after the move

Before the move, staff were asked to rate on a five-point scale whether they thought single rooms would be better or worse for different aspects of clinical work (e.g. minimising the risk of patient falls, maintaining patient confidentiality, knowing when other staff might need help). After the move they again rated whether single rooms were better or worse for clinical work, thus providing a measure of whether or not their expectations about single rooms were met in reality. The questions were a subset of 23 questions from the first part of the survey and were analysed using Fisher’s exact test.

Results ( Table 40 ) showed that staff perceptions of whether or not single rooms were better than multibedded wards changed after the move for five items. Staff perceptions of whether or not single rooms were better for responding to calls for assistance, knowing when other staff might need help and minimising walking distances were rated as worse or much worse by significantly more staff after than before the move. Staff rated single rooms as positive for patient sleep and rest and for interactions between patients and visitors after the move.

Relationship between expectations before the move and reality after the move

Tables 41 – 45 show the distribution of significant responses.

Distribution of responses for the item ‘Responding to patient calls for assistance’

Distribution of responses for the item ‘Minimising staff walking distances’

Distribution of responses for the item ‘Patient sleep and rest’

Distribution of responses for the item ‘Knowing when other staff might need a helping hand’

Distribution of responses for the item ‘Patient interaction with visitors’

Teamwork and safety climate survey

To take into account our changes to the survey, we combined the four items about the quality of communication with doctors, nurses, nursing assistants and AHPs with the items in the information handover subscale to form a new subscale of seven items. Although this is different from the scales reported by Hutchinson et al. , 98 reliability analysis confirmed the original factor structure of the survey. There were two teamwork subscales and three safety climate subscales with good to high reliability ( Table 46 ). See Appendix 20 for a list of the items contained in each subscale.

Mean scores for all subscales decreased following the move. Independent sample t -tests showed that ratings for information handover and communication decreased significantly following the move [ t  = 3.23, degrees of freedom (df) = 108, p  = 0.002], indicating that information exchange and sharing within teams was perceived to be worse after the move. There were no other significant differences.

Correspondence analysis

Correspondence analysis transforms cross-tabulated data into a biplot showing distances between variables. In this study, case study ward was a column variable and mean questionnaire subscale score was a row variable (see Table 33 ). As appropriate when analysing mean scores, Euclidean distance was used and standardisation by removing row means was used. 114 , 116 This means that differences between the subscale means were not represented in the perceptual map, as we were not interested in whether or not, for example, infection control was rated more highly than privacy. Differences between wards, contained in the columns, were of interest and are represented in the perceptual map. Separate analyses were conducted for before and after the move and for the ward attributes and teamwork/safety climate survey.

Figure 11 shows perceptual maps of the association between ward attributes and wards before and after the move. The pre-move map shows that the points on the map were dispersed, indicating that the ratings were not strongly associated with particular wards. There was one exception in that ratings for the efficiency of the physical environment, privacy and infection control were higher for the older people’s ward than for the other wards. The post-move map shows that the highest ratings for the efficiency of the physical environment, the delivery of care, the staff facilities and teamwork were obtained in the older people’s and surgical wards, indicated by proximity on the map. Ratings for patient amenity, infection control, privacy and family/visitors were highest for the surgical ward. High ratings for patient safety were obtained in maternity and the surgical ward. Ratings for staff safety were similar in the older people’s, surgical and maternity wards. The acute assessment ward was not associated with any particular ward attributes, as was the case before the move.

Perceptual maps of (a) pre- and (b) post-move ward attributes by ward.

Figure 12 shows perceptual maps before and after the move of the association between teamwork/safety climate ratings and wards. The teamwork/safety climate survey consisted of two teamwork subscales – team input into decisions, and information handover and communication – and three safety climate subscales – attitudes to safety within own team, overall confidence in safety of organisation and perceptions of management attitudes to safety. The pre-move map shows that ratings of input into decisions, information and handover, and overall confidence in safety of the organisation were highest for the acute assessment ward. Ratings of safety attitudes within the team and management attitudes to safety were highest for the surgical ward. After the move, the surgical ward had the highest ratings for safety attitudes within the team, overall attitudes to safety and management; ratings for team input into decisions and information handover and communication were highest for the older people’s ward. Ratings for all safety climate subscales decreased in the acute assessment ward, which is indicated on the perceptual map by its location in a quadrant by itself. Maternity scores did not show a consistent pattern.

Perceptual map of (a) pre- and (b) post-move ratings of teamwork/safety climate by ward. Att., attitude; mgt., management.

These maps reveal some differences between wards in perceptions of the ward environment and show that perceptions were different before and after the move.

Staff ward preferences

Nursing staff were asked to indicate whether they would prefer single rooms, multibedded accommodation or a combination. There was a range of views ( Figure 13 ). In each phase, fewer than 18% of staff indicated a preference for 100% single rooms. The most common preference in each phase was a combination of 50% of beds in single rooms and 50% in bays (see Figure 13 ). In the pre-move survey, more staff reported a preference for more beds in bays ( n  = 20) than in the post-move phase ( n  = 12).

Nurse preferences for single room or multibedded accommodation.

Staff stress and well-being

There were five categorical questions about staff well-being that investigated whether or not they had experienced injuries and harassment in the previous 12 months ( Table 47 ). There were three items about job stress that asked participants to rate their stress on a five-point Likert scale ( Table 48 ) . Results showed no differences in staff well-being and stress before and after the move.

Relationship between move and staff well-being

Relationship between move and staff stress

Staff were asked 10 questions about their satisfaction with their own performance of various tasks during their last shift, and one question about their overall job satisfaction. Results ( Table 49 ) showed no significant effect for any of the job satisfaction items.

Relationship between job satisfaction and move

Qualitative survey data

Four open-ended questions were used to gain qualitative data about staff attitudes. The questions were:

• What two things do you think would most improve the current ward environment for staff?
• What two things do you think would most improve the current ward environment for patients?
• What two things are you most looking forward to in relation to the move to 100% single rooms in the new hospital?
• What two things are you most concerned about in relation to the move to 100% single rooms in the new hospital?
• What two things do you like the most about single room wards in the new hospital?
• What two things do you dislike most about single room wards in the new hospital?

In the following sections we present the results of the thematic analysis with frequency data (almost equal numbers of staff responded before and after the move, n  = 55 and n  = 54 respectively) and examples from participants’ written responses where appropriate. Table 50 shows that staff identified a number of things that would improve the ward accommodation for patients. The need for more space, improved patient facilities, privacy, and rest and sleep were largely met, since there were fewer people identifying these as needs after the move. However, the need for improved patient–staff ratios and a day room to provide patient social interaction were still reported after the move.

What would improve the current ward environment for patients ? Response frequencies

The need that staff perceived before the move for space around patient beds and staffing levels had decreased after the move ( Table 51 ). However, ventilation/heating/lighting, access to equipment and supplies and facilities for staff, including staff bases, were identified as needing improvement after move. In addition there was a need for improvements in monitoring patients, keeping track of colleagues, reducing isolation and reducing walking distances. These have all been identified by other parts of our results (see Chapter 6 ).

What would improve the current ward environment for staff ? Response frequencies

Staff were asked about the features of the ward they were most looking forward to in the pre-move phase, and most liked in the post-move phase ( Table 52 ). Results showed that staff most liked the increased patient privacy, patient sleep and rest, increased space, working in a modern environment and improved patient bathroom facilities.

What are you most looking forward to/do you most like about 100% single room accommodation? Response frequencies

Table 53 shows that staff were most concerned about being able to monitor patients, patient isolation and the risk of falls. Being unable to find staff and increased walking distances also emerged as features staff disliked about single rooms.

What are you most concerned about/do you most dislike about 100% single room accommodation? Response frequencies

• Most staff would prefer a mix of single rooms and multibedded rooms on wards.
• Staff activity events observed per session were higher after the move and direct care and professional communication events per hour decreased significantly, suggesting fewer interruptions and less fragmented care.
• A significant increase in medication tasks among recorded events suggests medication administration was integrated into patient care activities and was not undertaken as a medication ‘round’.
• Travel distances increased for all staff, with highest increases for staff in the older people’s ward and surgical wards and for RNs/RMs.
• efficiency in carrying out tasks
• patient amenity, including comfort, space, sleep, light and ventilation
• infection control
• patient privacy
• patient interaction with family/visitors and their involvement in care.
• In open comments, staff most liked the increased patient privacy, working in a modern environment, improved patient sleep and rest, and space around the bedside.
• delivery of care, including factors such as spending time with patients, communication with patients, monitoring patients and remaining close to patients, responding to calls for assistance, minimising the risks to staff, minimising walking distances and staff spending time with patients
• teamwork, including being able to locate staff, obtain assistance from colleagues, informal learning, keeping team members updated, discussing care with colleagues and knowing when other staff might need help.
• In addition, in open comments staff were most concerned about patient isolation, the risk of falls and staff isolation.
• There were no perceived differences in staff amenity and patient and staff safety.
• Ratings for information handover and communication decreased significantly following the move. This suggests that information exchange and sharing within teams – and between professions – was perceived to be worse after the move.
• Different wards valued different aspects of the ward environment.
• Ratings for staff toilet facilities, locker facilities and space at staff bases were rated more highly but ratings for social interaction and natural light decreased.
• No differences were found in staff job satisfaction, well-being or stress before and after the move.
• The need for improved patient–staff ratios and a day room to provide patient social interaction was still reported after the move.

Included under terms of UK Non-commercial Government License .

• Cite this Page Maben J, Griffiths P, Penfold C, et al. Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation. Southampton (UK): NIHR Journals Library; 2015 Feb. (Health Services and Delivery Research, No. 3.3.) Chapter 5, Case study quantitative data findings.
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CASY Quantitative Stock Analysis

May 18, 2024 — 03:09 pm EDT

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Below is Validea's guru fundamental report for CASEYS GENERAL STORES INC ( CASY ) . Of the 22 guru strategies we follow, CASY rates highest using our Twin Momentum Investor model based on the published strategy of Dashan Huang . This momentum model looks for a combination of fundamental momentum and price momentum.

CASEYS GENERAL STORES INC ( CASY ) is a large-cap growth stock in the Retail (Grocery) industry. The rating using this strategy is 88% based on the firm’s underlying fundamentals and the stock’s valuation. A score of 80% or above typically indicates that the strategy has some interest in the stock and a score above 90% typically indicates strong interest.

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• Open access
• Published: 14 May 2024

Quantitative evaluation of vertical control in orthodontic camouflage treatment for skeletal class II with hyperdivergent facial type

• Yan-Ning Guo 1 , 2   na1 ,
• Sheng-Jie Cui 1   na1 ,
• Jie-Ni Zhang 1 ,
• Yan-Heng Zhou 1 &
• Xue-Dong Wang 1  

Head & Face Medicine volume  20 , Article number:  31 ( 2024 ) Cite this article

Metrics details

In this study, we sought to quantify the influence of vertical control assisted by a temporary anchorage device (TAD) on orthodontic treatment efficacy for skeletal class II patients with a hyperdivergent facial type and probe into the critical factors of profile improvement.

A total of 36 adult patients with skeletal class II and a hyperdivergent facial type were included in this retrospective case–control study. To exclude the effect of sagittal anchorage reinforcement, the patients were divided into two groups: a maxillary maximum anchorage (MMA) group ( N  = 17), in which TADs were only used to help with anterior tooth retraction, and the MMA with vertical control (MMA + VC) group ( N  = 19), for which TADs were also used to intrude the maxillary molars and incisors. The treatment outcome was evaluated using dental, skeletal, and soft-tissue-related parameters via a cephalometric analysis and cast superimposition.

A significant decrease in ANB ( P  < 0.05 for both groups), the retraction and uprighting of the maxillary and mandibular incisors, and the retraction of protruded upper and lower lips were observed in both groups. Moreover, a significant intrusion of the maxillary molars was observed via the cephalometric analysis (− 1.56 ± 1.52 mm, P  < 0.05) and cast superimposition (− 2.25 ± 1.03 mm, P  < 0.05) of the MMA + VC group but not the MMA group, which resulted in a remarkable decrease in the mandibular plane angle (− 1.82 ± 1.38°, P  < 0.05). The Z angle (15.25 ± 5.30°, P  < 0.05) and Chin thickness (− 0.97 ± 0.45°, P  < 0.05) also improved dramatically in the MMA + VC group, indicating a better profile and a relaxed mentalis. Multivariate regression showed that the improvement in the soft tissue was closely related to the counterclockwise rotation of the mandible plane ( P  < 0.05).

Conclusions

TAD-assisted vertical control can achieve intrusion of approximately 2 mm for the upper first molars and induce mandibular counterclockwise rotation of approximately 1.8°. Moreover, it is especially important for patients without sufficient retraction of the upper incisors or a satisfactory chin shape.

Peer Review reports

For adult patients with severe class II malocclusion accompanied by a hyperdivergent growth pattern, orthognathic surgery is usually the optimal therapy to improve facial aesthetics and masticatory function [ 1 , 2 ]. Nevertheless, some patients refuse surgery due to its possible risks and high cost. Orthodontic camouflage treatment provides an alternative for such patients [ 3 , 4 ].

To improve the profile of this kind of patient, both sagittal retraction and vertical control are important. Several studies have found and confirmed the importance of vertical control in orthodontic treatment for skeletal class II malocclusion [ 5 , 6 , 7 ]. However, varying treatment methods are used. For adolescent patients, the most effective approach is often to utilize their vertical growth potential to guide their facial development in the desired direction. Jamilian et al. applied a modified functional orthodontic appliance to induce sagittal and vertical changes in the mandible, achieving significant facial improvement for a patient with severe skeletal class II [ 8 ].

On the other hand, for adult patients lacking growth potential, active intrusion of posterior teeth is required to intervene vertically. Early on, high-pull headgear was the most common vertical control method, but this approach relied heavily on patient compliance, and it involved the application of intermittent force, making it relatively unreliable [ 9 , 10 , 11 ].

TADs’ emergence has greatly improved the convenience and efficiency of treatment [ 12 , 13 ]. Compared to headgear, TAD-assisted vertical control can provide more dental intrusion and counterclockwise rotation of the mandibular plane, which contributes to further improvement of profile [ 14 , 15 ]. Additionally, when active intrusion was applied, we typically utilize a sustained light force (approximately 50 g), which is more favorable for the remodeling of periodontal tissues compared to the intermittent heavy force exerted by headgear.

However, the mini-implants placed in the maxilla’s posterior region can also provide strong sagittal anchorage. Several studies have shown that maximum anchorage itself can achieve a better treatment outcome and improve the profile [ 16 , 17 , 18 ]. These findings have prompted the following questions: If sagittal retraction can already lead to sufficient facial aesthetics, is vertical tooth movement still necessary? To what extent can vertical movements benefit the facial profile?

Our research group has paid close attention to the efficacy of TAD-assisted vertical control in orthodontic camouflage treatments for patients with skeletal class II malocclusion. We have published several case reports and long-term follow-up studies showing that vertical control significantly improved the profiles of patients with skeletal class II malocclusion and a hyperdivergent facial type, achieving good long-term stability [ 19 , 20 , 21 , 22 , 23 ]. We believe that specifying how the active intrusion of upper dentition contributes to these craniofacial improvements will provide more information about the ability and limits of TAD-assisted vertical control and broaden the understanding of orthodontic camouflage treatment. Therefore, we included a control group whose TADs were used only to reinforce maxillary sagittal anchorage in order to exclude the influence of sagittal retraction.

With this retrospective case–control study, we aimed to quantify the effectiveness of TAD-assisted vertical control in the improvement of dentoalveolar malformation and soft tissue profiles in adult patients with a severe skeletal class II hyperdivergent pattern, and justified the necessity of active intrusion. We believe that this article provides specific references for orthodontists and general dentists concerning the camouflage treatment of patients with skeletal class II malocclusion.

This study was based on retrospective data obtained from orthodontic records at the Peking University School and Hospital of Stomatology, and it was approved by the institution’s biomedical ethics committee (approval number: PKUSSIRB-201630096, retrospectively registered). The patients included in this study accepted orthodontic treatment between 2006 and 2018.

The study’s sample selection was based on the following inclusion criteria: good-quality orthodontic records, the presence of permanent dentition, age > 18 years, a convex profile, skeletal class II (ANB > 5°), and a hyperdivergent skeletal pattern (FMA > 28°) [ 24 ]. The exclusion criteria included the following: dental anomalies in size, number, shape, or structure; permanent tooth loss; orthodontic–orthognathic combined surgery treatment; and Botox injection or prosthesis implantation before or during orthodontic treatment.

Treatment protocols

All the participants underwent systematic periodontal and endodontic assessments and therapies before orthodontic interventions. A straight-wire MBT technique was utilized after the extraction of four premolars from all patients. Braces and archwires were obtained from TP Orthodontics (La Porte, IN, USA). The alignment and leveling phases involved initial bracket-bonding followed by a certain procedure utilizing 0.014 in. NiTi, 0.016 in. NiTi, 0.016 in. × 0.022 in. NiTi, and 0.019 in. × 0.025 in. NiTi archwires sequentially. During the space-closing phase, a 0.019 × 0.025 in. stainless steel archwire was applied using a conventional sliding mechanism. This phase was terminated upon the complete closure of the premolar spaces. The patients’ dentition was finely adjusted before debonding. Miniscrews (diameter: 1.5 mm; length: 7 mm; Zhongbang Medical Treatment Appliance, Xi’an, China) were surgically inserted into the alveolar ridge.

The patients were divided into two groups: (1) the maxillary maximum anchorage (MMA) group, in which TADs were implanted only at the bilateral buccal side of the alveolar bone, between the roots of the upper premolar and the upper first molar or between the upper first molar and the upper second molar; and (2) the maxillary maximum anchorage with vertical control (MMA + VC) group, in which TADs were implanted into the bilateral buccal and lingual sides of the alveolar bone, between the roots of the upper first molar and the upper second molar, to intrude the upper molars with or without the TADs implanted in the anterior segment for incisor intrusion (Fig.  1 ).

Representative image of intraoral devices. A . TAD-assisted intrusion of the upper anterior teeth. B . Buccal view of the posterior intrusion devices. C . Palatal view of the posterior intrusion devices

Sample size calculation

In this study, the effect size of the primary outcome was expected to be 2.32. This number was the difference in mandibular counterclockwise rotation (the decrease in the FMA value) between the two groups calculated in our preliminary study. The sample size was calculated using online software ( http://hedwig.mgh.harvard.edu/sample_size/ ) by assuming 5% type I errors and 20% type II errors. The sample calculation indicated that at least 10 patients were needed in each group.

In total, 36 patients were selected for the current study. The MMA group comprised 17 patients (14 females, 3 males) with a mean age of 24.18 ± 3.83 years and a mean treatment duration of 34.4 ± 12.8 months. The MMA + VC group consisted of 19 patients (16 females, 3 males) aged 25.00 ± 4.99 years, whose mean treatment duration was 34.7 ± 6.8 months. No significant difference in the patients’ gender, age, or treatment duration was observed between the groups (Additional Table  1 ).

Cephalometric analysis

Pre-treatment and post-treatment lateral cephalograms were collected, digitized, and superimposed using the Dolphin 11.0 software (Dolphin Imaging, Chatsworth, CA). An investigator who was not informed about the study’s groups obtained the measurements, which a second blinded investigator checked for accuracy. Any disagreements between these investigators were resolved through a weighted reevaluation until they were both satisfied. The variables used in the cephalometric analysis included skeletal, dental, and soft-tissue-related measurements. In total, 29 such variables were used (8 skeletal, 12 dental, and 9 soft-tissue-related). Figure  2 depicts the landmarks and important variables used in this study, while Additional Table  2 provides definitions.

Tracing of a pretreatment cephalometric radiograph

Dental cast analysis

Pre-treatment and post-treatment dental casts were scanned using a 3Shape scanner (3Shape D, Kopenhagen, Dänemark) and measured in a double-blinded manner by a trained orthodontist using the Geomagic 13.0 software (Geomagic Qualify, Durham, NC, US). As Fig.  3 shows, the superimposition of the dental casts was based on the palate’s stable structure. A coordinate system was built, based on the definition of the anatomical occlusal plane and the midline of the palate. The tooth movements were analyzed in two dimensions, anterior or posterior (X) and intrusion or extrusion (Z). Additionally, posterior and extrusive movement was defined as positive.

Superimposition of the dental casts. A . The pre-treatment maxillary model. B . The post-treatment maxillary model. C . Superimposition based on the stable structure of the palate. D . Transfer of corresponding landmarks

To evaluate the method’s error, 10 post-treatment lateral cephalograms and digital casts were randomly selected and remeasured by the same examiners two weeks after the first measurement was obtained. The intraclass correlation coefficient (ICC) was used to assess intra-examiner reliability and the reproducibility of all linear and angular measurements.

Statistical analysis

The intraclass correlation efficient (ICC) was evaluated using a two-way random model. Descriptive statistics for the dental casts and radiographic measurements were calculated for both the first and second measurements. Comparisons were performed and correlations were identified using Student’s t test in accordance with the results of Shapiro–Wilk normality tests. The pre-treatment skeletal, dental, and soft-tissue-related variables were compared between the groups using independent-sample t tests. The same variables were also compared from pre-treatment to post-treatment using paired t tests. The differences in treatment changes (concerning both the lateral cephalograms and the dental casts) between the MMA and MMA + VC groups were evaluated using independent-sample t tests. Multiple linear regression analysis was used to test the correlation between the independent variables of craniofacial structures and the dependent variable, the Z angle. Both groups’ differences in treatment changes were normalized to the mean variance. Then, a backward method was used to screen the independent variables. The entry probability of F was 0.05, and the removal criterion was 0.1. The statistical tests were performed with SPSS 18.0 software (IBM Corp., Armonk, NY). The results were considered statistically significant at P  < 0.05.

The groups were similar in age at the beginning of the orthodontic treatment (Additional Table  1 ). ICC was calculated with good reproducibility of the measurements (0.810–0.997), as Additional Table  3 shows.

The two groups showed similar mandibular retrognathia and hyperdivergent skeletal patterns. However, differences were observed in several variables, such as the Z angle, ANB, and L1-NB (mm). These differences indicated that the patients in the MMA + VC group had a more convex profile and more severe malocclusion (Table  1 ).

TAD-assisted vertical control better improved patients’ profiles

TADs’ efficacy in improving therapeutic outcomes is certain. However, whether and to what extent TAD-assisted vertical control can help patients with skeletal class II achieve better results from camouflage orthodontic treatments compared to the simple reinforcement of the maxillary anchorage is unclear.

For most of the patients whose results we recorded, a convex profile was the main complaint. Therefore, we first analyzed the improvements in soft-tissue-related variables for both groups (Tables  2 and 3 ). We discovered a similar trend of lip retraction (the UL-SnV angle and distance and the LL-SnV distance) and soft tissue relaxation (UL thickness and LL thickness). However, the change in the Z angle and Chin thickness showed that patients in the MMA + VC group experienced more improvement in their profiles and mentalis relaxation. (Figures  4 and 5 show the representative cases of the two groups, respectively.) Through these results, we have shown that TAD-assisted vertical control further improved the patients’ profiles, but how this advantage was achieved remained unclear.

A representative case from the MMA group. The upper anterior incisors were restored using a ceramic veneer

A representative case from the MMA + VC group

TAD-assisted vertical control contributed to maxillary retraction and mandibular counterclockwise rotation

Remarkable decreases in SNA and ANB were discovered in both groups. Furthermore, the decrease in ANB in the MMA + VC group was significantly greater compared to MMA group, showing effective maxillary retraction, which partly explained the dramatic change in the soft tissue (Tables  4 and 5 ).

Additionally, no significant differences in the mandibular plane angle in the MMA group pre- and post-treatment were observed. Indeed, the lower facial height (ANS-Me) even increased slightly. Meanwhile, the MP-SN and FMA values significantly decreased in the MMA + VC group, suggesting that TAD-assisted vertical control effectively achieved mandibular counterclockwise rotation. The decrease in the mandibular plane angle showed a significant difference in the MP-SN and FMA values between the MMA and MMA + VC groups (Table  5 ). An emphatic change was also observed in the improvement of PFH/AFH, indicating an improvement in the hyperdivergent facial type. Thus, the application of TAD-assisted vertical control achieved a certain extent of mandibular counterclockwise rotation, which also helped improve patients’ profiles (Fig.  6 ).

Schematic graph of TAD-assisted vertical control during orthodontic camouflage treatment for patients with skeletal class II and a hyperdivergent facial type

TADs achieved substantial vertical control via the intrusion of maxillary dentition

Despite the gratifying sagittal retraction of the incisors in both groups (Table  6 ), the study’s cephalometric analysis showed significant intrusion of the upper molar on the P-P plane (U6-PP) in the MMA + VC group but not in the MMA group. Similarly, the upper incisor showed more intrusion (U1-PP) in the MMA + VC group, though no significance was observed (Table  7 ). These results were confirmed via dental cast superimposition (Table  8 ). Compared to the MMA group, the MMA + VC group experienced significant intrusion of the upper dentition. However, our cephalometric analysis also revealed a significantly lower molar extrusion (L6-MP) on the mandibular plane in both groups during orthodontic treatment. Thus, the tooth movement in the vertical dimension manifested the intrusion of the upper dentition for the MMA + VC group and the extrusion of the lower molars for both groups.

Multivariate regression analysis revealed the key factors of profile improvement

Since the changes occurred at the same time, assessing which factors played the most important role in altering the patients’ soft tissue profile was difficult. Therefore, we selected the Z angle—one of the most representative and remarkably changed profile indicators—as the dependent variable for our analysis, and we conducted multiple linear regression of the standardized bone, tooth, and soft tissue measurements.

Considering the interference of collinearity, we selected the following representative indicators: ANB, MP-SN, PFH/AFH, U1/SN, IMPA, U1-PP, U6-PP, L1-MP, L6-MP, Pog-NB, UL thickness, LL thickness, and Chin thickness.

The results showed that Y  = 0.000576 − 0.416 a  − 0.340 b  + 0.403 c (where Y denotes the Z angle and a , b , and c represent the MP-SN, U1-SN, and Pog-NB, respectively; Table  9 ). This finding indicated that the change in the Z angle was negatively correlated with the MP-SN and U1-SN variables and positively correlated with Pog-NB.

Thus, the gratifying profile improvement of patients with skeletal class II and the hyperdivergent facial type relied on the massive retraction of the upper incisors, the shape of the chin, and the mandibular plane’s counterclockwise rotation.

The efficacy of TAD-assisted vertical control

In this retrospective study, we endeavored to quantify the efficacy of TAD-facilitated vertical control in managing maxillary dental intrusion and consequent mandibular counterclockwise rotation. Subsequently, we elucidated their pivotal roles in enhancing soft tissue profiles according to the baseline of MMA group.

Evaluation of hard tissue showed that following en-masse retraction with mini-implants anchorage, the MMA group exhibited slight upper molar intrusion (U6: -0.86 ± 0.89 mm) and mandibular counterclockwise rotation (MP-SN: -0.16 ± 1.05°). This result is consistent with the randomized controlled trial conducted by Al-Sibale et al. [ 25 ] and the controlled clinical trial conducted by Chen et al. [ 14 ], suggesting that TADs in the maxillary alveolar can provide some vertical force even during sagittal retraction, necessitating attention to the direction of traction and the vertical position of the anterior teeth to avoid deepening of the overbite. Following active maxillary dental intrusion, the MMA + VC group exhibited greater upper molar intrusion (U6: -2.25 ± 1.03 mm) and mandibular counterclockwise rotation (MP-SN: -1.82 ± 1.38°), which is slightly lower than that reported by Ding et al. [ 15 ] and Deguchi et al. [ 26 ] This difference may be attributed to differences in inclusion criteria. In Ding’s study, the inclusion criteria were shallow overbite, while in Deguchi’s study were open bite. In contrast, our study included many patients with normal or even deep overbite. To achieve a favorable overbite after treatment, we conducted intrusion of not only molars but also anterior teeth (U1: -1.30 ± 1.61 mm; U3: -1.81 ± 1.28 mm) with the help of TADs in the anterior segment, which represented a more challenging improvement compared to the aforementioned studies.

In terms of soft tissue evaluation, many previous studies have discussed the main factors contributing to changes in various soft tissue landmarks. For instance, Maetevorakul et al. found that the improvement in incisor angle was most crucial for enhancing lower lip prominence, and the mandibular plane angle as well as different treatment modalities had significant effects on changes of soft tissue chin prominence [ 27 ]. Regarding the overall assessment of soft tissue profiles, Zhao et al. demonstrated that the Z angle had the best discriminative ability for female adults with Angle Class II Division 1 malocclusion [ 28 ]. Therefore, in this study, we stressed on the Z angle and found that the MMA + VC group showed a more significant improvement compared to the MMA group (15.25 ± 5.30° in the MMA + VC group; 10.54 ± 5.11° in the MMA group, P  = 0.011), which correlates with the poorer profiles before treatment in the MMA + VC group. To better identify which patients require active dental intrusion, we conducted a multiple linear regression analysis and found that this improvement was most closely associated with the retraction of the upper anterior teeth, prominence of the pogonion, and counterclockwise rotation of the mandibular plane. Therefore, we can conclude that vertical control is more necessary for patients with limited space for retraction or poor chin morphology.

Limitations and prospects of TAD-assisted vertical control

Although the occlusal plane’s counterclockwise rotation is considered an effective method to reduce the angle of the mandibular plane [ 29 ], in the current study, we observed a trend of clockwise rotation. However, this unexpected result is consistent with the findings of many similar studies in this field [ 12 , 13 ]. We speculate that this rotation results from the pendulum effect of the upper anterior teeth. Compared with the molars, the upper incisors have less intrusion, suggesting that we must pay particular attention to controlling the occlusal plane.

Additionally, despite TADs’ advantages of simplicity, flexibility, and independence from patient cooperation, they remain an invasive treatment [ 30 , 31 ]. In the current study, however, six miniscrews were needed to achieve effective vertical control. This approach does not apply to patients with improper bone conditions, and it also increases the difficulty of operation. Therefore, we hope to develop further methods that are more convenient and minimally invasive. The use of midpalatal miniscrews and personalized palatal bars may be an alternative option [ 12 ]; however, such an approach would still pose challenges in terms of operation and hygiene maintenance. Accordingly, we hope to further reduce orthodontic devices’ complexity in order to meet the requirements of comfortable treatment.

Methodologically, the current study’s evaluation of muscle response and profile changes was limited to a cephalometric analysis. Since soft tissue yields inaccurate measurements during lateral cephalograms, 3D facial scanning and electromyography could allow a more precise examination of patients’ aesthetic and functional changes. We plan to enhance the refinement of assessment modalities for both soft and hard tissues, endeavoring to substantiate vertical control’s efficacy and constraints through various methodologies, including randomized controlled trials.

The conclusions of this retrospective study are as follows.

TAD-reinforced maxillary anchorage with vertical control achieves intrusion of approximately 2 mm for the upper first molars.

TAD-reinforced maxillary anchorage with vertical control induces mandibular counterclockwise rotation of approximately 1.8° and improves patients’ hyperdivergent skeletal pattern.

When the upper incisors are not sufficiently retracted or the chin shape is not satisfying, active vertical control should be applied to help patients achieve better profiles.

Taken together, these conclusions demonstrate that TAD-assisted vertical control is essential for patients with skeletal class II and a hyperdivergent facial type. This approach constitutes a good alternative to improving occlusion and profiles via orthodontic camouflage treatment.

Data availability

The data sets used and analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Maxillary maximum anchorage

Temporary anchorage devices

• Vertical control

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Acknowledgements

We thank LetPub ( www.letpub.com ) and Scribendi ( www.scribendi.com ) for its linguistic assistance during the preparation of this manuscript.

This project is supported by the National Program for Multidisciplinary Cooperative Treatment on Major Diseases No. PKUSSNMP-202013; China Oral Health Foundation No. A2021-021; Beijing Municipal Science & Technology Commission No. Z171100001017128; National Natural Science Foundation of China No. 81901053, No.81900984 No. 82101043 and No. 8237030822; National High Level Hospital Clinical Research Funding No. 2023-NHLHCRF-YXHZ-TJMS-05; Elite Medical Professionals Project of China-Japan Friendship Hospital No.ZRJY2023-QM05; Beijing Municipal Natural Science Foundation No. 7242282.

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Yan-Ning Guo and Sheng-Jie Cui contributed equally to this work.

Authors and Affiliations

Department of Orthodontics, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of Stomatology, No.22, Zhongguancun South Avenue, Haidian District, Beijing, 100081, China

Yan-Ning Guo, Sheng-Jie Cui, Jie-Ni Zhang, Yan-Heng Zhou & Xue-Dong Wang

Dental Medical Center, China-Japan Friendship Hospital, Beijing, 100029, China

Yan-Ning Guo

Department of Orthodontics, the School of Stomatology, The Key Laboratory of Stomatology, Hebei Medical University, Shijiazhuang, 050017, China

Fourth Division Department, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of Stomatology, Beijing, 100081, China

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Contributions

Y-N G and S-J C: Investigation, Visualization, Writing - Original draft preparation, contributed equally to this work and joint first authors. Y L: Methodology, Investigation, Data Curation, and critically revised the manuscript. Y F: Investigation, Data Curation, and critically revised the manuscript. J-N Z, Y-H Z: Supervision and critically revised the manuscript. X-D W: Conceptualization, Validation, Writing- Reviewing and Editing, Corresponding author. All authors reviewed the manuscript.

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Correspondence to Xue-Dong Wang .

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This study was approved by the Biomedical Ethics Committee of Peking University School and Hospital of Stomatology. (PKUSSIRB-201630096, retrospectively registered) All methods were carried out in accordance with relevant guidelines and regulations. Informed consent was obtained from all subjects and/or their legal guardian(s).

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Guo, YN., Cui, SJ., Liu, Y. et al. Quantitative evaluation of vertical control in orthodontic camouflage treatment for skeletal class II with hyperdivergent facial type. Head Face Med 20 , 31 (2024). https://doi.org/10.1186/s13005-024-00432-2

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Received : 07 November 2023

Accepted : 29 April 2024

Published : 14 May 2024

DOI : https://doi.org/10.1186/s13005-024-00432-2

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