case study discussion section

When you choose to publish with PLOS, your research makes an impact. Make your work accessible to all, without restrictions, and accelerate scientific discovery with options like preprints and published peer review that make your work more Open.

• PLOS Biology
• PLOS Climate
• PLOS Complex Systems
• PLOS Computational Biology
• PLOS Digital Health
• PLOS Genetics
• PLOS Global Public Health
• PLOS Medicine
• PLOS Mental Health
• PLOS Neglected Tropical Diseases
• PLOS Pathogens
• PLOS Sustainability and Transformation
• PLOS Collections
• How to Write Discussions and Conclusions

The discussion section contains the results and outcomes of a study. An effective discussion informs readers what can be learned from your experiment and provides context for the results.

What makes an effective discussion?

When you’re ready to write your discussion, you’ve already introduced the purpose of your study and provided an in-depth description of the methodology. The discussion informs readers about the larger implications of your study based on the results. Highlighting these implications while not overstating the findings can be challenging, especially when you’re submitting to a journal that selects articles based on novelty or potential impact. Regardless of what journal you are submitting to, the discussion section always serves the same purpose: concluding what your study results actually mean.

A successful discussion section puts your findings in context. It should include:

• the results of your research,
• a discussion of related research, and
• a comparison between your results and initial hypothesis.

Tip: Not all journals share the same naming conventions.

You can apply the advice in this article to the conclusion, results or discussion sections of your manuscript.

Our Early Career Researcher community tells us that the conclusion is often considered the most difficult aspect of a manuscript to write. To help, this guide provides questions to ask yourself, a basic structure to model your discussion off of and examples from published manuscripts. 

Questions to ask yourself:

• Was my hypothesis correct?
• If my hypothesis is partially correct or entirely different, what can be learned from the results? 
• How do the conclusions reshape or add onto the existing knowledge in the field? What does previous research say about the topic? 
• Why are the results important or relevant to your audience? Do they add further evidence to a scientific consensus or disprove prior studies? 
• How can future research build on these observations? What are the key experiments that must be done? 
• What is the “take-home” message you want your reader to leave with?

How to structure a discussion

Trying to fit a complete discussion into a single paragraph can add unnecessary stress to the writing process. If possible, you’ll want to give yourself two or three paragraphs to give the reader a comprehensive understanding of your study as a whole. Here’s one way to structure an effective discussion:

Writing Tips

While the above sections can help you brainstorm and structure your discussion, there are many common mistakes that writers revert to when having difficulties with their paper. Writing a discussion can be a delicate balance between summarizing your results, providing proper context for your research and avoiding introducing new information. Remember that your paper should be both confident and honest about the results! 

• Read the journal’s guidelines on the discussion and conclusion sections. If possible, learn about the guidelines before writing the discussion to ensure you’re writing to meet their expectations. 
• Begin with a clear statement of the principal findings. This will reinforce the main take-away for the reader and set up the rest of the discussion. 
• Explain why the outcomes of your study are important to the reader. Discuss the implications of your findings realistically based on previous literature, highlighting both the strengths and limitations of the research. 
• State whether the results prove or disprove your hypothesis. If your hypothesis was disproved, what might be the reasons? 
• Introduce new or expanded ways to think about the research question. Indicate what next steps can be taken to further pursue any unresolved questions. 
• If dealing with a contemporary or ongoing problem, such as climate change, discuss possible consequences if the problem is avoided. 
• Be concise. Adding unnecessary detail can distract from the main findings. 

Don’t

• Rewrite your abstract. Statements with “we investigated” or “we studied” generally do not belong in the discussion. 
• Include new arguments or evidence not previously discussed. Necessary information and evidence should be introduced in the main body of the paper. 
• Apologize. Even if your research contains significant limitations, don’t undermine your authority by including statements that doubt your methodology or execution. 
• Shy away from speaking on limitations or negative results. Including limitations and negative results will give readers a complete understanding of the presented research. Potential limitations include sources of potential bias, threats to internal or external validity, barriers to implementing an intervention and other issues inherent to the study design. 
• Overstate the importance of your findings. Making grand statements about how a study will fully resolve large questions can lead readers to doubt the success of the research. 

Snippets of Effective Discussions:

Consumer-based actions to reduce plastic pollution in rivers: A multi-criteria decision analysis approach

Identifying reliable indicators of fitness in polar bears

• How to Write a Great Title
• How to Write an Abstract
• How to Write Your Methods
• How to Report Statistics
• How to Edit Your Work

The contents of the Peer Review Center are also available as a live, interactive training session, complete with slides, talking points, and activities. …

The contents of the Writing Center are also available as a live, interactive training session, complete with slides, talking points, and activities. …

There’s a lot to consider when deciding where to submit your work. Learn how to choose a journal that will help your study reach its audience, while reflecting your values as a researcher…

• Bipolar Disorder
• Therapy Center
• When To See a Therapist
• Types of Therapy
• Best Online Therapy
• Best Couples Therapy
• Best Family Therapy
• Managing Stress
• Sleep and Dreaming
• Understanding Emotions
• Self-Improvement
• Healthy Relationships
• Student Resources
• Personality Types
• Guided Meditations
• Verywell Mind Insights
• 2023 Verywell Mind 25
• Mental Health in the Classroom
• Editorial Process
• Meet Our Review Board
• Crisis Support

What Is a Case Study?

Weighing the pros and cons of this method of research

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Cara Lustik is a fact-checker and copywriter.

Verywell / Colleen Tighe

• Pros and Cons

What Types of Case Studies Are Out There?

Where do you find data for a case study, how do i write a psychology case study.

A case study is an in-depth study of one person, group, or event. In a case study, nearly every aspect of the subject's life and history is analyzed to seek patterns and causes of behavior. Case studies can be used in many different fields, including psychology, medicine, education, anthropology, political science, and social work.

The point of a case study is to learn as much as possible about an individual or group so that the information can be generalized to many others. Unfortunately, case studies tend to be highly subjective, and it is sometimes difficult to generalize results to a larger population.

While case studies focus on a single individual or group, they follow a format similar to other types of psychology writing. If you are writing a case study, we got you—here are some rules of APA format to reference.  

At a Glance

A case study, or an in-depth study of a person, group, or event, can be a useful research tool when used wisely. In many cases, case studies are best used in situations where it would be difficult or impossible for you to conduct an experiment. They are helpful for looking at unique situations and allow researchers to gather a lot of˜ information about a specific individual or group of people. However, it's important to be cautious of any bias we draw from them as they are highly subjective.

What Are the Benefits and Limitations of Case Studies?

A case study can have its strengths and weaknesses. Researchers must consider these pros and cons before deciding if this type of study is appropriate for their needs.

One of the greatest advantages of a case study is that it allows researchers to investigate things that are often difficult or impossible to replicate in a lab. Some other benefits of a case study:

• Allows researchers to capture information on the 'how,' 'what,' and 'why,' of something that's implemented
• Gives researchers the chance to collect information on why one strategy might be chosen over another
• Permits researchers to develop hypotheses that can be explored in experimental research

On the other hand, a case study can have some drawbacks:

• It cannot necessarily be generalized to the larger population
• Cannot demonstrate cause and effect
• It may not be scientifically rigorous
• It can lead to bias

Researchers may choose to perform a case study if they want to explore a unique or recently discovered phenomenon. Through their insights, researchers develop additional ideas and study questions that might be explored in future studies.

It's important to remember that the insights from case studies cannot be used to determine cause-and-effect relationships between variables. However, case studies may be used to develop hypotheses that can then be addressed in experimental research.

Case Study Examples

There have been a number of notable case studies in the history of psychology. Much of  Freud's work and theories were developed through individual case studies. Some great examples of case studies in psychology include:

• Anna O : Anna O. was a pseudonym of a woman named Bertha Pappenheim, a patient of a physician named Josef Breuer. While she was never a patient of Freud's, Freud and Breuer discussed her case extensively. The woman was experiencing symptoms of a condition that was then known as hysteria and found that talking about her problems helped relieve her symptoms. Her case played an important part in the development of talk therapy as an approach to mental health treatment.
• Phineas Gage : Phineas Gage was a railroad employee who experienced a terrible accident in which an explosion sent a metal rod through his skull, damaging important portions of his brain. Gage recovered from his accident but was left with serious changes in both personality and behavior.
• Genie : Genie was a young girl subjected to horrific abuse and isolation. The case study of Genie allowed researchers to study whether language learning was possible, even after missing critical periods for language development. Her case also served as an example of how scientific research may interfere with treatment and lead to further abuse of vulnerable individuals.

Such cases demonstrate how case research can be used to study things that researchers could not replicate in experimental settings. In Genie's case, her horrific abuse denied her the opportunity to learn a language at critical points in her development.

This is clearly not something researchers could ethically replicate, but conducting a case study on Genie allowed researchers to study phenomena that are otherwise impossible to reproduce.

There are a few different types of case studies that psychologists and other researchers might use:

• Collective case studies : These involve studying a group of individuals. Researchers might study a group of people in a certain setting or look at an entire community. For example, psychologists might explore how access to resources in a community has affected the collective mental well-being of those who live there.
• Descriptive case studies : These involve starting with a descriptive theory. The subjects are then observed, and the information gathered is compared to the pre-existing theory.
• Explanatory case studies : These   are often used to do causal investigations. In other words, researchers are interested in looking at factors that may have caused certain things to occur.
• Exploratory case studies : These are sometimes used as a prelude to further, more in-depth research. This allows researchers to gather more information before developing their research questions and hypotheses .
• Instrumental case studies : These occur when the individual or group allows researchers to understand more than what is initially obvious to observers.
• Intrinsic case studies : This type of case study is when the researcher has a personal interest in the case. Jean Piaget's observations of his own children are good examples of how an intrinsic case study can contribute to the development of a psychological theory.

The three main case study types often used are intrinsic, instrumental, and collective. Intrinsic case studies are useful for learning about unique cases. Instrumental case studies help look at an individual to learn more about a broader issue. A collective case study can be useful for looking at several cases simultaneously.

The type of case study that psychology researchers use depends on the unique characteristics of the situation and the case itself.

There are a number of different sources and methods that researchers can use to gather information about an individual or group. Six major sources that have been identified by researchers are:

• Archival records : Census records, survey records, and name lists are examples of archival records.
• Direct observation : This strategy involves observing the subject, often in a natural setting . While an individual observer is sometimes used, it is more common to utilize a group of observers.
• Documents : Letters, newspaper articles, administrative records, etc., are the types of documents often used as sources.
• Interviews : Interviews are one of the most important methods for gathering information in case studies. An interview can involve structured survey questions or more open-ended questions.
• Participant observation : When the researcher serves as a participant in events and observes the actions and outcomes, it is called participant observation.
• Physical artifacts : Tools, objects, instruments, and other artifacts are often observed during a direct observation of the subject.

If you have been directed to write a case study for a psychology course, be sure to check with your instructor for any specific guidelines you need to follow. If you are writing your case study for a professional publication, check with the publisher for their specific guidelines for submitting a case study.

Here is a general outline of what should be included in a case study.

Section 1: A Case History

This section will have the following structure and content:

Background information : The first section of your paper will present your client's background. Include factors such as age, gender, work, health status, family mental health history, family and social relationships, drug and alcohol history, life difficulties, goals, and coping skills and weaknesses.

Description of the presenting problem : In the next section of your case study, you will describe the problem or symptoms that the client presented with.

Describe any physical, emotional, or sensory symptoms reported by the client. Thoughts, feelings, and perceptions related to the symptoms should also be noted. Any screening or diagnostic assessments that are used should also be described in detail and all scores reported.

Your diagnosis : Provide your diagnosis and give the appropriate Diagnostic and Statistical Manual code. Explain how you reached your diagnosis, how the client's symptoms fit the diagnostic criteria for the disorder(s), or any possible difficulties in reaching a diagnosis.

Section 2: Treatment Plan

This portion of the paper will address the chosen treatment for the condition. This might also include the theoretical basis for the chosen treatment or any other evidence that might exist to support why this approach was chosen.

• Cognitive behavioral approach : Explain how a cognitive behavioral therapist would approach treatment. Offer background information on cognitive behavioral therapy and describe the treatment sessions, client response, and outcome of this type of treatment. Make note of any difficulties or successes encountered by your client during treatment.
• Humanistic approach : Describe a humanistic approach that could be used to treat your client, such as client-centered therapy . Provide information on the type of treatment you chose, the client's reaction to the treatment, and the end result of this approach. Explain why the treatment was successful or unsuccessful.
• Psychoanalytic approach : Describe how a psychoanalytic therapist would view the client's problem. Provide some background on the psychoanalytic approach and cite relevant references. Explain how psychoanalytic therapy would be used to treat the client, how the client would respond to therapy, and the effectiveness of this treatment approach.
• Pharmacological approach : If treatment primarily involves the use of medications, explain which medications were used and why. Provide background on the effectiveness of these medications and how monotherapy may compare with an approach that combines medications with therapy or other treatments.

This section of a case study should also include information about the treatment goals, process, and outcomes.

When you are writing a case study, you should also include a section where you discuss the case study itself, including the strengths and limitiations of the study. You should note how the findings of your case study might support previous research. 

In your discussion section, you should also describe some of the implications of your case study. What ideas or findings might require further exploration? How might researchers go about exploring some of these questions in additional studies?

Need More Tips?

Here are a few additional pointers to keep in mind when formatting your case study:

• Never refer to the subject of your case study as "the client." Instead, use their name or a pseudonym.
• Read examples of case studies to gain an idea about the style and format.
• Remember to use APA format when citing references .

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

Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach . BMC Med Res Methodol . 2011 Jun 27;11:100. doi:10.1186/1471-2288-11-100

Gagnon, Yves-Chantal.  The Case Study as Research Method: A Practical Handbook . Canada, Chicago Review Press Incorporated DBA Independent Pub Group, 2010.

Yin, Robert K. Case Study Research and Applications: Design and Methods . United States, SAGE Publications, 2017.

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

• Affiliate Program

• UNITED STATES
• 台灣 (TAIWAN)
• TÜRKIYE (TURKEY)
• Academic Editing Services
• - Research Paper
• - Journal Manuscript
• - Dissertation
• - College & University Assignments
• Admissions Editing Services
• - Application Essay
• - Personal Statement
• - Recommendation Letter
• - Cover Letter
• - CV/Resume
• Business Editing Services
• - Business Documents
• - Report & Brochure
• - Website & Blog
• Writer Editing Services
• - Script & Screenplay
• Our Editors
• Client Reviews
• Editing & Proofreading Prices
• Wordvice Points
• Partner Discount
• Plagiarism Checker
• APA Citation Generator
• MLA Citation Generator
• Chicago Citation Generator
• Vancouver Citation Generator
• - APA Style
• - MLA Style
• - Chicago Style
• - Vancouver Style
• Writing & Editing Guide
• Academic Resources
• Admissions Resources

How to Write a Case Study | Examples & Methods

What is a case study?

A case study is a research approach that provides an in-depth examination of a particular phenomenon, event, organization, or individual. It involves analyzing and interpreting data to provide a comprehensive understanding of the subject under investigation. 

Case studies can be used in various disciplines, including business, social sciences, medicine ( clinical case report ), engineering, and education. The aim of a case study is to provide an in-depth exploration of a specific subject, often with the goal of generating new insights into the phenomena being studied.

When to write a case study

Case studies are often written to present the findings of an empirical investigation or to illustrate a particular point or theory. They are useful when researchers want to gain an in-depth understanding of a specific phenomenon or when they are interested in exploring new areas of inquiry. 

Case studies are also useful when the subject of the research is rare or when the research question is complex and requires an in-depth examination. A case study can be a good fit for a thesis or dissertation as well.

Case study examples

Below are some examples of case studies with their research questions:

These examples demonstrate the diversity of research questions and case studies that can be explored. From studying small businesses in Ghana to the ethical issues in supply chains, case studies can be used to explore a wide range of phenomena.

Outlying cases vs. representative cases

An outlying case stud y refers to a case that is unusual or deviates significantly from the norm. An example of an outlying case study could be a small, family-run bed and breakfast that was able to survive and even thrive during the COVID-19 pandemic, while other larger hotels struggled to stay afloat.

On the other hand, a representative case study refers to a case that is typical of the phenomenon being studied. An example of a representative case study could be a hotel chain that operates in multiple locations that faced significant challenges during the COVID-19 pandemic, such as reduced demand for hotel rooms, increased safety and health protocols, and supply chain disruptions. The hotel chain case could be representative of the broader hospitality industry during the pandemic, and thus provides an insight into the typical challenges that businesses in the industry faced.

Steps for Writing a Case Study

As with any academic paper, writing a case study requires careful preparation and research before a single word of the document is ever written. Follow these basic steps to ensure that you don’t miss any crucial details when composing your case study.

Step 1: Select a case to analyze

After you have developed your statement of the problem and research question , the first step in writing a case study is to select a case that is representative of the phenomenon being investigated or that provides an outlier. For example, if a researcher wants to explore the impact of COVID-19 on the hospitality industry, they could select a representative case, such as a hotel chain that operates in multiple locations, or an outlying case, such as a small bed and breakfast that was able to pivot their business model to survive during the pandemic. Selecting the appropriate case is critical in ensuring the research question is adequately explored.

Step 2: Create a theoretical framework

Theoretical frameworks are used to guide the analysis and interpretation of data in a case study. The framework should provide a clear explanation of the key concepts, variables, and relationships that are relevant to the research question. The theoretical framework can be drawn from existing literature, or the researcher can develop their own framework based on the data collected. The theoretical framework should be developed early in the research process to guide the data collection and analysis.

To give your case analysis a strong theoretical grounding, be sure to include a literature review of references and sources relating to your topic and develop a clear theoretical framework. Your case study does not simply stand on its own but interacts with other studies related to your topic. Your case study can do one of the following: 

• Demonstrate a theory by showing how it explains the case being investigated
• Broaden a theory by identifying additional concepts and ideas that can be incorporated to strengthen it
• Confront a theory via an outlier case that does not conform to established conclusions or assumptions

Step 3: Collect data for your case study

Data collection can involve a variety of research methods , including interviews, surveys, observations, and document analyses, and it can include both primary and secondary sources . It is essential to ensure that the data collected is relevant to the research question and that it is collected in a systematic and ethical manner. Data collection methods should be chosen based on the research question and the availability of data. It is essential to plan data collection carefully to ensure that the data collected is of high quality

Step 4: Describe the case and analyze the details

The final step is to describe the case in detail and analyze the data collected. This involves identifying patterns and themes that emerge from the data and drawing conclusions that are relevant to the research question. It is essential to ensure that the analysis is supported by the data and that any limitations or alternative explanations are acknowledged.

The manner in which you report your findings depends on the type of research you are doing. Some case studies are structured like a standard academic paper, with separate sections or chapters for the methods section , results section , and discussion section , while others are structured more like a standalone literature review.

Regardless of the topic you choose to pursue, writing a case study requires a systematic and rigorous approach to data collection and analysis. By following the steps outlined above and using examples from existing literature, researchers can create a comprehensive and insightful case study that contributes to the understanding of a particular phenomenon.

Preparing Your Case Study for Publication

After completing the draft of your case study, be sure to revise and edit your work for any mistakes, including grammatical errors , punctuation errors , spelling mistakes, and awkward sentence structure . Ensure that your case study is well-structured and that your arguments are well-supported with language that follows the conventions of academic writing .  To ensure your work is polished for style and free of errors, get English editing services from Wordvice, including our paper editing services and manuscript editing services . Let our academic subject experts enhance the style and flow of your academic work so you can submit your case study with confidence.

How to Write a Case Study

A case study is an in-depth analysis of a specific situation, person, event, phenomenon, time,  place, or company. They look at various elements of the situation including history, trends,  specific outcomes, cause and effect, etc. 

A case study can either be part of a larger research assignment as one of the methodologies used or be a standalone assignment. You can include several case studies in the same paper or focus on just one case. Multiple case studies are useful when comparing different elements of a research question and trying to find similarities or analyzing the reasons where outcomes are different. 

Since the goal of a case study is to get an in-depth understanding of a specific situation, it is perfect for unique cases which may not have a lot of experimental or theoretical data. But this also makes it a very subjective method of analysis, one that cannot be generalized to fit larger groups of data. Case studies are often used in the initial stages of studying a new situation and can help come up with research questions and hypotheses for future studies. 

Don't worry if that all sounds complicated,  by the end of this article you will know not only how to write a case study assignment in college, but how to write a good case study for a scientific publication!

What is a Case Study?

A case study is one of the best ways of analyzing a unique phenomenon. It's particularly useful when the research question cannot be studied in a lab or through quantitative methods. Case studies are used in the social sciences, business, medicine, social work, and government reports. It is tough to have a case study definition because there are five main types of case studies. 

Explanatory 

An explanatory case study explores the cause of a specific event or tries to explain why something happens. These are most often used to analyze events rather than people or groups. 

Exploratory

An exploratory case study is most often used to develop in-depth research questions. They are often precursors to large-scale research about a new topic. The goal of this kind of case study is to find new pieces of information that will help develop hypotheses to be tested in the future. 

Multiple, Collective, or Cumulative

This kind of case study collects information from pre-existing case studies to develop a general theory. This saves time and money, as well as allows researchers to go over pre-existing data to either make generalizations or find differences in previous outcomes. 

An intrinsic case study is a case study where the subject of the study is of particular interest and is the subject of analysis rather than a general theory. This kind of study is useful when looking at a very specific case. 

Instrumental

Instrumental case studies are used to uncover the relationship between two things, or when the focus is not on the subjects, but on the underlying phenomena. 

Struggling with the Case Study Homework?

Get your assignments done by real pros. Save your precious time and boost your marks with ease.

Steps for Writing a Case Study

If you're tasked with writing a case study paper, it's important to begin by developing a strong research question and topic. This can be a daunting task, but there are resources available to help. Consider reaching out to custom writing services or admission essay writer for assistance in developing your research question and selecting a topic.

Once you have your topic and research question, it's time to begin the process of writing your case study paper. This can be a time-consuming and challenging process, but you don't have to go it alone. If you're feeling overwhelmed, consider hiring a coursework writing service or a " write my paper for me " service to help you complete your assignment.

When writing your case study paper, it's important to follow the proper format and structure. Your paper should include an introduction, background information, a description of the case, analysis of the case, and a conclusion. If you're unsure about how to structure your paper, don't hesitate to reach out for help from a do my essay for me service or a professional writer.

By working with custom writing services or professional writers, you can ensure that your case study paper is well-written, properly formatted, and meets all of your professor's requirements. Don't let the stress of writing a case study paper get in the way of your academic success - get the help you need today and watch your grades soar!

Step 1. Choosing a specific case

Once you have your research questions you are ready to think about what specific case answers those questions best. First, think about the different types of case studies and figure out which one is most applicable in your situation. Next, think about the kinds of questions that you want to find answers to, or the kinds of questions you want to uncover. Ask yourself

• Is the case you are interested in unique with the potential to uncover new kinds of information?
• Does the case you are interested in allow exploring a pre-existing idea or theory more in-depth?
• Does the case you are interested in have a conclusion or insight that is opposite or different from pre-existing ideas about the subject?
• Does the case you are interested in have the potential to solve a problem?
• Is the point of your case to come up with new hypotheses for future research?

As long as you think about these questions, you should be able to come up with a case that will both answer your research questions as well as provide relevant information.

Step 2. The literature review

Before jumping into collecting your data and running your experiments or interviews you should familiarize yourself with the pre-existing theoretical framework. Not only will this help you devise your data accumulation methodology, but it will also give you information to help describe and analyze your case. Some case studies may not have an extensive amount of pre-existing theories to go over, but doing a literature review is always going to be beneficial. 

Go over your lecture notes and textbook to see which theories are relevant to your case. Ask your friends, professors, and experts in the field for advice on what to research. Once you have a general idea of what topics to look into, use library resources and the internet to familiarize yourself with theories that may apply to your case and previous case study examples that are similar to yours. Looking into a similar example of a case study will make sure that you don't repeat research that has already happened, help you understand how to do a case study, give you guidance about how you should collect your data, and give you a case study template. 

Step 3. Collecting data

Data collection methodologies for a case study are usually qualitative rather than quantitative.  You can employ methods such as interviews and focus groups to collect specific or new types of data, or you can look at primary and secondary sources like journals, newspapers, online publications, etc. to collect information. 

Data collection for case studies can seem difficult because there is no specific goal that you are trying to reach. The goal is to collect as much relevant information as possible and develop your conclusions based on the data. Try to organize your data either thematically, chronologically, or in whatever way that makes the most sense to you. This will help when analyzing and describing while writing a case study in the next step.

Step 4. Writing the paper 

It's finally time to learn how to write a case study essay! Writing a case study is a complicated process because it does not follow the standard five-paragraph model of essay writing. The next section dives deep into actually writing a case study.

Did you like our Case Study Guide?

For more help, tap into our pool of professional writers and get expert essay editing services!‍

How to Format a Case Study

A case study can be structured in a few different ways depending on the type of case study and the subject being analyzed. You can go over some examples of case studies, but in general, there are five sections in a case study outline; introduction, literature review, method, discussion, and conclusion. Let's go over each section in a case study format in depth. 

Introduction 

The first few sentences of the case study should present the question you are answering or the case you are exploring interestingly so that you grab the reader's interest. Give some background information about the topic you are looking into and some details about the case you are going to present highlighting how the two are related. Make sure you mention why the research question is important and why the case you have chosen enhances information about that topic. Write a brief summary of your literature review, highlighting important theories or previous case studies that you plan to build upon. Finally, end your introduction with the potential ways that your case study can be used in the future. 

Literature Review

Your first body paragraph should go over the literature review. The goal of this section is to present information to the reader that allows them to understand the current state of research in a given topic as well as help them understand why your case study is important. 

If there is a lot of research about your topic, summarize the main findings of that research and explain why the case you’re exploring expands information about the topic. Present case studies examples that answer similar research questions using a different research methodology and explain why your methodology is beneficial. Talk about the main theories that are related to your topic giving brief descriptions of each one as well as talking about why these theories are important to your case study. 

By the end of your literature review section, the reader should have theoretical knowledge of your topic and be familiar with what kind of research has already happened. Most importantly, they should know how your case study fills a knowledge gap, enhances knowledge by analyzing a problem differently, or shows new directions for further research. 

This is the section where you present your case. Start by explaining why you chose your particular case and how it relates to the larger research question. Then explain why you chose the specific research method you did.  

Give all the important background details of your case. If your case is about a specific person, spend some time going over the person’s history and the specific incident or situation you are looking into. If your case is about an event or situation, give background information about the company, time, pre-existing theoretical frameworks, or literature. 

If you have run a focus group or conducted interviews, give the details of how you chose your participants, why you chose specific questions, and then the answers and data that you gathered.

Essentially the goal of this section is to present the new information that you have discovered. 

The discussion section combines your findings with the case study analysis. This is where you draw conclusions based on your research and connect them to your research question. Start this paragraph by restating your research questions and thesis. Briefly go over why you chose your case and how it relates to the topic, then present your findings. 

State your main finding and explain why it is important. If it is surprising, connect it to existing literature and explain why it is surprising. If it enhances the understanding of a specific topic, explain how it differs from the results of previous case studies. Do this for any other important results from your case study. Remember to explain why each one is important and how the results can be generalized beyond just your specific case study. 

Compare your case study to previous case studies done on similar topics. If the findings of your case study are different from the findings of previous similar case studies, explain why this is so. For example, this could be because of different research methodologies, different target audiences, generational changes, or you could have uncovered a new way of thinking about a problem. By comparing your case study to pre-existing case studies you can show either how you have answered a question raised previously, or how your case study findings can prompt future research. 

Towards the end of your discussion section, you should consider alternative explanations for your case study findings. Because case studies often look into not well-understood areas of research or are about very specific cases, the findings can be interpreted subjectively. Go over other possible interpretations of your findings to show that you have deeply considered your results. 

In most academic papers, the limitations of your study and avenues for possible research are included in the conclusion, but for a case study, they are important sections of the main discussion. While acknowledging the limitations of your study, you get a chance to explain why those limitations may not apply to your case. Use this as an opportunity to explain why certain questions could not be answered by your case study. This is also why suggesting avenues for further research make sense here. Make suggestions for research based on the limitations of your study or surprising results in your findings. 

The main goal of your conclusion is to explain why your case study and its findings are important. Repeat your research question and thesis and state your main findings clearly. Give a brief overview of the most important pre-existing case studies or theories related to your case and explain how your findings have expanded on that information. Finally, explain how your case studies and findings can contribute to further research. 

Whether it’s how to write a student case study, how to write a business case study, how to write a case study analysis, you now know how to make a case study! Writing a good case study can be challenging because it requires both a literature review as well as original research. Case studies are often used in the business world for marketing, in the social sciences for psychology, sociology, and anthropology, as well as in medicine. So, learning to write a case study is important! If you need help with writing a case study, the experts at Studyfy are always eager to lend a hand. 

Featured Posts

How to write a scholarship essay.

How to Write a Movie Review

How‌ ‌to‌ ‌Write‌ ‌an‌ ‌Argumentative‌ ‌Essay

How to Write a Cause and Effect Essay

How to Write an Expository Essay

How to Write an Analytical Essay

Have a language expert improve your writing

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

• Knowledge Base

Methodology

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

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

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

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

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

Table of contents

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

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

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

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

Prevent plagiarism. Run a free check.

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

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

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

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

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

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

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

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

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

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

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

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

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

Receive feedback on language, structure, and formatting

Professional editors proofread and edit your paper by focusing on:

• Academic style
• Vague sentences
• Style consistency

See an example

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

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

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

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

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

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

Research bias

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

Cite this Scribbr article

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

McCombes, S. (2023, November 20). What Is a Case Study? | Definition, Examples & Methods. Scribbr. Retrieved April 9, 2024, from https://www.scribbr.com/methodology/case-study/

Is this article helpful?

Shona McCombes

Other students also liked, primary vs. secondary sources | difference & examples, what is a theoretical framework | guide to organizing, what is action research | definition & examples, what is your plagiarism score.

We use essential cookies to make Venngage work. By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts.

Manage Cookies

Cookies and similar technologies collect certain information about how you’re using our website. Some of them are essential, and without them you wouldn’t be able to use Venngage. But others are optional, and you get to choose whether we use them or not.

Strictly Necessary Cookies

These cookies are always on, as they’re essential for making Venngage work, and making it safe. Without these cookies, services you’ve asked for can’t be provided.

Show cookie providers

• Google Login

Functionality Cookies

These cookies help us provide enhanced functionality and personalisation, and remember your settings. They may be set by us or by third party providers.

Performance Cookies

These cookies help us analyze how many people are using Venngage, where they come from and how they're using it. If you opt out of these cookies, we can’t get feedback to make Venngage better for you and all our users.

• Google Analytics

Targeting Cookies

These cookies are set by our advertising partners to track your activity and show you relevant Venngage ads on other sites as you browse the internet.

• Google Tag Manager
• Infographics
• Daily Infographics
• Graphic Design
• Graphs and Charts
• Data Visualization
• Human Resources
• Training and Development
• Beginner Guides

Blog Case Study

How to Present a Case Study like a Pro (With Examples)

By Danesh Ramuthi , Sep 07, 2023

Okay, let’s get real: case studies can be kinda snooze-worthy. But guess what? They don’t have to be!

In this article, I will cover every element that transforms a mere report into a compelling case study, from selecting the right metrics to using persuasive narrative techniques.

And if you’re feeling a little lost, don’t worry! There are cool tools like Venngage’s Case Study Creator to help you whip up something awesome, even if you’re short on time. Plus, the pre-designed case study templates are like instant polish because let’s be honest, everyone loves a shortcut.

Click to jump ahead: 

What is a case study presentation?

What is the purpose of presenting a case study, how to structure a case study presentation, how long should a case study presentation be, 5 case study presentation examples with templates, 6 tips for delivering an effective case study presentation, 5 common mistakes to avoid in a case study presentation, how to present a case study faqs.

A case study presentation involves a comprehensive examination of a specific subject, which could range from an individual, group, location, event, organization or phenomenon.

They’re like puzzles you get to solve with the audience, all while making you think outside the box.

Unlike a basic report or whitepaper, the purpose of a case study presentation is to stimulate critical thinking among the viewers. 

The primary objective of a case study is to provide an extensive and profound comprehension of the chosen topic. You don’t just throw numbers at your audience. You use examples and real-life cases to make you think and see things from different angles.

The primary purpose of presenting a case study is to offer a comprehensive, evidence-based argument that informs, persuades and engages your audience.

Here’s the juicy part: presenting that case study can be your secret weapon. Whether you’re pitching a groundbreaking idea to a room full of suits or trying to impress your professor with your A-game, a well-crafted case study can be the magic dust that sprinkles brilliance over your words.

Think of it like digging into a puzzle you can’t quite crack . A case study lets you explore every piece, turn it over and see how it fits together. This close-up look helps you understand the whole picture, not just a blurry snapshot.

It’s also your chance to showcase how you analyze things, step by step, until you reach a conclusion. It’s all about being open and honest about how you got there.

Besides, presenting a case study gives you an opportunity to connect data and real-world scenarios in a compelling narrative. It helps to make your argument more relatable and accessible, increasing its impact on your audience.

One of the contexts where case studies can be very helpful is during the job interview. In some job interviews, you as candidates may be asked to present a case study as part of the selection process.

Having a case study presentation prepared allows the candidate to demonstrate their ability to understand complex issues, formulate strategies and communicate their ideas effectively.

The way you present a case study can make all the difference in how it’s received. A well-structured presentation not only holds the attention of your audience but also ensures that your key points are communicated clearly and effectively.

In this section, let’s go through the key steps that’ll help you structure your case study presentation for maximum impact.

Let’s get into it. 

Open with an introductory overview 

Start by introducing the subject of your case study and its relevance. Explain why this case study is important and who would benefit from the insights gained. This is your opportunity to grab your audience’s attention.

Explain the problem in question

Dive into the problem or challenge that the case study focuses on. Provide enough background information for the audience to understand the issue. If possible, quantify the problem using data or metrics to show the magnitude or severity.

Detail the solutions to solve the problem

After outlining the problem, describe the steps taken to find a solution. This could include the methodology, any experiments or tests performed and the options that were considered. Make sure to elaborate on why the final solution was chosen over the others.

Key stakeholders Involved

Talk about the individuals, groups or organizations that were directly impacted by or involved in the problem and its solution. 

Stakeholders may experience a range of outcomes—some may benefit, while others could face setbacks.

For example, in a business transformation case study, employees could face job relocations or changes in work culture, while shareholders might be looking at potential gains or losses.

Discuss the key results & outcomes

Discuss the results of implementing the solution. Use data and metrics to back up your statements. Did the solution meet its objectives? What impact did it have on the stakeholders? Be honest about any setbacks or areas for improvement as well.

Include visuals to support your analysis

Visual aids can be incredibly effective in helping your audience grasp complex issues. Utilize charts, graphs, images or video clips to supplement your points. Make sure to explain each visual and how it contributes to your overall argument.

Pie charts illustrate the proportion of different components within a whole, useful for visualizing market share, budget allocation or user demographics.

This is particularly useful especially if you’re displaying survey results in your case study presentation.

Stacked charts on the other hand are perfect for visualizing composition and trends. This is great for analyzing things like customer demographics, product breakdowns or budget allocation in your case study.

Consider this example of a stacked bar chart template. It provides a straightforward summary of the top-selling cake flavors across various locations, offering a quick and comprehensive view of the data.

Not the chart you’re looking for? Browse Venngage’s gallery of chart templates to find the perfect one that’ll captivate your audience and level up your data storytelling.

Recommendations and next steps

Wrap up by providing recommendations based on the case study findings. Outline the next steps that stakeholders should take to either expand on the success of the project or address any remaining challenges.

Acknowledgments and references

Thank the people who contributed to the case study and helped in the problem-solving process. Cite any external resources, reports or data sets that contributed to your analysis.

Feedback & Q&A session

Open the floor for questions and feedback from your audience. This allows for further discussion and can provide additional insights that may not have been considered previously.

Closing remarks

Conclude the presentation by summarizing the key points and emphasizing the takeaways. Thank your audience for their time and participation and express your willingness to engage in further discussions or collaborations on the subject.

Well, the length of a case study presentation can vary depending on the complexity of the topic and the needs of your audience. However, a typical business or academic presentation often lasts between 15 to 30 minutes. 

This time frame usually allows for a thorough explanation of the case while maintaining audience engagement. However, always consider leaving a few minutes at the end for a Q&A session to address any questions or clarify points made during the presentation.

When it comes to presenting a compelling case study, having a well-structured template can be a game-changer. 

It helps you organize your thoughts, data and findings in a coherent and visually pleasing manner. 

Not all case studies are created equal and different scenarios require distinct approaches for maximum impact. 

To save you time and effort, I have curated a list of 5 versatile case study presentation templates, each designed for specific needs and audiences. 

Here are some best case study presentation examples that showcase effective strategies for engaging your audience and conveying complex information clearly.

1 . Lab report case study template

Ever feel like your research gets lost in a world of endless numbers and jargon? Lab case studies are your way out!

Think of it as building a bridge between your cool experiment and everyone else. It’s more than just reporting results – it’s explaining the “why” and “how” in a way that grabs attention and makes sense.

This lap report template acts as a blueprint for your report, guiding you through each essential section (introduction, methods, results, etc.) in a logical order.

Want to present your research like a pro? Browse our research presentation template gallery for creative inspiration!

2. Product case study template

It’s time you ditch those boring slideshows and bullet points because I’ve got a better way to win over clients: product case study templates.

Instead of just listing features and benefits, you get to create a clear and concise story that shows potential clients exactly what your product can do for them. It’s like painting a picture they can easily visualize, helping them understand the value your product brings to the table.

Grab the template below, fill in the details, and watch as your product’s impact comes to life!

3. Content marketing case study template

In digital marketing, showcasing your accomplishments is as vital as achieving them. 

A well-crafted case study not only acts as a testament to your successes but can also serve as an instructional tool for others. 

With this coral content marketing case study template—a perfect blend of vibrant design and structured documentation, you can narrate your marketing triumphs effectively.

4. Case study psychology template

Understanding how people tick is one of psychology’s biggest quests and case studies are like magnifying glasses for the mind. They offer in-depth looks at real-life behaviors, emotions and thought processes, revealing fascinating insights into what makes us human.

Writing a top-notch case study, though, can be a challenge. It requires careful organization, clear presentation and meticulous attention to detail. That’s where a good case study psychology template comes in handy.

Think of it as a helpful guide, taking care of formatting and structure while you focus on the juicy content. No more wrestling with layouts or margins – just pour your research magic into crafting a compelling narrative.

5. Lead generation case study template

Lead generation can be a real head-scratcher. But here’s a little help: a lead generation case study.

Think of it like a friendly handshake and a confident resume all rolled into one. It’s your chance to showcase your expertise, share real-world successes and offer valuable insights. Potential clients get to see your track record, understand your approach and decide if you’re the right fit.

No need to start from scratch, though. This lead generation case study template guides you step-by-step through crafting a clear, compelling narrative that highlights your wins and offers actionable tips for others. Fill in the gaps with your specific data and strategies, and voilà! You’ve got a powerful tool to attract new customers.

Related: 15+ Professional Case Study Examples [Design Tips + Templates]

So, you’ve spent hours crafting the perfect case study and are now tasked with presenting it. Crafting the case study is only half the battle; delivering it effectively is equally important. 

Whether you’re facing a room of executives, academics or potential clients, how you present your findings can make a significant difference in how your work is received. 

Forget boring reports and snooze-inducing presentations! Let’s make your case study sing. Here are some key pointers to turn information into an engaging and persuasive performance:

• Know your audience : Tailor your presentation to the knowledge level and interests of your audience. Remember to use language and examples that resonate with them.
• Rehearse : Rehearsing your case study presentation is the key to a smooth delivery and for ensuring that you stay within the allotted time. Practice helps you fine-tune your pacing, hone your speaking skills with good word pronunciations and become comfortable with the material, leading to a more confident, conversational and effective presentation.
• Start strong : Open with a compelling introduction that grabs your audience’s attention. You might want to use an interesting statistic, a provocative question or a brief story that sets the stage for your case study.
• Be clear and concise : Avoid jargon and overly complex sentences. Get to the point quickly and stay focused on your objectives.
• Use visual aids : Incorporate slides with graphics, charts or videos to supplement your verbal presentation. Make sure they are easy to read and understand.
• Tell a story : Use storytelling techniques to make the case study more engaging. A well-told narrative can help you make complex data more relatable and easier to digest.

Ditching the dry reports and slide decks? Venngage’s case study templates let you wow customers with your solutions and gain insights to improve your business plan. Pre-built templates, visual magic and customer captivation – all just a click away. Go tell your story and watch them say “wow!”

Nailed your case study, but want to make your presentation even stronger? Avoid these common mistakes to ensure your audience gets the most out of it:

Overloading with information

A case study is not an encyclopedia. Overloading your presentation with excessive data, text or jargon can make it cumbersome and difficult for the audience to digest the key points. Stick to what’s essential and impactful. Need help making your data clear and impactful? Our data presentation templates can help! Find clear and engaging visuals to showcase your findings.

Lack of structure

Jumping haphazardly between points or topics can confuse your audience. A well-structured presentation, with a logical flow from introduction to conclusion, is crucial for effective communication.

Ignoring the audience

Different audiences have different needs and levels of understanding. Failing to adapt your presentation to your audience can result in a disconnect and a less impactful presentation.

Poor visual elements

While content is king, poor design or lack of visual elements can make your case study dull or hard to follow. Make sure you use high-quality images, graphs and other visual aids to support your narrative.

Not focusing on results

A case study aims to showcase a problem and its solution, but what most people care about are the results. Failing to highlight or adequately explain the outcomes can make your presentation fall flat.

How to start a case study presentation?

Starting a case study presentation effectively involves a few key steps:

• Grab attention : Open with a hook—an intriguing statistic, a provocative question or a compelling visual—to engage your audience from the get-go.
• Set the stage : Briefly introduce the subject, context and relevance of the case study to give your audience an idea of what to expect.
• Outline objectives : Clearly state what the case study aims to achieve. Are you solving a problem, proving a point or showcasing a success?
• Agenda : Give a quick outline of the key sections or topics you’ll cover to help the audience follow along.
• Set expectations : Let your audience know what you want them to take away from the presentation, whether it’s knowledge, inspiration or a call to action.

How to present a case study on PowerPoint and on Google Slides?

Presenting a case study on PowerPoint and Google Slides involves a structured approach for clarity and impact using presentation slides :

• Title slide : Start with a title slide that includes the name of the case study, your name and any relevant institutional affiliations.
• Introduction : Follow with a slide that outlines the problem or situation your case study addresses. Include a hook to engage the audience.
• Objectives : Clearly state the goals of the case study in a dedicated slide.
• Findings : Use charts, graphs and bullet points to present your findings succinctly.
• Analysis : Discuss what the findings mean, drawing on supporting data or secondary research as necessary.
• Conclusion : Summarize key takeaways and results.
• Q&A : End with a slide inviting questions from the audience.

What’s the role of analysis in a case study presentation?

The role of analysis in a case study presentation is to interpret the data and findings, providing context and meaning to them. 

It helps your audience understand the implications of the case study, connects the dots between the problem and the solution and may offer recommendations for future action.

Is it important to include real data and results in the presentation?

Yes, including real data and results in a case study presentation is crucial to show experience,  credibility and impact. Authentic data lends weight to your findings and conclusions, enabling the audience to trust your analysis and take your recommendations more seriously

How do I conclude a case study presentation effectively?

To conclude a case study presentation effectively, summarize the key findings, insights and recommendations in a clear and concise manner. 

End with a strong call-to-action or a thought-provoking question to leave a lasting impression on your audience.

What’s the best way to showcase data in a case study presentation ?

The best way to showcase data in a case study presentation is through visual aids like charts, graphs and infographics which make complex information easily digestible, engaging and creative. 

Don’t just report results, visualize them! This template for example lets you transform your social media case study into a captivating infographic that sparks conversation.

Choose the type of visual that best represents the data you’re showing; for example, use bar charts for comparisons or pie charts for parts of a whole. 

Ensure that the visuals are high-quality and clearly labeled, so the audience can quickly grasp the key points. 

Keep the design consistent and simple, avoiding clutter or overly complex visuals that could distract from the message.

Choose a template that perfectly suits your case study where you can utilize different visual aids for maximum impact. 

Need more inspiration on how to turn numbers into impact with the help of infographics? Our ready-to-use infographic templates take the guesswork out of creating visual impact for your case studies with just a few clicks.

Related: 10+ Case Study Infographic Templates That Convert

Congrats on mastering the art of compelling case study presentations! This guide has equipped you with all the essentials, from structure and nuances to avoiding common pitfalls. You’re ready to impress any audience, whether in the boardroom, the classroom or beyond.

And remember, you’re not alone in this journey. Venngage’s Case Study Creator is your trusty companion, ready to elevate your presentations from ordinary to extraordinary. So, let your confidence shine, leverage your newly acquired skills and prepare to deliver presentations that truly resonate.

Go forth and make a lasting impact!

Organizing Your Social Sciences Research Assignments

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

Definition and Introduction

Case analysis is a problem-based teaching and learning method that involves critically analyzing complex scenarios within an organizational setting for the purpose of placing the student in a “real world” situation and applying reflection and critical thinking skills to contemplate appropriate solutions, decisions, or recommended courses of action. It is considered a more effective teaching technique than in-class role playing or simulation activities. The analytical process is often guided by questions provided by the instructor that ask students to contemplate relationships between the facts and critical incidents described in the case.

Cases generally include both descriptive and statistical elements and rely on students applying abductive reasoning to develop and argue for preferred or best outcomes [i.e., case scenarios rarely have a single correct or perfect answer based on the evidence provided]. Rather than emphasizing theories or concepts, case analysis assignments emphasize building a bridge of relevancy between abstract thinking and practical application and, by so doing, teaches the value of both within a specific area of professional practice.

Given this, the purpose of a case analysis paper is to present a structured and logically organized format for analyzing the case situation. It can be assigned to students individually or as a small group assignment and it may include an in-class presentation component. Case analysis is predominately taught in economics and business-related courses, but it is also a method of teaching and learning found in other applied social sciences disciplines, such as, social work, public relations, education, journalism, and public administration.

Ellet, William. The Case Study Handbook: A Student's Guide . Revised Edition. Boston, MA: Harvard Business School Publishing, 2018; Christoph Rasche and Achim Seisreiner. Guidelines for Business Case Analysis . University of Potsdam; Writing a Case Analysis . Writing Center, Baruch College; Volpe, Guglielmo. "Case Teaching in Economics: History, Practice and Evidence." Cogent Economics and Finance 3 (December 2015). doi:https://doi.org/10.1080/23322039.2015.1120977.

How to Approach Writing a Case Analysis Paper

The organization and structure of a case analysis paper can vary depending on the organizational setting, the situation, and how your professor wants you to approach the assignment. Nevertheless, preparing to write a case analysis paper involves several important steps. As Hawes notes, a case analysis assignment “...is useful in developing the ability to get to the heart of a problem, analyze it thoroughly, and to indicate the appropriate solution as well as how it should be implemented” [p.48]. This statement encapsulates how you should approach preparing to write a case analysis paper.

Before you begin to write your paper, consider the following analytical procedures:

• Review the case to get an overview of the situation . A case can be only a few pages in length, however, it is most often very lengthy and contains a significant amount of detailed background information and statistics, with multilayered descriptions of the scenario, the roles and behaviors of various stakeholder groups, and situational events. Therefore, a quick reading of the case will help you gain an overall sense of the situation and illuminate the types of issues and problems that you will need to address in your paper. If your professor has provided questions intended to help frame your analysis, use them to guide your initial reading of the case.
• Read the case thoroughly . After gaining a general overview of the case, carefully read the content again with the purpose of understanding key circumstances, events, and behaviors among stakeholder groups. Look for information or data that appears contradictory, extraneous, or misleading. At this point, you should be taking notes as you read because this will help you develop a general outline of your paper. The aim is to obtain a complete understanding of the situation so that you can begin contemplating tentative answers to any questions your professor has provided or, if they have not provided, developing answers to your own questions about the case scenario and its connection to the course readings,lectures, and class discussions.
• Determine key stakeholder groups, issues, and events and the relationships they all have to each other . As you analyze the content, pay particular attention to identifying individuals, groups, or organizations described in the case and identify evidence of any problems or issues of concern that impact the situation in a negative way. Other things to look for include identifying any assumptions being made by or about each stakeholder, potential biased explanations or actions, explicit demands or ultimatums , and the underlying concerns that motivate these behaviors among stakeholders. The goal at this stage is to develop a comprehensive understanding of the situational and behavioral dynamics of the case and the explicit and implicit consequences of each of these actions.
• Identify the core problems . The next step in most case analysis assignments is to discern what the core [i.e., most damaging, detrimental, injurious] problems are within the organizational setting and to determine their implications. The purpose at this stage of preparing to write your analysis paper is to distinguish between the symptoms of core problems and the core problems themselves and to decide which of these must be addressed immediately and which problems do not appear critical but may escalate over time. Identify evidence from the case to support your decisions by determining what information or data is essential to addressing the core problems and what information is not relevant or is misleading.
• Explore alternative solutions . As noted, case analysis scenarios rarely have only one correct answer. Therefore, it is important to keep in mind that the process of analyzing the case and diagnosing core problems, while based on evidence, is a subjective process open to various avenues of interpretation. This means that you must consider alternative solutions or courses of action by critically examining strengths and weaknesses, risk factors, and the differences between short and long-term solutions. For each possible solution or course of action, consider the consequences they may have related to their implementation and how these recommendations might lead to new problems. Also, consider thinking about your recommended solutions or courses of action in relation to issues of fairness, equity, and inclusion.
• Decide on a final set of recommendations . The last stage in preparing to write a case analysis paper is to assert an opinion or viewpoint about the recommendations needed to help resolve the core problems as you see them and to make a persuasive argument for supporting this point of view. Prepare a clear rationale for your recommendations based on examining each element of your analysis. Anticipate possible obstacles that could derail their implementation. Consider any counter-arguments that could be made concerning the validity of your recommended actions. Finally, describe a set of criteria and measurable indicators that could be applied to evaluating the effectiveness of your implementation plan.

Use these steps as the framework for writing your paper. Remember that the more detailed you are in taking notes as you critically examine each element of the case, the more information you will have to draw from when you begin to write. This will save you time.

NOTE : If the process of preparing to write a case analysis paper is assigned as a student group project, consider having each member of the group analyze a specific element of the case, including drafting answers to the corresponding questions used by your professor to frame the analysis. This will help make the analytical process more efficient and ensure that the distribution of work is equitable. This can also facilitate who is responsible for drafting each part of the final case analysis paper and, if applicable, the in-class presentation.

Framework for Case Analysis . College of Management. University of Massachusetts; Hawes, Jon M. "Teaching is Not Telling: The Case Method as a Form of Interactive Learning." Journal for Advancement of Marketing Education 5 (Winter 2004): 47-54; Rasche, Christoph and Achim Seisreiner. Guidelines for Business Case Analysis . University of Potsdam; Writing a Case Study Analysis . University of Arizona Global Campus Writing Center; Van Ness, Raymond K. A Guide to Case Analysis . School of Business. State University of New York, Albany; Writing a Case Analysis . Business School, University of New South Wales.

Structure and Writing Style

A case analysis paper should be detailed, concise, persuasive, clearly written, and professional in tone and in the use of language . As with other forms of college-level academic writing, declarative statements that convey information, provide a fact, or offer an explanation or any recommended courses of action should be based on evidence. If allowed by your professor, any external sources used to support your analysis, such as course readings, should be properly cited under a list of references. The organization and structure of case analysis papers can vary depending on your professor’s preferred format, but its structure generally follows the steps used for analyzing the case.

Introduction

The introduction should provide a succinct but thorough descriptive overview of the main facts, issues, and core problems of the case . The introduction should also include a brief summary of the most relevant details about the situation and organizational setting. This includes defining the theoretical framework or conceptual model on which any questions were used to frame your analysis.

Following the rules of most college-level research papers, the introduction should then inform the reader how the paper will be organized. This includes describing the major sections of the paper and the order in which they will be presented. Unless you are told to do so by your professor, you do not need to preview your final recommendations in the introduction. U nlike most college-level research papers , the introduction does not include a statement about the significance of your findings because a case analysis assignment does not involve contributing new knowledge about a research problem.

Background Analysis

Background analysis can vary depending on any guiding questions provided by your professor and the underlying concept or theory that the case is based upon. In general, however, this section of your paper should focus on:

• Providing an overarching analysis of problems identified from the case scenario, including identifying events that stakeholders find challenging or troublesome,
• Identifying assumptions made by each stakeholder and any apparent biases they may exhibit,
• Describing any demands or claims made by or forced upon key stakeholders, and
• Highlighting any issues of concern or complaints expressed by stakeholders in response to those demands or claims.

These aspects of the case are often in the form of behavioral responses expressed by individuals or groups within the organizational setting. However, note that problems in a case situation can also be reflected in data [or the lack thereof] and in the decision-making, operational, cultural, or institutional structure of the organization. Additionally, demands or claims can be either internal and external to the organization [e.g., a case analysis involving a president considering arms sales to Saudi Arabia could include managing internal demands from White House advisors as well as demands from members of Congress].

Throughout this section, present all relevant evidence from the case that supports your analysis. Do not simply claim there is a problem, an assumption, a demand, or a concern; tell the reader what part of the case informed how you identified these background elements.

Identification of Problems

In most case analysis assignments, there are problems, and then there are problems . Each problem can reflect a multitude of underlying symptoms that are detrimental to the interests of the organization. The purpose of identifying problems is to teach students how to differentiate between problems that vary in severity, impact, and relative importance. Given this, problems can be described in three general forms: those that must be addressed immediately, those that should be addressed but the impact is not severe, and those that do not require immediate attention and can be set aside for the time being.

All of the problems you identify from the case should be identified in this section of your paper, with a description based on evidence explaining the problem variances. If the assignment asks you to conduct research to further support your assessment of the problems, include this in your explanation. Remember to cite those sources in a list of references. Use specific evidence from the case and apply appropriate concepts, theories, and models discussed in class or in relevant course readings to highlight and explain the key problems [or problem] that you believe must be solved immediately and describe the underlying symptoms and why they are so critical.

Alternative Solutions

This section is where you provide specific, realistic, and evidence-based solutions to the problems you have identified and make recommendations about how to alleviate the underlying symptomatic conditions impacting the organizational setting. For each solution, you must explain why it was chosen and provide clear evidence to support your reasoning. This can include, for example, course readings and class discussions as well as research resources, such as, books, journal articles, research reports, or government documents. In some cases, your professor may encourage you to include personal, anecdotal experiences as evidence to support why you chose a particular solution or set of solutions. Using anecdotal evidence helps promote reflective thinking about the process of determining what qualifies as a core problem and relevant solution .

Throughout this part of the paper, keep in mind the entire array of problems that must be addressed and describe in detail the solutions that might be implemented to resolve these problems.

Recommended Courses of Action

In some case analysis assignments, your professor may ask you to combine the alternative solutions section with your recommended courses of action. However, it is important to know the difference between the two. A solution refers to the answer to a problem. A course of action refers to a procedure or deliberate sequence of activities adopted to proactively confront a situation, often in the context of accomplishing a goal. In this context, proposed courses of action are based on your analysis of alternative solutions. Your description and justification for pursuing each course of action should represent the overall plan for implementing your recommendations.

For each course of action, you need to explain the rationale for your recommendation in a way that confronts challenges, explains risks, and anticipates any counter-arguments from stakeholders. Do this by considering the strengths and weaknesses of each course of action framed in relation to how the action is expected to resolve the core problems presented, the possible ways the action may affect remaining problems, and how the recommended action will be perceived by each stakeholder.

In addition, you should describe the criteria needed to measure how well the implementation of these actions is working and explain which individuals or groups are responsible for ensuring your recommendations are successful. In addition, always consider the law of unintended consequences. Outline difficulties that may arise in implementing each course of action and describe how implementing the proposed courses of action [either individually or collectively] may lead to new problems [both large and small].

Throughout this section, you must consider the costs and benefits of recommending your courses of action in relation to uncertainties or missing information and the negative consequences of success.

The conclusion should be brief and introspective. Unlike a research paper, the conclusion in a case analysis paper does not include a summary of key findings and their significance, a statement about how the study contributed to existing knowledge, or indicate opportunities for future research.

Begin by synthesizing the core problems presented in the case and the relevance of your recommended solutions. This can include an explanation of what you have learned about the case in the context of your answers to the questions provided by your professor. The conclusion is also where you link what you learned from analyzing the case with the course readings or class discussions. This can further demonstrate your understanding of the relationships between the practical case situation and the theoretical and abstract content of assigned readings and other course content.

Problems to Avoid

The literature on case analysis assignments often includes examples of difficulties students have with applying methods of critical analysis and effectively reporting the results of their assessment of the situation. A common reason cited by scholars is that the application of this type of teaching and learning method is limited to applied fields of social and behavioral sciences and, as a result, writing a case analysis paper can be unfamiliar to most students entering college.

After you have drafted your paper, proofread the narrative flow and revise any of these common errors:

• Unnecessary detail in the background section . The background section should highlight the essential elements of the case based on your analysis. Focus on summarizing the facts and highlighting the key factors that become relevant in the other sections of the paper by eliminating any unnecessary information.
• Analysis relies too much on opinion . Your analysis is interpretive, but the narrative must be connected clearly to evidence from the case and any models and theories discussed in class or in course readings. Any positions or arguments you make should be supported by evidence.
• Analysis does not focus on the most important elements of the case . Your paper should provide a thorough overview of the case. However, the analysis should focus on providing evidence about what you identify are the key events, stakeholders, issues, and problems. Emphasize what you identify as the most critical aspects of the case to be developed throughout your analysis. Be thorough but succinct.
• Writing is too descriptive . A paper with too much descriptive information detracts from your analysis of the complexities of the case situation. Questions about what happened, where, when, and by whom should only be included as essential information leading to your examination of questions related to why, how, and for what purpose.
• Inadequate definition of a core problem and associated symptoms . A common error found in case analysis papers is recommending a solution or course of action without adequately defining or demonstrating that you understand the problem. Make sure you have clearly described the problem and its impact and scope within the organizational setting. Ensure that you have adequately described the root causes w hen describing the symptoms of the problem.
• Recommendations lack specificity . Identify any use of vague statements and indeterminate terminology, such as, “A particular experience” or “a large increase to the budget.” These statements cannot be measured and, as a result, there is no way to evaluate their successful implementation. Provide specific data and use direct language in describing recommended actions.
• Unrealistic, exaggerated, or unattainable recommendations . Review your recommendations to ensure that they are based on the situational facts of the case. Your recommended solutions and courses of action must be based on realistic assumptions and fit within the constraints of the situation. Also note that the case scenario has already happened, therefore, any speculation or arguments about what could have occurred if the circumstances were different should be revised or eliminated.

Bee, Lian Song et al. "Business Students' Perspectives on Case Method Coaching for Problem-Based Learning: Impacts on Student Engagement and Learning Performance in Higher Education." Education & Training 64 (2022): 416-432; The Case Analysis . Fred Meijer Center for Writing and Michigan Authors. Grand Valley State University; Georgallis, Panikos and Kayleigh Bruijn. "Sustainability Teaching using Case-Based Debates." Journal of International Education in Business 15 (2022): 147-163; Hawes, Jon M. "Teaching is Not Telling: The Case Method as a Form of Interactive Learning." Journal for Advancement of Marketing Education 5 (Winter 2004): 47-54; Georgallis, Panikos, and Kayleigh Bruijn. "Sustainability Teaching Using Case-based Debates." Journal of International Education in Business 15 (2022): 147-163; .Dean,  Kathy Lund and Charles J. Fornaciari. "How to Create and Use Experiential Case-Based Exercises in a Management Classroom." Journal of Management Education 26 (October 2002): 586-603; Klebba, Joanne M. and Janet G. Hamilton. "Structured Case Analysis: Developing Critical Thinking Skills in a Marketing Case Course." Journal of Marketing Education 29 (August 2007): 132-137, 139; Klein, Norman. "The Case Discussion Method Revisited: Some Questions about Student Skills." Exchange: The Organizational Behavior Teaching Journal 6 (November 1981): 30-32; Mukherjee, Arup. "Effective Use of In-Class Mini Case Analysis for Discovery Learning in an Undergraduate MIS Course." The Journal of Computer Information Systems 40 (Spring 2000): 15-23; Pessoa, Silviaet al. "Scaffolding the Case Analysis in an Organizational Behavior Course: Making Analytical Language Explicit." Journal of Management Education 46 (2022): 226-251: Ramsey, V. J. and L. D. Dodge. "Case Analysis: A Structured Approach." Exchange: The Organizational Behavior Teaching Journal 6 (November 1981): 27-29; Schweitzer, Karen. "How to Write and Format a Business Case Study." ThoughtCo. https://www.thoughtco.com/how-to-write-and-format-a-business-case-study-466324 (accessed December 5, 2022); Reddy, C. D. "Teaching Research Methodology: Everything's a Case." Electronic Journal of Business Research Methods 18 (December 2020): 178-188; Volpe, Guglielmo. "Case Teaching in Economics: History, Practice and Evidence." Cogent Economics and Finance 3 (December 2015). doi:https://doi.org/10.1080/23322039.2015.1120977.

Writing Tip

Ca se Study and Case Analysis Are Not the Same!

Confusion often exists between what it means to write a paper that uses a case study research design and writing a paper that analyzes a case; they are two different types of approaches to learning in the social and behavioral sciences. Professors as well as educational researchers contribute to this confusion because they often use the term "case study" when describing the subject of analysis for a case analysis paper. But you are not studying a case for the purpose of generating a comprehensive, multi-faceted understanding of a research problem. R ather, you are critically analyzing a specific scenario to argue logically for recommended solutions and courses of action that lead to optimal outcomes applicable to professional practice.

To avoid any confusion, here are twelve characteristics that delineate the differences between writing a paper using the case study research method and writing a case analysis paper:

• Case study is a method of in-depth research and rigorous inquiry ; case analysis is a reliable method of teaching and learning . A case study is a modality of research that investigates a phenomenon for the purpose of creating new knowledge, solving a problem, or testing a hypothesis using empirical evidence derived from the case being studied. Often, the results are used to generalize about a larger population or within a wider context. The writing adheres to the traditional standards of a scholarly research study. A case analysis is a pedagogical tool used to teach students how to reflect and think critically about a practical, real-life problem in an organizational setting.
• The researcher is responsible for identifying the case to study; a case analysis is assigned by your professor . As the researcher, you choose the case study to investigate in support of obtaining new knowledge and understanding about the research problem. The case in a case analysis assignment is almost always provided, and sometimes written, by your professor and either given to every student in class to analyze individually or to a small group of students, or students select a case to analyze from a predetermined list.
• A case study is indeterminate and boundless; a case analysis is predetermined and confined . A case study can be almost anything [see item 9 below] as long as it relates directly to examining the research problem. This relationship is the only limit to what a researcher can choose as the subject of their case study. The content of a case analysis is determined by your professor and its parameters are well-defined and limited to elucidating insights of practical value applied to practice.
• Case study is fact-based and describes actual events or situations; case analysis can be entirely fictional or adapted from an actual situation . The entire content of a case study must be grounded in reality to be a valid subject of investigation in an empirical research study. A case analysis only needs to set the stage for critically examining a situation in practice and, therefore, can be entirely fictional or adapted, all or in-part, from an actual situation.
• Research using a case study method must adhere to principles of intellectual honesty and academic integrity; a case analysis scenario can include misleading or false information . A case study paper must report research objectively and factually to ensure that any findings are understood to be logically correct and trustworthy. A case analysis scenario may include misleading or false information intended to deliberately distract from the central issues of the case. The purpose is to teach students how to sort through conflicting or useless information in order to come up with the preferred solution. Any use of misleading or false information in academic research is considered unethical.
• Case study is linked to a research problem; case analysis is linked to a practical situation or scenario . In the social sciences, the subject of an investigation is most often framed as a problem that must be researched in order to generate new knowledge leading to a solution. Case analysis narratives are grounded in real life scenarios for the purpose of examining the realities of decision-making behavior and processes within organizational settings. A case analysis assignments include a problem or set of problems to be analyzed. However, the goal is centered around the act of identifying and evaluating courses of action leading to best possible outcomes.
• The purpose of a case study is to create new knowledge through research; the purpose of a case analysis is to teach new understanding . Case studies are a choice of methodological design intended to create new knowledge about resolving a research problem. A case analysis is a mode of teaching and learning intended to create new understanding and an awareness of uncertainty applied to practice through acts of critical thinking and reflection.
• A case study seeks to identify the best possible solution to a research problem; case analysis can have an indeterminate set of solutions or outcomes . Your role in studying a case is to discover the most logical, evidence-based ways to address a research problem. A case analysis assignment rarely has a single correct answer because one of the goals is to force students to confront the real life dynamics of uncertainly, ambiguity, and missing or conflicting information within professional practice. Under these conditions, a perfect outcome or solution almost never exists.
• Case study is unbounded and relies on gathering external information; case analysis is a self-contained subject of analysis . The scope of a case study chosen as a method of research is bounded. However, the researcher is free to gather whatever information and data is necessary to investigate its relevance to understanding the research problem. For a case analysis assignment, your professor will often ask you to examine solutions or recommended courses of action based solely on facts and information from the case.
• Case study can be a person, place, object, issue, event, condition, or phenomenon; a case analysis is a carefully constructed synopsis of events, situations, and behaviors . The research problem dictates the type of case being studied and, therefore, the design can encompass almost anything tangible as long as it fulfills the objective of generating new knowledge and understanding. A case analysis is in the form of a narrative containing descriptions of facts, situations, processes, rules, and behaviors within a particular setting and under a specific set of circumstances.
• Case study can represent an open-ended subject of inquiry; a case analysis is a narrative about something that has happened in the past . A case study is not restricted by time and can encompass an event or issue with no temporal limit or end. For example, the current war in Ukraine can be used as a case study of how medical personnel help civilians during a large military conflict, even though circumstances around this event are still evolving. A case analysis can be used to elicit critical thinking about current or future situations in practice, but the case itself is a narrative about something finite and that has taken place in the past.
• Multiple case studies can be used in a research study; case analysis involves examining a single scenario . Case study research can use two or more cases to examine a problem, often for the purpose of conducting a comparative investigation intended to discover hidden relationships, document emerging trends, or determine variations among different examples. A case analysis assignment typically describes a stand-alone, self-contained situation and any comparisons among cases are conducted during in-class discussions and/or student presentations.

The Case Analysis . Fred Meijer Center for Writing and Michigan Authors. Grand Valley State University; Mills, Albert J. , Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010; Ramsey, V. J. and L. D. Dodge. "Case Analysis: A Structured Approach." Exchange: The Organizational Behavior Teaching Journal 6 (November 1981): 27-29; Yin, Robert K. Case Study Research and Applications: Design and Methods . 6th edition. Thousand Oaks, CA: Sage, 2017; Crowe, Sarah et al. “The Case Study Approach.” BMC Medical Research Methodology 11 (2011):  doi: 10.1186/1471-2288-11-100; Yin, Robert K. Case Study Research: Design and Methods . 4th edition. Thousand Oaks, CA: Sage Publishing; 1994.

• << Previous: Reviewing Collected Works
• Next: Writing a Case Study >>
• Last Updated: Mar 6, 2024 1:00 PM
• URL: https://libguides.usc.edu/writingguide/assignments

Have a language expert improve your writing

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

• Knowledge Base
• Dissertation
• How to Write a Discussion Section | Tips & Examples

How to Write a Discussion Section | Tips & Examples

Published on 21 August 2022 by Shona McCombes . Revised on 25 October 2022.

The discussion section is where you delve into the meaning, importance, and relevance of your results .

It should focus on explaining and evaluating what you found, showing how it relates to your literature review , and making an argument in support of your overall conclusion . It should not be a second results section .

There are different ways to write this section, but you can focus your writing around these key elements:

• Summary: A brief recap of your key results
• Interpretations: What do your results mean?
• Implications: Why do your results matter?
• Limitations: What can’t your results tell us?
• Recommendations: Avenues for further studies or analyses

Instantly correct all language mistakes in your text

Be assured that you'll submit flawless writing. Upload your document to correct all your mistakes.

Table of contents

What not to include in your discussion section, step 1: summarise your key findings, step 2: give your interpretations, step 3: discuss the implications, step 4: acknowledge the limitations, step 5: share your recommendations, discussion section example.

There are a few common mistakes to avoid when writing the discussion section of your paper.

• Don’t introduce new results: You should only discuss the data that you have already reported in your results section .
• Don’t make inflated claims: Avoid overinterpretation and speculation that isn’t directly supported by your data.
• Don’t undermine your research: The discussion of limitations should aim to strengthen your credibility, not emphasise weaknesses or failures.

Prevent plagiarism, run a free check.

Start this section by reiterating your research problem  and concisely summarising your major findings. Don’t just repeat all the data you have already reported – aim for a clear statement of the overall result that directly answers your main  research question . This should be no more than one paragraph.

Many students struggle with the differences between a discussion section and a results section . The crux of the matter is that your results sections should present your results, and your discussion section should subjectively evaluate them. Try not to blend elements of these two sections, in order to keep your paper sharp.

• The results indicate that …
• The study demonstrates a correlation between …
• This analysis supports the theory that …
• The data suggest  that …

The meaning of your results may seem obvious to you, but it’s important to spell out their significance for your reader, showing exactly how they answer your research question.

The form of your interpretations will depend on the type of research, but some typical approaches to interpreting the data include:

• Identifying correlations , patterns, and relationships among the data
• Discussing whether the results met your expectations or supported your hypotheses
• Contextualising your findings within previous research and theory
• Explaining unexpected results and evaluating their significance
• Considering possible alternative explanations and making an argument for your position

You can organise your discussion around key themes, hypotheses, or research questions, following the same structure as your results section. Alternatively, you can also begin by highlighting the most significant or unexpected results.

• In line with the hypothesis …
• Contrary to the hypothesised association …
• The results contradict the claims of Smith (2007) that …
• The results might suggest that x . However, based on the findings of similar studies, a more plausible explanation is x .

As well as giving your own interpretations, make sure to relate your results back to the scholarly work that you surveyed in the literature review . The discussion should show how your findings fit with existing knowledge, what new insights they contribute, and what consequences they have for theory or practice.

Ask yourself these questions:

• Do your results support or challenge existing theories? If they support existing theories, what new information do they contribute? If they challenge existing theories, why do you think that is?
• Are there any practical implications?

Your overall aim is to show the reader exactly what your research has contributed, and why they should care.

• These results build on existing evidence of …
• The results do not fit with the theory that …
• The experiment provides a new insight into the relationship between …
• These results should be taken into account when considering how to …
• The data contribute a clearer understanding of …
• While previous research has focused on  x , these results demonstrate that y .

Even the best research has its limitations. Acknowledging these is important to demonstrate your credibility. Limitations aren’t about listing your errors, but about providing an accurate picture of what can and cannot be concluded from your study.

Limitations might be due to your overall research design, specific methodological choices , or unanticipated obstacles that emerged during your research process.

Here are a few common possibilities:

• If your sample size was small or limited to a specific group of people, explain how generalisability is limited.
• If you encountered problems when gathering or analysing data, explain how these influenced the results.
• If there are potential confounding variables that you were unable to control, acknowledge the effect these may have had.

After noting the limitations, you can reiterate why the results are nonetheless valid for the purpose of answering your research question.

• The generalisability of the results is limited by …
• The reliability of these data is impacted by …
• Due to the lack of data on x , the results cannot confirm …
• The methodological choices were constrained by …
• It is beyond the scope of this study to …

Based on the discussion of your results, you can make recommendations for practical implementation or further research. Sometimes, the recommendations are saved for the conclusion .

Suggestions for further research can lead directly from the limitations. Don’t just state that more studies should be done – give concrete ideas for how future work can build on areas that your own research was unable to address.

• Further research is needed to establish …
• Future studies should take into account …
• Avenues for future research include …

Cite this Scribbr article

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

McCombes, S. (2022, October 25). How to Write a Discussion Section | Tips & Examples. Scribbr. Retrieved 9 April 2024, from https://www.scribbr.co.uk/thesis-dissertation/discussion/

Is this article helpful?

Shona McCombes

Other students also liked, how to write a results section | tips & examples, research paper appendix | example & templates, how to write a thesis or dissertation introduction.

A Step-by-Step Guide To Case Discussion

By ashi jain.

Join InsideIIM GOLD

Webinars & Workshops

• Compare B-Schools

• Free CAT Course

Take Free Mock Tests

Upskill With AltUni

CAT Study Planner

Are you comfortable in Decision Making in a given situation How aptly you analyze the situation with a logical approach How much time do you take in arriving at a decision How good are you in taking the rightful course of action

Solved Example:

Hari, the only working member of the family has been working an organization for 25 years. His job required long standing hours. One day, while working, he lost his leg in an accident. The company paid for his medical reimbursement.

Since he was a hardworking employee; the company offered him another compensatory job. He refused by saying, ‘Once a Lion, always a Lion’. As an HR, what solution would you suggest?

Identification of the Problem:

Obvious: accident, refusal of job, only earning member, his attitude, and inability to do his current job Hidden: the reputation of the company at stake, the course of action might influence other employees

Action Plan:

As an HR, you are first expected to check the company records and find out how a similar case has been dealt with in the past. Second, you need to take cognizance of the track record of the employee highlighted by the keyword ‘hardworking’.

Given the situation at hand, he is deemed unfit for his current role. However, the problem arises because of his attitude towards the compensatory job. Hence, in such a case, counselling is required.

Here, three levels of Counselling is required: 1.   Ist level is with Hari 2.   IInd level of counselling is required with the Union Leader (if any) to keep the collective interest and the reputation of the company in mind 3.   IIIrd level of counselling is required with his family members as they constitute of the afflicted party

If the counselling does not work, one should also identify a contingency plan or Plan B. In this case, the Contingency Plan would be – hire someone from his family for a compensatory role.

Note that the following options are out of scope and should be avoided: 1.   Increase Hari’s salary so that he gives in and agrees to do the compensatory job 2.   Status Quo – do not bother as long as the Company is making a profit 3.   Replace Hari with someone else

1. Pinpoint the key issues to be solved and identify their cause and effects

2. Start broad and try to work through a range of issues methodically

3. Connect the facts and evidence and focus on the big picture

4. Discuss any trade-offs or implications of your proposed solution

5. Relate your conclusion back to the problem statement and make sure you have answered all the questions

1. Do not be anxious if you are not able to understand the situation well or unable to justify the problem. Read again, a little slowly, it will help you understand better.

2. Do not jump to conclusions; try to move systematically and gradually.

3. Do not panic if you are unable to analyze the situation. Listen carefully to others as the discussion starts, it will help you gauge the problem at hand.

All the best! Ace the GDPI season.

Related Tags

Things About Woxsen University’s MBA That You Didn't Know

How To Calculate The Real Cost Of An MBA In 2024? Ft. IMT Nagpur Professors

SIBM Pune Summer Placement Report 2023 - Highest Stipend At INR 4.5 Lacs

Mini Mock Test

CUET-PG Mini Mock 2 (By TISS Mumbai HRM&LR)

CUET-PG Mini Mock 3 (By TISS Mumbai HRM&LR)

CUET-PG Mini Mock 1 (By TISS Mumbai HRM&LR)

MBA Admissions 2024 - WAT 1

SNAP Quantitative Skills

SNAP Quant - 1

SNAP VARC Mini Mock - 1

SNAP Quant Mini Mock - 2

SNAP DILR Mini Mock - 4

SNAP VARC Mini Mock - 2

SNAP Quant Mini Mock - 4

SNAP LR Mini Mock - 3

SNAP Quant Mini Mock - 3

SNAP VARC Mini Mock - 3

SNAP - Quant Mini Mock 5

XAT Decision Making 2020

XAT Decision Making 2019

XAT Decision Making 2018

XAT Decision Making -10

XAT Decision Making -11

XAT Decision Making - 12

XAT Decision Making - 13

XAT Decision Making - 14

XAT Decision Making - 15

XAT Decision Making - 16

XAT Decision Making - 17

XAT Decision Making 2021

LR Topic Test

DI Topic Test

ParaSummary Topic Test

Take Free Test Here

Life of indian mba students in milan, italy - what’s next.

By InsideIIM Career Services

IMI Delhi: Worth It? | MBA ROI, Fees, Selection Process, Campus Life & More | KYC

Mahindra university mba: worth it | campus life, academics, courses, placement | know your campus, how to uncover the reality of b-schools before joining, ft. masters' union, gmat focus edition: syllabus, exam pattern, scoring system, selection & more | new gmat exam, how to crack the jsw challenge 2023: insider tips and live q&a with industry leaders, why an xlri jamshedpur & fms delhi graduate decided to join the pharma industry, subscribe to our newsletter.

For a daily dose of the hottest, most insightful content created just for you! And don't worry - we won't spam you.

Who Are You?

Top B-Schools

Write a Story

InsideIIM Gold

InsideIIM.com is India's largest community of India's top talent that pursues or aspires to pursue a career in Management.

[email protected]

Follow Us Here

Konversations By InsideIIM

TestPrep By InsideIIM

• NMAT by GMAC
• Score Vs Percentile
• Exam Preparation
• Explainer Concepts
• Free Mock Tests
• RTI Data Analysis
• Selection Criteria
• CAT Toppers Interview
• Study Planner
• Admission Statistics
• Interview Experiences
• Explore B-Schools
• B-School Rankings
• Life In A B-School
• B-School Placements
• Certification Programs

Placement Preparation

• Summer Placements Guide
• Final Placements Guide

Career Guide

• Career Explorer
• The Top 0.5% League
• Konversations Cafe
• The AltUni Career Show
• Employer Rankings
• Alumni Reports
• Salary Reports

Copyright 2024 - Kira9 Edumedia Pvt Ltd. All rights reserved.

Organizing Your Social Sciences Research Paper: Writing a Case Study

• Purpose of Guide
• Design Flaws to Avoid
• Independent and Dependent Variables
• Glossary of Research Terms
• Narrowing a Topic Idea
• Broadening a Topic Idea
• Extending the Timeliness of a Topic Idea
• Academic Writing Style
• Choosing a Title
• Making an Outline
• Paragraph Development
• Executive Summary
• The C.A.R.S. Model
• Background Information
• The Research Problem/Question
• Theoretical Framework
• Citation Tracking
• Content Alert Services
• Evaluating Sources
• Reading Research Effectively
• Primary Sources
• Secondary Sources
• Tiertiary Sources
• What Is Scholarly vs. Popular?
• Qualitative Methods
• Quantitative Methods
• Using Non-Textual Elements
• Limitations of the Study
• Common Grammar Mistakes
• Writing Concisely
• Avoiding Plagiarism
• Footnotes or Endnotes?
• Further Readings
• Annotated Bibliography
• Dealing with Nervousness
• Using Visual Aids
• Grading Someone Else's Paper
• Types of Structured Group Activities
• Group Project Survival Skills
• Multiple Book Review Essay
• Reviewing Collected Essays
• Writing a Case Study
• About Informed Consent
• Writing Field Notes
• Writing a Policy Memo
• Writing a Research Proposal
• Bibliography

The term case study refers to both a method of analysis and a specific research design for examining a problem, both of which are used in most circumstances to generalize across populations. This tab focuses on the latter--how to design and organize a research paper in the social sciences that analyzes a specific case.

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

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

How to Approach Writing a Case Study Research Paper

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

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

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

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

Structure and Writing Style

The purpose of a paper in the social sciences designed around a case study is to thoroughly investigate a subject of analysis in order to reveal a new understanding about the research problem and, in so doing, contributing new knowledge to what is already known from previous studies. In applied social sciences disciplines [e.g., education, social work, public administration, etc.], case studies may also be used to reveal best practices, highlight key programs, or investigate interesting aspects of professional work. In general, the structure of a case study research paper is not all that different from a standard college-level research paper. However, there are subtle differences you should be aware of. Here are the key elements to organizing and writing a case study research paper.

I.  Introduction

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

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

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

II.  Literature Review

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

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

III.  Method

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

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

If your subject of analysis is a person. Explain why you selected this particular individual to be studied and describe what experience he or she has had that provides an opportunity to advance new understandings about the research problem. Mention any background about this person which might help the reader understand the significance of his/her experiences that make them worthy of study. This includes describing the relationships this person has had with other people, institutions, and/or events that support using him or her as the subject for a case study research paper. It is particularly important to differentiate the person as the subject of analysis from others and to succinctly explain how the person relates to examining the research problem.

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

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

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

IV.  Discussion

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

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

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

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

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

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

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

V.  Conclusion

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

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

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

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

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

Problems to Avoid

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

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

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

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

Writing Tip

At Least Five Misconceptions about Case Study Research

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

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

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

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

• << Previous: Reviewing Collected Essays
• Next: Writing a Field Report >>
• Last Updated: Jan 17, 2023 10:50 AM
• URL: https://libguides.pointloma.edu/ResearchPaper

• Search Menu
• Advance Articles
• Clinical Case Studies
• Journal Club
• Clinical Chemistry Podcasts
• Clinical Trainee Council
• Special Issues
• Clinical Chemistry Guide to Scientific Writing
• Clinical Chemistry Guide to Manuscript Review
• Author Guidelines
• Submission Site
• Self-Archiving Policy
• Call for Papers
• Why Publish?
• About Clinical Chemistry
• Editorial Board
• Advertising & Corporate Services
• Journals on Oxford Academic
• Books on Oxford Academic

Article Contents

Invert the cone, be fair and balanced, use transition words and phrases, learning exercise, final thoughts.

• < Previous

The Discussion Section: Your Closing Argument

• Article contents
• Figures & tables
• Supplementary Data

Thomas M Annesley, The Discussion Section: Your Closing Argument, Clinical Chemistry , Volume 56, Issue 11, 1 November 2010, Pages 1671–1674, https://doi.org/10.1373/clinchem.2010.155358

• Permissions Icon Permissions

In the judicial system in many countries, a jury decides the final outcome in a court case. The proceedings begin with a lawyer providing an opening statement telling the jury what he or she plans to present. Through a variety of chosen tactics and methods, the lawyer then presents the various pieces of evidence, all of which lead up to the closing argument. A poor closing argument can hurt even the best case. A great closing argument can convince the jury that the evidence is sound and the lawyer's interpretation of it has merit. In the original Law & Order TV show, which incorporated both the investigation of a crime and the courtroom proceedings, the closing arguments were often the most compelling and defining moments in the show.

The Discussion section in a scientific paper and the closing argument in a courtroom have similarities. For many readers, the most important information is not what your results show but what your results mean. The purpose of the Discussion section is to explain what your results mean and what contribution your paper makes to the field of study. The Discussion section is your closing argument. Numerous scientists have told me that when reading a paper they first look at the Abstract to get an overview of the topic and the purported findings. If the topic appears to be of interest, they then skip to the Discussion section. If the Discussion is neither stimulating nor convincing about the meaning and importance of the findings, it does not really matter how the experiments were performed or what results were reported. A poor Discussion detracts from a scientific paper. A good Discussion adds a strong finish to a scientific paper. It brings meaning to your study. My goal with this article is to help you understand the characteristics of a good Discussion section.

In a previous article on the Introduction section of a scientific paper ( 1 ), I discussed how this section could be envisioned as having the shape of a cone or funnel. The information in the Introduction flows from broad to narrow. The first paragraph provides general background material on the topic, and the last paragraph focuses on the specific question(s) being asked in the study.

In contrast, the Discussion can be envisioned as an inverted cone or funnel, from which the flow of information goes from narrow (top) to broad (bottom). This analogy helps to emphasize the need for the first paragraph of the Discussion to be very specific and focused. This goal is accomplished by getting right to the point, which is to answer the questions(s) presented in the Introduction. As Zeiger states ( 2 ), “Thus, the answer to the question is the culmination of the paper. It deserves the most prominent position in the Discussion—the beginning.” The hypothetical example below shows how the Discussion picks up where the Introduction leaves off.

End of the Introduction:

We therefore investigated whether β-selectin, vascular lipoprotein-binding molecule (VLM), and interleukin-6γ (IL-6γ) play a role in the vascular inflammation associated with atherosclerotic disease or are just markers that reflect vascular inflammation. Using a herpes simplex virus type 2 (HSV2) infection protocol to stimulate continuous production in mice, we investigated the effects of β-selectin, VLM, and IL-6γ production on the development of atherosclerotic lesions.

Beginning of the Discussion:

In this study, we investigated whether β-selectin, VLM, and IL-6γ play a role in the vascular inflammation associated with atherosclerotic disease or are just markers that reflect vascular inflammation. Our results show that in mice, IL-6γ (a) appears to play a role in vascular inflammation and (b) increases the development of atherosclerotic lesions.

Three points about the beginning of the Discussion are worth emphasizing here. First, because the Introduction and Discussion sections are separated by other sections of the paper, it is acceptable to provide in the Discussion an introductory sentence that restates the question or purpose of the study. One sentence is usually enough. Second, the restatement at the beginning of the Discussion must match the statement of purpose in the Introduction. In the example above, the authors found it convenient to use the same sentence from the Introduction to restate their purpose in the Discussion (boldface text). Third, it is important to answer the question as it was asked in the Introduction, with the same words and key terms. In the example, the authors indirectly asked 2 questions in the Introduction: whether any of 3 compounds played a role in vascular inflammation and whether these compounds had any effects on the development of atherosclerotic lesions. The second sentence of their Discussion thus contains 2 answers (boldface text) that clearly match the original questions in both wording and key terms.

After answering a specific question with a specific answer, you need to describe how the answer is supported by your results:

Our first finding that IL-6γ appears to play a role in vascular inflammation is supported by our protein expression experiments. Twenty-four weeks after injection with cDNA-transfected viral units, only β-selectin was present in sera from mice injected with HSV2–β-selectin, and only VLM was in sera from mice injected with HSV2-VLM. The injection of mice with HSV2–IL-6γ, however, yielded not only high serum IL-6γ concentrations as expected but also high concentrations of VLM and β-selectin, both of which are known to increase with vascular inflammation. Our second finding that IL-6γ appears to contribute to the formation of atherosclerotic lesions is supported by our observation that the mean areas of lesions in mice injected with HSV2–IL-6γ were nearly 3-fold larger than the mean areas of lesions in control mice.

The scope of the Discussion should then be broadened by describing how your results and your interpretation of the results are supported by, consistent with, or related to the results (evidence) from other published studies. If your results support the work of others, you can also use this approach to discuss your results:

Evidence of a possible linkage between serum IL-6γ concentrations and the formation of atherosclerotic lesions comes from the study by Proctor and Schlesser. These authors showed that dietary polyphenols in fruits and vegetables decrease the size and number of atherosclerotic lesions. A secondary finding in their study, which was not explored further, was the observation that polyphenols also reduce serum IL-6γ concentrations. Additional evidence comes from recent studies showing that HMG-CoA reductase inhibitors rapidly reduce both serum C-reactive protein and IL-6γ concentrations, followed by a reduction in arterial plaque density.

Previous studies have found an association between serum IL-6γ concentrations and the formation of atherosclerotic lesions. Proctor and Schlesser showed that dietary polyphenols in fruits and vegetables decrease the size and number of atherosclerotic lesions. A secondary finding in their study, which was not explored further, was the observation that polyphenols also reduce serum IL-6γ concentrations. A second study by the Canadian All Cause Mortality Coalition showed that HMG-CoA reductase inhibitors rapidly reduce both serum C-reactive protein and IL-6γ concentrations, followed by a reduction in arterial plaque density. The results of our study not only confirm an association between IL-6γ and the formation of atherosclerotic lesions but also show that overproduction of IL-6γ promotes the formation of atherosclerotic lesions.

Toward the end of the Discussion, the “big picture” should now be considered. It is important to describe the contribution your study makes to the field and how your findings can be applied to existing and future studies. For example:

Our demonstration that increased production of IL-6γ is associated with both vascular inflammation and a significant increase in the size of atherosclerotic lesions indicates the existence of multiple pathways that can promote vascular inflammation. It should be possible to design IL-6γ antagonists as therapeutic agents for those individuals who have high serum IL-6γ concentrations. Structural analog antagonists have already been described for IL-4, which plays a role in the allergic response. Another similar advance that supports the potential benefit of IL-6γ reduction is the development of tumor necrosis factor α antagonists that have been effective in treating rheumatoid arthritis.

Close the Discussion with 1 or 2 sentences that provide a take-home message for the reader. This take-home message can restate the answer one last time and/or indicate the importance of the work by stating implications, applications, or recommendations ( 2 ). It is important, however, not to repeat items already discussed. Some journals include an actual Summary or Conclusion section at the end of published articles, where these summary points belong. Whether such a message is considered a summary or a conclusion, the worst thing you can do is end with a weak statement, such as “further work is needed to solve this problem,” or “we plan on conducting future experiments,” or “we have already begun experiments to test our new theory.” The final sentences should provide a strong finish:

In summary, our study shows that IL-6γ induces the production of known inflammatory markers and appears to cause an increase in the size of atherosclerotic lesions in mice. Since IL-6γ binds to a different receptor family than C-reactive protein in both mice and humans, there are now at least 2 mechanisms that must be considered when developing new strategies to reduce the incidence and severity of atherosclerotic disease.

There is a major news network in the US that has used the trademark slogan “fair and balanced”—fair by being impartial and free from bias, and balanced by presenting all sides of a story. Your Discussion section should also be fair and balanced. There are important points that should be considered to help achieve fairness and balance ( 2 – 4 ).

First, be sure to give credit where it is deserved. If the methods or results from other studies added an important element to your study design or if the work of others supports your findings, state that in the Discussion. Conversely, if you believe that your work supports the findings of others or improves upon what others have done, give yourself the same credit. The key here is to be factual and not boastful about what you have done:

Of the 4 published procedures for nucleic acid insertion, we chose the one described by Wallenburg and Hughes because their procedure yields the highest percentage of cDNA-transfected viruses. Other researchers have successfully used the same procedure to generate viral vectors for the in vivo production of ferritin and transcobalamin, 2 smaller proteins with molecular weights in the same range as our 3 proteins. We were able to improve the yield of transfected viruses 2-fold by adding 0.01% glycerol to the trypsin-EDTA solution.

Second, if you encounter any unexpected results or find that your results (or answer) disagree with other studies, be transparent about these differences, and try to explain them rather than pretending they do not exist:

Smith et al. previously reported that in vitro exposure of cultured smooth muscle cells to IL-6γ does not elicit the release of β-selectin. We were able, however, to elicit the production of β-selectin when mice were injected with HSV2–IL-6γ. It is known that the vascular endothelium must sense both a hemodynamic pressure change and a modulation in signal from receptor–protein binding before microvascular changes occur. This combination can occur only in vivo. Therefore, the difference between our findings and theirs might be due to the in vivo nature of our experiments.

Third, use the Discussion section to acknowledge any limitations of your study and any alternative explanations for your findings. Acknowledging limitations up front makes you look better because you considered, even in retrospect, how the study could have been done better or differently. Recognizing alternative explanations shows that you have a good breadth of knowledge of the field and the factors that might have come into play throughout your experiments. Most importantly, acknowledging any limitations of your study or any alternative explanations preempts a peer reviewer's discovery of them and the opportunity to point them out. If you can explain how the conclusions drawn from the results are probably not affected, do so:

One limitation of our study is that our experiments have thus far been conducted only on mice; however, the results for many studies of atherosclerosis, such as those examining the effects of cholesterol-lowering drug therapy, that were originally performed on mice have subsequently been extended to humans. Such evidence suggests that IL-6γ might have the same effect on the formation of atherosclerotic lesions in humans. Another limitation is that the continuous production of IL-6γ in our cotransfected HSV2 model may not reflect the rate of production or the serum concentrations of IL-6γ that would be required to promote atherosclerotic lesions. Our experiments, however, were designed to examine a cause-and-effect scenario rather than a relative response.

Although our results show that IL-6γ appears to play a role in vascular inflammation and the development of atherosclerotic lesions, its contribution could be primary or secondary in nature. Our initial evidence, when combined with evidence from other studies, supports a primary effect; however, we did not construct a serum or tissue metabolomic profile to identify compounds that might have been up-regulated by increased IL-6γ concentrations. Thus, we cannot discount the possibility that IL-6γ acts in combination with another compound to promote vascular inflammation or that IL-6γ induces the production of another compound that itself is the active agent in vascular inflammation.

Our results show that …

Our first finding that …

Our second finding that …

Evidence of …

Additional evidence comes from …

Our demonstration that …

Previous studies have found …

The results of our study not only …

Therefore, …

What is the purpose of the Discussion?

How are the formats of the Discussion and Introduction different?

Name 3 types of information that should be included in the Discussion.

What is a good way to end the Discussion?

There is a well-known saying, “You don't get a second chance to make a first impression.” This saying certainly holds true if you consider the importance of the title and abstract of a scientific paper; however, for scientific papers there should also be a saying, “You don't get a second chance to make a final impression.” The Discussion is your opportunity to make a good final impression. If you apply the information presented in this article, you will be on your way to doing just that.

Author Contributions: All authors confirmed they have contributed to the intellectual content of this paper and have met the following 3 requirements: (a) significant contributions to the conception and design, acquisition of data, or analysis and interpretation of data; (b) drafting or revising the article for intellectual content; and (c) final approval of the published article.

Authors' Disclosures of Potential Conflicts of Interest: Upon manuscript submission, all authors completed the Disclosures of Potential Conflict of Interest form. Potential conflicts of interest:

Employment or Leadership: T.M. Annesley, Clinical Chemistry , AACC.

Consultant or Advisory Role: None declared.

Stock Ownership: None declared.

Honoraria: T.M. Annesley, Clinical Chemistry , AACC.

Research Funding: None declared.

Expert Testimony: None declared.

Role of Sponsor: The funding organizations played no role in the design of study, choice of enrolled patients, review and interpretation of data, or preparation or approval of manuscript.

Annesley TM . “It was a cold and rainy night”: Set the scene with a good introduction . Clin Chem 2010 ; 56 : 708 – 13 .

Google Scholar

Zeiger M . Essentials of writing biomedical research papers . New York : McGraw-Hill ; 2000 . p 176 – 219 .

Browner WS . Publishing and presenting clinical research . Philadelphia : Lippincott Williams & Wilkins ; 2008 . p 115 – 28 .

Hess DR . How to write an effective discussion . Resp Care 2004 ; 49 : 1238 – 41 .

The purpose of the Discussion section is to explain what your results mean and what contribution your paper makes to the field of study.

The Introduction presents information from broad to narrow (from the larger picture to the specific question). The Discussion presents information from narrow to broad (from the answer to a specific question to the larger picture).

The Discussion section should include:

The answer to the question

How the answer is supported by the results

How the results are supported by other studies

How the results support other studies

How the results differ from those from other studies

Any limitations to the study

Any alternative explanations for the results

Restate the answer one last time, and/or indicate the importance of the work by stating implications, applications, or recommendations.

Supplementary data

Email alerts, citing articles via.

• Recommend to Your Librarian
• Advertising and Corporate Services
• Journals Career Network

Affiliations

• Online ISSN 1530-8561
• Print ISSN 0009-9147
• Copyright © 2024 Association for Diagnostics & Laboratory Medicine
• About Oxford Academic
• Publish journals with us
• University press partners
• What we publish
• New features  
• Open access
• Institutional account management
• Rights and permissions
• Get help with access
• Accessibility
• Advertising
• Media enquiries
• Oxford University Press
• Oxford Languages
• University of Oxford

Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide

• Copyright © 2024 Oxford University Press
• Cookie settings
• Cookie policy
• Privacy policy
• Legal notice

This Feature Is Available To Subscribers Only

Sign In or Create an Account

This PDF is available to Subscribers Only

For full access to this pdf, sign in to an existing account, or purchase an annual subscription.

• Open access
• Published: 23 September 2023

Educational interventions targeting pregnant women to optimise the use of caesarean section: What are the essential elements? A qualitative comparative analysis

• Rana Islamiah Zahroh   ORCID: orcid.org/0000-0001-7831-2336 1 ,
• Katy Sutcliffe   ORCID: orcid.org/0000-0002-5469-8649 2 ,
• Dylan Kneale   ORCID: orcid.org/0000-0002-7016-978X 2 ,
• Martha Vazquez Corona   ORCID: orcid.org/0000-0003-2061-9540 1 ,
• Ana Pilar Betrán   ORCID: orcid.org/0000-0002-5631-5883 3 ,
• Newton Opiyo   ORCID: orcid.org/0000-0003-2709-3609 3 ,
• Caroline S. E. Homer   ORCID: orcid.org/0000-0002-7454-3011 4 &
• Meghan A. Bohren   ORCID: orcid.org/0000-0002-4179-4682 1  

BMC Public Health volume  23 , Article number:  1851 ( 2023 ) Cite this article

1228 Accesses

1 Citations

1 Altmetric

Metrics details

Caesarean section (CS) rates are increasing globally, posing risks to women and babies. To reduce CS, educational interventions targeting pregnant women have been implemented globally, however, their effectiveness is varied. To optimise benefits of these interventions, it is important to understand which intervention components influence success. In this study, we aimed to identify essential intervention components that lead to successful implementation of interventions focusing on pregnant women to optimise CS use.

We re-analysed existing systematic reviews that were used to develop and update WHO guidelines on non-clinical interventions to optimise CS. To identify if certain combinations of intervention components (e.g., how the intervention was delivered, and contextual characteristics) are associated with successful implementation, we conducted a Qualitative Comparative Analysis (QCA). We defined successful interventions as interventions that were able to reduce CS rates. We included 36 papers, comprising 17 CS intervention studies and an additional 19 sibling studies (e.g., secondary analyses, process evaluations) reporting on these interventions to identify intervention components. We conducted QCA in six stages: 1) Identifying conditions and calibrating the data; 2) Constructing truth tables, 3) Checking quality of truth tables; 4) Identifying parsimonious configurations through Boolean minimization; 5) Checking quality of the solution; 6) Interpretation of solutions. We used existing published qualitative evidence synthesis to develop potential theories driving intervention success.

We found successful interventions were those that leveraged social or peer support through group-based intervention delivery, provided communication materials to women, encouraged emotional support by partner or family participation, and gave women opportunities to interact with health providers. Unsuccessful interventions were characterised by the absence of at least two of these components.

We identified four key essential intervention components which can lead to successful interventions targeting women to reduce CS. These four components are 1) group-based delivery, 2) provision of IEC materials, 3) partner or family member involvement, and 4) opportunity for women to interact with health providers. Maternal health services and hospitals aiming to better prepare women for vaginal birth and reduce CS can consider including the identified components to optimise health and well-being benefits for the woman and baby.

Peer Review reports

Introduction

In recent years, caesarean section (CS) rates have increased globally [ 1 , 2 , 3 , 4 ]. CS can be a life-saving procedure when vaginal birth is not possible; however, it comes with higher risks both in the short- and long-term for women and babies [ 1 , 5 ]. Women with CS have increased risks of surgical complications, complications in future pregnancies, subfertility, bowel obstruction, and chronic pain [ 5 , 6 , 7 , 8 ]. Similarly, babies born through CS have increased risks of hypoglycaemia, respiratory problems, allergies and altered immunity [ 9 , 10 , 11 ]. At a population level, CS rates exceeding 15% are unlikely to reduce mortality rates [ 1 , 12 ]. Despite these risks, an analysis across 154 countries reported a global average CS rate of 21.1% in 2018, projected to increase to 28.5% by 2030 [ 3 ].

There are many reasons for the increasing CS rates, and these vary between and within countries. Increasingly, non-clinical factors across different societal dimensions and stakeholders (e.g. women and communities, health providers, and health systems) are contributing to this increase [ 13 , 14 , 15 , 16 , 17 ]. Women may prefer CS over vaginal birth due to fear of labour or vaginal birth, previous negative experience of childbirth, perceived increased risks of vaginal birth, beliefs about an auspicious or convenient day of birth, or beliefs that caesarean section is safer, quick, and painless compared to vaginal birth [ 13 , 14 , 15 ].

Interventions targeting pregnant women to reduce CS have been implemented globally. A Cochrane intervention review synthesized evidence from non-clinical interventions targeting pregnant women and family, providers, and health systems to reduce unnecessary CS, and identified 15 interventions targeting women [ 18 ]. Interventions targeting women primarily focused on improving women’s knowledge around birth, improving women’s ability to cope during labour, and decreasing women’s stress related to labour through childbirth education, and decision aids for women with previous CS [ 18 ]. These types of interventions aim to reduce the concerns of pregnant women and their partners around childbirth, and prepare them for vaginal birth.

The effectiveness of interventions targeting women in reducing CS is mixed [ 18 , 19 ]. Plausible explanations for this limited success include the multifactorial nature of the factors driving increases in CS, as well as the contextual characteristics of the interventions, which may include the study environment, participant characteristics, intensity of exposure to the intervention and method of implementation. Understanding which intervention components are essential influencers of the success of the interventions is conducive to optimising benefits. This study used a Qualitative Comparative Analysis (QCA) approach to re-analyse evidence from existing systematic reviews to identify essential intervention components that lead to the successful implementation of non-clinical interventions focusing on pregnant women to optimise the use of CS. Updating and re-analysing existing systematic reviews using new analytical frameworks may help to explore the heterogeneity in effects and ascertain why some studies appear to be effective while others are not.

Data sources, case selection, and defining outcomes

Developing a logic model.

We developed a logic model to guide our understanding of different pathways and intervention components potentially leading to successful implementation (Additional file 1 ). The logic model was developed based on published qualitative evidence syntheses and systematic reviews [ 18 , 20 , 21 , 22 , 23 , 24 ]. The logic model depicts the desired outcome of reduced CS rates in low-risk women (at the time of admission for birth, these women are typically represented by Robson groups 1–4 [ 25 ] and are women with term, cephalic, singleton pregnancies without a previous CS) and works backwards to understand what inputs and processes are needed to achieve the desired outcome. Our logic model shows multiple pathways to success and highlights the interactions between different levels of factors (women, providers, societal, health system) (Additional file 1 ). Based on the logic model, we have separated our QCA into two clusters of interventions: 1) interventions targeting women, and 2) interventions targeting health providers. The results of analysis on interventions targeting health providers have been published elsewhere [ 26 ]. The logic model was also used to inform the potential important components that influence success.

Identifying data sources and selecting cases

We re-analysed the systematic reviews which were used to inform the development and update of World Health Organization (WHO) guidelines. In 2018, WHO issued global guidance on non-clinical interventions to reduce unnecessary CS, with interventions designed to target three different levels or stakeholders: women, health providers, and health systems [ 27 ]. As part of the guideline recommendations, a series of systematic reviews about CS interventions were conducted: 1) a Cochrane intervention review of effectiveness by Chen et al. (2018) [ 18 ] and 2) three qualitative evidence syntheses exploring key stakeholder perspectives and experiences of interventions focusing on women and communities, health professionals, and health organisations, facilities and systems by Kingdon et al. (2018) [ 20 , 21 , 22 ]. Later on, Opiyo and colleagues (2020) published a scoping review of financial and regulatory interventions to optimise the use of CS [ 23 ].

Therefore, the primary data sources of this QCA are the intervention studies included in Chen et al. (2018) [ 18 ] and Opiyo et al. (2020) [ 23 ]. We used these two systematic reviews as not only they are comprehensive, but they were also used to inform the WHO guidelines development. A single intervention study is referred to as a “case”. Eligible cases were intervention studies focusing on pregnant women and aimed to reduce or optimise the use of CS. No restrictions on study design were imposed in the QCA. Therefore, we also assessed the eligibility of intervention studies excluded from Chen et al. (2018) [ 18 ] and Opiyo et al. (2020) [ 23 ] due to ineligible study designs (such as cohort study, uncontrolled before and after study, interrupted time series with fewer than three data points), as these studies could potentially show other pathways to successful implementation. We complemented these intervention studies with additional intervention studies published since the last review updates in 2018 and 2020, to include intervention studies that are likely to meet the review inclusion criteria for future review updates. No further search was conducted as QCA is suitable for medium-N cases, approximately around 10–50 cases, and inclusion of more studies may threaten study rigour [ 28 ].

Once eligible studies were selected, we searched for their ‘sibling studies’. Sibling studies are studies linked to the included intervention studies, such as formative research or process evaluations which may have been published separately. Sibling studies can provide valuable additional information about study context, intervention components, and implementation outcomes (e.g. acceptability, fidelity, adherence, dosage), which may not be well described in a single article about intervention effectiveness. We searched for sibling studies using the following steps: 1) reference list search of the intervention studies included in Chen et al. (2018) [ 18 ] and Opiyo et al. (2020) [ 23 ], 2) reference list search of the qualitative studies included in Kingdon et al. (2018) reviews [ 20 , 21 , 22 ]; and 3) forward reference search of the intervention studies (through “Cited by” function) in Scopus and Web of Science. Sibling studies were included if they included any information on intervention components or implementation outcomes, regardless of the methodology used. One author conducted the study screening independently (RIZ), and 10% of the screening was double-checked by a second author (MAB). Disagreements during screening were discussed until consensus, and with the rest of the author team if needed.

Defining outcomes

We assessed all outcomes related to the mode of birth in the studies included in the Chen et al. (2018) [ 18 ] and Opiyo et al. (2020) [ 23 ] reviews. Based on the consistency of outcome reporting, we selected “overall CS rate” as the primary outcome of interest due to its presence across studies. We planned to rank the rate ratio across these studies to select the 10 most successful and unsuccessful intervention studies. However, due to heterogeneity in how CS outcomes were reported across studies (e.g. odds ratios, rate ratios, percentages across different intervention stages), the final categorisation of successful or unsuccessful interventions is based on whether the CS rate decreased, based on the precision of the confidence interval or p-value (successful, coded as 1), or CS rate increased or did not change (unsuccessful, coded as 0).

Assessing risk of bias in intervention studies

All intervention studies eligible for inclusion were assessed for risk of bias. All studies included in Chen et al. (2018) and Opiyo et al. (2020) already had risk of bias assessed and reported [ 18 , 23 ], and we used these assessments. Additional intervention studies outside the included studies on these reviews were assessed using the same tools depending on the type of evidence (two randomized controlled trials and one uncontrolled before and after study), and details of the risk of bias assessment results can be found in Additional file 2 . We excluded studies with a high risk of bias to ensure that the analysis was based on high-quality studies and to enhance the ability of researchers to develop deep case knowledge by limiting the overall number of studies.

Qualitative comparative analysis (QCA)

QCA was first developed and used in political sciences and has since been extended to systematic reviews of complex health interventions [ 24 , 29 , 30 , 31 ]. Despite the term “qualitative”, QCA is not a typical qualitative analysis, and is often conceptualised as a methodology that bridges qualitative and quantitative methodologies based on its process, data used and theoretical standpoint [ 24 ]. Here, QCA is used to identify if certain configurations or combinations of intervention components (e.g. participants, types of interventions, contextual characteristics, and intervention delivery) are associated with the desired outcome [ 31 ]. These intervention components are referred to as “conditions” in the QCA methodology. Whilst statistical synthesis methods may be used to examine intervention heterogeneity in systematic reviews, such as meta-regression, QCA is a particularly suitable method to understand complex interventions like those aiming to optimise CS, as it allows for multiple overlapping pathways to causality [ 31 ]. Moreover, QCA allows the exploration of different combinations of conditions, rather than relying on a single condition leading to intervention effectiveness [ 31 ]. Although meta-regression allows for the assessment of multiple conditions, a sufficient number of studies may not be available to conduct the analysis. In complex interventions, such as interventions aiming to optimise the use of CS, single condition or standard meta-analysis may be less likely to yield usable and nuanced information about what intervention components are more or less likely to yield success [ 31 ].

QCA uses ‘set theory’ to systematically compare characteristics of the cases (e.g. intervention in the case of systematic reviews) in relation to the outcomes [ 31 , 32 ]. This means QCA compares the characteristics of the successful ‘cases’ (e.g. interventions that are effective) to those unsuccessful ‘cases’ (e.g. interventions that are not effective). The comparison is conducted using a scoring system based on ‘set membership’ [ 31 , 32 ]. In this scoring, conditions and outcomes are coded based on the extent to which a certain feature is present or absent to form set membership scores [ 31 , 32 ]. There are two scoring systems in QCA: 1) crisp set QCA (csQCA) and 2) fuzzy set QCA (fsQCA). csQCA assigns binary scores of 0 (“fully out” to set membership for cases with certain conditions) and 1 (“fully in” to set membership for cases with certain conditions), while fsQCA assigns ordinal scoring of conditions and outcomes, permitting partial membership scores between 0 and 1 [ 31 , 32 ]. For example, using fsQCA we may assign a five-level scoring system (0, 0.33, 0.5, 0.67, 1), where 0.33 would indicate “more out” than “in” to the set of membership, and 0.67 would indicate “more in” than “out”, and 0.5 would indicate ambiguity (i.e. a lack of information about whether a case was “in” or “out”) [ 31 , 32 ]. In our analysis, we used the combination of both csQCA and fsQCA to calibrate our data. This approach was necessary because some conditions were better suited to binary options using csQCA, while others were more complex, depending on the distribution of cases, and required fsQCA to capture the necessary information. In our final analysis, however, the conditions run on the final analysis were all using the csQCA scoring system.

Two relationships can be investigated using QCA [ 24 , 31 ]. First, if all instances of successful interventions share the same condition(s), this suggests these features are ‘necessary’ to trigger successful outcomes [ 24 , 31 ]. Second, if all instances of a particular condition are associated with successful interventions, this suggests these conditions are ‘sufficient’ for triggering successful outcomes [ 24 , 31 ]. In this QCA, we were interested to explore the relationship of sufficiency: that is, to assess the various combinations of intervention components that can trigger successful outcomes. We were interested in sufficiency because our logic model (explained further below) highlighted the multiple pathways that can lead to a CS and different interventions that may optimise the use of CS along those pathways, which suggested that it would be unlikely for all successful interventions to share the same conditions. We calculated the degree of sufficiency using consistency measures, which evaluate the frequency in which conditions are present when the desired outcome is achieved [ 31 , 32 ]. The conditions with a consistency score of at least 0.8 were considered sufficient in triggering successful interventions [ 31 , 32 ]. At present, there is no tool available for reporting guidelines in the re-analysis of systematic reviews using QCA, however, CARU-QCA is currently being developed for this purpose [ 33 ]. QCA was conducted using R programming software with a package developed by Thiem & Duşa (2013) and QCA with R guidebook [ 32 ]. QCA was conducted in six stages based on Thomas et al. (2014) [ 31 ] and explained below.

QCA stage 1: Identifying conditions, building data tables and calibration

We used a deductive and inductive process to determine the potential conditions (intervention components) that may trigger successful implementation. Conditions were first derived deductively using the developed logic model (Additional file 1 ). We then added additional conditions inductively using Intervention Component Analysis from the intervention studies [ 34 ], and qualitative evidence (“view”) synthesis [ 22 ] using Melendez-Torres’s (2018) approach [ 35 ]. Intervention Component Analysis is a methodological approach that examines factors affecting implementation through reflections from the trialist, which is typically presented in the discussion section of a published trial [ 34 ]. Examples of conditions identified in the Intervention Component Analysis include using an individualised approach, interaction with health providers, policies that encourage CS and acknowledgement of women’s previous birth experiences. After consolidating or merging similar conditions, a total of 52 conditions were selected and extracted from each included intervention and analysed in this QCA (Details of conditions and definitions generated for this study can be found in Additional files 3 and 4 ). We adapted the coding framework from Harris et al. (2019) [ 24 ] by adapting coding rules and six domains that were used, to organize the 52 conditions and make more sense of the data. These six domains are broadly classified as 1) context and participants, 2) intervention design, 3) program content, 4) method of engagement, 5) health system factors, and 6) process outcomes.

One author (RIZ) extracted data relevant to the conditions for each included study into a data table, which was then double-reviewed by two other authors (MVC, MAB). The data table is a matrix in which each case is represented in a row, and columns are used to represent the conditions. Following data extraction, calibration rules using either csQCA or fsQCA (e.g. group-based intervention delivery condition: yes = 1 (present), no = 0 (absent)) were developed through consultation with all authors. We developed a table listing the conditions and rules of coding the conditions, by either direct or transformational assignment of quantitative and qualitative data [ 24 , 32 ] (Additional file 3 depicts the calibration rules). The data tables were then calibrated by applying scores, to explore the extent to which interventions have ‘set membership’ with the outcome or conditions of interest. During this iterative process, the calibration criteria were explicitly defined, emerging from the literature and the cases themselves. It is important to note, that maximum ambiguity is typically scored as 0.5 in QCA, however, we decided it would be more appropriate to assume that if a condition was not reported it was unlikely to be a feature of the intervention, so we treated not reported as “absence” that is we coded it 0.

QCA stage 2: Constructing truth tables

Truth tables are an analytical tool used in QCA to analyse associations between configurations of conditions and outcomes. Whereas the data table represents individual cases (rows) and individual conditions (columns) – the truth table synthesises this data to examine configurations – with each row representing a different configuration of the conditions. The columns indicate a) which conditions are featured in the configuration in that row, b) how many of the cases are represented by that configuration, and c) their association with the outcome.

We first constructed the truth tables based on context and participants, intervention designs, program content, and method of engagement; however, no configurations to trigger successful interventions were observed. Instead, we observed limited diversity, meaning there were many instances in which the configurations were unsupported by cases, likely due to the presence of too many conditions in the truth tables. We used the learning from these truth tables to return to the literature to explore potential explanatory theories about what conditions are important from the perspectives of participants and trialists to trigger successful interventions (adhering to the ‘utilisation of view’ perspective [ 35 ]). Through this process, we found that women and communities liked to learn new information about childbirth, and desired emotional support from partners and health providers while learning [ 22 ]. They also appreciated educational interventions that provide opportunities for discussion and dialogue with health providers and align with current clinical practice and advice from health providers [ 22 ]. Therefore, three models of truth tables were iteratively constructed and developed based on three important hypothesised theories about how the interventions should be delivered: 1) how birth information was provided to women, 2) emotional support was provided to women (including interactions between women and providers), and 3) a consolidated model examining the interactions of important conditions identified from model 1 and 2. We also conducted a sub-analysis of interventions targeting both women and health providers or systems (‘multi-target interventions’). This sub-analysis was conducted to explore if similar conditions were observed in triggering successful interventions in multi-target interventions, among the components for women only. Table 1 presents the list of truth tables that were iteratively constructed and refined.

QCA stage 3: Checking quality of truth tables

We iteratively developed and improved the quality of truth tables by checking the configurations of successful and unsuccessful interventions, as recommended by Thomas et al. (2014) [ 31 ]. This includes by assessing the number of studies clustering to each configuration, and exploring the presence of any contradictory results between successful and unsuccessful interventions. We found contradictory configurations across the five truth tables, which were resolved by considering the theoretical perspectives and iteratively refining the truth tables.

QCA stage 4: Identifying parsimonious configurations through Boolean minimization

Once we determined that the truth tables were suitable for further analysis, we used Boolean minimisation to explore pathways resulting in successful intervention through the configurations of different conditions [ 31 ]. We simplified the “complex solution” of the pathways to a “parsimonious solution” and an “intermediate solution” by incorporating logical remainders (configurations where no cases were observed) [ 36 ].

QCA stage 5: Checking the quality of the solution

We presented the intermediate solution as the final solution instead of the most parsimonious solution, as it is most closely aligned with the underlying theory. We checked consistency and coverage scores to assess if the pathways identified were sufficient to trigger success. We also checked the intermediate solution by negating the outcome to see if it predicts the observed solutions.

QCA stage 6: Interpretation of solutions

We iteratively interpreted the results of the findings through discussions among the QCA team. This reflexive approach ensured that the results of the analysis considered the perspectives from the literature discourse, methodological approach, and that the results were coherent with the current understanding of the phenomenon.

Overview of included studies

Out of 79 intervention studies assessed by Chen et al. (2018) [ 18 ] and Opiyo et al. (2020) [ 23 ], 17 intervention studies targeted women and are included, comprising 11 interventions targeting only women [ 37 , 38 , 39 , 40 , 41 , 42 , 43 ] and six interventions targeting both women and health providers or systems [ 44 , 45 , 46 , 47 , 48 , 49 ]. From 17 included studies, 19 sibling studies were identified [ 43 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ]. Thus, a total of 36 papers from 17 intervention studies are included in this QCA (See Fig.  1 : PRISMA Flowchart).

PRISMA flowchart. *Sibling studies: studies that were conducted in the same settings, participants, and timeframe; **Intervention components: information on intervention input, activities, and outputs, including intervention context and other characteristics

The 11 interventions targeting women comprised of five successful interventions [ 37 , 68 , 69 , 70 , 71 ] and six unsuccessful interventions [ 37 , 38 , 39 , 40 , 41 , 42 , 43 ] in reducing CS. Sixteen sibling studies were identified, from five out of 11 included interventions [ 37 , 41 , 43 , 70 , 71 ]. Included studies were conducted in six countries across North America (2 from Canada [ 38 ] and 1 from United States of America [ 71 ]), Asia–Pacific (1 from Australia [ 41 ]), 5 from Iran [ 39 , 40 , 68 , 69 , 70 ]), Europe (2 from Finland [ 37 , 42 ], 1 from United Kingdom [ 43 ]). Six studies were conducted in high-income countries, while five studies were conducted in upper-middle-income countries (all from Iran). All 11 studies targeted women, with three studies also explicitly targeting women’s partners [ 68 , 69 , 71 ]. One study delivering psychoeducation allowed women to bring any family members to accompany them during the intervention but did not specifically target partners [ 37 ]. All 11 studies delivered childbirth education, with four delivering general antenatal education [ 38 , 40 , 68 , 69 ], six delivering psychoeducation [ 37 , 39 , 41 , 42 , 70 , 71 ], and one implementing decision aids [ 43 ]. All studies were included in Chen et al. (2018), and some risks of bias were identified [ 18 ] (Additional file 2).

The multi-target interventions consisted of five successful interventions [ 44 , 45 , 46 , 47 , 48 ] and one unsuccessful intervention [ 49 ]. Sibling studies were only identified from one study [ 48 ]. The interventions were delivered in five countries across: South America (1 from Brazil [ 46 ]), Asia–Pacific (4 from China [ 44 , 45 , 47 , 49 ]), Europe (1 from Italy [ 48 ], 1 from Ireland [ 48 ], and 1 from Germany [ 48 ]). Three studies were conducted in high-income countries and five studies in upper middle-income countries. The multi-target interventions targeted women, health providers and health organisations. For this analysis, however, we only consider the components of the intervention that targeted women, which was typically childbirth education. One study came from Chen et al. (2018) [ 18 ] and was graded as having some concerns [ 47 ], two studies from Opiyo et al. (2020) [ 23 ] were graded as having no serious concerns [ 45 , 46 ], and three studies are newly published studies assessed as low [ 44 ] and some concerns about risk of bias [ 48 , 49 ] Table 2 and 3 show characteristics of included studies.

The childbirth education interventions included information about mode of birth, birth process, mental health and coping strategies, pain relief methods, and partners’ roles in birth. Most interventions were delivered in group settings, and only in three studies they were delivered on a one-to-one basis [ 38 , 41 , 42 ]. Only one study explicitly stated that the intervention was individualised to a woman’s unique needs and experiences [ 38 ].

Overall, there was limited theory used to design interventions among the included studies: less than half of interventions (7/17) explicitly used theory in designing the intervention. Among the seven interventions that used theory in intervention development, the theories included the health promotion-disease prevention framework [ 38 ], midwifery counselling framework [ 41 ], cognitive behavioural therapy [ 42 ], Ost’s applied relaxation [ 70 ], conceptual model of parenting [ 71 ], attachment and social cognitive theories [ 37 ], and healthcare improvement scale-up framework [ 46 ]. The remaining 10 studies only relied on previously published studies to design the interventions. We identified very limited process evaluation or implementation outcome evidence related to the included interventions, which is a limitation of the field of CS and clinical interventions more broadly.

• Qualitative comparative analysis

Model 1 – How birth information was provided to women

Model 1 is constructed based on the finding from Kingdon et al. (2018) [ 22 ] that women and communities enjoy learning new birth information, as it opens up new ways of thinking about vaginal birth and CS. Learning new information allows them to understand better the benefits and risks of CS and vaginal births, as well as increase their knowledge about CS [ 22 ].

We used four conditions in constructing model 1 truth table: 1) the provision of information, education, and communication (IEC) materials on what to expect during labour and birth, 2) type of education delivered (antenatal education or psychoeducation), and 3) group-based intervention delivery. We explored this model considering other conditions, such as type of information provided (e.g. information about mode of birth including birth process, mental health and coping strategies, pain relief), delivery technique (e.g. didactic, practical) and frequency and duration of intervention delivery; however these additional conditions did not result in configurations.

Of 16 possible configurations, we identified seven configurations (Table 4 ). The first two row shows perfect consistency of configurations (inclusion = 1) in five studies [ 37 , 68 , 69 , 70 , 71 ] in which all conditions are present, except antenatal education or psychoeducation. The remaining configurations are unsuccessful interventions. Interestingly, when either IEC materials or group-based intervention delivery are present (but not both), implementation is likely to be unsuccessful (rows 3–7).

Boolean minimisation identified two intermediate pathways to successful interventions (Fig.  2 ). The two pathways are similar, except for one condition: type of education. The antenatal education or psychoeducation materials is the content tailored to the type of women they target. Therefore, from the two pathways, we can see that the presence of distribution of IEC materials on birth information and group-based intervention delivery of either antenatal education to the general population of women (e.g. not groups of women with specific risks or conditions) or psychoeducation to women with fear of birth trigger successful interventions. From this solution, we can see that the successful interventions are consistently characterised by the presence of both IEC materials and group-based intervention delivery.

Intermediate pathways from model 1 that trigger successful interventions targeting pregnant women to optimise CS. In QCA, asterisk (*) denotes an ‘AND’ relationship; Inclusion score (InclS), also known as consistency, indicates the degree to which the evidence is consistent with the hypothesis that there is sufficient relation between the configuration and the outcome; Proportional Reduction in Inconsistency (PRI) refers to the extent in which a configuration is sufficient in triggering successful outcome as well as the negation of the outcome; Coverage score (CovS) refers to percentage of cases in which the configuration is valid

Model 2 – Emotional support was provided to women

Model 2 was constructed based on the theory that women desire emotional support alongside the communication of information about childbirth [ 22 ]. This includes emotional support from husbands or partners, health professional, or doulas [ 22 ]. Furthermore, Kingdon et al. (2018) describe the importance of two-way conversation and dialogue between women and providers during pregnancy care, particularly to ensure the opportunity for discussion [ 22 ]. Interventions may generate more questions than they answered, creating the need and desire of women to have more dialogue with health professionals [ 22 ]. Women considered intervention content to be most useful when it complements clinical care, is consistent with advice from health professionals and provides a basis for more informed, meaningful dialogue between women and care providers [ 22 ].

Based on this underlying theory, we constructed model 3 truth table by considering three conditions representative of providing emotional support to women, including partner or family member involvement, group-based intervention delivery which provide social or peer support to women, and opportunity for women to interact with health providers. Of 8 possible configurations, we identified six configurations (Table 5 ). The first three rows represent successful interventions with perfect consistency (inclusion = 1). The first row shows successful interventions with all conditions present. The second and third row shows successful interventions with all conditions except partner or family member involvement or interaction with health providers. The remaining rows represent unsuccessful interventions, where at least two conditions are absent.

Boolean minimisation identified two intermediate pathways to successful interventions (Fig.  3 ). In the first pathway, the partner or family members involvement and group-based intervention delivery enable successful interventions. In the second pathway, however, when partner or family members are not involved, successful interventions can happen only when interaction with health providers is included alongside group-based intervention. From these two pathways, we can see that group-based intervention, involvement of partner and family member, and opportunity for women to interact with providers seem to be important in driving intervention success.

Intermediate pathways from model 2 that trigger successful interventions targeting pregnant women to optimise CS. In QCA, asterisk (*) denotes an ‘AND’ relationship; Inclusion score (InclS), also known as consistency, indicates the degree to which the evidence is consistent with the hypothesis that there is sufficient relation between the configuration and the outcome; Proportional Reduction in Inconsistency (PRI) refers to the extent in which a configuration is sufficient in triggering successful outcome as well as the negation of the outcome; Coverage score (CovS) refers to percentage of cases in which the configuration is valid

Consolidated model – Essential conditions to prompt successful interventions focusing on women

Using the identified important conditions observed in models 1 and 2, we constructed a consolidated model to examine the final essential conditions which could prompt successful educational interventions targeting women. We merged and tested four conditions: the provision of IEC materials on what to expect during labour and birth, group-based intervention delivery, partner or family member involvement, and opportunity for interaction between women and health providers.

Of the 16 possible configurations, we identified six configurations (Table 6 ). The first three rows show configurations resulting in successful interventions with perfect consistency (inclusion = 1). The first row shows successful interventions with all conditions present; the second and third rows show successful interventions with all conditions present except interaction with health providers or partner or family member involvement. The remaining three rows are configurations of unsuccessful interventions, missing at least two conditions, including the consistent absence of partner or family member involvement.

Boolean minimisation identified two intermediate pathways to successful intervention (Fig.  4 ). The first pathway shows that the opportunity for women to interact with health providers, provision of IEC materials, and group-based intervention delivery prompts successful interventions. The second pathway, however, shows that when there is no opportunity for women to interact with health providers, it is important to have partner or family member involvement alongside group-based intervention delivery and provision of IEC materials. These two pathways suggest that the delivery of educational interventions accompanied by provision of IEC materials and presence of emotional support for women during the intervention is important to trigger successful interventions. These pathways also emphasise that emotional support for women during the intervention can come from either partner, family member, or health provider. For the consolidated model, we did not simplify the solution further, as the intermediate solution is more theoretically sound compared to the most parsimonious solution.

Intermediate pathways from consolidated model that trigger successful interventions targeting pregnant women to optimise CS.  In QCA, asterisk (*) denotes an ‘AND’ relationship; Inclusion score (InclS), also known as consistency, indicates the degree to which the evidence is consistent with the hypothesis that there is sufficient relation between the configuration and the outcome; Proportional Reduction in Inconsistency (PRI) refers to the extent in which a configuration is sufficient in triggering successful outcome as well as the negation of the outcome; Coverage score (CovS) refers to percentage of cases in which the configuration is valid.

Sub-analysis – Interventions targeting both women and health providers or systems

In this sub-analysis, we run the important conditions identified from the consolidated model, added condition of multi-target intervention, and applied it to 17 interventions: 11 interventions targeting women, and six interventions targeting both women and health providers or systems (multi-target interventions).

Of 32 possible configurations, we identified eight configurations (Table 7 ). The first four rows show configurations with successful interventions with perfect consistency (inclusion = 1). The first row is where all the multi-target interventions are clustered, except the unsuccessful intervention Zhang (2020) [ 49 ], and where all the conditions are present. All the conditions in the second to fourth rows are present, except multi-target interventions (all rows), interaction with health providers (third row) and partner and family member involvement (fourth row). The remaining rows are all configurations to unsuccessful interventions, where at least three conditions are missing, except row 8, which is a single case row. This case is the only multi-target intervention that is unsuccessful and in which partner or family members were not involved.

The Boolean minimisation identified two intermediate pathways (Fig.  5 ). The first pathway shows that partner or family involvement, provision of IEC materials, and group-based intervention delivery prompt successful interventions. The first pathway is comprised of all five successful multi-target interventions [ 44 , 45 , 46 , 47 , 48 ] and four of 11 interventions targeting only women [ 37 , 68 , 69 , 71 ]. The second pathway shows that when multi-target interventions are absent, but when interaction with health providers is present, alongside provision of IEC materials and group-based intervention delivery, it prompts successful interventions (3/11 interventions targeting women only [ 37 , 69 , 70 ]). The first pathway shows that there are successful configurations with and without multi-target interventions. Therefore, similar to the interventions targeting women, when implementing multi-target interventions, intervention components targeting women are more likely to be successful when partners or family members are involved, interventions are implemented through group-based intervention delivery, IEC materials were provided, and there is an opportunity for women to interact with health providers.

Intermediate pathways from multi-target interventions sub-analysis that trigger successful interventions targeting pregnant women to optimise CS. In QCA, asterisk (*) denotes an ‘AND’ relationship; Inclusion score (InclS), also known as consistency, indicates the degree to which the evidence is consistent with the hypothesis that there is sufficient relation between the configuration and the outcome; Proportional Reduction in Inconsistency (PRI) refers to the extent in which a configuration is sufficient in triggering successful outcome as well as the negation of the outcome; Coverage score (CovS) refers to percentage of cases in which the configuration is valid

To summarise, there are four essential intervention components which trigger successful educational interventions focusing on pregnant women to reduce CS, this includes 1) group-based intervention delivery, 2) provision of IEC materials on what to expect during labour and birth, 3) partner or family member involvement on the intervention, and 4) opportunity for women to interact with health providers. These conditions do not work in siloed or independently but instead work jointly as parts of configurations to enable successful interventions.

Our extensive QCA identified configurations of essential intervention components which are sufficient to trigger successful interventions to optimised CS. Educational interventions focusing on women were successful by: 1) leveraging social or peer support through group-based intervention delivery, 2) improving women’s knowledge and awareness of what to expect during labour and birth, 3) ensuring women have emotional support through partner or family participation in the intervention, and 4) providing opportunities for women to interact with health providers. We found that the absence of two or more of the above characteristics in an intervention result in unsuccessful interventions. Unlike our logic model, which predicted engagement strategies (i.e. intensity, frequency, technique, recruitment, incentives) to be essential to intervention success, we found that “support” seems to be central in maximising benefits of interventions targeting women.

Group-based intervention delivery is present across all four truth tables and eight pathways leading to successful intervention implementation, suggesting that group-based intervention delivery is an essential component of interventions targeting women. Despite this, we cannot conclude that group-based intervention delivery is a necessary condition, as there may be other pathways not captured in this QCA. The importance of group-based intervention delivery may be due to the group setting providing women with a sense of confidence through peer support and engagement. In group-based interventions, women may feel more confident when learning with others and peer support may motivate women. Furthermore, all group-based interventions in our included studies are conducted at health facilities, which may provide women with more confidence that information is aligned with clinical recommendations. Evidence on benefits of group-based interventions involving women who are pregnant has been demonstrated previously [ 72 , 73 ]. Women reported that group-based interventions reduce their feelings of isolation, provide access to group support, and allow opportunities for them to share their experiences [ 72 , 74 , 75 , 76 ]. This is aligned with social support theory, in which social support through a group or social environment may provide women with feelings of reassurance, compassion, reduce feelings of uncertainty, increase sense of control, access to new contacts to solve problems, and provision of instrumental support, which eventually influence positive health behaviours [ 72 , 77 ]. Women may resolve their uncertainties around mode of birth by sharing their concerns with others and learning at the same time how others cope with it. These findings are consistent with the benefits associated with group-based antenatal care, which is recommended by WHO [ 78 , 79 ].

Kingdon et al. (2018) reported that women and communities liked learning new birth information, as it opens new ways of thinking about vaginal birth and CS, and educates about benefits of different modes of birth, including risks of CS. Our QCA is aligned with this finding where provision of information about birth through education delivery leads to successful interventions but with certain caveats. That is, provision of birth information should be accompanied by IEC materials and through group-based intervention delivery. There is not enough information to distinguish what type of IEC materials lead to successful intervention; however, it is important to note that the format of the IEC materials (such as paper-based or mobile application) may affect success. More work is needed to understand how women and families react to format of IEC materials; for example, will paper-based IEC materials be relegated over more modern methods of reaching women with information through digital applications? The QUALI-DEC (Quality decision-making (QUALI-DEC) by women and healthcare providers for appropriate use of caesarean section) study is currently implementing a decision-analysis tool to help women make an informed decision on preferred mode of birth using both a paper-based and mobile application that may shed some light on this [ 80 ].

Previous research has shown that women who participated in interventions aiming to reduce CS desired emotional support (from partners, doulas or health providers) alongside the communication about childbirth [ 22 ]. Our QCA is aligned with this finding in which emotional support from partners or family members is highly influential in leading to successful interventions. Partner involvement in maternity care has been extensively studied and has been demonstrated to improve maternal health care utilisation and outcomes [ 81 ]. Both women and their partners perceived that partner involvement is crucial as it facilitates men to learn directly from providers, thus promoting shared decision-making among women and partners and enabling partners to reinforce adherence to any beneficial suggestions [ 82 , 83 , 84 , 85 , 86 ]. Partners provide psychosocial support to women, for example through being present during pregnancy and the childbirth process, as well as instrumental support, which includes supporting women financially [ 82 , 83 , 84 ]. Despite the benefits of partner involvement, partner's participation in maternity care is still low [ 82 ], as reflected in this study where only four out of 11 included interventions on this study involved partner or family member involvement. Reasons for this low participation, which include unequal gender norms and limited health system capability [ 82 , 84 , 85 , 86 ], should be explored and addressed to ensure the benefits of the interventions.

Furthermore, our QCA demonstrates the importance of interaction with health providers to trigger successful interventions. The interaction of women with providers in CS decision-making, however, is on a “nexus of power, trust, and risk”, where it may be beneficial but can also reinforce the structural oppression of women [ 13 ]. A recent study on patient-provider interaction in CS decision-making concluded that the interaction between providers who are risk-averse, and women who are cautious about their pregnancies in the health system results in discouragement of vaginal births [ 87 ]. However, this decision could be averted by meaningful communication between women and providers where CS risks and benefits are communicated in an environment where vaginal birth is encouraged [ 87 ]. Furthermore, the reasons women desire interaction with providers can come from opposite directions. Some women see providers as the most trusted and knowledgeable source, in which women can trust the judgement and ensure that the information learned is reliable and evidenced-based [ 22 ]. On the other hand, some women may have scepticism towards providers where women understand that providers’ preference may negatively influence their preferred mode of birth [ 22 ]. Therefore, adequate, two-way interaction is important for women to build a good rapport with providers.

It is also important to note that we have limited evidence (3/17 intervention studies) involving women with previous CS. Vaginal birth after previous CS (VBAC) can be a safe and positive experience for some women, but there are also potential risks depending on their obstetric history [ 88 , 89 , 90 ]. Davis (2020) found that women were motivated to have VBAC due to negative experiences of CS, such as the difficult recovery, and that health providers' roles served as pivotal drivers in motivating women towards VBAC [ 91 ]. Other than this, VBAC also requires giving birth in a suitably staffed and equipped maternity unit, with staff trained on VBAC, equipment for labour monitoring, and resources for emergency CS if needed [ 89 , 90 ]. There is comparatively less research conducted on VBAC and trial of labour after CS [ 88 ]. Therefore, more work is needed to explore if there are potentially different pathways that lead to successful intervention implementation for women with previous CS. It may be more likely that interventions targeting various stakeholders are more crucial in this group of women. For example, both education for women and partners or families, as well as training to upskill health providers might be needed to support VBAC.

Strength and limitations

We found many included studies had poor reporting of the interventions, including the general intervention components (e.g. presence of policies that may support interventions) and process evaluation components, which is reflective of the historical approach to reporting trial data. This poor reporting means we could not engage further in the interventions and thus may have missed important conditions that were not reported. However, we have attempted to compensate for limited process evaluation components by identifying all relevant sibling studies that could contribute to a better understanding of context. Furthermore, there are no studies conducted in low-income countries, despite rapidly increasing CS rates in these settings. Lastly, we were not able to conduct more nuanced analyses about CS, such as exploring how CS interventions impacted changes to emergency versus elective CS, VBAC, or instrumental birth, due to an insufficient number of studies and heterogeneity in outcome measurements. Therefore, it is important to note that we are not necessarily measuring the optimal outcome of interest—reducing unnecessary CS. However, it is unlikely that these non-clinical interventions will interfere with a decision of CS based on clinical indications.

Despite these limitations, this is the first study aiming to understand how certain interventions can be successful in targeting women to optimise CS use. We used the QCA approach and new analytical frameworks to re-analyse existing systematic review evidence to generate new knowledge. We ensure robustness through the use of a logic model and worked backwards in understanding what aspects are different in the intervention across different outcomes. The use of QCA and qualitative evidence synthesis ensured that the results are theory-driven, incorporate participants’ perspectives into the analysis, and explored iteratively to find the appropriate configurations, reducing the risk of data fishing. Lastly, this QCA extends the understanding of effectiveness review conducted by Chen et al. (2018) [ 18 ] by explaining the potential intervention components which may influence heterogeneity.

Implications for practice and research

To aid researchers and health providers to reduce CS in their contexts and designing educational interventions targeting women during pregnancy, we have developed a checklist of key components or questions to consider when designing the interventions that may help lead to successful implementation:

Is the intervention delivered in a group setting?

Are IEC materials on what to expect during labour and birth disseminated to women?

Are women’s partners or families involved in the intervention?

Do women have opportunities to interact with health providers?

We have used this checklist to explore the extent to which the included interventions in our QCA include these components using a matrix model (Fig.  6 ).

Matrix model assessing the extent to which the included intervention studies have essential intervention components identified in the QCA

Additionally, future research on interventions to optimise the use of CS should report the intervention components implemented, including process outcomes such as fidelity, attrition, contextual factors (e.g. policies, details of how the intervention is delivered), and stakeholder factors (e.g. women’s perceptions and satisfaction). These factors are important in not just evaluating whether the intervention is successful or not, but also in exploring why similar interventions can work in one but not in another context. There is also a need for more intervention studies implementing VBAC to reduce CS, to understand how involving women with previous CS may result in successful interventions. Furthermore, more studies understanding impact of the interventions targeting women in LMICs are needed.

This QCA illustrates crucial intervention components and potential pathways that can trigger successful educational interventions to optimise CS, focusing on pregnant women. The following intervention components are found to be sufficient in triggering successful outcomes: 1) group-based delivery, 2) provision of IEC materials, 3) partner or family member involvement, and 4) opportunity for women to interact with health providers. These intervention components do not work in siloed or independently but instead work jointly as parts of configurations to enable successful interventions. Researchers, trialists, hospitals, or other institutions and stakeholders planning interventions focusing on pregnant women can consider including these components to ensure benefits. More studies understanding impact of the interventions targeting women to optimise CS are needed from LMICs. Researchers should clearly describe and report intervention components in trials, and consider how process evaluations can help explain why trials were successful or not. More robust trial reporting and process evaluations can help to better understand mechanisms of action and why interventions may work in one context yet not another.

Availability of data and materials

Additional information files have been provided and more data may be provided upon request to [email protected].

Abbreviations

Coverage score

• Caesarean section

Crisp set qualitative comparative analysis

Fuzzy set qualitative comparative analysis

Information, education, and communication

Inclusion score

Low- and middle-income countries

Proportional reduction in inconsistency

Quality decision-making by women and healthcare providers for appropriate use of caesarean section

Vaginal birth after previous caesarean section

World Health Organization

World Health Organization. WHO statement on caesarean section rates. Available from: https://www.who.int/publications/i/item/WHO-RHR-15.02 . Cited 20 Sept 2023.

Zahroh RI, Disney G, Betrán AP, Bohren MA. Trends and sociodemographic inequalities in the use of caesarean section in Indonesia, 1987–2017. BMJ Global Health. 2020;5:e003844. https://doi.org/10.1136/bmjgh-2020-003844 .

Article   PubMed   PubMed Central   Google Scholar  

Betran AP, Ye J, Moller A-B, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Global Health. 2021;6:e005671. https://doi.org/10.1136/bmjgh-2021-005671 .

Boerma T, Ronsmans C, Melesse DY, Barros AJD, Barros FC, Juan L, et al. Global epidemiology of use of and disparities in caesarean sections. The Lancet. 2018;392:1341–8. https://doi.org/10.1016/S0140-6736(18)31928-7 .

Article   Google Scholar  

Sandall J, Tribe RM, Avery L, Mola G, Visser GH, Homer CS, et al. Short-term and long-term effects of caesarean section on the health of women and children. Lancet. 2018;392:1349–57. https://doi.org/10.1016/S0140-6736(18)31930-5 .

Article   PubMed   Google Scholar  

Abenhaim HA, Tulandi T, Wilchesky M, Platt R, Spence AR, Czuzoj-Shulman N, et al. Effect of Cesarean Delivery on Long-term Risk of Small Bowel Obstruction. Obstet Gynecol. 2018;131:354–9. https://doi.org/10.1097/AOG.0000000000002440 .

Gurol-Urganci I, Bou-Antoun S, Lim CP, Cromwell DA, Mahmood TA, Templeton A, et al. Impact of Caesarean section on subsequent fertility: a systematic review and meta-analysis. Hum Reprod. 2013;28:1943–52. https://doi.org/10.1093/humrep/det130 .

Article   CAS   PubMed   Google Scholar  

Hesselman S, Högberg U, Råssjö E-B, Schytt E, Löfgren M, Jonsson M. Abdominal adhesions in gynaecologic surgery after caesarean section: a longitudinal population-based register study. BJOG: An Int J Obstetrics Gynaecology. 2018;125:597–603. https://doi.org/10.1111/1471-0528.14708 .

Article   CAS   Google Scholar  

Tita ATN, Landon MB, Spong CY, Lai Y, Leveno KJ, Varner MW, et al. Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med. 2009;360:111–20. https://doi.org/10.1056/NEJMoa0803267 .

Article   CAS   PubMed   PubMed Central   Google Scholar  

Wilmink FA, Hukkelhoven CWPM, Lunshof S, Mol BWJ, van der Post JAM, Papatsonis DNM. Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: a 7-year retrospective analysis of a national registry. Am J Obstet Gynecol. 2010;202(250):e1-8. https://doi.org/10.1016/j.ajog.2010.01.052 .

Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. PLoS Med. 2018;15:e1002494. https://doi.org/10.1371/journal.pmed.1002494 .

Ye J, Betrán AP, Guerrero Vela M, Souza JP, Zhang J. Searching for the optimal rate of medically necessary cesarean delivery. Birth. 2014;41:237–44. https://doi.org/10.1111/birt.12104 .

Eide KT, Morken N-H, Bærøe K. Maternal reasons for requesting planned cesarean section in Norway: a qualitative study. BMC Pregnancy Childbirth. 2019;19:102. https://doi.org/10.1186/s12884-019-2250-6 .

Long Q, Kingdon C, Yang F, Renecle MD, Jahanfar S, Bohren MA, et al. Prevalence of and reasons for women’s, family members’, and health professionals’ preferences for cesarean section in China: A mixed-methods systematic review. PLoS Med. 2018;15. https://doi.org/10.1371/journal.pmed.1002672 .

McAra-Couper J, Jones M, Smythe L. Caesarean-section, my body, my choice: The construction of ‘informed choice’ in relation to intervention in childbirth. Fem Psychol. 2012;22:81–97. https://doi.org/10.1177/0959353511424369 .

Panda S, Begley C, Daly D. Clinicians’ views of factors influencing decision-making for caesarean section: A systematic review and metasynthesis of qualitative, quantitative and mixed methods studies. PLoS One 2018;13. https://doi.org/10.1371/journal.pone.0200941 .

Takegata M, Smith C, Nguyen HAT, Thi HH, Thi Minh TN, Day LT, et al. Reasons for increased Caesarean section rate in Vietnam: a qualitative study among Vietnamese mothers and health care professionals. Healthcare. 2020;8:41. https://doi.org/10.3390/healthcare8010041 .

Chen I, Opiyo N, Tavender E, Mortazhejri S, Rader T, Petkovic J, et al. Non-clinical interventions for reducing unnecessary caesarean section. Cochrane Database Syst Rev. 2018. https://doi.org/10.1002/14651858.CD005528.pub3 .

Catling-Paull C, Johnston R, Ryan C, Foureur MJ, Homer CSE. Non-clinical interventions that increase the uptake and success of vaginal birth after caesarean section: a systematic review. J Adv Nurs. 2011;67:1662–76. https://doi.org/10.1111/j.1365-2648.2011.05662.x .

Kingdon C, Downe S, Betran AP. Non-clinical interventions to reduce unnecessary caesarean section targeted at organisations, facilities and systems: Systematic review of qualitative studies. PLOS ONE. 2018;13:e0203274. https://doi.org/10.1371/journal.pone.0203274 .

Kingdon C, Downe S, Betran AP. Interventions targeted at health professionals to reduce unnecessary caesarean sections: a qualitative evidence synthesis. BMJ Open. 2018;8:e025073. https://doi.org/10.1136/bmjopen-2018-025073 .

Kingdon C, Downe S, Betran AP. Women’s and communities’ views of targeted educational interventions to reduce unnecessary caesarean section: a qualitative evidence synthesis. Reprod Health. 2018;15:130. https://doi.org/10.1186/s12978-018-0570-z .

Opiyo N, Young C, Requejo JH, Erdman J, Bales S, Betrán AP. Reducing unnecessary caesarean sections: scoping review of financial and regulatory interventions. Reprod Health. 2020;17:133. https://doi.org/10.1186/s12978-020-00983-y .

Harris K, Kneale D, Lasserson TJ, McDonald VM, Grigg J, Thomas J. School-based self-management interventions for asthma in children and adolescents: a mixed methods systematic review. Cochrane Database Syst Rev. 2019. https://doi.org/10.1002/14651858.CD011651.pub2 .

World Health Organization. Robson Classifcation: Implementation Manual. 2017. Available from: https://www.who.int/publications/i/item/9789241513197 . Cited 20 Sept 2023.

Zahroh RI, Kneale D, Sutcliffe K, Vazquez Corona M, Opiyo N, Homer CSE, et al. Interventions targeting healthcare providers to optimise use of caesarean section: a qualitative comparative analysis to identify important intervention features. BMC Health Serv Res. 2022;22:1526. https://doi.org/10.1186/s12913-022-08783-9 .

World Health Organization. WHO recommendations: non-clinical interventions to reduce unnecessary caesarean sections. 2018. Available from: https://www.who.int/publications/i/item/9789241550338 . Cited 20 Sept 2023.

Hanckel B, Petticrew M, Thomas J, Green J. The use of Qualitative Comparative Analysis (QCA) to address causality in complex systems: a systematic review of research on public health interventions. BMC Public Health. 2021;21:877. https://doi.org/10.1186/s12889-021-10926-2 .

Melendez-Torres GJ, Sutcliffe K, Burchett HED, Rees R, Richardson M, Thomas J. Weight management programmes: Re-analysis of a systematic review to identify pathways to effectiveness. Health Expect. 2018;21:574–84. https://doi.org/10.1111/hex.12667 .

Chatterley C, Javernick-Will A, Linden KG, Alam K, Bottinelli L, Venkatesh M. A qualitative comparative analysis of well-managed school sanitation in Bangladesh. BMC Public Health. 2014;14:6. https://doi.org/10.1186/1471-2458-14-6 .

Thomas J, O’Mara-Eves A, Brunton G. Using qualitative comparative analysis (QCA) in systematic reviews of complex interventions: a worked example. Syst Rev. 2014;3:67. https://doi.org/10.1186/2046-4053-3-67 .

Dușa A. QCA with R: A Comprehensive Resource. 2021. Available from: https://bookdown.org/dusadrian/QCAbook/ . Cited 20 Sept 2023.

Kneale D, Sutcliffe K, Thomas J. Critical Appraisal of Reviews Using Qualitative Comparative Analyses (CARU-QCA): a tool to critically appraise systematic reviews that use qualitative comparative analysis. In: Abstracts of the 26th Cochrane Colloquium, Santiago, Chile. Cochrane Database of Systematic Reviews 2020;(1 Suppl 1). https://doi.org/10.1002/14651858.CD201901 .

Sutcliffe K, Thomas J, Stokes G, Hinds K, Bangpan M. Intervention Component Analysis (ICA): a pragmatic approach for identifying the critical features of complex interventions. Syst Rev. 2015;4:140. https://doi.org/10.1186/s13643-015-0126-z .

Melendez-Torres GJ, Sutcliffe K, Burchett HED, Rees R, Thomas J. Developing and testing intervention theory by incorporating a views synthesis into a qualitative comparative analysis of intervention effectiveness. Res Synth Methods. 2019;10:389–97. https://doi.org/10.1002/jrsm.1341 .

Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8:45. https://doi.org/10.1186/1471-2288-8-45 .

Rouhe H, Salmela-Aro K, Toivanen R, Tokola M, Halmesmäki E, Saisto T. Obstetric outcome after intervention for severe fear of childbirth in nulliparous women – randomised trial. BJOG: An Int J Obstetrics Gynaecology. 2013;120:75–84. https://doi.org/10.1111/1471-0528.12011 .

Fraser W, Maunsell E, Hodnett E, Moutquin JM. Randomized controlled trial of a prenatal vaginal birth after cesarean section education and support program Childbirth alternatives Post-Cesarean study group. Am J Obstet Gynecol. 1997;176:419–25. https://doi.org/10.1016/s0002-9378(97)70509-x .

Masoumi SZ, Kazemi F, Oshvandi K, Jalali M, Esmaeili-Vardanjani A, Rafiei H. Effect of training preparation for childbirth on fear of normal vaginal delivery and choosing the type of delivery among pregnant women in Hamadan, Iran: a randomized controlled trial. J Family Reprod Health. 2016;10:115–21.

PubMed   PubMed Central   Google Scholar  

Navaee M, Abedian Z. Effect of role play education on primiparous women’s fear of natural delivery and their decision on the mode of delivery. Iran J Nurs Midwifery Res. 2015;20:40–6.

Fenwick J, Toohill J, Gamble J, Creedy DK, Buist A, Turkstra E, et al. Effects of a midwife psycho-education intervention to reduce childbirth fear on women’s birth outcomes and postpartum psychological wellbeing. BMC Pregnancy Childbirth. 2015;15:284. https://doi.org/10.1186/s12884-015-0721-y .

Saisto T, Salmela-Aro K, Nurmi J-E, Könönen T, Halmesmäki E. A randomized controlled trial of intervention in fear of childbirth. Obstet Gynecol. 2001;98:820–6. https://doi.org/10.1016/S0029-7844(01)01552-6 .

Montgomery AA, Emmett CL, Fahey T, Jones C, Ricketts I, Patel RR, et al. Two decision aids for mode of delivery among women with previous Caesarean section: randomised controlled trial. BMJ: British Medic J. 2007;334:1305–9.

Xia X, Zhou Z, Shen S, Lu J, Zhang L, Huang P, et al. Effect of a two-stage intervention package on the cesarean section rate in Guangzhou, China: A before-and-after study. PLOS Medicine. 2019;16:e1002846. https://doi.org/10.1371/journal.pmed.1002846 .

Yu Y, Zhang X, Sun C, Zhou H, Zhang Q, Chen C. Reducing the rate of cesarean delivery on maternal request through institutional and policy interventions in Wenzhou. China PLoS ONE. 2017;12:1–12. https://doi.org/10.1371/journal.pone.0186304 .

Borem P, de Cássia SR, Torres J, Delgado P, Petenate AJ, Peres D, et al. A quality improvement initiative to increase the frequency of Vaginal delivery in Brazilian hospitals. Obstet Gynecol. 2020;135:415–25. https://doi.org/10.1097/AOG.0000000000003619 .

Ma R, Lao Terence T, Sun Y, Xiao H, Tian Y, Li B, et al. Practice audits to reduce caesareans in a tertiary referral hospital in south-western China. Bulletin World Health Organiz. 2012;90:488–94. https://doi.org/10.2471/BLT.11.093369 .

Clarke M, Devane D, Gross MM, Morano S, Lundgren I, Sinclair M, et al. OptiBIRTH: a cluster randomised trial of a complex intervention to increase vaginal birth after caesarean section. BMC Pregnancy Childbirth. 2020;20:143. https://doi.org/10.1186/s12884-020-2829-y .

Zhang L, Zhang L, Li M, Xi J, Zhang X, Meng Z, et al. A cluster-randomized field trial to reduce cesarean section rates with a multifaceted intervention in Shanghai. China BMC Medicine. 2020;18:27. https://doi.org/10.1186/s12916-020-1491-6 .

Fenwick J, Gamble J, Creedy DK, Buist A, Turkstra E, Sneddon A, et al. Study protocol for reducing childbirth fear: a midwife-led psycho-education intervention. BMC Pregnancy Childbirth. 2013;13:190. https://doi.org/10.1186/1471-2393-13-190 .

Toohill J, Fenwick J, Gamble J, Creedy DK, Buist A, Turkstra E, et al. A randomized controlled trial of a psycho-education intervention by midwives in reducing childbirth fear in pregnant women. Birth. 2014;41:384–94. https://doi.org/10.1111/birt.12136 .

Toohill J, Callander E, Gamble J, Creedy D, Fenwick J. A cost effectiveness analysis of midwife psycho-education for fearful pregnant women – a health system perspective for the antenatal period. BMC Pregnancy Childbirth. 2017;17:217. https://doi.org/10.1186/s12884-017-1404-7 .

Turkstra E, Mihala G, Scuffham PA, Creedy DK, Gamble J, Toohill J, et al. An economic evaluation alongside a randomised controlled trial on psycho-education counselling intervention offered by midwives to address women’s fear of childbirth in Australia. Sex Reprod Healthc. 2017;11:1–6. https://doi.org/10.1016/j.srhc.2016.08.003 .

Emmett CL, Shaw ARG, Montgomery AA, Murphy DJ, DiAMOND study group. Women’s experience of decision making about mode of delivery after a previous caesarean section: the role of health professionals and information about health risks. BJOG 2006;113:1438–45. https://doi.org/10.1111/j.1471-0528.2006.01112.x .

Emmett CL, Murphy DJ, Patel RR, Fahey T, Jones C, Ricketts IW, et al. Decision-making about mode of delivery after previous caesarean section: development and piloting of two computer-based decision aids. Health Expect. 2007;10:161–72. https://doi.org/10.1111/j.1369-7625.2006.00429.x .

Hollinghurst S, Emmett C, Peters TJ, Watson H, Fahey T, Murphy DJ, et al. Economic evaluation of the DiAMOND randomized trial: cost and outcomes of 2 decision aids for mode of delivery among women with a previous cesarean section. Med Decis Making. 2010;30:453–63. https://doi.org/10.1177/0272989X09353195 .

Frost J, Shaw A, Montgomery A, Murphy D. Women’s views on the use of decision aids for decision making about the method of delivery following a previous caesarean section: Qualitative interview study. BJOG : An Int J Obstetrics Gynaecology. 2009;116:896–905. https://doi.org/10.1111/j.1471-0528.2009.02120.x .

Rees KM, Shaw ARG, Bennert K, Emmett CL, Montgomery AA. Healthcare professionals’ views on two computer-based decision aids for women choosing mode of delivery after previous caesarean section: a qualitative study. BJOG. 2009;116:906–14. https://doi.org/10.1111/j.1471-0528.2009.02121.x .

Emmett CL, Montgomery AA, Murphy DJ. Preferences for mode of delivery after previous caesarean section: what do women want, what do they get and how do they value outcomes? Health Expect. 2011;14:397–404. https://doi.org/10.1111/j.1369-7625.2010.00635.x .

Bastani F, Hidarnia A, Montgomery KS, Aguilar-Vafaei ME, Kazemnejad A. Does relaxation education in anxious primigravid Iranian women influence adverse pregnancy outcomes?: a randomized controlled trial. J Perinat Neonatal Nurs. 2006;20:138–46. https://doi.org/10.1097/00005237-200604000-00007 .

Feinberg ME, Kan ML. Establishing Family Foundations: Intervention Effects on Coparenting, Parent/Infant Well-Being, and Parent-Child Relations. J Fam Psychol. 2008;22:253–63. https://doi.org/10.1037/0893-3200.22.2.253 .

Me F, Ml K, Mc G. Enhancing coparenting, parenting, and child self-regulation: effects of family foundations 1 year after birth. Prevention Science: Official J Soc Prevention Res. 2009;10. https://doi.org/10.1007/s11121-009-0130-4 .

Rouhe H, Salmela-Aro K, Toivanen R, Tokola M, Halmesmäki E, Saisto T. Life satisfaction, general well-being and costs of treatment for severe fear of childbirth in nulliparous women by psychoeducative group or conventional care attendance. Acta Obstet Gynecol Scand. 2015;94:527–33. https://doi.org/10.1111/aogs.12594 .

Rouhe H, Salmela-Aro K, Toivanen R, Tokola M, Halmesmäki E, Ryding E-L, et al. Group psychoeducation with relaxation for severe fear of childbirth improves maternal adjustment and childbirth experience–a randomised controlled trial. J Psychosom Obstet Gynaecol. 2015;36:1–9. https://doi.org/10.3109/0167482X.2014.980722 .

Healy P, Smith V, Savage G, Clarke M, Devane D, Gross MM, et al. Process evaluation for OptiBIRTH, a randomised controlled trial of a complex intervention designed to increase rates of vaginal birth after caesarean section. Trials. 2018;19:9. https://doi.org/10.1186/s13063-017-2401-x .

Clarke M, Savage G, Smith V, Daly D, Devane D, Gross MM, et al. Improving the organisation of maternal health service delivery and optimising childbirth by increasing vaginal birth after caesarean section through enhanced women-centred care (OptiBIRTH trial): study protocol for a randomised controlled trial (ISRCTN10612254). Trials. 2015;16:542. https://doi.org/10.1186/s13063-015-1061-y .

Lundgren I, Healy P, Carroll M, Begley C, Matterne A, Gross MM, et al. Clinicians’ views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section): a study from countries with low VBAC rates. BMC Pregnancy Childbirth. 2016;16:350. https://doi.org/10.1186/s12884-016-1144-0 .

Sharifirad G, Rezaeian M, Soltani R, Javaheri S, Mazaheri MA. A survey on the effects of husbands’ education of pregnant women on knowledge, attitude, and reducing elective cesarean section. J Educ Health Promotion. 2013;2:50. https://doi.org/10.4103/2277-9531.119036 .

Valiani M, Haghighatdana Z, Ehsanpour S. Comparison of childbirth training workshop effects on knowledge, attitude, and delivery method between mothers and couples groups referring to Isfahan health centers in Iran. Iran J Nurs Midwifery Res. 2014;19:653–8.

Bastani F, Hidarnia A, Kazemnejad A, Vafaei M, Kashanian M. A randomized controlled trial of the effects of applied relaxation training on reducing anxiety and perceived stress in pregnant women. J Midwifery Womens Health. 2005;50:e36-40. https://doi.org/10.1016/j.jmwh.2004.11.008 .

Feinberg ME, Roettger ME, Jones DE, Paul IM, Kan ML. Effects of a psychosocial couple-based prevention program on adverse birth outcomes. Matern Child Health J. 2015;19:102–11. https://doi.org/10.1007/s10995-014-1500-5 .

Evans K, Spiby H, Morrell CJ. Developing a complex intervention to support pregnant women with mild to moderate anxiety: application of the medical research council framework. BMC Pregnancy Childbirth. 2020;20:777. https://doi.org/10.1186/s12884-020-03469-8 .

Rising SS. Centering pregnancy. An interdisciplinary model of empowerment. J Nurse Midwifery. 1998;43:46–54. https://doi.org/10.1016/s0091-2182(97)00117-1 .

Breustedt S, Puckering C. A qualitative evaluation of women’s experiences of the Mellow Bumps antenatal intervention. British J Midwife. 2013;21:187–94. https://doi.org/10.12968/bjom.2013.21.3.187 .

Evans K, Spiby H, Morrell JC. Non-pharmacological interventions to reduce the symptoms of mild to moderate anxiety in pregnant women a systematic review and narrative synthesis of women’s views on the acceptability of and satisfaction with interventions. Arch Womens Ment Health. 2020;23:11–28. https://doi.org/10.1007/s00737-018-0936-9 .

Hoddinott P, Chalmers M, Pill R. One-to-one or group-based peer support for breastfeeding? Women’s perceptions of a breastfeeding peer coaching intervention. Birth. 2006;33:139–46. https://doi.org/10.1111/j.0730-7659.2006.00092.x .

Heaney CA, Israel BA. Social networks and social support. In Glanz K, Rimer BK, Viswanath K (Eds.), Health behavior and health education: Theory, research, and practice. Jossey-Bass; 2008. pp. 189–210. https://psycnet.apa.org/record/2008-17146-009 .

World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. 2016. Available from: https://www.who.int/publications/i/item/9789241549912 . Cited 20 Sept 2023.

World Health Organization. WHO recommendation on group antenatal care. WHO - RHL. 2021. Available from: https://srhr.org/rhl/article/who-recommendation-on-group-antenatal-care . Cited 20 Sept 2023.

Dumont A, Betrán AP, Kabore C, de Loenzien M, Lumbiganon P, Bohren MA, et al. Implementation and evaluation of nonclinical interventions for appropriate use of cesarean section in low- and middle-income countries: protocol for a multisite hybrid effectiveness-implementation type III trial. Implementation Science 2020. https://doi.org/10.21203/rs.3.rs-35564/v2 .

Tokhi M, Comrie-Thomson L, Davis J, Portela A, Chersich M, Luchters S. Involving men to improve maternal and newborn health: A systematic review of the effectiveness of interventions. PLOS ONE. 2018;13:e0191620. https://doi.org/10.1371/journal.pone.0191620 .

Gibore NS, Bali TAL. Community perspectives: An exploration of potential barriers to men’s involvement in maternity care in a central Tanzanian community. PLOS ONE. 2020;15:e0232939. https://doi.org/10.1371/journal.pone.0232939 .

Galle A, Plaieser G, Steenstraeten TV, Griffin S, Osman NB, Roelens K, et al. Systematic review of the concept ‘male involvement in maternal health’ by natural language processing and descriptive analysis. BMJ Global Health. 2021;6:e004909. https://doi.org/10.1136/bmjgh-2020-004909 .

Ladur AN, van Teijlingen E, Hundley V. Male involvement in promotion of safe motherhood in low- and middle-income countries: a scoping review. Midwifery. 2021;103:103089. https://doi.org/10.1016/j.midw.2021.103089 .

Comrie-Thomson L, Tokhi M, Ampt F, Portela A, Chersich M, Khanna R, et al. Challenging gender inequity through male involvement in maternal and newborn health: critical assessment of an emerging evidence base. Cult Health Sex. 2015;17:177–89. https://doi.org/10.1080/13691058.2015.1053412 .

Article   PubMed Central   Google Scholar  

Comrie-Thomson L, Gopal P, Eddy K, Baguiya A, Gerlach N, Sauvé C, et al. How do women, men, and health providers perceive interventions to influence men’s engagement in maternal and newborn health? A qualitative evidence synthesis. Soc Scie Medic. 2021;291:114475. https://doi.org/10.1016/j.socscimed.2021.114475 .

Doraiswamy S, Billah SM, Karim F, Siraj MS, Buckingham A, Kingdon C. Physician–patient communication in decision-making about Caesarean sections in eight district hospitals in Bangladesh: a mixed-method study. Reprod Health. 2021;18:34. https://doi.org/10.1186/s12978-021-01098-8 .

Dodd JM, Crowther CA, Huertas E, Guise J-M, Horey D. Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth. Cochrane Database Syst Rev. 2013. https://doi.org/10.1002/14651858.CD004224.pub3 .

Royal College of Obstetricians and Gynaecologists. Birth After Previous Caesarean Birth:Green-top Guideline No. 45. 2015. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_45.pdf . Cited 20 Sept 2023.

Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Birth after previous caesarean section. 2019. Available from: https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Birth-after-previous-Caesarean-Section-(C-Obs-38)Review-March-2019.pdf?ext=.pdf . Cited 20 Sept 2023.

Davis D, Homer CS, Clack D, Turkmani S, Foureur M. Choosing vaginal birth after caesarean section: Motivating factors. Midwifery. 2020;88:102766. https://doi.org/10.1016/j.midw.2020.102766 .

Download references

Acknowledgements

We extend our thanks to Jim Berryman (Brownless Medical Library, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne) for his help in refining the search strategy for sibling studies.

This research was made possible with the support of UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a co-sponsored programme executed by the World Health Organization (WHO). RIZ is supported by Melbourne Research Scholarship and Human Rights Scholarship from The University of Melbourne. CSEH is supported by a National Health and Medical Research Council (NHMRC) Principal Research Fellowship. MAB’s time is supported by an Australian Research Council Discovery Early Career Researcher Award (DE200100264) and a Dame Kate Campbell Fellowship (University of Melbourne Faculty of Medicine, Dentistry, and Health Sciences). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The contents of this publication are the responsibility of the authors and do not reflect the views of the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization.

Author information

Authors and affiliations.

Gender and Women’s Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia

Rana Islamiah Zahroh, Martha Vazquez Corona & Meghan A. Bohren

EPPI Centre, UCL Social Research Institute, University College London, London, UK

Katy Sutcliffe & Dylan Kneale

Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland

Ana Pilar Betrán & Newton Opiyo

Maternal, Child, and Adolescent Health Programme, Burnet Institute, Melbourne, VIC, Australia

Caroline S. E. Homer

You can also search for this author in PubMed   Google Scholar

Contributions

- Conceptualisation and study design: MAB, APB, RIZ

- Funding acquisition: MAB, APB

- Data curation: RIZ, MAB, MVC

- Investigation, methodology and formal analysis: all authors

- Visualisation: RIZ, MAB

- Writing – original draft preparation: RIZ, MAB

- Writing – review and editing: all authors

Corresponding author

Correspondence to Rana Islamiah Zahroh .

Ethics declarations

Ethics approval and consent to participate.

This study utilised published and openly available data, and thus ethics approval is not required.

Consent for publication

No direct individual contact is involved in this study, therefore consent for publication is not needed.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's note.

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

Supplementary Information

Additional file 1..

Logic model in optimizing CS use.

Additional file 2.

Risk of bias assessments.

Additional file 3.

Coding framework and calibration rules.

Additional file 4.

Coding framework as applied to each intervention (data table).

Rights and permissions

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

Reprints and permissions

About this article

Cite this article.

Zahroh, R.I., Sutcliffe, K., Kneale, D. et al. Educational interventions targeting pregnant women to optimise the use of caesarean section: What are the essential elements? A qualitative comparative analysis. BMC Public Health 23 , 1851 (2023). https://doi.org/10.1186/s12889-023-16718-0

Download citation

Received : 07 March 2022

Accepted : 07 September 2023

Published : 23 September 2023

DOI : https://doi.org/10.1186/s12889-023-16718-0

Share this article

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

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

Provided by the Springer Nature SharedIt content-sharing initiative

• Maternal health
• Complex intervention
• Intervention implementation

BMC Public Health

ISSN: 1471-2458

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

An official website of the United States government

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

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

• Publications
• Account settings

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

• Advanced Search
• Journal List
• Heart Views
• v.18(3); Jul-Sep 2017

Guidelines To Writing A Clinical Case Report

What is a clinical case report.

A case report is a detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient. Case reports usually describe an unusual or novel occurrence and as such, remain one of the cornerstones of medical progress and provide many new ideas in medicine. Some reports contain an extensive review of the relevant literature on the topic. The case report is a rapid short communication between busy clinicians who may not have time or resources to conduct large scale research.

WHAT ARE THE REASONS FOR PUBLISHING A CASE REPORT?

The most common reasons for publishing a case are the following: 1) an unexpected association between diseases or symptoms; 2) an unexpected event in the course observing or treating a patient; 3) findings that shed new light on the possible pathogenesis of a disease or an adverse effect; 4) unique or rare features of a disease; 5) unique therapeutic approaches; variation of anatomical structures.

Most journals publish case reports that deal with one or more of the following:

• Unusual observations
• Adverse response to therapies
• Unusual combination of conditions leading to confusion
• Illustration of a new theory
• Question regarding a current theory
• Personal impact.

STRUCTURE OF A CASE REPORT[ 1 , 2 ]

Different journals have slightly different formats for case reports. It is always a good idea to read some of the target jiurnals case reports to get a general idea of the sequence and format.

In general, all case reports include the following components: an abstract, an introduction, a case, and a discussion. Some journals might require literature review.

The abstract should summarize the case, the problem it addresses, and the message it conveys. Abstracts of case studies are usually very short, preferably not more than 150 words.

Introduction

The introduction gives a brief overview of the problem that the case addresses, citing relevant literature where necessary. The introduction generally ends with a single sentence describing the patient and the basic condition that he or she is suffering from.

This section provides the details of the case in the following order:

• Patient description
• Case history
• Physical examination results
• Results of pathological tests and other investigations
• Treatment plan
• Expected outcome of the treatment plan
• Actual outcome.

The author should ensure that all the relevant details are included and unnecessary ones excluded.

This is the most important part of the case report; the part that will convince the journal that the case is publication worthy. This section should start by expanding on what has been said in the introduction, focusing on why the case is noteworthy and the problem that it addresses.

This is followed by a summary of the existing literature on the topic. (If the journal specifies a separate section on literature review, it should be added before the Discussion). This part describes the existing theories and research findings on the key issue in the patient's condition. The review should narrow down to the source of confusion or the main challenge in the case.

Finally, the case report should be connected to the existing literature, mentioning the message that the case conveys. The author should explain whether this corroborates with or detracts from current beliefs about the problem and how this evidence can add value to future clinical practice.

A case report ends with a conclusion or with summary points, depending on the journal's specified format. This section should briefly give readers the key points covered in the case report. Here, the author can give suggestions and recommendations to clinicians, teachers, or researchers. Some journals do not want a separate section for the conclusion: it can then be the concluding paragraph of the Discussion section.

Notes on patient consent

Informed consent in an ethical requirement for most studies involving humans, so before you start writing your case report, take a written consent from the patient as all journals require that you provide it at the time of manuscript submission. In case the patient is a minor, parental consent is required. For adults who are unable to consent to investigation or treatment, consent of closest family members is required.

Patient anonymity is also an important requirement. Remember not to disclose any information that might reveal the identity of the patient. You need to be particularly careful with pictures, and ensure that pictures of the affected area do not reveal the identity of the patient.