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The theory contribution of case study research designs

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• Published: 16 February 2017
• Volume 10 , pages 281–305, ( 2017 )

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• Hans-Gerd Ridder 1  

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The objective of this paper is to highlight similarities and differences across various case study designs and to analyze their respective contributions to theory. Although different designs reveal some common underlying characteristics, a comparison of such case study research designs demonstrates that case study research incorporates different scientific goals and collection and analysis of data. This paper relates this comparison to a more general debate of how different research designs contribute to a theory continuum. The fine-grained analysis demonstrates that case study designs fit differently to the pathway of the theory continuum. The resulting contribution is a portfolio of case study research designs. This portfolio demonstrates the heterogeneous contributions of case study designs. Based on this portfolio, theoretical contributions of case study designs can be better evaluated in terms of understanding, theory-building, theory development, and theory testing.

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1 Introduction

Case study research scientifically investigates into a real-life phenomenon in-depth and within its environmental context. Such a case can be an individual, a group, an organization, an event, a problem, or an anomaly (Burawoy 2009 ; Stake 2005 ; Yin 2014 ). Unlike in experiments, the contextual conditions are not delineated and/or controlled, but part of the investigation. Typical for case study research is non-random sampling; there is no sample that represents a larger population. Contrary to quantitative logic, the case is chosen, because the case is of interest (Stake 2005 ), or it is chosen for theoretical reasons (Eisenhardt and Graebner 2007 ). For within-case and across-case analyses, the emphasis in data collection is on interviews, archives, and (participant) observation (Flick 2009 : 257; Mason 2002 : 84). Case study researchers usually triangulate data as part of their data collection strategy, resulting in a detailed case description (Burns 2000 ; Dooley 2002 ; Eisenhardt 1989 ; Ridder 2016 ; Stake 2005 : 454). Potential advantages of a single case study are seen in the detailed description and analysis to gain a better understanding of “how” and “why” things happen. In single case study research, the opportunity to open a black box arises by looking at deeper causes of the phenomenon (Fiss 2009 ). The case data can lead to the identification of patterns and relationships, creating, extending, or testing a theory (Gomm et al. 2000 ). Potential advantages of multiple case study research are seen in cross-case analysis. A systematic comparison in cross-case analysis reveals similarities and differences and how they affect findings. Each case is analyzed as a single case on its own to compare the mechanisms identified, leading to theoretical conclusions (Vaughan 1992 : 178). As a result, case study research has different objectives in terms of contributing to theory. On the one hand, case study research has its strength in creating theory by expanding constructs and relationships within distinct settings (e.g., in single case studies). On the other hand, case study research is a means of advancing theories by comparing similarities and differences among cases (e.g., in multiple case studies).

Unfortunately, such diverging objectives are often neglected in case study research. Burns ( 2000 : 459) emphasizes: “The case study has unfortunately been used as a ‘catch –all’ category for anything that does not fit into experimental, survey, or historical methods.”

Therefore, this paper compares case study research designs. Such comparisons have been conducted previously regarding their philosophical assumptions and orientations, key elements of case study research, their range of application, and the lacks of methodological procedures in publications. (Baxter and Jack 2008 ; Dooley 2002 ; Dyer and Wilkins 1991 ; Piekkari et al. 2009 ; Welch et al. 2011 ). This paper aims to compare case study research designs regarding their contributions to theory.

Case study research designs will be analyzed regarding their various strengths on a theory continuum. Edmondson and McManus ( 2007 ) initiated a debate on whether the stage of theory fits to research questions, style of data collection, and analyses. Similarly, Colquitt and Zapata-Phelan ( 2007 ) created a taxonomy capturing facets of empirical article’s theoretical contributions by distinguishing between theory-building and theory testing. Corley and Gioia ( 2011 ) extended this debate by focusing on the practicality of theory and the importance of prescience. While these papers consider the whole range of methodological approaches on a higher level, they treat case studies as relatively homogeneous. This paper aims to delve into a deeper level of analysis by solely focusing on case study research designs and their respective fit on this theory continuum. This approach offers a more fine-grained understanding that sheds light on the diversity of case study research designs in terms of their differential theory contributions. Such a deep level of analysis on case study research designs enables more rigor in theory contribution. To analyze alternative case study research designs regarding their contributions to theory, I engage into the following steps:

First, differences between case study research designs are depicted. I outline and compare the case study research designs with regard to the key elements, esp. differences in research questions, frameworks, sampling, data collection, and data analysis. These differences result in a portfolio of various case study research designs.

Second, I outline and substantiate a theory continuum that varies between theory-building, theory development, and testing theory. Based on this continuum, I analyze and discuss each of the case study research designs with regard to their location on the theory continuum. This analysis is based on a detailed differentiation of the phenomenon (inside or outside the theory), the status of the theory, research strategy, and methods.

As a result, the contribution to the literature is a portfolio of case study research designs explicating their unique contributions to theory. The contribution of this paper lies in a fine-grained analysis of the interplay of methods and theory (van Maanen et al. 2007 ) and the methodological fit (Edmondson and McManus 2007 ) of case study designs and the continuum of theory. It demonstrates that different designs have various strengths and that there is a fit between case study designs and different points on a theory continuum. If there is no clarity as to whether a case study design aims at creating, elaborating, extending, or testing theory, the contribution to theory is difficult to identify for authors, reviewers, and readers. Consequently, this paper aims to clarify at which point of the continuum of theory case study research designs can provide distinct contributions that can be identified beyond their traditionally claimed exploratory character.

2 Differences across case study design: a portfolio approach

Only few papers have compared case study research designs so far. In all of these comparisons, the number of designs differs as well as the issues under consideration. In an early debate between Dyer and Wilkins ( 1991 ) and Eisenhardt ( 1991 ), Dyer and Wilkins compared the case study research design by Eisenhardt ( 1989 ) with “classical” case studies. The core of the debate concerns a difference between in-depth single case studies (classical case study) to a focus on the comparison of multiple cases. Dyer and Wilkins ( 1991 : 614) claim that the essence of a case study lies in the careful study of a single case to identify new relationships and, as a result, question the Eisenhardt approach which puts a lot of emphasis on comparison of multiple cases. Eisenhardt, on the contrary, claims that multiple cases allow replication between cases and is, therefore, seen as a means of corroboration of propositions (Eisenhardt 1991 ). Classical case studies prefer deep descriptions of a single case, considering the context to reveal insights into the single case and by that elaborate new theories. The comparison of multiple cases, therefore, tends—in the opinion of Dyer and Wilkens—to surface descriptions. This weakens the possibility of context-related, rich descriptions. While, in classic case study, good stories are the aim, the development of good constructs and their relationships is aimed in Eisenhardt’s approach. Eisenhardt ( 1991 : 627) makes a strong plea on more methodological rigor in case study research, while Dyer and Wilkins ( 1991 : 613) criticize that the new approach “… includes many of the attributes of hypothesis-testing research (e.g., sampling and controls).”

Dooley ( 2002 : 346) briefly takes the case study research designs by Yin (1994) and Eisenhardt ( 1989 ) as exemplars of how the processes of case study research can be applied. The approach by Eisenhardt is seen as an exemplar that advances conceptualization and operationalization in the phases of theory-building, while the approach by Yin is seen as exemplar that advances minimally conceptualized and operationalized existing theory.

Baxter and Jack ( 2008 ) describe the designs by Yin (2003) and Stake ( 1995 ) to demonstrate key elements of qualitative case study. The authors outline and carefully compare the approaches by Yin and Stake in conducting the research process, neglecting philosophical differences and theoretical goals.

Piekkari et al. ( 2009 ) outline the methodological richness of case study research using the approaches of Yin et al. (1998), and Stake. They specifically exhibit the role of philosophical assumptions, establishing differences in conventionally accepted practices of case study research in published papers. The authors analyze 135 published case studies in four international business journals. The analysis reveals that, in contrast to the richness of case study approaches, the majority of published case studies draw on positivistic foundations and are narrowly declared as explorative with a lack of clarity of the theoretical purpose of the case study. Case studies are often designed as multiple case studies with cross-sectional designs based on interviews. In addition to the narrow use of case study research, the authors find out that “… most commonly cited methodological literature is not consistently followed” (Piekkari et al. 2009 : 567).

Welch et al. ( 2011 ) develop a typology of theorizing modes in case study methods. Based on the two dimensions “contextualization” and “causal explanation”, they differentiate in their typology between inductive theory-building (Eisenhardt), interpretive sensemaking (Stake), natural experiment (Yin), and contextualised explanation (Ragin/Bhaskar). The typology is used to analyze 199 case studies from three highly ranked journals over a 10-year period for whether the theorizing modes are exercised in the practice of publishing case studies. As a result, the authors identify a strong emphasis on the exploratory function of case studies, neglecting the richness of case study methods to challenge, refine, verify, and test theories (Welch et al. 2011 : 755). In addition, case study methods are not consistently related to theory contribution: “By scrutinising the linguistic elements of texts, we found that case researchers were not always clear and consistent in the way that they wrote up their theorising purpose and process” (Welch et al. 2011 : 756).

As a result, the comparisons reveal a range of case study designs which are rarely discussed. In contrast, published case studies are mainly introduced as exploratory design. Explanatory, interpretivist, and critical/reflexive designs are widely neglected, narrowing the possible applications of case study research. In addition, comparisons containing an analysis of published case studies reveal a low degree in accuracy when applying case study methods.

What is missing is a comparison of case study research designs with regard to differences in the contribution to theory. Case study designs have different purposes in theory contribution. Confusing these potential contributions by inconsistently utilizing the appropriate methods weakens the contribution of case studies to scientific progress and, by that, damages the reputation of case studies.

To conduct such a comparison, I consider the four case study research approaches of Yin, Eisenhardt, Burawoy, and Stake for the following reasons.

These approaches are the main representatives of case study research design outlined in the comparisons elaborated above (Baxter and Jack 2008 ; Dooley 2002 ; Dyer and Wilkins 1991 ; Piekkari et al. 2009 ; Welch et al. 2011 ). I follow especially the argument by Piekkari et al. ( 2009 ) that these approaches contain a broad spectrum of methodological foundations of exploratory, explanatory, interpretivist, and critical/reflexive designs. The chosen approaches have an explicit and detailed methodology which can be reconstructed and compared with regard to their theory contribution. Although there are variations in the application of the designs, to the best of my knowledge, the designs represent the spectrum of case study methodologies. A comparison of these methodologies revealed main distinguishable differences. To highlight these main differences, I summarized these differences into labels of “no theory first”; “gaps and holes”; “social construction of reality”; and “anomalies”.

I did not consider descriptions of case study research in text books which focus more or less on general descriptions of the common characteristics of case studies, but do not emphasize differences in methodologies and theory contribution. In addition, I did not consider so-called “home grown” designs (Eisenhardt 1989 : 534) which lack a systematic and explicit demonstration of the methodology and where “… the hermeneutic process of inference—how all these interviews, archival records, and notes were assembled into a coherent whole, what was counted and what was discounted—remains usually hidden from the reader” (Fiss 2009 : 425).

Finally, although often cited in the methodological section of case studies, books are not considered which concentrate on data analysis in qualitative research per se (Miles et al. 2014 ; Corbin and Strauss 2015 ). Therefore, to analyze the contribution of case study research to the scientific development, it needs to compare explicit methodology. This comparison will be outlined in the following sections with regard to main methodological steps: the role of the case, the collection of data, and the analysis of data.

2.1 Case study research design 1: no theory first

A popular template for building theory from case studies is a paper by Eisenhardt ( 1989 ). It follows a dramaturgy with a precise order of single steps for constructing a case study and is one of the most cited papers in methods sections (Ravenswood 2011 ). This is impressive for two reasons. On the one hand, Eisenhardt herself has provided a broader spectrum of case study research designs in her own empirical papers, for example, by combining theory-building and theory elaboration (Bingham and Eisenhardt 2011 ). On the other hand, she “updated” her design in a paper with Graebner (Eisenhardt and Graebner 2007 ), particularly by extending the range of inductive theory-building. These developments do not seem to be seriously considered by most authors, as differences and elaborations of this spectrum are rarely found in publications. Therefore, in the following, I focus on the standards provided by Eisenhardt ( 1989 ) and Eisenhardt and Graebner ( 2007 ) as exemplary guidelines.

Eisenhardt follows the ideal of ‘no theory first’ to capture the richness of observations without being limited by a theory. The research question may stem from a research gap meaning that the research question is of relevance. Tentative a priori constructs or variables guide the investigation, but no relationships between such constructs or variables are assumed so far: “Thus, investigators should formulate a research problem and possibly specify some potentially important variables, with some reference to extant literature. However, they should avoid thinking about specific relationships between variables and theories as much as possible, especially at the outset of the process” (Eisenhardt 1989 : 536).

Cases are chosen for theoretical reasons: for the likelihood that the cases offer insights into the phenomenon of interest. Theoretical sampling is deemed appropriate for illuminating and extending constructs and identifying relationships for the phenomenon under investigation (Eisenhardt and Graebner 2007 ). Cases are sampled if they provide an unusual phenomenon, replicate findings from other cases, use contrary replication, and eliminate alternative explanations.

With respect to data collection, qualitative data are the primary choice. Data collection is based on triangulation, where interviews, documents, and observations are often combined. A combination of qualitative data and quantitative data is possible as well (Eisenhardt 1989 : 538). Data analysis is conducted via the search for within-case patterns and cross-case patterns. Systematic procedures are conducted to compare the emerging constructs and relationships with the data, eventually leading to new theory.

A good exemplar for this design is the investigation of technology collaborations (Davis and Eisenhardt 2011 ). The purpose of this paper is to understand processes by which technology collaborations support innovations. Eight technology collaborations among ten firms were sampled for theoretical reasons. Qualitative and quantitative data were used from semi-structured interviews, public and private data, materials provided by informants, corporate intranets, and business publications. The data was measured, coded, and triangulated. Writing case histories was a basis for within-case and cross-case analysis. Iteration between cases and emerging theory and considering the relevant literature provided the basis for the development of a theoretical framework.

Another example is the investigation of what is learned in organizational processes (Bingham and Eisenhardt 2011 ). This paper demonstrates that the case study design is not only used for theory-building, but can also be combined with theory elaboration. Based on the lenses of the organizational knowledge literature, organizational routines literature, and heuristics literature, six technology-based ventures were chosen for theoretical reasons. Several data sources were used, especially quantitative and qualitative data from semi-structured interviews, archival data, observations, e-mails, phone calls, and follow-up interviews. Within-case analysis revealed what each firm has learned from process experience. Cross-case analysis revealed emerging patterns from which tentative constructs and propositions were formed. In replication logic constructs and propositions were refined across the cases. When mirroring the findings with the literature, both the emergences of the constructs were compared and unexpected types were considered. The iteration of theory and data as well as the consideration of related research sharpened the theoretical arguments, eventually leading to a theoretical framework. “Thus, we combined theory elaboration (Lee 1999 ) and theory generation (Eisenhardt 1989 )” (Bingham and Eisenhardt 2011 : 1448).

2.2 Case study research design 2: gaps and holes

Contrary to “No Theory First”, case study research design can also aim at specifying gaps or holes in existing theory with the ultimate goal of advancing theoretical explanations (Ridder 2016 ). A well-known template for this case study research design is the book by Yin ( 2014 ). It is a method-orientated handbook of how to design single and multiple case studies with regard to this purpose. Such a case study research design includes: “A ‘how’ and ‘why’ question” (Yin 2014 : 14). Research questions can be identified and shaped using literature to narrow the interest in a specific topic, looking for key studies and identifying questions in these studies. According to Yin’s design, existing theory is the starting point of case study research. In addition, propositions or frameworks provide direction, reflect the theoretical perspective, and guide the search for relevant evidence.

There are different rationales for choosing a single case design (Yin 2014 : 51). Purposeful sampling is conducted if an extreme case or an unusual case is chosen and if rarely observable phenomena can be investigated with regard to unknown matters and their relationships. Common cases allow conclusions for a broader class of cases. Revelatory cases provide the opportunity to investigate into a previously inaccessible inquiry, and the longitudinal study enables one to investigate a single case at several points in time. A rationale for multiple case designs has its strength in replication logic (Yin 2014 : 56). In the case of literal replication, cases are selected to predict similar results. In the case of theoretical replication, cases are selected to predict contrasting results but for theoretical reasons. Yin provides several tactics to increase the reliability (protocol; data base) of the study.

Yin ( 2014 : 103) emphasizes that interviews are one of the most important sources of data collection but considers other sources of qualitative data as well. Data triangulation is designed to narrow problems of construct validity, as multiple sources of data provide multiple measures of the same phenomenon. Yin ( 2014 : 133) offers a number of data analysis strategies (e.g., case description; examining rival explanations) and analytic techniques which are apt to compare the proposed relationships with empirical patterns. Pattern-matching logic compares empirically based patterns with predicted patterns, enabling further data analysis techniques (explanation building, time series analysis, logic models, and cross-case synthesis). In analytical generalization, the theory is compared with the empirical results, leading to the modification or extension of the theory.

An appropriate model for this case study design can be identified in a paper by Ellonen et al. ( 2009 ). The paper is based on the emerging dynamic capability theory. The four cases were chosen for theoretical reasons to deliver an empirical contribution to the dynamic capability theory by investigating the relationship of dynamic capabilities and innovation outcomes. The authors followed a literal replication strategy and identified patterns between dynamic capabilities of the firms and their innovation outcomes.

Shane ( 2000 ) is an author who developed specific propositions from a framework and examined the propositions in eight entrepreneurial cases. Using several sources of interviews and archival data, the author compared the data with the propositions using the pattern-matching logic, which concluded in developing entrepreneurship theory.

2.3 Case study research design 3: social construction of reality

So far, the outlined case study research designs are based on positivist roots, but there is richness and variety in case study research stemming from different philosophical realms. The case study research design by Stake ( 1995 , 2000 , 2005 ), for example, is based on constructivist assumptions and aims to investigate the social construction of reality and meaning (Schwandt 1994 : 125).

According to this philosophical assumption, there is no unique “real world” that preexists independently of human mental activity and symbolic language. The world is a product of socially and historically related interchanges amongst people (social construction). The access to reality is given through social constructions, such as language and shared meanings: “The meaning-making activities themselves are of central interest to social constructionists/constructivists, simply because it is the meaning-making/sense making attributional activities that shape action or (inaction)” (Guba and Lincoln 2005 : 197). Therefore, the researcher is not looking for objective “facts”, nor does he aim at identifying and measuring patterns which can be generalized. Contrarily, the constructivist is researching into specific actions, in specific places, at specific times. The scientist tries to understand the construction and the sharing of meaning (Schwandt 1994 ).

According to Stake ( 2005 ), the direction of the case study is shaped by the interest in the case. In an intrinsic case study, the case itself is of interest. The purpose is not theory-building but curiosity in the case itself. In an instrumental case study, the case itself is of secondary interest. It plays a supportive role, as it facilitates the understanding of a research issue. The case can be typical of other cases. Multiple or collective case study research designs extend the instrumental case study. It is assumed that a number of cases will increase the understanding and support theorizing by comparison of the cases.

The differentiation by Stake ( 1995 , 2005 ) into intrinsic and instrumental cases guides the purposive sampling strategy. In intrinsic case studies, the case is, by definition, already selected. The researcher looks for specific characteristics, aiming for thick descriptions with the opportunity to learn. Representativeness or generalization is not considered. In instrumental case study design, purposive sampling leads to the phenomenon under investigation. In multiple case study designs, the ability to compare cases enhances the opportunity to theorize.

A case study requires an integrated, holistic comprehension of the case complexity. According to Stake ( 2005 ), the case study is constructed by qualitative data, such as observations, interviews, and documents. Triangulation first serves as clarification of meaning. Second, the researcher is interested in the diversity of perceptions.

Two methods of data analysis are considered in such qualitative case study design: direct interpretation and categorical aggregation (Stake 1995 : 74). The primary task of an intrinsic case study is to understand the case. This interpretation is offered to the reader, but the researcher has to provide the material in a sufficient way (thick descriptions), so that the reader can learn from the case as well as draw his or her own conclusions. Readers can thus make some generalizations based on personal and vicarious experiences (“naturalistic generalization”). In instrumental case studies, the understanding of phenomena and relationships leads to categorical aggregation, and the focus is on how the phenomenon exists across several cases.

Greenwood and Suddaby ( 2006 ), for example, used the instrumental case study design by Stake, combining network location theory and dialectical theory. They identified new dynamics creating a process model of elite institutional entrepreneurship.

Ituma et al. ( 2011 ) highlighted the social construction of reality in their study of career success. The majority of career studies have been conducted in Western countries and findings have been acknowledged as universally applicable. The authors demonstrated that realities of managers in other areas are constructed differently. As a result of their study, they provided a contextually sensitive frame for the analysis of career outcomes.

2.4 Case study research design 4: anomalies

Identifying anomalies as a basis for further research is common in management and organization research (Gilbert and Christensen 2005 ). In case study research, the extended case study method is used for this case study research design (Ridder 2016 ). Following Burawoy ( 1991 , 1998 , 2009 ), the research question derives from curiosity. Researchers normally look at what is “interesting” and what is “surprising” in a social situation that existing theory cannot explain. Initially, it is not important whether the expectations develop from some popular belief, stereotype, or from an academic theory. The extended case study research design is guided by anomalies that the previous theory was not able to explain through internal contradictions of theory, theoretical gaps, or silences. An anomaly does not reject theory, but rather demonstrates that the theory is incomplete. Theory is aimed to be improved by “… turning anomalies into exemplars” (Burawoy 1991 : 10).

The theoretical sampling strategy in this case study research design stems from the theoretical failure in confrontation with the site. According to the reflexive design, such cases do not favour individuals or isolated phenomena, but social situations in which a comparative strategy allows the tracing of differences across the cases to external forces.

In the extended case study, the researcher deals with qualitative data, but also considers the broader complex social situation. The researcher engages into a dialogue with the respondents (Burawoy ( 1991 , 1998 , 2009 ). An interview is an intervention into the life of a respondent. By means of mutual interaction it is possible to discover the social order under investigation. The observer has to unpack those situational experiences by means of participant observation and mutual interpretation. This situational comprehension aims at understanding divergent “voices”, reflecting the variety of respondents’ understandings of the social situation.

As in other sciences, these voices have to be aggregated. This aggregation of multiple readings of a single case is conducted by turning the aggregation into social processes: “The move from situation to process is accomplished differently in different reflexive methods, but it is always reliant on existing theory” (Burawoy 2009 : 41). Social processes are now traced to the external field as the conditions of the social processes. Consequently, this leads to the question concerning “… how those micro situations are shaped by wider structures” (Burawoy 1991 : 282). “Reflexive science insists, therefore, on studying the everyday world from the standpoint of its structuration, that is, by regarding it as simultaneously shaped by and shaping an external field of forces” (Burawoy 2009 : 42). Such social fields cannot be held constant, which undermines the idea of replication. The external field is in continuous flux. Accordingly, social forces that influence the social processes are identified, shaping the phenomenon under investigation. Extension of theory does not target representativeness as a relationship of sample and population. Generality in reflexive science is to reconstruct an existing theory: “We begin with our favorite theory but seek not confirmations but refutations that inspire us to deepen that theory. Instead of discovering grounded theory, we elaborate existing theory. We do not worry about the uniqueness of our case, since we are not as interested in its representativeness as its contribution to reconstructing theory. Our theoretical point of departure can range from the folk theory of participants to any abstract law. We consider only that the scientist consider it worth developing” (Burawoy 2009 : 43). Such elaboration stems from the identification of anomalies and offers new predictions with regard to the theory.

It is somewhat surprising that the extended case study design has been neglected in the management literature so far, and it appears that critical reflexive principles have to be resurrected as they have been in other disciplines (see the overview at Wadham and Warren 2014 ). Examples in the management and organization literature are rare. Danneels ( 2011 ) used the extended case study design to extend the dynamic capabilities theory. In his famous Smith Corona case, Danneels shows how a company tried to change its resource base. Based on detailed data, the Smith Corona case provides insights into the resource alteration processes and how dynamic capabilities operate. As a result, the paper fills a process gap in dynamic capability theory. Iterating between data collection and analysis, Danneels revealed resource cognition as an element not considered so far in dynamic capability theory. The use of the extended case study method is limited to the iteration of data and theory. First, there is “running exchange” (Burawoy 1991 : 10) between field notes and analysis. Second, there is iteration between analysis and existing theory. Unlike Burawoy, who aims to reconstruct existing theory on the basis of “emergent anomalies” (Burawoy 1991 : 11) considering social processes and external forces, Danneels confronts the dynamic capabilities literature with the Smith Corona case to extend the theory of dynamic capabilities.

2.5 A comparison of case study research processes

Commonalities and differences emerged from the comparison of the designs. Table  1 provides a brief summary of these main differences and the resulting portfolio of case study research designs which will be discussed in more detail.

There is an extensive range between the different designs regarding the research processes. In “no theory first”, there is a broad and tentative research question with some preliminary variables at the outset. The research question may be modified during the study as well as the variables. This design avoids any propositions regarding relationships.

On the contrary, the research question in “gaps and holes” is strongly related to existing theory, focusing on “how and why” questions. The existing theory contains research gaps which, once identified within the existing theory, lead accordingly to assumed relationships which are the basis for framework and propositions to be matched by empirical data. This broad difference is even more elaborated by a design that aims the “social construction of reality”. There is no research question at the outset, but a curiosity in the case or the case is a facilitator to understand a research issue. This is far away from curiosity in the “anomaly approach”. Here, the research question is inspired by questioning why an anomaly cannot be explained by the existing theory. What kind of gaps, silences, or internal contradictions demonstrates the insufficiency of the existing theory?

Various sampling strategies are used across these case study research designs, including theoretical sampling and purposeful sampling, which serve different objectives. Theoretical sampling in “no theory first” aims at selecting a case or cases that are appropriate to highlight new or extend preliminary constructs and reveal new relationships. There is a distinct difference from theoretical sampling in the “anomalies” approach. Such a sampling strategy aims to choose a case that is a demonstration of the failure of the theory. In “gaps and holes” sampling is highly focused on the purpose of the case study. Extreme and unusual cases have other purposes compared to common cases or revelatory cases. A single case may be chosen to investigate deeply into new phenomena. A multiple case study may serve a replication logic by which the findings have relevance beyond the cases under investigation. In “social construction of reality”, the sampling is purposeful as well, but for different reasons. Either the case is of interest per se or the case represents a good opportunity to understand a theoretical issue.

Although qualitative data are preferred in all of the designs, quantitative data are seen as a possible opportunity to strengthen cases by such data. Nevertheless, in “social construction of reality”, there is a strong emphasis on thick descriptions and a holistic understanding of the case. This is in contrast to a more construct- and variable- oriented collection of data in “no theory first” and “gaps and holes”. In addition, in contrast to that, the “anomaly” approach is the only design that receives data from dialogue between observer and participants and participant observation.

Finally, data analysis lies within a wide range. In “no theory first”, the research process is finalized by inspecting the emerging constructs within the case or across cases. Based on a priory constructs, systematic comparisons reveal patterns and relationships resulting in a tentative theory. On the contrary, in “gaps and holes”, a tentative theory exists. The final analysis concentrates on the matching of the framework or propositions with patterns from the data. While both of these approaches condense data, the approach of “social construction of reality” ends the research process with thick descriptions of the case to learn from the case or with categorical comparisons. In the “anomaly” approach, the data analysis is aggregation of data, but these aggregated data are related to its external field and their pressures and influences by structuration to reconstruct the theory.

As a result, it is unlikely that the specified case study designs contribute to theory in a homogeneous manner. This result will be discussed in light of the question regarding how these case study designs can inform theory at several points of a continuum of theory. This analysis will be outlined in the following sections. In a first step, I review the main elements of a theory continuum. In a second step, I discuss the respective contribution of the previously identified case study research designs to the theory continuum.

3 Elements of a theory continuum

What a theory is and what a theory is not is a classic debate (Sutton and Staw 1995 ; Weick 1995 ). Often, theories are described in terms of understanding relationships between phenomena which have not been or were not well understood before (Chiles 2003 ; Edmondson and McManus 2007 ; Shah and Corley 2006 ), but there is no overall acceptance as to what constitutes a theory. Theory can be seen as a final product or as a continuum, and there is an ongoing effort to define different stages of this continuum (Andersen and Kragh 2010 ; Colquitt and Zapata-Phelan 2007 ; Edmondson and McManus 2007 ; Snow 2004 ; Swedberg 2012 ). In the following section, basic elements of the theory and the construction of the theory continuum are outlined.

3.1 Basic elements of a theory

Most of the debate concerning what a theory is comprises three basic elements (Alvesson and Kärreman 2007 ; Bacharach 1989 ; Dubin 1978 ; Kaplan 1998 ; Suddaby 2010 ; Weick 1989 , 1995 ; Whetten 1989 ). A theory comprises components (concepts and constructs), used to identify the necessary elements of the phenomenon under investigation. The second is relationships between components (concepts and constructs), explaining the how and whys underlying the relationship. Third, temporal and contextual boundaries limit the generalizability of the theory. As a result, definitions of theory emphasize these components, relationships, and boundaries:

“It is a collection of assertions, both verbal and symbolic, that identifies what variables are important for what reasons, specifies how they are interrelated and why, and identifies the conditions under which they should be related or not related” (Campbell 1990 : 65).

“… a system of constructs and variables in which the constructs are related to each other by propositions and the variables are related to each other by hypotheses” (Bacharach 1989 : 498).

“Theory is about the connections among phenomena, a story about why acts, events, structure, and thoughts occur. Theory emphasizes the nature of causal relationships, identifying what comes first as well as the timing of such events” (Sutton and Staw 1995 : 378).

“… theory is a statement of concepts and their interrelationships that shows how and/or why a phenomenon occurs” (Corley and Gioia 2011 : 12).

The terms “constructs” and “concepts” are either used interchangeably or with different meanings. Positivists use “constructs” as a lens for the observation of a phenomenon (Suddaby 2010 ). Such constructs have to be operationalized and measured. Non-positivists often use the term “concept” as a more value neutral term in place of the term construct (Gioia et al. 2013 ; Suddaby 2010 : 354). Non-positivists aim at developing concepts on the basis of data that contain richness and complexity of the observed phenomenon instead of narrow definitions and operationalizations of constructs. Gioia et al. ( 2013 : 16) clarify the demarcation line between constructs and concepts as follows: “By ‘concept,’ we mean a more general, less well-specified notion capturing qualities that describe or explain a phenomenon of theoretical interest. Put simply, in our way of thinking, concepts are precursors to constructs in making sense of organizational worlds—whether as practitioners living in those worlds, researchers trying to investigate them, or theorists working to model them”.

In sum, theories are a systematic combination of components and their relationships within boundaries. The use of the terms constructs and concepts is related to different philosophical assumptions reflected in different types of case study designs.

3.2 Theory continuum

Weick ( 1995 ) makes an important point that theory is more a continuum than a product. In his view, theorizing is a process containing assumptions, accepted principles, and rules of procedures to explain or predict the behavior of a specified set of phenomena. In similar vein, Gilbert and Christensen ( 2005 ) demonstrate the process character of theory. In their view, a first step of theory building is a careful description of the phenomena. Having already observed and described the phenomena, researchers then classify the phenomena into similar categories. In this phase a framework defines categories and relationships amongst phenomena. In the third phase, researchers build theories to understand (causal) relationships, and in this phase, a model or theory asserts what factors drive the phenomena and under what circumstances. The categorization scheme enables the researchers to predict what they will observe. The “test” offers a confirmation under which circumstances the theory is useful. The early drafts of a theory may be vague in terms of the number and adequateness of factors and their relationships. At the end of the continuum, there may be more precise variables and predicted relationships. These theories have to be extended by boundaries considering time and space.

Across that continuum, different research strategies have various strengths. Several classifications in the literature intend to match research strategies to the different phases of a theory continuum (Andersen and Kragh 2010 ; Colquitt and Zapata-Phelan 2007 ; Edmondson and McManus 2007 ; Snow 2004 ; Swedberg 2012 ). These classifications, although there are differences in terms, comprise three phases with distinguishable characteristics.

3.2.1 Building theory

Here, the careful description of the phenomena is the starting point of theorizing. For example, Snow ( 2004 ) puts this phase as theory discovery, where analytic understandings are generated by means of detailed examination of data. Edmondson and McManus ( 2007 ) state the starting phase of a theory as nascent theory providing answers to new questions revealing new connections among phenomena. Therefore, research questions are open and researchers avoid hypotheses predicting relationships between variables. Swedberg ( 2012 ) highlights the necessity of observation and extensive involvement with the phenomenon at the early stage of theory-building. It is an attempt to understand something of interest by observing and interpreting social facts. Creativity and inspiration are necessary conditions to put observations into concepts and outline a tentative theory.

3.2.2 Developing theory

This tentative theory exists in the second phase of the continuum and has to be developed. Several possibilities exist. In theory extension, the preexisting constructs are extended to other groups or other contexts. In theoretical refinement, a modification of existing theoretical perspectives is conducted (Edmondson and McManus ( 2007 ). New antecedents, moderators, mediators, and outcomes are investigated, enhancing the explanation power of the tentative theory.

3.2.3 Test of theories

Constructs and relationships are well developed to a mature state; measures are precise and operationalized. Such theories are empirically tested with elaborate methods, and research questions are more precise. In the quantitative realm, testing of hypotheses is conducted and statistical analysis is the usual methodological foundation. Recently, researchers criticize that testing theories has become the major focus of scientists today (Delbridge and Fiss 2013 ); testing theories does not only happen to mature theory but to intermediate theory as well. The boundary between theory development and theory testing is not always so clear. While theory development is adding new components to a theory and elaborating the measures, testing a theory implies precise measures, variables, and predicted relationships considering time and space (Gilbert and Christensen ( 2005 ). It will be of interest whether case studies are eligible to test theories as well.

To summarize: there is a conversation as to where on a continuum of theory development, various methods are required to target different contributions to theory (methodological fit). In this discussion, case study research designs have been discussed as a homogeneous set that mostly contributes to theory-building in an exploratory manner. Hence, what is missing is a more differentiated analysis of how case study methodology fits into this conversation, particularly how case study research methodologically fits theory development and theory testing beyond its widely assumed explorative role. In the following section, the above types of case study research designs will be discussed with regard to their positions across the theory continuum.

This distinction adds to existing literature by demonstrating that case study research does not only contribute to theory-building, but also to the development of tentative theories and to the testing of theories. This distinction leads to the next question: is there any interplay between case study research designs and their contributions to the theory continuum? This paper aims at reconciling this interplay with regard to case study design by mirroring phases of a theory continuum with specific types of case study research designs as outlined above. The importance of the interplay between theory and method lies in the capacity to generate and shape theory, while theory can generate and shape method. “In this long march, theory and method surely matter, for they are the tools with which we build both our representations and understandings of organizational life and our reputations” (van Maanen et al. 2007 : 1145). Theory is not the same as methods, but a relationship of this interplay can broaden or restrict both parts of the equation (Swedberg 2012 : 7).

In the following, I discuss how the above-delineated case study research designs unfold their capacities and contribute differently to the theory continuum to build, develop, and test theory.

4 Discussion of the contribution of case study research to a theory continuum

Case study research is diverse with distinct contributions to the continuum of theory. The following table provides the main differences in terms of contributions to theory and specifically locates the case study research designs on the theory continuum (Table  2 ).

In the following, I outline how these specific contributions of case study designs provide better opportunities to enhance the rigor of building theory, developing theory, testing, and reconstructing theory.

4.1 Building theory

In building theory, the phenomenon is new or not understood so far. There is no theory which explains the phenomenon. At the very beginning of the theory continuum, there is curiosity in the phenomenon itself. I focus on the intrinsic case study design which is located in the social construction of reality approach on the very early phase of the theory continuum, as intrinsic case study research design is not theory-building per se but curiosity in the case itself. It is not the purpose of the intrinsic case study to identify abstract concepts and relationships; the specific research strategy lies in the observation and description of a case and the primary method is observation, enabling understanding from personal and vicarious experience. This meets long lasting complaints concerning the lack of (new) theory in management and organization research and signals that the gap between research and management practice is growing. It is argued that the complexity of the reality is not adequately captured (Suddaby et al. 2011 ). It is claimed that management and organization research systematically neglect the dialogue with practice and, as a result, miss new trends or recognize important trends with delay (Corley and Gioia 2011 ).

The specific case study research design’s contribution to theory is in building concrete, context-dependent knowledge with regard to the identification of new phenomena and trends. Openness with regard to the new phenomena, avoiding theoretical preconceptions but building insights out of data, enables the elaboration of meanings and the construction of realities in intrinsic case studies. Intrinsic case studies will enhance the understanding by researcher and reader concerning new phenomena.

The “No Theory First” case study research design is a classic and often cited candidate for building theory. As the phenomenon is new and in the absence of a theory, qualitative data are inspected for aggregation and interpretation. In instrumental case study design, a number of cases will increase the understanding and support building theories by description, aggregation, and interpretation (Stake 2000 ). New themes and concepts are revealed by case descriptions, interviews, documents, and observations, and the analysis of the data enables the specific contribution of the case study design through a constructivist perspective in theory-building.

Although the design by Eisenhardt ( 1989 ) stems from other philosophical assumptions and there are variations and developments in this design, there is still an overwhelming tendency to quote and to stick to her research strategy which aims developing new constructs and new relationships out of real-life cases. Data are collected mainly by interviews, documents, and observations. From within-site analysis and cross-case analysis, themes, concepts, and relationships emerge. Shaping hypotheses comprises: “… refining the definition of the construct and (…) building evidence which measures the construct in each case” (Eisenhardt 1989 : 541). Having identified the emerged constructs, the emergent relationships between constructs are verified in each case. The underlying logic is validation by replication. Cases are treated as experiments in which the hypotheses are replicated case by case. In replication logic cases that confirm the emergent relationships enhance confidence in the validity of the relationships. Disconfirmation of the relationships leads to refinement of the theory. This is similar to Yin’s replication logic, but targets the precision and measurement of constructs and the emerging relationships with regard to the emerging theory. The building of a theory concludes in an understanding of the dynamics underlying the relationship; the primary theoretical reasons for why the relationships exist (Huy 2012 ). Finally, a visual theory with “boxes and arrows” (Eisenhardt and Graebner 2007 ) may visually demonstrate the emerged theory. The theory-building process is finalized by iterating case data, emerging theory, and extant literature.

The “No Theory First” and “Social Construction of Reality” case study research designs, although they represent different philosophical assumptions, adequately fit the theory-building phase concerning new phenomena. The main contribution of case study designs in this phase of the theory continuum lies in the generation of tentative theories.

Case studies at this point of the theory continuum, therefore, have to demonstrate: why the phenomenon is new or of interest; that no previous theory that explains the phenomenon exists; how and why detailed descriptions enhance the understanding of the phenomenon; and how and why new concepts (constructs) and new relationships will enhance our understanding of the phenomenon.

As a result, it has to be demonstrated that the research strategy is in sync with an investigation of a new phenomenon, building a tentative theory.

4.2 Developing theory

In the “Gaps and Holes” case study research design, the phenomenon is partially understood. There is a tentative theory and the research strategy is theory driven. Compared to the theory-building phase, the existence and not the development of propositions differentiate this design along the continuum. The prediction comes first, out of an existing theory. The research strategy and the data have to be confronted by pattern-matching. Pattern-matching is a means to compare the theoretically based predictions with the data in the site: “For case study analysis, one of the most preferred techniques is to use a pattern-matching logic. Such a logic (…) compares an empirically based pattern–that is, one based on the findings from your case study–with a predicted one made before you collected your data (….)” (Yin 2014 : 143). The comparison of propositions and the rich case material is the ground for new elements or relationships within the tentative theory.

Such findings aim to enhance the scientific usefulness of the theory (Corley and Gioia 2011 ). To enhance the validity of the new elements or relationships of the tentative theory, literal replication is a means to confirm the new findings. By that, the theory is developed by new antecedents, moderators, mediators, or outcomes. This modification or extension of the theory contributes to the analytical generalization of the theory.

If new cases provide similar results, the search for regularities is based on more solid ground. Therefore, the strength of case study research in “Gaps and Holes” lies in search for mechanisms in their specific context which can reveal causes and effects more precisely.

The “Gaps and Holes” case study research design is an adequate candidate for this phase of the theory continuum. Case studies at this point of the theory continuum, therefore, have to outline the tentative theory; to demonstrate the lacks and gaps of the tentative theory; to specify how and why the tentative theory is aimed to be extended and/or modified; to develop theoretically based propositions which guide the investigation; and to evaluate new elements, relationships, and mechanisms related to the previous theory (analytical generalization).

As a result and compared to theory-building, a different research strategy exists. While in theory building the research strategy is based on the eliciting of concepts (constructs) and relationships out of data, in theory development, it has to be demonstrated that the research strategy aims to identify new elements and relationships within a tentative theory, identifying mechanisms which explain the phenomenon more precisely.

4.3 Test of theory

In “Gaps and Holes” and “Anomalies”, an extended theory exists. The phenomenon is understood. There is no search for additional components or relationships. Mechanisms seem to explain the functioning or processes of the phenomenon. The research strategy is focused on testing whether the theory holds under different circumstances or under different conditions. Such a test of theories is mainly the domain of experimental and quantitative studies. It is based on previously developed constructs and variables which are the foundation for stating specific testable hypotheses and testing the relations on the basis of quantitative data sets. As a result, highly sophisticated statistical tools enable falsification of the theory. Therefore, testing theory in “Gaps and Holes” is restricted on specific events.

Single case can serve as a test. There is a debate in case study research whether the test of theories is related to the falsification logic of Karl Popper (Flyvbjerg 2006 ; Tsang 2013 ). Another stream of the debate is related to theoretical generalizability (Hillebrand et al. 2001 ; Welch et al. 2011 ). More specifically, test in” Gaps and Holes” is analogous to a single experiment if a single case represents a critical case. If the theory has specified a clear set of propositions and defines the exact conditions within which the theory might explain the phenomena under investigation, a single case study, testing the theory, can confirm or challenge the theory. In sum Yin states: “Overall, the single-case design is eminently justifiable under certain conditions—where the case represents (a) a critical test of existing theory, …” (Yin 2014 : 56). In their survey in the field of International Business, Welch et al. conclude: “In addition, the widespread assumption that the role of the case study lies only in the exploratory, theory-building phase of research downplays its potential to propose causal mechanisms and linkages, and test existing theories” (Welch et al. 2011 : 755).

In multiple case studies, a theoretical replication is a test of theory by comparing the findings with new cases. If a series of cases have revealed pattern-matching between propositions and the data, theoretical replication can be revealed by new waves of cases with contrasting propositions. If the contrasting propositions reveal contrasting results, the findings of the first wave are confirmed. Several possibilities exist to test the initial findings of multiple case studies using different lenses from inside and outside the management realm (Corley and Gioia 2011 ; LePine and Wilcox-King 2010 ; Okhuysen and Bonardi 2011 ; Zahra and Newey 2009 ), but have not become a standard in case study research.

In rival explanations, rival theoretical propositions are developed as a test of the previous theory. This can be distinguished from theoretical replication where contrasting propositions aim to confirm the initial findings. This can, as well, be distinguished from developing theory where rival explanations might develop theory by the elimination of possible influences (interventions, implementations). The rich data enable one to identify internal and external interventions that might be responsible for the findings. Alternative explanations in a new series of cases enable to test, whether a theory “different from the original theory explains the results better (…)” (Yin 2014 : 141).

As a result, it astonishes that theoretical replication and rival explanations, being one of the strengths of case study research, are rarely used. Although the general debate about “lenses” has informed the discussion about theory contributions, this paper demonstrates that there is a wide range of possible integration of vertical or horizontal lenses in case study research design. Case study research designs aiming to test theories have to outline modes of replication and the elimination of rival explanations.

The “anomaly approach” is placed in the final phase of the theory testing, as well. In this approach, a theory exists, but the theory fails to explain anomalies. Burawoy goes a step further. While Yin ( 2014 ) sees a critical case as a test that challenges or contradicts a well formulated theory, in Burawoy’s approach, in contrast to falsification logic (Popper 2002 ), the theory is not rejected but reconstructed. Burawoy relates extended case study design to society and history. Existing theory is challenged by intervention into the social field. Identifying processes of historical roots and social circumstances and considering external forces by structuration lead to the reconstruction of the theory.

It is surprising that this design has been neglected so far in management research. Is there no need to reflect social tensions and distortions in management research? While case study research has, per definition, to investigate phenomena in its natural environment, it is hard to understand why this design has widely been ignored in management and organization research. As a result, testing theory in case study research has to demonstrate that an extended theory exists; a critical case or an anomaly can challenge the theory; theoretical replication and rival explanations will be means to contradict or confirm the theory; and societal circumstances and external forces explain the anomaly.

Compared to theory-building (new concepts/constructs and relationships out of data) and theory development (new elements and relationships within a tentative theory), testing theory challenges extended theory by empirical investigations into failures and anomalies that the current theory cannot explain.

5 Conclusion

Case studies provide a better understanding of phenomena regarding concrete context-dependent knowledge (Andersen and Kragh 2010 ; Flyvbjerg 2006 : 224), but as literature reviews indicate, there is still confusion regarding the adequate utilization of case study methodology (Welch et al. 2011 ). This can be interpreted in a way that authors and even reviewers are not always aware of the methodological fit in case study research. Case study research is mainly narrowed to its “explorative” function, neglecting the scope of possibilities that case study research provides. The claim for more homogeneity of specified rules in case study research misses the important aspect that a method is not a means in itself, but aims at providing improved theories (van Maanen et al. 2007 ). This paper contributes to the fit of case study research designs and the theory continuum regarding the following issues.

5.1 Heterogeneity of case study designs

Although case study research, overall, has similar characteristics, it incorporates various case study research designs that have heterogeneous theoretical goals and use various elements to reach these goals. The analysis revealed that the classical understanding, whereby case study research is adequate for the “exploration” of a theory and quantitative research is adequate for “testing” theory, is oversimplified. Therefore, the theoretical goals of case study research have to be outlined precisely. This study demonstrates that there is variety of case study research designs that have thus far been largely neglected. Case study researchers can utilize the entire spectrum, but have to consider how the phenomenon is related to the theory continuum.

Case study researchers have to demonstrate how they describe new or surprising phenomena, develop new constructs and relationships, add constructs (variables), antecedents, outcomes, moderators, or mediators to a tentative theory, challenge a theory by a critical case, theoretical replication or discarding rival explanations, and reconstruct a theory by tracking failures and anomalies to external circumstances.

5.2 Methodological fit

The rigor of the case study can be enhanced by considering the specific contribution of various case study research designs in each phase of the theory continuum. This paper provides a portfolio of case study research designs that enables researchers and reviewers to evaluate whether the case study arsenal has been adequately located:

At an early phase of the theory continuum, case studies have their strengths in rich descriptions and investigations into new or surprising empirical phenomena and trends. Researchers and readers can benefit from such rich descriptions in understanding and analyzing these phenomena.

Next, on the theory continuum, there is the well-known contribution of case study research in building tentative theory by eliciting constructs or concepts and their relationships out of data.

Third, development of theories is strongly related to literal replication. Strict comparisons, on the one hand, and controlled theoretical advancement, on the other hand, enable the identification of mechanisms, strengthen the notions of causality, and provide generalizable statements.

Fourth, there are specific circumstances under which case study approaches enable one to test theories. This is to confront the theory with a critical case, to test findings of pattern-matching by theoretical replication and discarding rival explanations. Therefore, “Gaps and Holes” provide the opportunity for developing and testing theories through case study design on the theory continuum.

Finally, testing and contradicting theory are not the final rejection of a theory, but is the basis for reconstructing theory by means of case study design. Anomalies can be traced to historical sources, social processes, and external forces.

This paper demonstrates that the precise interplay of case study research designs and theory contributions on the theory continuum is a prerequisite for the contribution of case study research to better theories. If case study research design is differentiated from qualitative research, the intended contribution to theory is stated and designs that fit the aimed contribution to theory are outlined and substantiated; this will critically enhance the rigor of case study research.

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Home » Case Study – Methods, Examples and Guide

Case Study – Methods, Examples and Guide

Table of Contents

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

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

Types of Case Study

Types and Methods of Case Study are as follows:

Single-Case Study

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

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

Multiple-Case Study

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

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

Exploratory Case Study

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

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

Descriptive Case Study

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

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

Instrumental Case Study

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

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

Case Study Data Collection Methods

Here are some common data collection methods for case studies:

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

Observations

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

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

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

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

How to conduct Case Study Research

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

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

Examples of Case Study

Here are some examples of case study research:

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

Application of Case Study

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

Business and Management

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

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

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

Social Sciences

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

Law and Ethics

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

Purpose of Case Study

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

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

Case studies can also serve other purposes, including:

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

Advantages of Case Study Research

There are several advantages of case study research, including:

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

Limitations of Case Study Research

There are several limitations of case study research, including:

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

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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Types of journal articles

It is helpful to familiarise yourself with the different types of articles published by journals. Although it may appear there are a large number of types of articles published due to the wide variety of names they are published under, most articles published are one of the following types; Original Research, Review Articles, Short reports or Letters, Case Studies, Methodologies.

Original Research:

This is the most common type of journal manuscript used to publish full reports of data from research. It may be called an  Original Article, Research Article, Research, or just  Article, depending on the journal. The Original Research format is suitable for many different fields and different types of studies. It includes full Introduction, Methods, Results, and Discussion sections.

Short reports or Letters:

These papers communicate brief reports of data from original research that editors believe will be interesting to many researchers, and that will likely stimulate further research in the field. As they are relatively short the format is useful for scientists with results that are time sensitive (for example, those in highly competitive or quickly-changing disciplines). This format often has strict length limits, so some experimental details may not be published until the authors write a full Original Research manuscript. These papers are also sometimes called Brief communications .

Review Articles:

Review Articles provide a comprehensive summary of research on a certain topic, and a perspective on the state of the field and where it is heading. They are often written by leaders in a particular discipline after invitation from the editors of a journal. Reviews are often widely read (for example, by researchers looking for a full introduction to a field) and highly cited. Reviews commonly cite approximately 100 primary research articles.

TIP: If you would like to write a Review but have not been invited by a journal, be sure to check the journal website as some journals to not consider unsolicited Reviews. If the website does not mention whether Reviews are commissioned it is wise to send a pre-submission enquiry letter to the journal editor to propose your Review manuscript before you spend time writing it.  

Case Studies:

These articles report specific instances of interesting phenomena. A goal of Case Studies is to make other researchers aware of the possibility that a specific phenomenon might occur. This type of study is often used in medicine to report the occurrence of previously unknown or emerging pathologies.

Methodologies or Methods

These articles present a new experimental method, test or procedure. The method described may either be completely new, or may offer a better version of an existing method. The article should describe a demonstrable advance on what is currently available.

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• v.11(2); 2022

Defining case management success: a qualitative study of case manager perspectives from a large-scale health and social needs support program

Margae knox.

1 School of Public Health, University of California, Berkeley, Berkeley, California, USA

Emily E Esteban

2 Contra Costa Health Services, Martinez, California, USA

Elizabeth A Hernandez

Mark d fleming, nadia safaeinilli, amanda l brewster, associated data.

No data are available. Data are not publicly available to protect potentially sensitive information. For data inquiries, please contact the corresponding author.

Health systems are expanding efforts to address health and social risks, although the heterogeneity of early evidence indicates need for more nuanced exploration of how such programs work and how to holistically assess program success. This qualitative study aims to identify characteristics of success in a large-scale, health and social needs case management program from the perspective of interdisciplinary case managers.

Case management program for high-risk, complex patients run by an integrated, county-based public health system.

Participants

30 out of 70 case managers, purposively sampled to represent their interdisciplinary health and social work backgrounds. Interviews took place in March–November 2019.

Primary and secondary outcome measures

The analysis intended to identify characteristics of success working with patients.

Case managers described three characteristics of success working with patients: (1) establishing trust; (2) observing change in patients’ mindset or initiative and (3) promoting stability and independence. Cross-cutting these characteristics, case managers emphasised the importance of patients defining their own success, often demonstrated through individualised, incremental progress. Thus, moments of success commonly contrasted with external perceptions and operational or productivity metrics.

Conclusions

Themes emphasise the importance of compassion for complexity in patients’ lives, and success as a step-by-step process that is built over longitudinal relationships.

What is already known on this topic?

• Case management programs to support health and social needs have demonstrated promising yet mixed results. Underlying mechanisms and shared definitions of successful case management are underdeveloped.

What this study adds?

• Case managers emphasised building trust over time and individual, patient-defined objectives as key markers of success, a contrast to commonly used quantitative evaluation metrics.

How this study might affect research, practice or policy?

• Results suggest that lighter touch case management interventions face limitations without an established patient relationship. Results also support a need for alternative definitions of case management success including patient-centered measures such as trust in one’s case manager.

Introduction

Health system efforts to address both health and social needs are expanding. In the USA, some state Medicaid programmes are testing payments for non-medical services to address transportation, housing instability and food insecurity. Medicaid provides healthcare coverage for lower income individuals and families, jointly funded by federal and state governments. Similarly, social prescribing, or the linking of patients with social needs to community resources, is supported by the UK’s National Health Service and has also been piloted by Canada’s Alliance for Healthier Communities. 1

A growing evidence base suggests promising outcomes from healthcare interventions addressing social needs. In some contexts, case managers or navigators providing social needs assistance can improve health 2 and reduce costly hospital use. 3–5 Yet systematic reviews also report mixed results for measures of health and well-being, hospitalisation and emergency department use, and overall healthcare costs. 6–9 Notably, a randomised trial of the Camden Care Coalition programme for patients with frequent hospitalisations due to medically and socially complex needs 10 found no difference in 180-day readmission between patients assigned to a care transitions programme compared with usual hospital postdischarge care. In the care transition programme, patients received follow-up from a multidisciplinary team of nurses, social workers and community health workers. The team conducted home visits, scheduled and accompanied patients to follow-up outpatient visits, helped with managing medications, coached patients on self-care and connected patients with social services and behavioural healthcare. The usual care group received usual postdischarge care with limited follow-up. 11 This heterogeneity of early evidence indicates a need for more nuanced explorations of how social needs assistance programmes work, and how to holistically assess whether programmes are successful. 12 13

Social needs case management may lead to health and well-being improvements through multiple pathways involving both material and social support. 14 15 Improvements are often a long-term, non-linear process. 16 17 At the same time, quality measures specific to social needs assistance programmes currently remain largely undefined. Studies often analyse utilisation and cost outcomes but lack granularity on interim processes and markers of success.

In order to translate a complex and context-dependent intervention like social needs case management from one setting to another, these interim processes and outcomes need greater recognition. 18–20 Early efforts to refine complex care measures are underway and call out a need for person-centred and goal-concordant measures. 21 Further research on how frontline social needs case managers themselves define successes in their work could help leaders improve programme design and management and could also inform broader quality measure development efforts.

Our in-depth, qualitative study sought to understand how case managers defined success in their work with high-risk patients. Case managers were employed by CommunityConnect, a large-scale health and social needs care management programme that serves a mixed-age adult population with varying physical health, mental health and social needs. Each case manager’s workflow includes an individualised, regularly updated dashboard of operational metrics. It is unclear, however, whether or how these operational factors relate to patient success in a complex care programme. Thus, the case managers’ perspectives on defining success are critical for capturing how programmes work and identifying essential principles.

Study design and setting

In 2017, the Contra Costa County Health Services Department in California launched CommunityConnect, a case management programme to coordinate health, behavioural health and social services for County Medicaid patients with complex health and social conditions. The County Health Services Department serves approximately 15% (180 000) of Contra Costa’s nearly 1.2 million residents. CommunityConnect enrollees were selected based on a predictive model, which leveraged data from multiple county systems to identify individuals most likely to use hospital or emergency room services for preventable reasons. Enrollees are predominantly women (59%) and under age 40 (49%). Seventy-seven per cent of enrollees have more than one chronic condition, particularly hypertension (42%), mood disorders (40%) and chronic pain (35%). 22 Programme goals include improving beneficiary health and well-being through more efficient and effective use of resources.

Each case manager interviewed in this study worked full time with approximately 90 patients at a time. Case managers met patients in-person, ideally at least once a month for 1 year, although patients sometimes continue to receive ongoing support at the case manager’s discretion in cases of continued need. Overall, up to 6000 individuals at a time receive in-person case management services through CommunityConnect, with approximately 200–300 added and 200–300 graduated per month. At the time of the study, CommunityConnect employed approximately 70 case managers trained in various public health and social work disciplines (see table 1 , Interview Sample). Case managers and patients are matched based on an algorithm that prioritises mental health history, primary language and county region.

Interview sample

Although case managers bring unique experience from their respective discipline, all are expected to conduct similar case management services. Services included discussing any unmet social needs with patients, coordinating applicable resources and partnering with the patient and patient’s care team to improve physical and emotional health. The programme tracks hospital and emergency department utilisation as well as patient benefits such as food stamps, housing or transportation vouchers and continuous Medicaid coverage on an overall basis. Each case manager has access to an individualised dashboard that includes operational metrics such as new patients to contact, and frequency of patient contacts, timeliness for calling patients recently discharged from the hospital, whether patients have continuous Medicaid coverage, and completion of social risk screenings.

Study recruitment

Semistructured interviews were conducted with 30 field-based case managers as part of the programme’s evaluation and quality improvement process. Participants included four mental health clinical specialists, five substance abuse counsellors, six social workers, nine public health nurses, four housing support specialists and two community health worker specialists. Case managers were recruited by email and selected based on purposive sampling to reflect membership across disciplines and experience working with CommunityConnect for at least 1 year. Three case managers declined to participate. Interviews ended when data saturation was achieved. 23

Interview procedures

Interviews were conducted by five CommunityConnect evaluation staff members (including EEE), who received training and supervision from the evaluation director (EH), who also conducted interviews. The evaluation staff were bachelor and masters-level trained. The evaluation director was masters-level trained and held prior experience in healthcare quality and programme planning.

The evaluation team drafted the interview guide to ask about a variety of work processes and experiences with the goal of improving programme operations including staff and patient experiences. Specific questions analysed for this study were (1) how case managers define success with a patient and (2) examples where case managers considered work with patients a success.

Interviews took place in-person in private meeting rooms at case managers’ workplace from March 2019 – November 2019. Interviews lasted 60–90 min and only the interviewer and case manager were present. All interviewers were familiar with CommunityConnect yet did not have a prior relationship with case managers. Case managers did not receive compensation beyond their regular salary for participating in the study and were allowed to opt out of recruitment or end the interview early for any reason. All interviews were audio recorded, transcribed and entered into Nvivo V.12 for analysis.

Patient and public involvement

This project focused on case manager’s perspectives and thus did not directly involve patients. Rather, patients were involved through case manager recollections of experiences working with patients.

Data analysis

We used an integrated approach to develop an initial set of qualitative codes including deductive coding of programme processes and concepts, followed by inductive coding of how case managers defined success. All interviews were coded by two researchers experienced in qualitative research (EEE and MK). Themes were determined based on recurrence across interviews and illustrative examples and being described by more than one case manager type. The two researchers identified preliminary themes independently, then consulted with one another to achieve consensus on final themes. Themes and supporting quotes were then presented to the full author team to ensure collective agreement that key perspectives had been included. Preliminary results were also shared at a staff meeting attended by case managers and other staff as an opportunity for feedback on study findings. This manuscript addresses the Standards for Reporting Qualitative Research, 24 and the Consolidated Criteria for Reporting Qualitative Research checklist is provided as an appendix. 25

All case manager participants provided informed consent. Research procedures were approved by the Contra Costa Regional Medical Center and Health Centers Institutional Review Committee (Protocol 12-17-2018).

Case managers frequently and across multiple roles mentioned three characteristics of success when working with patients: (1) establishing trust; (2) fostering change in patients’ mindset or initiative and (3) promoting stability and independence. Across these characteristics, case managers expressed that success is patient-defined, with individualised and often incremental progress—a contrast with external perceptions of success and common operational or productivity metrics (see figure 1 ).

Illustration of key themes.

Success is establishing trust

Trusting relationships were the most widely noted characteristic of success. Trust was described as both a product of case managers’ consistent follow-up and helpfulness over time and a foundational step to enable progress on patient-centred goals. To build trust, case managers explained, patients must feel seen and heard, and understand the case managers’ desire to help: ‘Success is to know that she knows me very well…I look for her on the streets, and I’m waiting for her to call me back. Hopefully she knows that when she’s ready I will be there at least to provide that resource for her and so it’s that personal relationship that you build’ (Case manager 11, social worker). Case managers also highlighted the longitudinal relationship required to establish trust, distinguishing success as more than one-time information delivery or navigating bureaucratic processes to procure services.

Case managers also identified trust as foundational to provide better support for patients: ‘So they’re as honest with me as they can be. That way I have a clear understanding about realistically what I can do to help them coordinate their care or link them to services.’ (Case manager 2, mental health clinician specialist). Establishing trust was essential to improve communication with patients and produced an amplifying effect. That is, a case manager’s initial help and follow-up builds trust so that patients can be more open, and open communication helps the case manager know what specific services can be most useful. This positive feedback loop further cements trust and builds momentum for a longitudinal relationship.

Permission to have a home visit was mentioned as a valuable indicator of early success in building trust: ‘(Your home is) your sanctuary’, expressed one case manager (Case manager 29, public health nurse), acknowledging the vulnerability of opening one’s home to an outsider. For another case manager, regular home visits in the context of a trusting relationship made the case manager aware of and able to address a difficult situation: ‘Every time I was going to her home, I was noticing more and more gnats flying around… She said it’s because of the garbage…’ After establishing trust, the patient allowed the case manager access to the bedroom where the case manager uncovered numerous soiled diapers. The case manager arranged professional cleaning and sanitation through CommunityConnect, after which, ‘there was room for a dance floor in her bedroom. There was so much room, and the look on her face, it was almost as if her chest got proud, just in that day. She didn’t seem so burdened…So that’s a success’ (Case manager 4, substance abuse counsellor). Across multiple examples, case managers expressed trust as a critical element for effective patient partnerships.

However, the pathways to building trust are less clear cut. Quick wins through tangible support such as a transportation voucher to a medical appointment could help engage a patient initially. Yet case managers more frequently emphasised strategies based on relationships over time. Strategies included expressing empathy (putting yourself in the patient’s shoes), demonstrating respect (especially when the patient has experienced disrespect in other health system encounters), keeping appointments, following through on what you say you will do, calling to check in and ‘being there’. Overall, case managers expressed that trust lets patients know they are not alone and sets the stage for future success.

Success is fostering a change in patients’ mindset or initiative

Case managers described a change in patients’ mindset or initiative as evidence of further success. One case manager explained, ‘Really (success) could be a switch in mind state… If I can get someone to consider addressing an issue. Or just acknowledging an issue. That’s progress’ (Case manager 24, substance abuse counsellor). Another case manager spoke to the importance of mindset by stating, ‘what I try to do is not just change the surface of life’. This case manager elaborated, ‘You help (a patient) get their housing and they’re gonna lose it again, unless they change; something changes in their mindset, and then they see things differently.’ (Case manager 6, mental health clinician specialist). Some case managers suggested that the supportive resources they provide are only band-aid solutions if unaccompanied by a changed mindset to address root causes.

Case managers reported that shared goals and plans are essential, in contrast to solutions identified by case managers without patient involvement. ‘I can’t do everything for them’, expressed one case manager (Case manager 21, public health nurse), while others similarly acknowledged that imposing self-improvement goals or providing resources for which a patient may not be ready may be counterproductive. Rather, one case manager emphasised, ‘I think it’s really important to celebrate people’s ideas, their beliefs, their own goals and values’. (Case manager 4, substance abuse counsellor). As an example, the case manager applauded a patient’s ideas of getting a driver’s license and completing an education certificate. In summary, case managers viewed success as a two-way street where patient’s own ideas and motivation were essential for long-term impact.

Success is promoting stability and independence

Case managers also identified patients’ stability and independence as a characteristic of success. One case manager stated, ‘I define success as having them be more independent in their just manoeuvring the system…how they problem solve’ (Case manager 30, public health nurse). Relative to the other characteristics of success, stability and independence more closely built on resources and services coordinated or procured by the case manager. For example, CommunityConnect provides cell phones free-of-charge to patients who do not currently have a phone or continuous service, which has helped patients build a network beyond the case manager: ‘Once we get them that cell phone then they’re able to make a lot of connections … linking to services on their own. They actually become a lot more confident in themselves is what I’ve seen’. (Case manager 23, substance abuse counsellor). In another example, a case manager helped a patient experiencing complex health issues to reconcile and understand various medications. For this patient stability means, ‘when he does go into the emergency room, it’s needed. … even though he’s taking his medication like he’s supposed to… it’s just his health gets bad. So, yea I would say that one (is a success)’ (Case manager 8, social worker). Thus, stability represents maintained, improved well-being, supported by care coordination and resources, even while challenges may still be present.

As a step further, ‘Absolute success’, according to one case manager, ‘(is when a patient) drops off my caseload and I don’t hear from them, not because they’re not doing well but because they are doing well, because they are independent’ (Case manager 12, social worker). Patients may still need periodic help knowing who to contact but can follow through on their own. This independence may arise because patients have found personal support networks and other resources that allow them to rely less and less on the case manager. While not all patients reach this step of sustained independence and stability, it is an accomplishment programmatically and for case managers personally.

Success is patient-defined, built on individualised and incremental progress

Case managers widely recognised that success comes in different shapes and sizes, dependent on their patient’s situation. Irrespective of the primary concern, many identified the patient’s own judgement as the benchmark for success. One case manager explained, ‘I define success with my patients by they are telling me it was a success. It’s by their expression, it’s just not a success until they say it’s a success for them’ (Case manager 7, social worker). In a more specific example, a case manager highlighted checking in with a patient instead of assuming a change is successful: ‘It’s not just getting someone housed or getting someone income. Like the male who we’re working towards reconciliation with his parents… that’s a huge step but if he doesn’t feel good about it… then that’s not a success.’ The same case manager elaborated, ‘it’s really engaging with the knowing where the patient him or herself is at mentally, for me. Yeah. That’s a success’ (Case manager 18, homeless services specialist). This comment challenges the current paradigm where, for example, if a patient has a housing need and is matched to housing, then the case is a success. Rather, case managers viewed success as more than meeting a need but also reciprocal satisfaction from the patient.

Often, case managers valued individualised, even if seemingly small, achievements as successes: ‘Every person’s different you know. A success could be just getting up and brushing their teeth. Sometimes success is actually getting them out of the house or getting the care they need’ (Case manager 28, social worker). Another case manager echoed, ‘(Success) depends on where they’re at … it runs the gamut, you know, but they’re all successes’ (Case manager 10, public health nurse). CommunityConnect’s interdisciplinary focus was identified as an important facilitator for tailoring support to individualised client needs. In contrast with condition-specific case management settings, for example, a case manager with substance abuse training noted, ‘whether someone wants to address their substance use or not, they still have these other needs, and (with CommunityConnect) I can still provide assistance’ (Case manager 24).

However, the individualised and incremental successes are not well captured by common case management metrics. One case manager highlighted a tension between operational productivity metrics and patient success, noting, ‘I get it, that there has to be accountability. We’re out in the field, I mean people could really be doing just a whole lot of nothing… (Yet), for me I don’t find the success in the numbers. I don’t think people are a number. Oh, look I got a pamphlet for you, I’m dropping it off… I don’t think that that is what’s really going to make this programme successful’ (Case manager 8, social worker). One case manager mentioned change in healthcare utilisation as a marker of success, but more often, case managers offered stories of patient success that diverge from common programme measures. For example, one case manager observed, ‘The clear (successes) are nice: when you apply for Social Security and they get it that’s like a hurrah. And then there’s other times it’s just getting them to the dentist’ (Case manager 28, social worker). Another case manager elaborated, ‘It’s not always the big number—the how many people did I house this year. It’s the little stuff like the fact that this 58-year-old woman who believes she’s pregnant and has been living outside for years and years, a victim of domestic violence, has considered going inside. Like that is gigantic’ (Case manager 18, homeless services specialist). Overwhelmingly, case managers defined success through the interpersonal relationship with their patients within patients’ complex, daily life circumstances.

Case managers’ definitions of success focused on establishing trust, fostering patients change in mindset or initiative, and, for some patients, achieving independence and stability. Examples of success were commonly incremental and specific to an individual’s circumstances, contrasting with programmatic measures such as reduction in hospital or emergency department utilisation, benefits and other resources secured, or productivity expectations. Study themes heavily emphasise the interpersonal relationship that case managers have with patients and underscore the importance of patient-centred and patient-defined definitions of success over other outcome measures.

Our results complement prior work on clinic-based programmes for complex patients. For example, interdisciplinary staff in a qualitative study of an ambulatory intensive care centre also identified warm relationships between patients and staff as a marker of success. 26 In another study interviewing clinicians and leaders across 12 intensive outpatient programmes, three key facilitators of patient engagement emerged: (1) financial assistance and other resources to help meet basic needs, (2) working as a multi-disciplinary care team and (3) adequate time and resources to develop close relationships focused on patient goals. 27 Our results concur on the importance of a multi-disciplinary approach, establishing trusting relationships, and pursuing patient-centred goals. Our results diverge on the role of resources to meet basic needs. Case managers in our study indicated that while connections to social services benefits and other resources help initiate the case manager-patient relationship, lasting success involved longer-term relationships in which they supported patients in developing patients’ own goal setting skills and motivation.

An important takeaway from case managers’ definitions of success is the ‘how’ they go about their work, in contrast to the ‘what’ of particular care coordination activities. For example, case managers emphasise interpersonal approaches such as empathy and respect over specific processes and resource availability. Primary care clinicians, too, have expressed how standard HEDIS or CAHPS quality metrics fail to capture, and in some cases disincentivise, the intuitions in their work that are important for high quality care. 28 29 Complex care management programmes must also wrestle with this challenge of identifying standards without extinguishing underlying quality constructs.

Strengths and limitations

This study brings several strengths, including bringing to light the unique, unexplored perspective of case managers working on both health and social needs with patients facing diverse circumstances that contribute to high-risk of future hospital or emergency department utilisation. The fact that our study explores perspectives across an array of case manager disciplines is also a strength, however a limitation is that we are unable to distinguish how success differed by discipline based on smaller numbers of each discipline in this study sample. Other study limitations include generalisability to other settings, given that all case managers worked for a single large-scale social needs case management programme. Comments around productivity concerns or interdisciplinary perspectives on ways to support patients may be unique to the infrastructure or management of this organisation. In addition, at the time of the study, all case managers were able to meet with patients in-person; future studies may explore whether definitions of success change when interactions become virtual or telephonic as occurred amidst COVID-19 concerns.

This study is the first to our knowledge to inquire about holistic patient success from the perspective of case managers in the context of a social needs case management programme. The findings offer important implications for researchers as well as policy makers and managers who are designing complex case management programmes.

Our results identify patient-directed goals, stability and satisfaction, as aspects of social needs case management which are difficult to measure but nonetheless critical to fostering health and well-being. Case managers indicated these aspects are most likely to emerge through a longer-term connection with their patients. Thus, while resource-referral solutions may play an important role in addressing basic needs, 30 our findings suggest that weak patient–referrer rapport may be a limitation for such lighter touch interventions. The need for sustained rapport building is also one explanation why longer time horizons may be necessary to show outcome improvements in rigorous studies. 16

Relatedly, results point to trusting relationships as an under-recognised and understudied feature of social needs case management. Existing research finds that patients’ trust in their primary care physician is associated with greater self-reported medication adherence 31 along with health behaviours such as exercise and smoking cessation. 32 Similar quantitative results have not yet been illuminated in social needs case management contexts, yet the prominence of trusting relationships in this study as well as other sources 26 27 33 34 suggests that measures of trust should be used to complement currently emphasised outcomes such as inpatient and outpatient utilisation. Future research and programme evaluation will need to develop new trust measurement or modify existing trust measures for the social needs case management context. 31 35

In summary, study themes provide waypoints of how to conceptualise programme design, new staff training and potential measurement development for complex case management programmes like CommunityConnect. Despite the broad swath of social needs addressed, case managers coalesced on establishing a trusting relationship as a necessary foundation to appropriately identify needs and facilitate connections. Second, fostering patients’ own ideas, including a change their mindset or initiative, was important to fully make use of programme resources. Third, supporting new-found independence or stability was a gratifying, but not universally achieved marker of success. Commonly, case managers highlighted moments of success with mindfulness toward small victories, illuminating that success is non-linear with no certain path nor single end point. Themes emphasise the importance of bringing compassion for the complexity in patients’ lives and developing collaborative relationships one interaction at a time.

Acknowledgments

The authors would like to thank the CommunityConnect evaluation team for their support conducting and transcribing interviews and applying preliminary coding, especially Gabriella Quintana, Alison Stribling, Julia Surges and Camella Taylor.

Contributors: MK coded and analysed qualitative data, identified key themes and related discussion areas, and drafted and critically revised the manuscript. EEE conducted interviews, coded and analysed qualitative data, and drafted and critically revised the manuscript. EH developed the study instrument, conducted interviews, supervised data collection, contributed to the data interpretation and critically revised the manuscript. MDF contributed to the interpretation and critically revised the manuscript. NS contributed to the interpretation and critically revised the manuscript. ALB contributed to the design and interpretation and critically revised the manuscript. All authors approve of the final version to be published.

Funding: MK was supported by the Agency for Healthcare Research and Quality (AHRQ) under the Ruth L. Kirschstein National Research Service Award T32 (T32HS022241). MDF was supported by the Agency for Healthcare Research and Quality, grant # K01HS027648.

Disclaimer: Its contents are solely the responsibility of the authors and do not necessarily represent the official views of AHRQ. Funding had no role in the study’s design, conduct or reporting.

Competing interests: None declared.

Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Provenance and peer review: Not commissioned; externally peer reviewed.

Data availability statement

Ethics statements, patient consent for publication.

Not applicable.

Ethics approval

This study involves human participants and was approved by Contra Costa Regional Medical Center and Health Centers Institutional Review Committee (Protocol 12-17-2018). Participants gave informed consent to participate in the study before taking part.

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• 15 April 2024
• Correction 22 April 2024

Revealed: the ten research papers that policy documents cite most

• Dalmeet Singh Chawla 0

Dalmeet Singh Chawla is a freelance science journalist based in London.

You can also search for this author in PubMed   Google Scholar

Policymakers often work behind closed doors — but the documents they produce offer clues about the research that influences them. Credit: Stefan Rousseau/Getty

When David Autor co-wrote a paper on how computerization affects job skill demands more than 20 years ago, a journal took 18 months to consider it — only to reject it after review. He went on to submit it to The Quarterly Journal of Economics , which eventually published the work 1 in November 2003.

Autor’s paper is now the third most cited in policy documents worldwide, according to an analysis of data provided exclusively to Nature . It has accumulated around 1,100 citations in policy documents, show figures from the London-based firm Overton (see ‘The most-cited papers in policy’), which maintains a database of more than 12 million policy documents, think-tank papers, white papers and guidelines.

“I thought it was destined to be quite an obscure paper,” recalls Autor, a public-policy scholar and economist at the Massachusetts Institute of Technology in Cambridge. “I’m excited that a lot of people are citing it.”

The most-cited papers in policy

Economics papers dominate the top ten papers that policy documents reference most.

Data from Overton as of 15 April 2024

The top ten most cited papers in policy documents are dominated by economics research; the number one most referenced study has around 1,300 citations. When economics studies are excluded, a 1997 Nature paper 2 about Earth’s ecosystem services and natural capital is second on the list, with more than 900 policy citations. The paper has also garnered more than 32,000 references from other studies, according to Google Scholar. Other highly cited non-economics studies include works on planetary boundaries, sustainable foods and the future of employment (see ‘Most-cited papers — excluding economics research’).

These lists provide insight into the types of research that politicians pay attention to, but policy citations don’t necessarily imply impact or influence, and Overton’s database has a bias towards documents published in English.

Interdisciplinary impact

Overton usually charges a licence fee to access its citation data. But last year, the firm worked with the publisher Sage to release a free web-based tool , based in Thousand Oaks, California, that allows any researcher to find out how many times policy documents have cited their papers or mention their names. Overton and Sage said they created the tool, called Sage Policy Profiles, to help researchers to demonstrate the impact or influence their work might be having on policy. This can be useful for researchers during promotion or tenure interviews and in grant applications.

Autor thinks his study stands out because his paper was different from what other economists were writing at the time. It suggested that ‘middle-skill’ work, typically done in offices or factories by people who haven’t attended university, was going to be largely automated, leaving workers with either highly skilled jobs or manual work. “It has stood the test of time,” he says, “and it got people to focus on what I think is the right problem.” That topic is just as relevant today, Autor says, especially with the rise of artificial intelligence.

Most-cited papers — excluding economics research

When economics studies are excluded, the research papers that policy documents most commonly reference cover topics including climate change and nutrition.

Walter Willett, an epidemiologist and food scientist at the Harvard T.H. Chan School of Public Health in Boston, Massachusetts, thinks that interdisciplinary teams are most likely to gain a lot of policy citations. He co-authored a paper on the list of most cited non-economics studies: a 2019 work 3 that was part of a Lancet commission to investigate how to feed the global population a healthy and environmentally sustainable diet by 2050 and has accumulated more than 600 policy citations.

“I think it had an impact because it was clearly a multidisciplinary effort,” says Willett. The work was co-authored by 37 scientists from 17 countries. The team included researchers from disciplines including food science, health metrics, climate change, ecology and evolution and bioethics. “None of us could have done this on our own. It really did require working with people outside our fields.”

Sverker Sörlin, an environmental historian at the KTH Royal Institute of Technology in Stockholm, agrees that papers with a diverse set of authors often attract more policy citations. “It’s the combined effect that is often the key to getting more influence,” he says.

Has your research influenced policy? Use this free tool to check

Sörlin co-authored two papers in the list of top ten non-economics papers. One of those is a 2015 Science paper 4 on planetary boundaries — a concept defining the environmental limits in which humanity can develop and thrive — which has attracted more than 750 policy citations. Sörlin thinks one reason it has been popular is that it’s a sequel to a 2009 Nature paper 5 he co-authored on the same topic, which has been cited by policy documents 575 times.

Although policy citations don’t necessarily imply influence, Willett has seen evidence that his paper is prompting changes in policy. He points to Denmark as an example, noting that the nation is reformatting its dietary guidelines in line with the study’s recommendations. “I certainly can’t say that this document is the only thing that’s changing their guidelines,” he says. But “this gave it the support and credibility that allowed them to go forward”.

Broad brush

Peter Gluckman, who was the chief science adviser to the prime minister of New Zealand between 2009 and 2018, is not surprised by the lists. He expects policymakers to refer to broad-brush papers rather than those reporting on incremental advances in a field.

Gluckman, a paediatrician and biomedical scientist at the University of Auckland in New Zealand, notes that it’s important to consider the context in which papers are being cited, because studies reporting controversial findings sometimes attract many citations. He also warns that the list is probably not comprehensive: many policy papers are not easily accessible to tools such as Overton, which uses text mining to compile data, and so will not be included in the database.

The top 100 papers

“The thing that worries me most is the age of the papers that are involved,” Gluckman says. “Does that tell us something about just the way the analysis is done or that relatively few papers get heavily used in policymaking?”

Gluckman says it’s strange that some recent work on climate change, food security, social cohesion and similar areas hasn’t made it to the non-economics list. “Maybe it’s just because they’re not being referred to,” he says, or perhaps that work is cited, in turn, in the broad-scope papers that are most heavily referenced in policy documents.

As for Sage Policy Profiles, Gluckman says it’s always useful to get an idea of which studies are attracting attention from policymakers, but he notes that studies often take years to influence policy. “Yet the average academic is trying to make a claim here and now that their current work is having an impact,” he adds. “So there’s a disconnect there.”

Willett thinks policy citations are probably more important than scholarly citations in other papers. “In the end, we don’t want this to just sit on an academic shelf.”

doi: https://doi.org/10.1038/d41586-024-00660-1

Updates & Corrections

Correction 22 April 2024 : The original version of this story credited Sage, rather than Overton, as the source of the policy papers’ citation data. Sage’s location has also been updated.

Autor, D. H., Levy, F. & Murnane, R. J. Q. J. Econ. 118 , 1279–1333 (2003).

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Costanza, R. et al. Nature 387 , 253–260 (1997).

Willett, W. et al. Lancet 393 , 447–492 (2019).

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Steffen, W. et al. Science 347 , 1259855 (2015).

Rockström, J. et al. Nature 461 , 472–475 (2009).

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Coral reefs can't keep up with climate change. So scientists are speeding up evolution

Lauren Sommer

Ryan Kellman

Record levels of heat in the ocean are causing a worldwide mass bleaching event on coral reefs, as seen here on the Great Barrier Reef. Scientists are working on creating more heat-resistant coral to help restore reefs. Veronique Mocellin /AIMS hide caption

Record levels of heat in the ocean are causing a worldwide mass bleaching event on coral reefs. It's the second one this decade, where the delicate skeletons of corals turn a ghostly white.

With mass bleaching only expected to get worse as the climate keeps warming, coral scientists are urgently searching for ways to help reefs endure. Bleaching can kill corals, putting some of the most diverse ecosystems in the world at risk. So scientists are homing in on how bleaching happens.

It boils down to relationship drama between corals and a tiny organism that's too small to see.

Scientists estimate that a quarter of all marine species depend on coral reefs. Biologists say that's a best guess and it's very likely there are species yet to be discovered. Ryan Kellman/NPR hide caption

Corals are the builders of reefs, their skeletons creating the vast infrastructure that tens of thousands of other species depend on. But corals are powered by the tiny algae that live in their tissue, which provide food for them.

"They're these microscopic, sort of nondescript algae," says Matthew Nitschke, research scientist at the Australian Institute of Marine Science, as he magnifies a few under a microscope, revealing golden-brown circles.

Scientists are breeding 'super corals.' Can they withstand climate change?

"People are like: why are you so interested in them?" he says. "And it's because they, for me, are really at the foundation of the ecosystem."

The tiny algae and coral make up one of the most productive roommate relationships on the planet. But as the climate gets hotter, that relationship is increasingly going bad. When ocean temperatures rise, corals get stressed and their algae get expelled. Without their roommates, corals can starve and eventually die.

Studies show that if climate change continues at the same pace, 99% of the world's coral reefs are likely to die off by the end of the century. To buy reefs a little extra time, scientists are breeding both algae and corals to withstand more heat, speeding up the natural process of evolution. But with oceans heating up more rapidly than expected, they're racing against the clock.

"I think anyone who wasn't worried, needs to be worried now," says Kate Quigley, coral biologist at James Cook University in Australia and the Minderoo Foundation. "Nature has time to make mistakes and then adjust. We don't have that time."

"There just doesn't seem be enough time," says Kate Quigley, coral biologist at James Cook University in Australia and the Minderoo Foundation. "We're going from one bleaching event to the next." Ryan Kellman/NPR hide caption

Natural selection in a bottle

The tanks at the Australian Institute of Marine Science, just outside of Townsville in Queensland, are full of delicate branching corals in a vast array of colors. Another lab there is somewhat less eye-catching – full of scientific flasks with clouds of brown algae in them. They're zooxanthellae, the algae that live in coral, but these have been isolated from their coral homes (the algae can live in the ocean without the coral, but coral can't live without algae).

"If you look at a coral, they look bright, they look colorful," Nitschke says. "They're actually mostly translucent and a lot of the color of the coral that you see comes from the algae."

The algae in Nitschke's lab have been grown over hundreds of generations, subjected to an accelerated version of survival-of-the-fittest. They've been exposed to heat, singling out those best able to handle higher temperatures, which then go to produce future algal generations.

"What we're really doing is natural selection in a bottle," he says. "We're really excited about the possibility for that to help corals persist into the future."

Algae in Nitschke's lab, grown over hundreds of generations. They've been exposed to heat, singling out those best able to handle higher temperatures, which then go to produce more heat-tolerant algae. Ryan Kellman/NPR hide caption

Scientists are still trying to tease out exactly what happens between a coral and its algae when temperatures get hot. They depend on a carefully-balanced living arrangement. The algae get a comfy home and nutrients they need from the coral. In return, they do photosynthesis, using sunlight to produce energy for the coral.

But when the ocean heats up, that balance gets upset. Scientists believe one reason is that the warmer water stresses the coral, upsetting the nutrient exchange between the coral and algae. Another reason could be that the hotter water impairs how cells function, causing them to release too much of certain chemicals. The result is that most algae get the boot, leaving the coral without its main food supply.

"They begin to starve," Nitschke says. "That primary energy source – the loss of that during a heat stress event is potentially catastrophic for an individual coral. They are now in a race against time."

Corals bleach, turning ghostly white, when they're under stress from hotter temperatures. If the heat subsides, they can recover. But long periods of heat and repeated marine heat waves cause corals to die, wreaking havoc on one of the most biodiverse ecosystems on the planet. Veronique Mocellin /AIMS hide caption

Buying time for coral

If the heat subsides, corals can recover, slowly building back their algae population. But if the heat persists, or if there are too many marine heat waves back-to-back, the corals die.

Bleaching events are becoming more frequent, putting corals on a path for a mass die-off by the end of the century if the planet warms more than 2 degrees Celsius (3.6 degrees Fahrenheit). The effects could be devastating for marine biodiversity and for human communities. Hundreds of millions of people worldwide live near coral reefs, relying on them for food and coastal protection, since reefs can reduce flooding by absorbing wave energy.

It's why Nitschke and his colleagues have focused on breeding algae. They're in the process of testing them, giving them to tiny brain corals the size of walnuts. In trials, they've found corals inoculated with the heat-tolerant algae seem to resist bleaching for longer .

Corals the size of walnuts have been inoculated with heat resistant algae by Matthew Nitschke and his colleagues at the Australian Institute of Marine Science. They've found corals inoculated with heat-tolerant algae seem to resist bleaching for longer. Ryan Kellman/NPR hide caption

Researchers are also breeding corals themselves to be more heat-tolerant, in the hope that a combination of both a "super coral" and "super algae" can be used to restore reefs someday. Both are "assisted evolution" – a technique to speed up the natural process organisms use to adapt to their environment.

"Assisted evolution is an umbrella term for many things we've been doing in many other systems: agriculture, for pets." Nitschke says. "We're really only just starting to understand what we can do in the coral space."

Research aquarist Andrea Severati peers at large sheets over which coral larvae were released to settle. Once corals have picked their spot, each will be assessed for coral growth and survival. Ryan Kellman/NPR hide caption

Not a "get out of jail free" card

Still, in nature, there is no free lunch. Heat-tolerant algae may not share as many nutrients with their coral hosts, which means corals grow more slowly and reproduce later than they would otherwise. That could hamper their ability to restore reefs impacted by climate change. A key step will be testing the corals and algae on the Great Barrier Reef itself to see how they do.

"The last thing we want to do is make things worse," says Line Bay, a research program director at the Australian Institute of Marine Science. "We don't want to produce lab-adapted corals and then put them out in the real world where they don't do well."

Even if the heat-tolerant corals prove to be successful, the number of coral needed to restore impaired reefs could be enormous. The Great Barrier Reef is more than 1,000 miles long. And regulators will need to assess if the corals pose any risk to wild populations or the ecosystem as a whole.

The corals developed at AIMS are placed by divers on the Great Barrier reef. They are being tested in the ocean, as part of a large field trial.

Credit: AIMS

"Coral reefs are magical places," Bay says. "I think we need to be brave and we should use all the tools at our disposal in a humble and sensitive manner."

Coral scientists are clear about one aspect of the work: it's not a long-term solution. At best, it only buys coral reefs extra time until the effects of climate change become too much.

"It's not our 'get out of jail free' card," Quigley says. "Maybe that gets us to 2030, 2050 for a very few number of species that we can work with. If we don't have an ocean to put them back in that's healthy, no amount of incredible technology or money is worth it."

The hope is that giving coral reefs a few extra years, or even decades, will be enough time for humans to slow the pace of climate change. That means cutting heat-trapping emissions from the largest source – burning fossil fuels – and switching to alternative energy sources like solar and wind.

"We could all be despondent and be hopeless if there weren't great solutions on the table to turn climate change problems around," Quigley says. "We just need to get it on, now, really."

• coral reefs
• Great Barrier Reef
• conservation
• climate change

Experts available: Trump trial opening statements, TikTok bill, SCOTUS homeless case, avian flu, and more

22 Apr 2024

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The Virginia Tech media relations office has the following experts available for interviews this week surrounding issues in the news. To schedule an interview, please contact [email protected] .

Virginia Tech experts available to discuss headlines in the news

Historic trial of former President Trump begins today

Opening statements start today in the first criminal trial of a former U.S. president in the nation’s history. In a complex case, Manhattan’s district attorney seeks to prosecute Donald Trump on 34 counts of falsifying business records. The trial is expected to last several weeks, disrupting the presumptive Republican nominee’s campaign to retake the presidency. Political science expert Karen Hult can discuss the historic and governance aspects of this unprecedented trial, while public relations expert Cayce Myers should shed light on how the trial hurts and helps Trump’s reelection efforts. Read more here . 

Passing foreign aid package puts U.S. House Speaker’s job in jeopardy

Republican U.S. House Speaker Mike Johnson over the weekend worked with Democrats to orchestrate the passage of a $95 billion aid package to Ukraine, Israel, and Taiwan. Throughout the process, former allies in the most pro-Trump wing of his own party threatened to depose him, and with the aid package approved in defiance of their wishes, those threats could now come to fruition. Political science expert Karen Hult can provide analysis.

What the House TikTok ban bill means for users, social media

Over the weekend, the House of Representatives passed a bill that could lead to a nationwide ban of the popular social media app TikTok. It now moves to the Senate, and President Biden has said he will sign the bill should it reach his desk. TikTok is owned by Chinese company ByteDance, which some lawmakers say makes it a potential national security threat, due to its surveillance capabilities. Professor of public relations Cayce Myers says that “targeting a specific company like this is unusual, but it may signal a new approach to social media regulation.” More here .

Supreme Court to weigh bans on sleeping outdoors

The Supreme Court will hear today for what’s considered one of the most significant cases concerning homelessness in decades. The question is whether banning homeless people from sleeping outside when shelter is lacking amounts to cruel and unusual punishment. Political science professor Brandy Faulkner is available to speak about the case and its implications.

Veterinary experts offer update and advice on avian influenza outbreak

Experts are calling the avian flu the worst in U.S. history. The outbreak has now been detected in poultry and cattle and is raising significant concerns within the agricultural and public health communities. The Virginia Tech Animal Laboratory Services (ViTALS) lab at the Virginia-Maryland College of Veterinary Medicine , as part of the National Animal Health Laboratory Network (NAHLN), along with federal and state organizations are monitoring the situation. Dr. Tanya LeRoith is available to discuss the work being done in the lab and Virginia’s response to the outbreak. Michael Persia with the College of Agriculture and Life Sciences is available to speak to the precautions poultry owners and industry members need to take to protect their flocks. More here .

Earth Day 2024: Experts available to discuss environmental issues and how to solve them

Virginia Tech has a number of Earth Day experts available for interviews surrounding a variety of topics and research, including sustainable transportation, 3D printing wind turbines, plants that pollute the air, AI and sustainability, and more. Story ideas are available here .

Podcast: Earth’s most pivotal moments explained

Ben Gill joined Virginia Tech’s “Curious Conversations” to chat about piecing together Earth history through a combination of geology and chemistry. Gill explained how studying the cycles of different elements can tell a story and help us better understand the planet’s most pivotal moments, such as mass extinctions. He also shared how studying both the worth and best times of our planet can provide us valuable insights for the future.  

Gill is an associate professor in the Department of Geosciences and a faculty affiliate of the Global Change Center in the Fralin Life Sciences Institute . As a geochemist and sedimentary geologist, Gill specializes in reconstructing the present and past chemical cycles on our planet. His research combines classic sedimentologic and stratigraphic methods with both proven and novel geochemical and numerical modeling techniques.

Research Highlights

Researchers develop a new way to safely boost immune cells to fight cancer

Cancer is the monster of our society. Last year alone, more than 600,000 people in the United States died from cancer, according to the American Cancer Society . The relentless pursuit of understanding this complex disease has shaped medical progress on developing treatment procedures that are less invasive while still highly effective.

Rong Tong , associate professor in chemical engineering , has teamed up with Wenjun "Rebecca" Cai , associate professor in materials science and engineering , to explore a cancer immunotherapy treatment that has long been of interest to researchers. In their newly published article in the journal Science Advances , Tong and Cai detailed their approach, which involves activating the immune cells in the body and reprogramming them to attack and destroy the cancer cells. This therapeutic method is frequently implemented with the protein cytokine. Cytokines are small protein molecules that act as intercellular biochemical messengers and are released by the body's immune cells to coordinate their response. Read more here .

Wind turbine blades get a sustainable upgrade

The average wind turbine generates enough electricity in 46 minutes to power a home in the United States for an entire month, according to the United States Geological Survey . And with more than 70,800 turbines scattered throughout the country, wind power has now surpassed hydroelectric power as the largest producer of renewable energy.

With a $2 million grant from the Department of Energy , researchers from Virginia Tech are pioneering processes to make this sustainable energy source even more sustainable. The grant is part of a $72 million initiative to innovate manufacturing processes for wind technologies and create sustainable solutions for harnessing wind energy. The research team at Virginia Tech will be using new methods of additive manufacturing, computational design, and a recyclable, high strength thermoplastic material. Read more here .

Margaret Ashburn

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Only 1 in 3 US adults think Trump acted illegally in New York hush money case, AP-NORC poll shows

The first criminal trial facing former President Donald Trump is also the one in which Americans are least convinced he committed a crime, a new AP-NORC Center for Public Affairs Research poll finds.

FILE - Former President Donald Trump sits in Manhattan criminal court with his legal team in New York, April 15, 2024. (Jabin Botsford/Pool Photo via AP)

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WASHINGTON (AP) — The first criminal trial facing former President Donald Trump is also the one in which Americans are least convinced he committed a crime, a new AP-NORC Center for Public Affairs Research poll finds.

Only about one-third of U.S. adults say Trump did something illegal in the hush money case for which jury selection began Monday, while close to half think he did something illegal in the other three criminal cases pending against him. And they’re fairly skeptical that Trump is getting a fair shake from the prosecutors in the case — or that the judge and jurors can be impartial in cases involving him.

What to know about Trump’s hush money trial:

• Follow AP’s live coverage of opening statements.
• Trump will be first ex-president on criminal trial. Here’s what to know about the hush money case.
• A jury of his peers: A look at how jury selection will work in Donald Trump’s first criminal trial .
• Trump is facing four criminal indictments, and a civil lawsuit. You can track all of the cases here.

Still, half of Americans would consider Trump unfit to serve as president if he is convicted of falsifying business documents to cover up hush money payments to a woman who said he had a sexual encounter with her.

While a New York jury will decide whether to convict Trump of felony charges, public opinion of the trial proceedings could hurt him politically. The poll suggests a conviction could hurt Trump’s campaign. Trump enters a rematch with President Joe Biden as the first presumptive nominee of a major party — and the first former president — to be under indictment. A verdict is expected in roughly six weeks, well before the Republican National Convention, at which he will accept the GOP nomination.

Trump has made the prosecutions against him a centerpiece of his campaign and argued without evidence that Biden, a Democrat, engineered the cases. That argument helped him consolidate GOP support during the Republican primary, but a conviction might influence how many Americans — including independent voters and people long skeptical of Trump — perceive his candidacy.

“Any conviction should disqualify him,” said Callum Schlumpf, a 31-year-old engineering student and political independent from Clifton, Texas. “It sets a bad example to the rest of the world. I think it misrepresents us, as a country, as to what we believe is important and virtuous.”

Yet, a cloud of doubt hangs over all the proceedings. Only about 3 in 10 Americans feel that any of the prosecutors who have brought charges against Trump are treating the former president fairly. And only about 2 in 10 Americans are extremely or very confident that the judges and jurors in the cases against him can be fair and impartial.

“It’s very obvious political persecution,” said Christopher Ruff, a 46-year-old political independent and museum curator from Sanford, North Carolina. “I’m no fan of Trump in any way, shape or form. Didn’t vote for him, never will. But it’s obviously all political.”

Former President Donald Trump sits in Manhattan criminal court with his legal team in New York, April 15, 2024. (Jabin Botsford/Pool Photo via AP)

Consistent with AP-NORC polls conducted over the past year, the new poll found that about half of Americans say Trump did something illegal regarding the classified documents found at his Florida home , and a similar share think he did something illegal regarding his alleged attempt to interfere in Georgia’s vote count in the 2020 presidential election . The poll also found that nearly half of Americans believe he did something illegal related to his effort to overturn the results of the 2020 election .

Prosecutors in New York will argue that Trump falsified his company’s internal records to hide the true nature of a payment to his former lawyer Michael Cohen. Cohen alleges he was directed by Trump to pay adult film actor Stormy Daniels $130,000 one month before the 2016 election to silence her claims about an extramarital sexual encounter with Trump.

Trump has pleaded not guilty to the 34-count indictment and denied any sexual encounter with Daniels.

The poll found that 35% of Americans say Trump has done something illegal with regard to the hush money allegations. Slightly fewer, about 3 in 10, think he did something unethical without breaking the law. Fourteen percent think he did nothing wrong at all. Those numbers haven’t shifted meaningfully in the year since he was first charged in the case.

Republicans are much less likely than Democrats and independents to say Trump committed a crime in the hush money case.

“He’s done nothing wrong,” said Louie Tsonos, a 43-year-old sales representative and Republican from Carleton, Michigan, a suburb of Detroit. “Because Trump has a lot of money and fame, they want to destroy his reputation. Or at least they are trying to.”

Fewer than one in 10 Republicans say Trump did something illegal in the case, while 4 in 10 Republicans think he did something unethical but did not break the law. About 3 in 10 Republicans, like Tsonos, say he did nothing wrong.

By contrast, about 6 in 10 Democrats and roughly 3 in 10 independents believe he did something illegal.

Monica Brown, a Democrat from Knoxville, Tennessee, thinks Trump did something unethical, though not illegal, in the New York criminal case under way. But a conviction would ruin his credibility to serve as president, she said.

“I don’t believe any president – whether it’s Donald Trump or anyone else – should have a criminal conviction on his record,” said Brown, a 60-year-old veterinary technician and social worker. “Even if it’s related to something like hush money, what respect are they going to get from anyone? Citizens of the country or world leaders, they aren’t going to respect you.”

Nearly 6 in 10 Republicans say they would consider Trump fit to be president even if he were to be convicted of falsifying business documents in the hush money case. About 8 in 10 Democrats say Trump would not be fit to serve in the event of a conviction. About half of independents think he would be unfit to serve, with 22% saying he would be fit and 30% saying they didn’t know enough to say.

“I don’t think any of that stuff has any relevance to his ability to lead this country,” said Jennifer Solich, a Republican from York, Pennsylvania, and retired nuclear engineer who believes Trump would be fit to serve if convicted in the New York case. “There may be some unethical aspects to it. I just think it’s more trivial than what we’re facing as a nation.”

Beaumont reported from Des Moines, Iowa.

The poll of 1,204 adults was conducted April 4-8, 2024, using a sample drawn from NORC’s probability-based AmeriSpeak Panel, which is designed to be representative of the U.S. population. The margin of sampling error for all respondents is plus or minus 3.9 percentage points.