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How to Write a Critique for a Case Analysis

Law, science, psychology, medicine, business and education -- these fields all use case studies to glean quantifiable data from anecdotal situations both in the classroom and professional world. A case analysis provides a review and interpretation, also known as an assessment, of the study results to draw conclusions and solutions that can be applied on a broader basis. It’s the job of the critique to investigate and evaluate the case analysis findings.

Case Details Overview

A critique of a case analysis must first delineate the details of the case study for readability and clarity. This includes all of the factual data produced by the original case study, such as the dates the study was conducted, significant statistical data and the impact of variables. The case overview may also need to address whether the case study data is qualitative or quantitative, which involves noting whether the information is mathematically measurable. The case overview should be a brief synopsis of the case study designed to provide information needed to understand the critique, not a full explanation.

Unbiased Interpretation of Analysis

A critique must also detail the findings of the case analysis using impartial language. Whether your critique questions or validates the analysis, calls the findings into question or simply suggests alternative viewpoints, the conclusions of the case analysis under evaluation must first be presented objectively. This means employing the use of objective language to avoid making personal, judgmental or emotive statements in the paragraphs presenting the findings.

Thesis Rationale

The thesis statement for a critique must address the fundamental issues being raised or questions being asked about the case analysis. Unlike pure analysis, a critique is influenced by personal opinions and beliefs, and the thesis statement should indicate the author’s rationale. The thesis must provide the critique writer’s position statement clearly and concisely. The thesis should also identify the intent of the critique, such as whether it aims to validate or question the case analysis.

Point and Counterpoint

Support for the opinions presented in the thesis statement are provided by counterpoints that address the points made in the case analysis. It’s important to provide a counterargument for all of the major arguments and findings in a case study analysis to prove the validity of your thesis statement. Critiques that gloss over or ignore significant data may be considered invalid for failing to address the full analysis.

Validation or Dissension

A critique is typically either a dissension or validation of the case study analysis, and it should avoid presenting new information from other sources, such as data from other case studies not addressed by the case analysis. In some instances, a critique may present new thoughts or ideas in the form of alternative interpretations of the original case study that the case analysis did not cover.

• Kansas State University: Criticism and Critical Analysis
• Nova Southeastern University: Introduction to Case Study
• Hobart and William Smith Colleges: Writing a Critique (Critical Analysis)
• The University of Adelaide: Objective Language

A former art instructor, high school counselor and party planner, Christine Bartsch writes fashion, travel, interior design, education and entertainment content. Bartsch earned a Bachelor of Fine Arts in communications/psychology/fine arts from Wisconsin Lutheran College and a creative writing Master of Fine Arts from Spalding University. She's written scripts for film/television productions and worked as the senior writer at a video game company.

Organizing Your Social Sciences Research Assignments

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• Grading Someone Else's Paper
• Types of Structured Group Activities
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• Writing a Case Analysis Paper
• Writing a Case Study
• About Informed Consent
• Writing Field Notes
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• Acknowledgments

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

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

How to Approach Writing a Case Study Research Paper

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

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

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

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

Structure and Writing Style

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

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

I.  Introduction

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

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

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

II.  Literature Review

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

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

III.  Method

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

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

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

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

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

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

IV.  Discussion

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

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

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

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

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

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

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

V.  Conclusion

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

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

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

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

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

Problems to Avoid

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

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

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

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

Writing Tip

At Least Five Misconceptions about Case Study Research

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

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

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

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

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Methodology or method? A critical review of qualitative case study reports

Despite on-going debate about credibility, and reported limitations in comparison to other approaches, case study is an increasingly popular approach among qualitative researchers. We critically analysed the methodological descriptions of published case studies. Three high-impact qualitative methods journals were searched to locate case studies published in the past 5 years; 34 were selected for analysis. Articles were categorized as health and health services ( n= 12), social sciences and anthropology ( n= 7), or methods ( n= 15) case studies. The articles were reviewed using an adapted version of established criteria to determine whether adequate methodological justification was present, and if study aims, methods, and reported findings were consistent with a qualitative case study approach. Findings were grouped into five themes outlining key methodological issues: case study methodology or method, case of something particular and case selection, contextually bound case study, researcher and case interactions and triangulation, and study design inconsistent with methodology reported. Improved reporting of case studies by qualitative researchers will advance the methodology for the benefit of researchers and practitioners.

Case study research is an increasingly popular approach among qualitative researchers (Thomas, 2011 ). Several prominent authors have contributed to methodological developments, which has increased the popularity of case study approaches across disciplines (Creswell, 2013b ; Denzin & Lincoln, 2011b ; Merriam, 2009 ; Ragin & Becker, 1992 ; Stake, 1995 ; Yin, 2009 ). Current qualitative case study approaches are shaped by paradigm, study design, and selection of methods, and, as a result, case studies in the published literature vary. Differences between published case studies can make it difficult for researchers to define and understand case study as a methodology.

Experienced qualitative researchers have identified case study research as a stand-alone qualitative approach (Denzin & Lincoln, 2011b ). Case study research has a level of flexibility that is not readily offered by other qualitative approaches such as grounded theory or phenomenology. Case studies are designed to suit the case and research question and published case studies demonstrate wide diversity in study design. There are two popular case study approaches in qualitative research. The first, proposed by Stake ( 1995 ) and Merriam ( 2009 ), is situated in a social constructivist paradigm, whereas the second, by Yin ( 2012 ), Flyvbjerg ( 2011 ), and Eisenhardt ( 1989 ), approaches case study from a post-positivist viewpoint. Scholarship from both schools of inquiry has contributed to the popularity of case study and development of theoretical frameworks and principles that characterize the methodology.

The diversity of case studies reported in the published literature, and on-going debates about credibility and the use of case study in qualitative research practice, suggests that differences in perspectives on case study methodology may prevent researchers from developing a mutual understanding of practice and rigour. In addition, discussion about case study limitations has led some authors to query whether case study is indeed a methodology (Luck, Jackson, & Usher, 2006 ; Meyer, 2001 ; Thomas, 2010 ; Tight, 2010 ). Methodological discussion of qualitative case study research is timely, and a review is required to analyse and understand how this methodology is applied in the qualitative research literature. The aims of this study were to review methodological descriptions of published qualitative case studies, to review how the case study methodological approach was applied, and to identify issues that need to be addressed by researchers, editors, and reviewers. An outline of the current definitions of case study and an overview of the issues proposed in the qualitative methodological literature are provided to set the scene for the review.

Definitions of qualitative case study research

Case study research is an investigation and analysis of a single or collective case, intended to capture the complexity of the object of study (Stake, 1995 ). Qualitative case study research, as described by Stake ( 1995 ), draws together “naturalistic, holistic, ethnographic, phenomenological, and biographic research methods” in a bricoleur design, or in his words, “a palette of methods” (Stake, 1995 , pp. xi–xii). Case study methodology maintains deep connections to core values and intentions and is “particularistic, descriptive and heuristic” (Merriam, 2009 , p. 46).

As a study design, case study is defined by interest in individual cases rather than the methods of inquiry used. The selection of methods is informed by researcher and case intuition and makes use of naturally occurring sources of knowledge, such as people or observations of interactions that occur in the physical space (Stake, 1998 ). Thomas ( 2011 ) suggested that “analytical eclecticism” is a defining factor (p. 512). Multiple data collection and analysis methods are adopted to further develop and understand the case, shaped by context and emergent data (Stake, 1995 ). This qualitative approach “explores a real-life, contemporary bounded system (a case ) or multiple bounded systems (cases) over time, through detailed, in-depth data collection involving multiple sources of information … and reports a case description and case themes ” (Creswell, 2013b , p. 97). Case study research has been defined by the unit of analysis, the process of study, and the outcome or end product, all essentially the case (Merriam, 2009 ).

The case is an object to be studied for an identified reason that is peculiar or particular. Classification of the case and case selection procedures informs development of the study design and clarifies the research question. Stake ( 1995 ) proposed three types of cases and study design frameworks. These include the intrinsic case, the instrumental case, and the collective instrumental case. The intrinsic case is used to understand the particulars of a single case, rather than what it represents. An instrumental case study provides insight on an issue or is used to refine theory. The case is selected to advance understanding of the object of interest. A collective refers to an instrumental case which is studied as multiple, nested cases, observed in unison, parallel, or sequential order. More than one case can be simultaneously studied; however, each case study is a concentrated, single inquiry, studied holistically in its own entirety (Stake, 1995 , 1998 ).

Researchers who use case study are urged to seek out what is common and what is particular about the case. This involves careful and in-depth consideration of the nature of the case, historical background, physical setting, and other institutional and political contextual factors (Stake, 1998 ). An interpretive or social constructivist approach to qualitative case study research supports a transactional method of inquiry, where the researcher has a personal interaction with the case. The case is developed in a relationship between the researcher and informants, and presented to engage the reader, inviting them to join in this interaction and in case discovery (Stake, 1995 ). A postpositivist approach to case study involves developing a clear case study protocol with careful consideration of validity and potential bias, which might involve an exploratory or pilot phase, and ensures that all elements of the case are measured and adequately described (Yin, 2009 , 2012 ).

Current methodological issues in qualitative case study research

The future of qualitative research will be influenced and constructed by the way research is conducted, and by what is reviewed and published in academic journals (Morse, 2011 ). If case study research is to further develop as a principal qualitative methodological approach, and make a valued contribution to the field of qualitative inquiry, issues related to methodological credibility must be considered. Researchers are required to demonstrate rigour through adequate descriptions of methodological foundations. Case studies published without sufficient detail for the reader to understand the study design, and without rationale for key methodological decisions, may lead to research being interpreted as lacking in quality or credibility (Hallberg, 2013 ; Morse, 2011 ).

There is a level of artistic license that is embraced by qualitative researchers and distinguishes practice, which nurtures creativity, innovation, and reflexivity (Denzin & Lincoln, 2011b ; Morse, 2009 ). Qualitative research is “inherently multimethod” (Denzin & Lincoln, 2011a , p. 5); however, with this creative freedom, it is important for researchers to provide adequate description for methodological justification (Meyer, 2001 ). This includes paradigm and theoretical perspectives that have influenced study design. Without adequate description, study design might not be understood by the reader, and can appear to be dishonest or inaccurate. Reviewers and readers might be confused by the inconsistent or inappropriate terms used to describe case study research approach and methods, and be distracted from important study findings (Sandelowski, 2000 ). This issue extends beyond case study research, and others have noted inconsistencies in reporting of methodology and method by qualitative researchers. Sandelowski ( 2000 , 2010 ) argued for accurate identification of qualitative description as a research approach. She recommended that the selected methodology should be harmonious with the study design, and be reflected in methods and analysis techniques. Similarly, Webb and Kevern ( 2000 ) uncovered inconsistencies in qualitative nursing research with focus group methods, recommending that methodological procedures must cite seminal authors and be applied with respect to the selected theoretical framework. Incorrect labelling using case study might stem from the flexibility in case study design and non-directional character relative to other approaches (Rosenberg & Yates, 2007 ). Methodological integrity is required in design of qualitative studies, including case study, to ensure study rigour and to enhance credibility of the field (Morse, 2011 ).

Case study has been unnecessarily devalued by comparisons with statistical methods (Eisenhardt, 1989 ; Flyvbjerg, 2006 , 2011 ; Jensen & Rodgers, 2001 ; Piekkari, Welch, & Paavilainen, 2009 ; Tight, 2010 ; Yin, 1999 ). It is reputed to be the “the weak sibling” in comparison to other, more rigorous, approaches (Yin, 2009 , p. xiii). Case study is not an inherently comparative approach to research. The objective is not statistical research, and the aim is not to produce outcomes that are generalizable to all populations (Thomas, 2011 ). Comparisons between case study and statistical research do little to advance this qualitative approach, and fail to recognize its inherent value, which can be better understood from the interpretive or social constructionist viewpoint of other authors (Merriam, 2009 ; Stake, 1995 ). Building on discussions relating to “fuzzy” (Bassey, 2001 ), or naturalistic generalizations (Stake, 1978 ), or transference of concepts and theories (Ayres, Kavanaugh, & Knafl, 2003 ; Morse et al., 2011 ) would have more relevance.

Case study research has been used as a catch-all design to justify or add weight to fundamental qualitative descriptive studies that do not fit with other traditional frameworks (Merriam, 2009 ). A case study has been a “convenient label for our research—when we ‘can't think of anything ‘better”—in an attempt to give it [qualitative methodology] some added respectability” (Tight, 2010 , p. 337). Qualitative case study research is a pliable approach (Merriam, 2009 ; Meyer, 2001 ; Stake, 1995 ), and has been likened to a “curious methodological limbo” (Gerring, 2004 , p. 341) or “paradigmatic bridge” (Luck et al., 2006 , p. 104), that is on the borderline between postpositivist and constructionist interpretations. This has resulted in inconsistency in application, which indicates that flexibility comes with limitations (Meyer, 2001 ), and the open nature of case study research might be off-putting to novice researchers (Thomas, 2011 ). The development of a well-(in)formed theoretical framework to guide a case study should improve consistency, rigour, and trust in studies published in qualitative research journals (Meyer, 2001 ).

Assessment of rigour

The purpose of this study was to analyse the methodological descriptions of case studies published in qualitative methods journals. To do this we needed to develop a suitable framework, which used existing, established criteria for appraising qualitative case study research rigour (Creswell, 2013b ; Merriam, 2009 ; Stake, 1995 ). A number of qualitative authors have developed concepts and criteria that are used to determine whether a study is rigorous (Denzin & Lincoln, 2011b ; Lincoln, 1995 ; Sandelowski & Barroso, 2002 ). The criteria proposed by Stake ( 1995 ) provide a framework for readers and reviewers to make judgements regarding case study quality, and identify key characteristics essential for good methodological rigour. Although each of the factors listed in Stake's criteria could enhance the quality of a qualitative research report, in Table I we present an adapted criteria used in this study, which integrates more recent work by Merriam ( 2009 ) and Creswell ( 2013b ). Stake's ( 1995 ) original criteria were separated into two categories. The first list of general criteria is “relevant for all qualitative research.” The second list, “high relevance to qualitative case study research,” was the criteria that we decided had higher relevance to case study research. This second list was the main criteria used to assess the methodological descriptions of the case studies reviewed. The complete table has been preserved so that the reader can determine how the original criteria were adapted.

Framework for assessing quality in qualitative case study research.

Adapted from Stake ( 1995 , p. 131).

Study design

The critical review method described by Grant and Booth ( 2009 ) was used, which is appropriate for the assessment of research quality, and is used for literature analysis to inform research and practice. This type of review goes beyond the mapping and description of scoping or rapid reviews, to include “analysis and conceptual innovation” (Grant & Booth, 2009 , p. 93). A critical review is used to develop existing, or produce new, hypotheses or models. This is different to systematic reviews that answer clinical questions. It is used to evaluate existing research and competing ideas, to provide a “launch pad” for conceptual development and “subsequent testing” (Grant & Booth, 2009 , p. 93).

Qualitative methods journals were located by a search of the 2011 ISI Journal Citation Reports in Social Science, via the database Web of Knowledge (see m.webofknowledge.com). No “qualitative research methods” category existed in the citation reports; therefore, a search of all categories was performed using the term “qualitative.” In Table II , we present the qualitative methods journals located, ranked by impact factor. The highest ranked journals were selected for searching. We acknowledge that the impact factor ranking system might not be the best measure of journal quality (Cheek, Garnham, & Quan, 2006 ); however, this was the most appropriate and accessible method available.

International Journal of Qualitative Studies on Health and Well-being.

Search strategy

In March 2013, searches of the journals, Qualitative Health Research , Qualitative Research , and Qualitative Inquiry were completed to retrieve studies with “case study” in the abstract field. The search was limited to the past 5 years (1 January 2008 to 1 March 2013). The objective was to locate published qualitative case studies suitable for assessment using the adapted criterion. Viewpoints, commentaries, and other article types were excluded from review. Title and abstracts of the 45 retrieved articles were read by the first author, who identified 34 empirical case studies for review. All authors reviewed the 34 studies to confirm selection and categorization. In Table III , we present the 34 case studies grouped by journal, and categorized by research topic, including health sciences, social sciences and anthropology, and methods research. There was a discrepancy in categorization of one article on pedagogy and a new teaching method published in Qualitative Inquiry (Jorrín-Abellán, Rubia-Avi, Anguita-Martínez, Gómez-Sánchez, & Martínez-Mones, 2008 ). Consensus was to allocate to the methods category.

Outcomes of search of qualitative methods journals.

In Table III , the number of studies located, and final numbers selected for review have been reported. Qualitative Health Research published the most empirical case studies ( n= 16). In the health category, there were 12 case studies of health conditions, health services, and health policy issues, all published in Qualitative Health Research . Seven case studies were categorized as social sciences and anthropology research, which combined case study with biography and ethnography methodologies. All three journals published case studies on methods research to illustrate a data collection or analysis technique, methodological procedure, or related issue.

The methodological descriptions of 34 case studies were critically reviewed using the adapted criteria. All articles reviewed contained a description of study methods; however, the length, amount of detail, and position of the description in the article varied. Few studies provided an accurate description and rationale for using a qualitative case study approach. In the 34 case studies reviewed, three described a theoretical framework informed by Stake ( 1995 ), two by Yin ( 2009 ), and three provided a mixed framework informed by various authors, which might have included both Yin and Stake. Few studies described their case study design, or included a rationale that explained why they excluded or added further procedures, and whether this was to enhance the study design, or to better suit the research question. In 26 of the studies no reference was provided to principal case study authors. From reviewing the description of methods, few authors provided a description or justification of case study methodology that demonstrated how their study was informed by the methodological literature that exists on this approach.

The methodological descriptions of each study were reviewed using the adapted criteria, and the following issues were identified: case study methodology or method; case of something particular and case selection; contextually bound case study; researcher and case interactions and triangulation; and, study design inconsistent with methodology. An outline of how the issues were developed from the critical review is provided, followed by a discussion of how these relate to the current methodological literature.

Case study methodology or method

A third of the case studies reviewed appeared to use a case report method, not case study methodology as described by principal authors (Creswell, 2013b ; Merriam, 2009 ; Stake, 1995 ; Yin, 2009 ). Case studies were identified as a case report because of missing methodological detail and by review of the study aims and purpose. These reports presented data for small samples of no more than three people, places or phenomenon. Four studies, or “case reports” were single cases selected retrospectively from larger studies (Bronken, Kirkevold, Martinsen, & Kvigne, 2012 ; Coltart & Henwood, 2012 ; Hooghe, Neimeyer, & Rober, 2012 ; Roscigno et al., 2012 ). Case reports were not a case of something, instead were a case demonstration or an example presented in a report. These reports presented outcomes, and reported on how the case could be generalized. Descriptions focussed on the phenomena, rather than the case itself, and did not appear to study the case in its entirety.

Case reports had minimal in-text references to case study methodology, and were informed by other qualitative traditions or secondary sources (Adamson & Holloway, 2012 ; Buzzanell & D'Enbeau, 2009 ; Nagar-Ron & Motzafi-Haller, 2011 ). This does not suggest that case study methodology cannot be multimethod, however, methodology should be consistent in design, be clearly described (Meyer, 2001 ; Stake, 1995 ), and maintain focus on the case (Creswell, 2013b ).

To demonstrate how case reports were identified, three examples are provided. The first, Yeh ( 2013 ) described their study as, “the examination of the emergence of vegetarianism in Victorian England serves as a case study to reveal the relationships between boundaries and entities” (p. 306). The findings were a historical case report, which resulted from an ethnographic study of vegetarianism. Cunsolo Willox, Harper, Edge, ‘My Word’: Storytelling and Digital Media Lab, and Rigolet Inuit Community Government (2013) used “a case study that illustrates the usage of digital storytelling within an Inuit community” (p. 130). This case study reported how digital storytelling can be used with indigenous communities as a participatory method to illuminate the benefits of this method for other studies. This “case study was conducted in the Inuit community” but did not include the Inuit community in case analysis (Cunsolo Willox et al., 2013 , p. 130). Bronken et al. ( 2012 ) provided a single case report to demonstrate issues observed in a larger clinical study of aphasia and stroke, without adequate case description or analysis.

Case study of something particular and case selection

Case selection is a precursor to case analysis, which needs to be presented as a convincing argument (Merriam, 2009 ). Descriptions of the case were often not adequate to ascertain why the case was selected, or whether it was a particular exemplar or outlier (Thomas, 2011 ). In a number of case studies in the health and social science categories, it was not explicit whether the case was of something particular, or peculiar to their discipline or field (Adamson & Holloway, 2012 ; Bronken et al., 2012 ; Colón-Emeric et al., 2010 ; Jackson, Botelho, Welch, Joseph, & Tennstedt, 2012 ; Mawn et al., 2010 ; Snyder-Young, 2011 ). There were exceptions in the methods category ( Table III ), where cases were selected by researchers to report on a new or innovative method. The cases emerged through heuristic study, and were reported to be particular, relative to the existing methods literature (Ajodhia-Andrews & Berman, 2009 ; Buckley & Waring, 2013 ; Cunsolo Willox et al., 2013 ; De Haene, Grietens, & Verschueren, 2010 ; Gratton & O'Donnell, 2011 ; Sumsion, 2013 ; Wimpenny & Savin-Baden, 2012 ).

Case selection processes were sometimes insufficient to understand why the case was selected from the global population of cases, or what study of this case would contribute to knowledge as compared with other possible cases (Adamson & Holloway, 2012 ; Bronken et al., 2012 ; Colón-Emeric et al., 2010 ; Jackson et al., 2012 ; Mawn et al., 2010 ). In two studies, local cases were selected (Barone, 2010 ; Fourie & Theron, 2012 ) because the researcher was familiar with and had access to the case. Possible limitations of a convenience sample were not acknowledged. Purposeful sampling was used to recruit participants within the case of one study, but not of the case itself (Gallagher et al., 2013 ). Random sampling was completed for case selection in two studies (Colón-Emeric et al., 2010 ; Jackson et al., 2012 ), which has limited meaning in interpretive qualitative research.

To demonstrate how researchers provided a good justification for the selection of case study approaches, four examples are provided. The first, cases of residential care homes, were selected because of reported occurrences of mistreatment, which included residents being locked in rooms at night (Rytterström, Unosson, & Arman, 2013 ). Roscigno et al. ( 2012 ) selected cases of parents who were admitted for early hospitalization in neonatal intensive care with a threatened preterm delivery before 26 weeks. Hooghe et al. ( 2012 ) used random sampling to select 20 couples that had experienced the death of a child; however, the case study was of one couple and a particular metaphor described only by them. The final example, Coltart and Henwood ( 2012 ), provided a detailed account of how they selected two cases from a sample of 46 fathers based on personal characteristics and beliefs. They described how the analysis of the two cases would contribute to their larger study on first time fathers and parenting.

Contextually bound case study

The limits or boundaries of the case are a defining factor of case study methodology (Merriam, 2009 ; Ragin & Becker, 1992 ; Stake, 1995 ; Yin, 2009 ). Adequate contextual description is required to understand the setting or context in which the case is revealed. In the health category, case studies were used to illustrate a clinical phenomenon or issue such as compliance and health behaviour (Colón-Emeric et al., 2010 ; D'Enbeau, Buzzanell, & Duckworth, 2010 ; Gallagher et al., 2013 ; Hooghe et al., 2012 ; Jackson et al., 2012 ; Roscigno et al., 2012 ). In these case studies, contextual boundaries, such as physical and institutional descriptions, were not sufficient to understand the case as a holistic system, for example, the general practitioner (GP) clinic in Gallagher et al. ( 2013 ), or the nursing home in Colón-Emeric et al. ( 2010 ). Similarly, in the social science and methods categories, attention was paid to some components of the case context, but not others, missing important information required to understand the case as a holistic system (Alexander, Moreira, & Kumar, 2012 ; Buzzanell & D'Enbeau, 2009 ; Nairn & Panelli, 2009 ; Wimpenny & Savin-Baden, 2012 ).

In two studies, vicarious experience or vignettes (Nairn & Panelli, 2009 ) and images (Jorrín-Abellán et al., 2008 ) were effective to support description of context, and might have been a useful addition for other case studies. Missing contextual boundaries suggests that the case might not be adequately defined. Additional information, such as the physical, institutional, political, and community context, would improve understanding of the case (Stake, 1998 ). In Boxes 1 and 2 , we present brief synopses of two studies that were reviewed, which demonstrated a well bounded case. In Box 1 , Ledderer ( 2011 ) used a qualitative case study design informed by Stake's tradition. In Box 2 , Gillard, Witt, and Watts ( 2011 ) were informed by Yin's tradition. By providing a brief outline of the case studies in Boxes 1 and 2 , we demonstrate how effective case boundaries can be constructed and reported, which may be of particular interest to prospective case study researchers.

Article synopsis of case study research using Stake's tradition

Ledderer ( 2011 ) used a qualitative case study research design, informed by modern ethnography. The study is bounded to 10 general practice clinics in Denmark, who had received federal funding to implement preventative care services based on a Motivational Interviewing intervention. The researcher question focussed on “why is it so difficult to create change in medical practice?” (Ledderer, 2011 , p. 27). The study context was adequately described, providing detail on the general practitioner (GP) clinics and relevant political and economic influences. Methodological decisions are described in first person narrative, providing insight on researcher perspectives and interaction with the case. Forty-four interviews were conducted, which focussed on how GPs conducted consultations, and the form, nature and content, rather than asking their opinion or experience (Ledderer, 2011 , p. 30). The duration and intensity of researcher immersion in the case enhanced depth of description and trustworthiness of study findings. Analysis was consistent with Stake's tradition, and the researcher provided examples of inquiry techniques used to challenge assumptions about emerging themes. Several other seminal qualitative works were cited. The themes and typology constructed are rich in narrative data and storytelling by clinic staff, demonstrating individual clinic experiences as well as shared meanings and understandings about changing from a biomedical to psychological approach to preventative health intervention. Conclusions make note of social and cultural meanings and lessons learned, which might not have been uncovered using a different methodology.

Article synopsis of case study research using Yin's tradition

Gillard et al. ( 2011 ) study of camps for adolescents living with HIV/AIDs provided a good example of Yin's interpretive case study approach. The context of the case is bounded by the three summer camps of which the researchers had prior professional involvement. A case study protocol was developed that used multiple methods to gather information at three data collection points coinciding with three youth camps (Teen Forum, Discover Camp, and Camp Strong). Gillard and colleagues followed Yin's ( 2009 ) principles, using a consistent data protocol that enhanced cross-case analysis. Data described the young people, the camp physical environment, camp schedule, objectives and outcomes, and the staff of three youth camps. The findings provided a detailed description of the context, with less detail of individual participants, including insight into researcher's interpretations and methodological decisions throughout the data collection and analysis process. Findings provided the reader with a sense of “being there,” and are discovered through constant comparison of the case with the research issues; the case is the unit of analysis. There is evidence of researcher immersion in the case, and Gillard reports spending significant time in the field in a naturalistic and integrated youth mentor role.

This case study is not intended to have a significant impact on broader health policy, although does have implications for health professionals working with adolescents. Study conclusions will inform future camps for young people with chronic disease, and practitioners are able to compare similarities between this case and their own practice (for knowledge translation). No limitations of this article were reported. Limitations related to publication of this case study were that it was 20 pages long and used three tables to provide sufficient description of the camp and program components, and relationships with the research issue.

Researcher and case interactions and triangulation

Researcher and case interactions and transactions are a defining feature of case study methodology (Stake, 1995 ). Narrative stories, vignettes, and thick description are used to provoke vicarious experience and a sense of being there with the researcher in their interaction with the case. Few of the case studies reviewed provided details of the researcher's relationship with the case, researcher–case interactions, and how these influenced the development of the case study (Buzzanell & D'Enbeau, 2009 ; D'Enbeau et al., 2010 ; Gallagher et al., 2013 ; Gillard et al., 2011 ; Ledderer, 2011 ; Nagar-Ron & Motzafi-Haller, 2011 ). The role and position of the researcher needed to be self-examined and understood by readers, to understand how this influenced interactions with participants, and to determine what triangulation is needed (Merriam, 2009 ; Stake, 1995 ).

Gillard et al. ( 2011 ) provided a good example of triangulation, comparing data sources in a table (p. 1513). Triangulation of sources was used to reveal as much depth as possible in the study by Nagar-Ron and Motzafi-Haller ( 2011 ), while also enhancing confirmation validity. There were several case studies that would have benefited from improved range and use of data sources, and descriptions of researcher–case interactions (Ajodhia-Andrews & Berman, 2009 ; Bronken et al., 2012 ; Fincham, Scourfield, & Langer, 2008 ; Fourie & Theron, 2012 ; Hooghe et al., 2012 ; Snyder-Young, 2011 ; Yeh, 2013 ).

Study design inconsistent with methodology

Good, rigorous case studies require a strong methodological justification (Meyer, 2001 ) and a logical and coherent argument that defines paradigm, methodological position, and selection of study methods (Denzin & Lincoln, 2011b ). Methodological justification was insufficient in several of the studies reviewed (Barone, 2010 ; Bronken et al., 2012 ; Hooghe et al., 2012 ; Mawn et al., 2010 ; Roscigno et al., 2012 ; Yeh, 2013 ). This was judged by the absence, or inadequate or inconsistent reference to case study methodology in-text.

In six studies, the methodological justification provided did not relate to case study. There were common issues identified. Secondary sources were used as primary methodological references indicating that study design might not have been theoretically sound (Colón-Emeric et al., 2010 ; Coltart & Henwood, 2012 ; Roscigno et al., 2012 ; Snyder-Young, 2011 ). Authors and sources cited in methodological descriptions were inconsistent with the actual study design and practices used (Fourie & Theron, 2012 ; Hooghe et al., 2012 ; Jorrín-Abellán et al., 2008 ; Mawn et al., 2010 ; Rytterström et al., 2013 ; Wimpenny & Savin-Baden, 2012 ). This occurred when researchers cited Stake or Yin, or both (Mawn et al., 2010 ; Rytterström et al., 2013 ), although did not follow their paradigmatic or methodological approach. In 26 studies there were no citations for a case study methodological approach.

The findings of this study have highlighted a number of issues for researchers. A considerable number of case studies reviewed were missing key elements that define qualitative case study methodology and the tradition cited. A significant number of studies did not provide a clear methodological description or justification relevant to case study. Case studies in health and social sciences did not provide sufficient information for the reader to understand case selection, and why this case was chosen above others. The context of the cases were not described in adequate detail to understand all relevant elements of the case context, which indicated that cases may have not been contextually bounded. There were inconsistencies between reported methodology, study design, and paradigmatic approach in case studies reviewed, which made it difficult to understand the study methodology and theoretical foundations. These issues have implications for methodological integrity and honesty when reporting study design, which are values of the qualitative research tradition and are ethical requirements (Wager & Kleinert, 2010a ). Poorly described methodological descriptions may lead the reader to misinterpret or discredit study findings, which limits the impact of the study, and, as a collective, hinders advancements in the broader qualitative research field.

The issues highlighted in our review build on current debates in the case study literature, and queries about the value of this methodology. Case study research can be situated within different paradigms or designed with an array of methods. In order to maintain the creativity and flexibility that is valued in this methodology, clearer descriptions of paradigm and theoretical position and methods should be provided so that study findings are not undervalued or discredited. Case study research is an interdisciplinary practice, which means that clear methodological descriptions might be more important for this approach than other methodologies that are predominantly driven by fewer disciplines (Creswell, 2013b ).

Authors frequently omit elements of methodologies and include others to strengthen study design, and we do not propose a rigid or purist ideology in this paper. On the contrary, we encourage new ideas about using case study, together with adequate reporting, which will advance the value and practice of case study. The implications of unclear methodological descriptions in the studies reviewed were that study design appeared to be inconsistent with reported methodology, and key elements required for making judgements of rigour were missing. It was not clear whether the deviations from methodological tradition were made by researchers to strengthen the study design, or because of misinterpretations. Morse ( 2011 ) recommended that innovations and deviations from practice are best made by experienced researchers, and that a novice might be unaware of the issues involved with making these changes. To perpetuate the tradition of case study research, applications in the published literature should have consistencies with traditional methodological constructions, and deviations should be described with a rationale that is inherent in study conduct and findings. Providing methodological descriptions that demonstrate a strong theoretical foundation and coherent study design will add credibility to the study, while ensuring the intrinsic meaning of case study is maintained.

The value of this review is that it contributes to discussion of whether case study is a methodology or method. We propose possible reasons why researchers might make this misinterpretation. Researchers may interchange the terms methods and methodology, and conduct research without adequate attention to epistemology and historical tradition (Carter & Little, 2007 ; Sandelowski, 2010 ). If the rich meaning that naming a qualitative methodology brings to the study is not recognized, a case study might appear to be inconsistent with the traditional approaches described by principal authors (Creswell, 2013a ; Merriam, 2009 ; Stake, 1995 ; Yin, 2009 ). If case studies are not methodologically and theoretically situated, then they might appear to be a case report.

Case reports are promoted by university and medical journals as a method of reporting on medical or scientific cases; guidelines for case reports are publicly available on websites ( http://www.hopkinsmedicine.org/institutional_review_board/guidelines_policies/guidelines/case_report.html ). The various case report guidelines provide a general criteria for case reports, which describes that this form of report does not meet the criteria of research, is used for retrospective analysis of up to three clinical cases, and is primarily illustrative and for educational purposes. Case reports can be published in academic journals, but do not require approval from a human research ethics committee. Traditionally, case reports describe a single case, to explain how and what occurred in a selected setting, for example, to illustrate a new phenomenon that has emerged from a larger study. A case report is not necessarily particular or the study of a case in its entirety, and the larger study would usually be guided by a different research methodology.

This description of a case report is similar to what was provided in some studies reviewed. This form of report lacks methodological grounding and qualities of research rigour. The case report has publication value in demonstrating an example and for dissemination of knowledge (Flanagan, 1999 ). However, case reports have different meaning and purpose to case study, which needs to be distinguished. Findings of our review suggest that the medical understanding of a case report has been confused with qualitative case study approaches.

In this review, a number of case studies did not have methodological descriptions that included key characteristics of case study listed in the adapted criteria, and several issues have been discussed. There have been calls for improvements in publication quality of qualitative research (Morse, 2011 ), and for improvements in peer review of submitted manuscripts (Carter & Little, 2007 ; Jasper, Vaismoradi, Bondas, & Turunen, 2013 ). The challenging nature of editor and reviewers responsibilities are acknowledged in the literature (Hames, 2013 ; Wager & Kleinert, 2010b ); however, review of case study methodology should be prioritized because of disputes on methodological value.

Authors using case study approaches are recommended to describe their theoretical framework and methods clearly, and to seek and follow specialist methodological advice when needed (Wager & Kleinert, 2010a ). Adequate page space for case study description would contribute to better publications (Gillard et al., 2011 ). Capitalizing on the ability to publish complementary resources should be considered.

Limitations of the review

There is a level of subjectivity involved in this type of review and this should be considered when interpreting study findings. Qualitative methods journals were selected because the aims and scope of these journals are to publish studies that contribute to methodological discussion and development of qualitative research. Generalist health and social science journals were excluded that might have contained good quality case studies. Journals in business or education were also excluded, although a review of case studies in international business journals has been published elsewhere (Piekkari et al., 2009 ).

The criteria used to assess the quality of the case studies were a set of qualitative indicators. A numerical or ranking system might have resulted in different results. Stake's ( 1995 ) criteria have been referenced elsewhere, and was deemed the best available (Creswell, 2013b ; Crowe et al., 2011 ). Not all qualitative studies are reported in a consistent way and some authors choose to report findings in a narrative form in comparison to a typical biomedical report style (Sandelowski & Barroso, 2002 ), if misinterpretations were made this may have affected the review.

Case study research is an increasingly popular approach among qualitative researchers, which provides methodological flexibility through the incorporation of different paradigmatic positions, study designs, and methods. However, whereas flexibility can be an advantage, a myriad of different interpretations has resulted in critics questioning the use of case study as a methodology. Using an adaptation of established criteria, we aimed to identify and assess the methodological descriptions of case studies in high impact, qualitative methods journals. Few articles were identified that applied qualitative case study approaches as described by experts in case study design. There were inconsistencies in methodology and study design, which indicated that researchers were confused whether case study was a methodology or a method. Commonly, there appeared to be confusion between case studies and case reports. Without clear understanding and application of the principles and key elements of case study methodology, there is a risk that the flexibility of the approach will result in haphazard reporting, and will limit its global application as a valuable, theoretically supported methodology that can be rigorously applied across disciplines and fields.

Conflict of interest and funding

The authors have not received any funding or benefits from industry or elsewhere to conduct this study.

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

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

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

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

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

Table of contents

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Research bias

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

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The Advantages and Limitations of Single Case Study Analysis

As Andrew Bennett and Colin Elman have recently noted, qualitative research methods presently enjoy “an almost unprecedented popularity and vitality… in the international relations sub-field”, such that they are now “indisputably prominent, if not pre-eminent” (2010: 499). This is, they suggest, due in no small part to the considerable advantages that case study methods in particular have to offer in studying the “complex and relatively unstructured and infrequent phenomena that lie at the heart of the subfield” (Bennett and Elman, 2007: 171). Using selected examples from within the International Relations literature[1], this paper aims to provide a brief overview of the main principles and distinctive advantages and limitations of single case study analysis. Divided into three inter-related sections, the paper therefore begins by first identifying the underlying principles that serve to constitute the case study as a particular research strategy, noting the somewhat contested nature of the approach in ontological, epistemological, and methodological terms. The second part then looks to the principal single case study types and their associated advantages, including those from within the recent ‘third generation’ of qualitative International Relations (IR) research. The final section of the paper then discusses the most commonly articulated limitations of single case studies; while accepting their susceptibility to criticism, it is however suggested that such weaknesses are somewhat exaggerated. The paper concludes that single case study analysis has a great deal to offer as a means of both understanding and explaining contemporary international relations.

The term ‘case study’, John Gerring has suggested, is “a definitional morass… Evidently, researchers have many different things in mind when they talk about case study research” (2006a: 17). It is possible, however, to distil some of the more commonly-agreed principles. One of the most prominent advocates of case study research, Robert Yin (2009: 14) defines it as “an empirical enquiry that investigates a contemporary phenomenon in depth and within its real-life context, especially when the boundaries between phenomenon and context are not clearly evident”. What this definition usefully captures is that case studies are intended – unlike more superficial and generalising methods – to provide a level of detail and understanding, similar to the ethnographer Clifford Geertz’s (1973) notion of ‘thick description’, that allows for the thorough analysis of the complex and particularistic nature of distinct phenomena. Another frequently cited proponent of the approach, Robert Stake, notes that as a form of research the case study “is defined by interest in an individual case, not by the methods of inquiry used”, and that “the object of study is a specific, unique, bounded system” (2008: 443, 445). As such, three key points can be derived from this – respectively concerning issues of ontology, epistemology, and methodology – that are central to the principles of single case study research.

First, the vital notion of ‘boundedness’ when it comes to the particular unit of analysis means that defining principles should incorporate both the synchronic (spatial) and diachronic (temporal) elements of any so-called ‘case’. As Gerring puts it, a case study should be “an intensive study of a single unit… a spatially bounded phenomenon – e.g. a nation-state, revolution, political party, election, or person – observed at a single point in time or over some delimited period of time” (2004: 342). It is important to note, however, that – whereas Gerring refers to a single unit of analysis – it may be that attention also necessarily be given to particular sub-units. This points to the important difference between what Yin refers to as an ‘holistic’ case design, with a single unit of analysis, and an ’embedded’ case design with multiple units of analysis (Yin, 2009: 50-52). The former, for example, would examine only the overall nature of an international organization, whereas the latter would also look to specific departments, programmes, or policies etc.

Secondly, as Tim May notes of the case study approach, “even the most fervent advocates acknowledge that the term has entered into understandings with little specification or discussion of purpose and process” (2011: 220). One of the principal reasons for this, he argues, is the relationship between the use of case studies in social research and the differing epistemological traditions – positivist, interpretivist, and others – within which it has been utilised. Philosophy of science concerns are obviously a complex issue, and beyond the scope of much of this paper. That said, the issue of how it is that we know what we know – of whether or not a single independent reality exists of which we as researchers can seek to provide explanation – does lead us to an important distinction to be made between so-called idiographic and nomothetic case studies (Gerring, 2006b). The former refers to those which purport to explain only a single case, are concerned with particularisation, and hence are typically (although not exclusively) associated with more interpretivist approaches. The latter are those focused studies that reflect upon a larger population and are more concerned with generalisation, as is often so with more positivist approaches[2]. The importance of this distinction, and its relation to the advantages and limitations of single case study analysis, is returned to below.

Thirdly, in methodological terms, given that the case study has often been seen as more of an interpretivist and idiographic tool, it has also been associated with a distinctly qualitative approach (Bryman, 2009: 67-68). However, as Yin notes, case studies can – like all forms of social science research – be exploratory, descriptive, and/or explanatory in nature. It is “a common misconception”, he notes, “that the various research methods should be arrayed hierarchically… many social scientists still deeply believe that case studies are only appropriate for the exploratory phase of an investigation” (Yin, 2009: 6). If case studies can reliably perform any or all three of these roles – and given that their in-depth approach may also require multiple sources of data and the within-case triangulation of methods – then it becomes readily apparent that they should not be limited to only one research paradigm. Exploratory and descriptive studies usually tend toward the qualitative and inductive, whereas explanatory studies are more often quantitative and deductive (David and Sutton, 2011: 165-166). As such, the association of case study analysis with a qualitative approach is a “methodological affinity, not a definitional requirement” (Gerring, 2006a: 36). It is perhaps better to think of case studies as transparadigmatic; it is mistaken to assume single case study analysis to adhere exclusively to a qualitative methodology (or an interpretivist epistemology) even if it – or rather, practitioners of it – may be so inclined. By extension, this also implies that single case study analysis therefore remains an option for a multitude of IR theories and issue areas; it is how this can be put to researchers’ advantage that is the subject of the next section.

Having elucidated the defining principles of the single case study approach, the paper now turns to an overview of its main benefits. As noted above, a lack of consensus still exists within the wider social science literature on the principles and purposes – and by extension the advantages and limitations – of case study research. Given that this paper is directed towards the particular sub-field of International Relations, it suggests Bennett and Elman’s (2010) more discipline-specific understanding of contemporary case study methods as an analytical framework. It begins however, by discussing Harry Eckstein’s seminal (1975) contribution to the potential advantages of the case study approach within the wider social sciences.

Eckstein proposed a taxonomy which usefully identified what he considered to be the five most relevant types of case study. Firstly were so-called configurative-idiographic studies, distinctly interpretivist in orientation and predicated on the assumption that “one cannot attain prediction and control in the natural science sense, but only understanding ( verstehen )… subjective values and modes of cognition are crucial” (1975: 132). Eckstein’s own sceptical view was that any interpreter ‘simply’ considers a body of observations that are not self-explanatory and “without hard rules of interpretation, may discern in them any number of patterns that are more or less equally plausible” (1975: 134). Those of a more post-modernist bent, of course – sharing an “incredulity towards meta-narratives”, in Lyotard’s (1994: xxiv) evocative phrase – would instead suggest that this more free-form approach actually be advantageous in delving into the subtleties and particularities of individual cases.

Eckstein’s four other types of case study, meanwhile, promote a more nomothetic (and positivist) usage. As described, disciplined-configurative studies were essentially about the use of pre-existing general theories, with a case acting “passively, in the main, as a receptacle for putting theories to work” (Eckstein, 1975: 136). As opposed to the opportunity this presented primarily for theory application, Eckstein identified heuristic case studies as explicit theoretical stimulants – thus having instead the intended advantage of theory-building. So-called p lausibility probes entailed preliminary attempts to determine whether initial hypotheses should be considered sound enough to warrant more rigorous and extensive testing. Finally, and perhaps most notably, Eckstein then outlined the idea of crucial case studies , within which he also included the idea of ‘most-likely’ and ‘least-likely’ cases; the essential characteristic of crucial cases being their specific theory-testing function.

Whilst Eckstein’s was an early contribution to refining the case study approach, Yin’s (2009: 47-52) more recent delineation of possible single case designs similarly assigns them roles in the applying, testing, or building of theory, as well as in the study of unique cases[3]. As a subset of the latter, however, Jack Levy (2008) notes that the advantages of idiographic cases are actually twofold. Firstly, as inductive/descriptive cases – akin to Eckstein’s configurative-idiographic cases – whereby they are highly descriptive, lacking in an explicit theoretical framework and therefore taking the form of “total history”. Secondly, they can operate as theory-guided case studies, but ones that seek only to explain or interpret a single historical episode rather than generalise beyond the case. Not only does this therefore incorporate ‘single-outcome’ studies concerned with establishing causal inference (Gerring, 2006b), it also provides room for the more postmodern approaches within IR theory, such as discourse analysis, that may have developed a distinct methodology but do not seek traditional social scientific forms of explanation.

Applying specifically to the state of the field in contemporary IR, Bennett and Elman identify a ‘third generation’ of mainstream qualitative scholars – rooted in a pragmatic scientific realist epistemology and advocating a pluralistic approach to methodology – that have, over the last fifteen years, “revised or added to essentially every aspect of traditional case study research methods” (2010: 502). They identify ‘process tracing’ as having emerged from this as a central method of within-case analysis. As Bennett and Checkel observe, this carries the advantage of offering a methodologically rigorous “analysis of evidence on processes, sequences, and conjunctures of events within a case, for the purposes of either developing or testing hypotheses about causal mechanisms that might causally explain the case” (2012: 10).

Harnessing various methods, process tracing may entail the inductive use of evidence from within a case to develop explanatory hypotheses, and deductive examination of the observable implications of hypothesised causal mechanisms to test their explanatory capability[4]. It involves providing not only a coherent explanation of the key sequential steps in a hypothesised process, but also sensitivity to alternative explanations as well as potential biases in the available evidence (Bennett and Elman 2010: 503-504). John Owen (1994), for example, demonstrates the advantages of process tracing in analysing whether the causal factors underpinning democratic peace theory are – as liberalism suggests – not epiphenomenal, but variously normative, institutional, or some given combination of the two or other unexplained mechanism inherent to liberal states. Within-case process tracing has also been identified as advantageous in addressing the complexity of path-dependent explanations and critical junctures – as for example with the development of political regime types – and their constituent elements of causal possibility, contingency, closure, and constraint (Bennett and Elman, 2006b).

Bennett and Elman (2010: 505-506) also identify the advantages of single case studies that are implicitly comparative: deviant, most-likely, least-likely, and crucial cases. Of these, so-called deviant cases are those whose outcome does not fit with prior theoretical expectations or wider empirical patterns – again, the use of inductive process tracing has the advantage of potentially generating new hypotheses from these, either particular to that individual case or potentially generalisable to a broader population. A classic example here is that of post-independence India as an outlier to the standard modernisation theory of democratisation, which holds that higher levels of socio-economic development are typically required for the transition to, and consolidation of, democratic rule (Lipset, 1959; Diamond, 1992). Absent these factors, MacMillan’s single case study analysis (2008) suggests the particularistic importance of the British colonial heritage, the ideology and leadership of the Indian National Congress, and the size and heterogeneity of the federal state.

Most-likely cases, as per Eckstein above, are those in which a theory is to be considered likely to provide a good explanation if it is to have any application at all, whereas least-likely cases are ‘tough test’ ones in which the posited theory is unlikely to provide good explanation (Bennett and Elman, 2010: 505). Levy (2008) neatly refers to the inferential logic of the least-likely case as the ‘Sinatra inference’ – if a theory can make it here, it can make it anywhere. Conversely, if a theory cannot pass a most-likely case, it is seriously impugned. Single case analysis can therefore be valuable for the testing of theoretical propositions, provided that predictions are relatively precise and measurement error is low (Levy, 2008: 12-13). As Gerring rightly observes of this potential for falsification:

“a positivist orientation toward the work of social science militates toward a greater appreciation of the case study format, not a denigration of that format, as is usually supposed” (Gerring, 2007: 247, emphasis added).

In summary, the various forms of single case study analysis can – through the application of multiple qualitative and/or quantitative research methods – provide a nuanced, empirically-rich, holistic account of specific phenomena. This may be particularly appropriate for those phenomena that are simply less amenable to more superficial measures and tests (or indeed any substantive form of quantification) as well as those for which our reasons for understanding and/or explaining them are irreducibly subjective – as, for example, with many of the normative and ethical issues associated with the practice of international relations. From various epistemological and analytical standpoints, single case study analysis can incorporate both idiographic sui generis cases and, where the potential for generalisation may exist, nomothetic case studies suitable for the testing and building of causal hypotheses. Finally, it should not be ignored that a signal advantage of the case study – with particular relevance to international relations – also exists at a more practical rather than theoretical level. This is, as Eckstein noted, “that it is economical for all resources: money, manpower, time, effort… especially important, of course, if studies are inherently costly, as they are if units are complex collective individuals ” (1975: 149-150, emphasis added).

Limitations

Single case study analysis has, however, been subject to a number of criticisms, the most common of which concern the inter-related issues of methodological rigour, researcher subjectivity, and external validity. With regard to the first point, the prototypical view here is that of Zeev Maoz (2002: 164-165), who suggests that “the use of the case study absolves the author from any kind of methodological considerations. Case studies have become in many cases a synonym for freeform research where anything goes”. The absence of systematic procedures for case study research is something that Yin (2009: 14-15) sees as traditionally the greatest concern due to a relative absence of methodological guidelines. As the previous section suggests, this critique seems somewhat unfair; many contemporary case study practitioners – and representing various strands of IR theory – have increasingly sought to clarify and develop their methodological techniques and epistemological grounding (Bennett and Elman, 2010: 499-500).

A second issue, again also incorporating issues of construct validity, concerns that of the reliability and replicability of various forms of single case study analysis. This is usually tied to a broader critique of qualitative research methods as a whole. However, whereas the latter obviously tend toward an explicitly-acknowledged interpretive basis for meanings, reasons, and understandings:

“quantitative measures appear objective, but only so long as we don’t ask questions about where and how the data were produced… pure objectivity is not a meaningful concept if the goal is to measure intangibles [as] these concepts only exist because we can interpret them” (Berg and Lune, 2010: 340).

The question of researcher subjectivity is a valid one, and it may be intended only as a methodological critique of what are obviously less formalised and researcher-independent methods (Verschuren, 2003). Owen (1994) and Layne’s (1994) contradictory process tracing results of interdemocratic war-avoidance during the Anglo-American crisis of 1861 to 1863 – from liberal and realist standpoints respectively – are a useful example. However, it does also rest on certain assumptions that can raise deeper and potentially irreconcilable ontological and epistemological issues. There are, regardless, plenty such as Bent Flyvbjerg (2006: 237) who suggest that the case study contains no greater bias toward verification than other methods of inquiry, and that “on the contrary, experience indicates that the case study contains a greater bias toward falsification of preconceived notions than toward verification”.

The third and arguably most prominent critique of single case study analysis is the issue of external validity or generalisability. How is it that one case can reliably offer anything beyond the particular? “We always do better (or, in the extreme, no worse) with more observation as the basis of our generalization”, as King et al write; “in all social science research and all prediction, it is important that we be as explicit as possible about the degree of uncertainty that accompanies out prediction” (1994: 212). This is an unavoidably valid criticism. It may be that theories which pass a single crucial case study test, for example, require rare antecedent conditions and therefore actually have little explanatory range. These conditions may emerge more clearly, as Van Evera (1997: 51-54) notes, from large-N studies in which cases that lack them present themselves as outliers exhibiting a theory’s cause but without its predicted outcome. As with the case of Indian democratisation above, it would logically be preferable to conduct large-N analysis beforehand to identify that state’s non-representative nature in relation to the broader population.

There are, however, three important qualifiers to the argument about generalisation that deserve particular mention here. The first is that with regard to an idiographic single-outcome case study, as Eckstein notes, the criticism is “mitigated by the fact that its capability to do so [is] never claimed by its exponents; in fact it is often explicitly repudiated” (1975: 134). Criticism of generalisability is of little relevance when the intention is one of particularisation. A second qualifier relates to the difference between statistical and analytical generalisation; single case studies are clearly less appropriate for the former but arguably retain significant utility for the latter – the difference also between explanatory and exploratory, or theory-testing and theory-building, as discussed above. As Gerring puts it, “theory confirmation/disconfirmation is not the case study’s strong suit” (2004: 350). A third qualification relates to the issue of case selection. As Seawright and Gerring (2008) note, the generalisability of case studies can be increased by the strategic selection of cases. Representative or random samples may not be the most appropriate, given that they may not provide the richest insight (or indeed, that a random and unknown deviant case may appear). Instead, and properly used , atypical or extreme cases “often reveal more information because they activate more actors… and more basic mechanisms in the situation studied” (Flyvbjerg, 2006). Of course, this also points to the very serious limitation, as hinted at with the case of India above, that poor case selection may alternatively lead to overgeneralisation and/or grievous misunderstandings of the relationship between variables or processes (Bennett and Elman, 2006a: 460-463).

As Tim May (2011: 226) notes, “the goal for many proponents of case studies […] is to overcome dichotomies between generalizing and particularizing, quantitative and qualitative, deductive and inductive techniques”. Research aims should drive methodological choices, rather than narrow and dogmatic preconceived approaches. As demonstrated above, there are various advantages to both idiographic and nomothetic single case study analyses – notably the empirically-rich, context-specific, holistic accounts that they have to offer, and their contribution to theory-building and, to a lesser extent, that of theory-testing. Furthermore, while they do possess clear limitations, any research method involves necessary trade-offs; the inherent weaknesses of any one method, however, can potentially be offset by situating them within a broader, pluralistic mixed-method research strategy. Whether or not single case studies are used in this fashion, they clearly have a great deal to offer.

References 

Bennett, A. and Checkel, J. T. (2012) ‘Process Tracing: From Philosophical Roots to Best Practice’, Simons Papers in Security and Development, No. 21/2012, School for International Studies, Simon Fraser University: Vancouver.

Bennett, A. and Elman, C. (2006a) ‘Qualitative Research: Recent Developments in Case Study Methods’, Annual Review of Political Science , 9, 455-476.

Bennett, A. and Elman, C. (2006b) ‘Complex Causal Relations and Case Study Methods: The Example of Path Dependence’, Political Analysis , 14, 3, 250-267.

Bennett, A. and Elman, C. (2007) ‘Case Study Methods in the International Relations Subfield’, Comparative Political Studies , 40, 2, 170-195.

Bennett, A. and Elman, C. (2010) Case Study Methods. In C. Reus-Smit and D. Snidal (eds) The Oxford Handbook of International Relations . Oxford University Press: Oxford. Ch. 29.

Berg, B. and Lune, H. (2012) Qualitative Research Methods for the Social Sciences . Pearson: London.

Bryman, A. (2012) Social Research Methods . Oxford University Press: Oxford.

David, M. and Sutton, C. D. (2011) Social Research: An Introduction . SAGE Publications Ltd: London.

Diamond, J. (1992) ‘Economic development and democracy reconsidered’, American Behavioral Scientist , 35, 4/5, 450-499.

Eckstein, H. (1975) Case Study and Theory in Political Science. In R. Gomm, M. Hammersley, and P. Foster (eds) Case Study Method . SAGE Publications Ltd: London.

Flyvbjerg, B. (2006) ‘Five Misunderstandings About Case-Study Research’, Qualitative Inquiry , 12, 2, 219-245.

Geertz, C. (1973) The Interpretation of Cultures: Selected Essays by Clifford Geertz . Basic Books Inc: New York.

Gerring, J. (2004) ‘What is a Case Study and What Is It Good for?’, American Political Science Review , 98, 2, 341-354.

Gerring, J. (2006a) Case Study Research: Principles and Practices . Cambridge University Press: Cambridge.

Gerring, J. (2006b) ‘Single-Outcome Studies: A Methodological Primer’, International Sociology , 21, 5, 707-734.

Gerring, J. (2007) ‘Is There a (Viable) Crucial-Case Method?’, Comparative Political Studies , 40, 3, 231-253.

King, G., Keohane, R. O. and Verba, S. (1994) Designing Social Inquiry: Scientific Inference in Qualitative Research . Princeton University Press: Chichester.

Layne, C. (1994) ‘Kant or Cant: The Myth of the Democratic Peace’, International Security , 19, 2, 5-49.

Levy, J. S. (2008) ‘Case Studies: Types, Designs, and Logics of Inference’, Conflict Management and Peace Science , 25, 1-18.

Lipset, S. M. (1959) ‘Some Social Requisites of Democracy: Economic Development and Political Legitimacy’, The American Political Science Review , 53, 1, 69-105.

Lyotard, J-F. (1984) The Postmodern Condition: A Report on Knowledge . University of Minnesota Press: Minneapolis.

MacMillan, A. (2008) ‘Deviant Democratization in India’, Democratization , 15, 4, 733-749.

Maoz, Z. (2002) Case study methodology in international studies: from storytelling to hypothesis testing. In F. P. Harvey and M. Brecher (eds) Evaluating Methodology in International Studies . University of Michigan Press: Ann Arbor.

May, T. (2011) Social Research: Issues, Methods and Process . Open University Press: Maidenhead.

Owen, J. M. (1994) ‘How Liberalism Produces Democratic Peace’, International Security , 19, 2, 87-125.

Seawright, J. and Gerring, J. (2008) ‘Case Selection Techniques in Case Study Research: A Menu of Qualitative and Quantitative Options’, Political Research Quarterly , 61, 2, 294-308.

Stake, R. E. (2008) Qualitative Case Studies. In N. K. Denzin and Y. S. Lincoln (eds) Strategies of Qualitative Inquiry . Sage Publications: Los Angeles. Ch. 17.

Van Evera, S. (1997) Guide to Methods for Students of Political Science . Cornell University Press: Ithaca.

Verschuren, P. J. M. (2003) ‘Case study as a research strategy: some ambiguities and opportunities’, International Journal of Social Research Methodology , 6, 2, 121-139.

Yin, R. K. (2009) Case Study Research: Design and Methods . SAGE Publications Ltd: London.

[1] The paper follows convention by differentiating between ‘International Relations’ as the academic discipline and ‘international relations’ as the subject of study.

[2] There is some similarity here with Stake’s (2008: 445-447) notion of intrinsic cases, those undertaken for a better understanding of the particular case, and instrumental ones that provide insight for the purposes of a wider external interest.

[3] These may be unique in the idiographic sense, or in nomothetic terms as an exception to the generalising suppositions of either probabilistic or deterministic theories (as per deviant cases, below).

[4] Although there are “philosophical hurdles to mount”, according to Bennett and Checkel, there exists no a priori reason as to why process tracing (as typically grounded in scientific realism) is fundamentally incompatible with various strands of positivism or interpretivism (2012: 18-19). By extension, it can therefore be incorporated by a range of contemporary mainstream IR theories.

— Written by: Ben Willis Written at: University of Plymouth Written for: David Brockington Date written: January 2013

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• Imperialism’s Legacy in the Study of Contemporary Politics: The Case of Hegemonic Stability Theory
• Recreating a Nation’s Identity Through Symbolism: A Chinese Case Study
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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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Qualitative Research Methods

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

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

Research question

• Conceptual framework
• Conceptual vs. theoretical framework

Data collection

• Qualitative research methods
• Focus groups
• Observational research

What is a case study?

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

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

Case studies

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

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

Definition of a case study

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

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

Characteristics of case studies

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

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

The role of case studies in research

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

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

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

What is the purpose of a case study?

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

Why use case studies in qualitative research?

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

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

The explanatory, exploratory, and descriptive roles of case studies

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

The impact of case studies on knowledge development

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

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

Types of case studies

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

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

Exploratory case studies

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

Descriptive case studies

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

Explanatory case studies

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

Intrinsic, instrumental, and collective case studies

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

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

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

Critical information systems research

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

Health research

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

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

Asthma research studies

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

Other fields

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

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

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

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

Propositions

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

Units of analysis

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

Argumentation

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

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

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

Defining the research question

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

Selecting and defining the case

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

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

Developing a detailed case study protocol

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

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

Collecting data

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

Analyzing and interpreting data

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

Writing the case study report

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

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

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

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

Observations

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

Documents and artifacts

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

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

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

Ensuring the quality of data collection

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

Data analysis

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

Organizing the data

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

Categorizing and coding the data

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

Identifying patterns and themes

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

Interpreting the data

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

Verification of the data

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

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

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

Benefits include the following:

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

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

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

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

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• Corpus ID: 55288756

Criticisms, Constraints and Constructions of Case Study Research Strategy

• O. E. Idowu
• Published 15 October 2016
• Asian Journal of Business and management

9 Citations

Evaluating case study and action research reports: real-world research in cybersecurity, experiences of educational researchers in the use of the case study design during the covid-19 pandemic: lessons from a south african rural setting, a city in crisis: communication network, ethics, and power in the city of dallas, contradictory stereotypical depictions of japan's relationship with technology in the british press, the use of new media applications in corporate social responsibility, lost in translation tanzanian students’ views on sustainability and language, and the implications for the pledge to leave no one behind, what characteristics account for who participates in adult basic education at vancouver island university a case study of policy and practice, on material selection and its consequences in product development, the role of primary school principals in teacher professional development in ekurhuleni south district, 13 references, case study methodology in business research, a case for the case study, building theories from case study research, the case-study method in psychology and related disciplines, what is a case study.

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• Writing well

How to write a critique

• Starting well
• How to write an annotated bibliography
• How to write a case study response
• How to write an empirical article
• How to write an essay
• How to write a literature review
• How to write a reflective task
• How to write a report
• Finishing well

Before you start writing, it is important to have a thorough understanding of the work that will be critiqued.

• Study the work under discussion.
• Make notes on key parts of the work.
• Develop an understanding of the main argument or purpose being expressed in the work.
• Consider how the work relates to a broader issue or context.

Example template

There are a variety of ways to structure a critique. You should always check your unit materials or Canvas site for guidance from your lecturer. The following template, which showcases the main features of a critique, is provided as one example.

Introduction

Typically, the introduction is short (less than 10% of the word length) and you should:

• name the work being reviewed as well as the date it was created and the name of the author/creator
• describe the main argument or purpose of the work
• explain the context in which the work was created - this could include the social or political context, the place of the work in a creative or academic tradition, or the relationship between the work and the creator’s life experience
• have a concluding sentence that signposts what your evaluation of the work will be - for instance, it may indicate whether it is a positive, negative, or mixed evaluation.

Briefly summarise the main points and objectively describe how the creator portrays these by using techniques, styles, media, characters or symbols. This summary should not be the focus of the critique and is usually shorter than the critical evaluation.

Critical evaluation

This section should give a systematic and detailed assessment of the different elements of the work, evaluating how well the creator was able to achieve the purpose through these. For example: you would assess the plot structure, characterisation and setting of a novel; an assessment of a painting would look at composition, brush strokes, colour and light; a critique of a research project would look at subject selection, design of the experiment, analysis of data and conclusions.

A critical evaluation does not simply highlight negative impressions. It should deconstruct the work and identify both strengths and weaknesses. It should examine the work and evaluate its success, in light of its purpose.

Examples of key critical questions that could help your assessment include:

• Who is the creator? Is the work presented objectively or subjectively?
• What are the aims of the work? Were the aims achieved?
• What techniques, styles, media were used in the work? Are they effective in portraying the purpose?
• What assumptions underlie the work? Do they affect its validity?
• What types of evidence or persuasion are used? Has evidence been interpreted fairly?
• How is the work structured? Does it favour a particular interpretation or point of view? Is it effective?
• Does the work enhance understanding of key ideas or theories? Does the work engage (or fail to engage) with key concepts or other works in its discipline?

This evaluation is written in formal academic style and logically presented. Group and order your ideas into paragraphs. Start with the broad impressions first and then move into the details of the technical elements. For shorter critiques, you may discuss the strengths of the works, and then the weaknesses. In longer critiques, you may wish to discuss the positive and negative of each key critical question in individual paragraphs.

To support the evaluation, provide evidence from the work itself, such as a quote or example, and you should also cite evidence from related sources. Explain how this evidence supports your evaluation of the work.

This is usually a very brief paragraph, which includes:

• a statement indicating the overall evaluation of the work
• a summary of the key reasons, identified during the critical evaluation, why this evaluation was formed
• in some circumstances, recommendations for improvement on the work may be appropriate.

Reference list

Include all resources cited in your critique. Check with your lecturer/tutor for which referencing style to use.

• Mentioned the name of the work, the date of its creation and the name of the creator?
• Accurately summarised the work being critiqued?
• Mainly focused on the critical evaluation of the work?
• Systematically outlined an evaluation of each element of the work to achieve the overall purpose?
• Used evidence, from the work itself as well as other sources, to back and illustrate my assessment of elements of the work?
• Formed an overall evaluation of the work, based on critical reading?
• Used a well structured introduction, body and conclusion?
• Used correct grammar, spelling and punctuation; clear presentation; and appropriate referencing style?

Further information

• University of New South Wales: Writing a Critical Review
• University of Toronto: The Book Review or Article Critique

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What Is a Case Study? How to Write, Examples, and Template

In this post

How to write a case study

Case study template, case study examples, types of case studies, what are the benefits of case studies , what are the limitations of case studies , case study vs. testimonial.

In today's marketplace, conveying your product's value through a compelling narrative is crucial to genuinely connecting with your customers.

Your business can use marketing analytics tools to understand what customers want to know about your product. Once you have this information, the next step is to showcase your product and its benefits to your target audience. This strategy involves a mix of data, analysis, and storytelling. Combining these elements allows you to create a narrative that engages your audience. So, how can you do this effectively?

What is a case study? 

A case study is a powerful tool for showcasing a business's success in helping clients achieve their goals. It's a form of storytelling that details real-world scenarios where a business implemented its solutions to deliver positive results for a client.

In this article, we explore the concept of a case study , including its writing process, benefits, various types, challenges, and more.

Understanding how to write a case study is an invaluable skill. You'll need to embrace decision-making – from deciding which customers to feature to designing the best format to make them as engaging as possible.  This can feel overwhelming in a hurry, so let's break it down.

Step 1: Reach out to the target persona

If you've been in business for a while, you have no shortage of happy customers. But w ith limited time and resources, you can't choose everyone.  So, take some time beforehand to flesh out your target buyer personas. 

Once you know precisely who you're targeting, go through your stable of happy customers to find a buyer representative of the audience you're trying to reach. The closer their problems, goals, and industries align, the more your case study will resonate.

What if you have more than one buyer persona? No problem. This is a common situation for companies because buyers comprise an entire committee. You might be marketing to procurement experts, executives, engineers, etc. Try to develop a case study tailored to each key persona. This might be a long-term goal, and that's fine. The better you can personalize the experience for each stakeholder, the easier it is to keep their attention.  

Here are a few considerations to think about before research:

• Products/services of yours the customer uses (and how familiar they are with them)
• The customer's brand recognition in the industry
• Whether the results they've achieved are specific and remarkable
• Whether they've switched from a competitor's product/service
• How closely aligned they are with your target audience

These items are just a jumping-off point as you develop your criteria.  Once you have a list, run each customer through it to determine your top targets. Approach the ones on the top (your "dream" case study subjects) and work your way down as needed.

Who to interview

You should consider interviewing top-level managers or executives because those are high-profile positions. But consider how close they are to your product and its results.

Focusing on an office manager or engineer who uses your product daily would be better. Look for someone with a courtside view of the effects.

The ways to request customer participation in case studies can vary, but certain principles can improve your chances:

• Make it easy for customers to work with you, respecting their valuable time. Be well-prepared and minimize their involvement.
• Emphasize how customers will benefit through increased publicity, revenue opportunities, or recognition for their success. 
• Acknowledge their contributions and showcase their achievements.
• Standardizing the request process with a script incorporating these principles can help your team consistently secure case study approvals and track performance.

Step 2: Prepare for the interview

Case study interviews are like school exams. The more prepared you are for them, the better they turn out. Preparing thoroughly also shows participants that you value their time. You don't waste precious minutes rehashing things you should have already known. You focus on getting the information you need as efficiently as possible.

You can conduct your case study interview in multiple formats, from exchanging emails to in-person interviews. This isn't a trivial decision.  As you'll see in the chart below, each format has its unique advantages and disadvantages. 

You'll also have to consider who will ask and answer the questions during your case study interview. It's wise to consider this while considering the case study format.  The number of participants factors into which format will work best. Pulling off an in-person interview becomes much harder if you're trying to juggle four or five people's busy schedules. Try a video conference instead.

Before interviewing your case study participant, it is crucial to identify the specific questions that need to be asked.  It's essential to thoroughly evaluate your collaboration with the client and understand how your product's contributions impact the company. 

Remember that structuring your case study is akin to crafting a compelling narrative. To achieve this, follow a structured approach:

• Beginning of your story. Delve into the customer's challenge that ultimately led them to do business with you. What were their problems like? What drove them to make a decision finally? Why did they choose you?
• The middle of the case study.  Your audience also wants to know about the experience of working with you. Your customer has taken action to address their problems. What happened once you got on board?
• An ending that makes you the hero.  Describe the specific results your company produced for the customer. How has the customer's business (and life) changed once they implemented your solution?

Sample questions for the case study interview

If you're preparing for a case study interview, here are some sample case study research questions to help you get started:

• What challenges led you to seek a solution?
• When did you realize the need for immediate action? Was there a tipping point?
• How did you decide on the criteria for choosing a B2B solution, and who was involved?
• What set our product or service apart from others you considered?
• How was your experience working with us post-purchase?
• Were there any pleasant surprises or exceeded expectations during our collaboration?
• How smoothly did your team integrate our solution into their workflows?
• How long before you started seeing positive results?
• How have you benefited from our products or services?
• How do you measure the value our product or service provides?

Step 3: Conduct the interview

Preparing for case study interviews can be different from everyday conversations. Here are some tips to keep in mind:

• Create a comfortable atmosphere.  Before diving into the discussion, talk about their business and personal interests. Ensure everyone is at ease, and address any questions or concerns.
• Prioritize key questions.  Lead with your most crucial questions to respect your customer's time. Interview lengths can vary, so starting with the essentials ensures you get the vital information.
• Be flexible.  Case study interviews don't have to be rigid. If your interviewee goes "off script," embrace it. Their spontaneous responses often provide valuable insights.
• Record the interview.  If not conducted via email, ask for permission to record the interview. This lets you focus on the conversation and capture valuable quotes without distractions.

Step 4: Figure out who will create the case study

When creating written case studies for your business, deciding who should handle the writing depends on cost, perspective, and revisions.

Outsourcing might be pricier, but it ensures a professionally crafted outcome. On the other hand, in-house writing has its considerations, including understanding your customers and products. 

Technical expertise and equipment are needed for video case studies, which often leads companies to consider outsourcing due to production and editing costs. 

Tip: When outsourcing work, it's essential to clearly understand pricing details to avoid surprises and unexpected charges during payment.

Step 5: Utilize storytelling

Understanding and applying storytelling elements can make your case studies unforgettable, offering a competitive edge. 

Source: The Framework Bank

Every great study follows a narrative arc (also called a "story arc"). This arc represents how a character faces challenges, struggles against raising stakes, and encounters a formidable obstacle before the tension resolves.

In a case study narrative, consider:

• Exposition. Provide background information about the company, revealing their "old life" before becoming your customer.
• Inciting incident. Highlight the problem that drove the customer to seek a solution, creating a sense of urgency.
• Obstacles (rising action). Describe the customer's journey in researching and evaluating solutions, building tension as they explore options.
• Midpoint. Explain what made the business choose your product or service and what set you apart.
• Climax. Showcase the success achieved with your product.
• Denouement. Describe the customer's transformed business and end with a call-to-action for the reader to take the next step.

Step 6: Design the case study

The adage "Don't judge a book by its cover" is familiar, but people tend to do just that quite often!

A poor layout can deter readers even if you have an outstanding case study. To create an engaging case study, follow these steps:

• Craft a compelling title. Just like you wouldn't read a newspaper article without an eye-catching headline, the same goes for case studies. Start with a title that grabs attention.
• Organize your content. Break down your content into different sections, such as challenges, results, etc. Each section can also include subsections. This case study approach divides the content into manageable portions, preventing readers from feeling overwhelmed by lengthy blocks of text.
• Conciseness is key. Keep your case study as concise as possible. The most compelling case studies are precisely long enough to introduce the customer's challenge, experience with your solution, and outstanding results. Prioritize clarity and omit any sections that may detract from the main storyline.
• Utilize visual elements. To break up text and maintain reader interest, incorporate visual elements like callout boxes, bulleted lists, and sidebars.
• Include charts and images. Summarize results and simplify complex topics by including pictures and charts. Visual aids enhance the overall appeal of your case study.
• Embrace white space. Avoid overwhelming walls of text to prevent reader fatigue. Opt for plenty of white space, use shorter paragraphs, and employ subsections to ensure easy readability and navigation.
• Enhance video case studies. In video case studies, elements like music, fonts, and color grading are pivotal in setting the right tone. Choose music that complements your message and use it strategically throughout your story. Carefully select fonts to convey the desired style, and consider how lighting and color grading can influence the mood. These elements collectively help create the desired tone for your video case study.

Step 7: Edits and revisions

Once you've finished the interview and created your case study, the hardest part is over. Now's the time for editing and revision. This might feel frustrating for impatient B2B marketers, but it can turn good stories into great ones.

Ideally, you'll want to submit your case study through two different rounds of editing and revisions:

• Internal review. Seek feedback from various team members to ensure your case study is captivating and error-free. Gather perspectives from marketing, sales, and those in close contact with customers for well-rounded insights. Use patterns from this feedback to guide revisions and apply lessons to future case studies.
• Customer feedback. Share the case study with customers to make them feel valued and ensure accuracy. Let them review quotes and data points, as they are the "heroes" of the story, and their logos will be prominently featured. This step maintains positive customer relationships.

Case study mistakes to avoid

• Ensure easy access to case studies on your website.
• Spotlight the customer, not just your business.
• Tailor each case study to a specific audience.
• Avoid excessive industry jargon in your content.

Step 8: Publishing

Take a moment to proofread your case study one more time carefully. Even if you're reasonably confident you've caught all the errors, it's always a good idea to check. Your case study will be a valuable marketing tool for years, so it's worth the investment to ensure it's flawless. Once done, your case study is all set to go!

Consider sharing a copy of the completed case study with your customer as a thoughtful gesture. They'll likely appreciate it; some may want to keep it for their records. After all, your case study wouldn't have been possible without their help, and they deserve to see the final product.

Where you publish your case study depends on its role in your overall marketing strategy. If you want to reach as many people as possible with your case study, consider publishing it on your website and social media platforms. 

Tip: Some companies prefer to keep their case studies exclusive, making them available only to those who request them. This approach is often taken to control access to valuable information and to engage more deeply with potential customers who express specific interests. It can create a sense of exclusivity and encourage interested parties to engage directly with the company.

Step 9: Case study distribution

When sharing individual case studies, concentrate on reaching the audience with the most influence on purchasing decisions

Here are some common distribution channels to consider:

• Sales teams. Share case studies to enhance customer interactions, retention , and upselling among your sales and customer success teams. Keep them updated on new studies and offer easily accessible formats like PDFs or landing page links.
• Company website. Feature case studies on your website to establish authority and provide valuable information to potential buyers. Organize them by categories such as location, size, industry, challenges, and products or services used for effective presentation.
• Events. Use live events like conferences and webinars to distribute printed case study copies, showcase video case studies at trade show booths, and conclude webinars with links to your case study library. This creative approach blends personal interactions with compelling content.
• Industry journalists. Engage relevant industry journalists to gain media coverage by identifying suitable publications and journalists covering related topics. Building relationships is vital, and platforms like HARO (Help A Reporter Out) can facilitate connections, especially if your competitors have received coverage before.

Want to learn more about Marketing Analytics Software? Explore Marketing Analytics products.

It can seem daunting to transform the information you've gathered into a cohesive narrative.  We’ve created a versatile case study template that can serve as a solid starting point for your case study.

With this template, your business can explore any solutions offered to satisfied customers, covering their background, the factors that led them to choose your services, and their outcomes.

The template boasts a straightforward design, featuring distinct sections that guide you in effectively narrating your and your customer's story. However, remember that limitless ways to showcase your business's accomplishments exist.

To assist you in this process, here's a breakdown of the recommended sections to include in a case study:

• Title.  Keep it concise. Create a brief yet engaging project title summarizing your work with your subject. Consider your title like a newspaper headline; do it well, and readers will want to learn more. 
• Subtitle . Use this section to elaborate on the achievement briefly. Make it creative and catchy to engage your audience.
• Executive summary.  Use this as an overview of the story, followed by 2-3 bullet points highlighting key success metrics.
• Challenges and objectives. This section describes the customer's challenges before adopting your product or service, along with the goals or objectives they sought to achieve.
• How product/service helped.  A paragraph explaining how your product or service addressed their problem.
• Testimonials.  Incorporate short quotes or statements from the individuals involved in the case study, sharing their perspectives and experiences.
• Supporting visuals.  Include one or two impactful visuals, such as graphs, infographics, or highlighted metrics, that reinforce the narrative.
• Call to action (CTA).  If you do your job well, your audience will read (or watch) your case studies from beginning to end. They are interested in everything you've said. Now, what's the next step they should take to continue their relationship with you? Give people a simple action they can complete. 

Case studies are proven marketing strategies in a wide variety of B2B industries. Here are just a few examples of a case study:

• Amazon Web Services, Inc.  provides companies with cloud computing platforms and APIs on a metered, pay-as-you-go basis. This case study example illustrates the benefits Thomson Reuters experienced using AWS.
• LinkedIn Marketing Solutions combines captivating visuals with measurable results in the case study created for BlackRock. This case study illustrates how LinkedIn has contributed to the growth of BlackRock's brand awareness over the years. 
• Salesforce , a sales and marketing automation SaaS solutions provider, seamlessly integrates written and visual elements to convey its success stories with Pepe Jeans. This case study effectively demonstrates how Pepe Jeans is captivating online shoppers with immersive and context-driven e-commerce experiences through Salesforce.
• HubSpot offers a combination of sales and marketing tools. Their case study demonstrates the effectiveness of its all-in-one solutions. These typically focus on a particular client's journey and how HubSpot helped them achieve significant results.

There are two different types of case studies that businesses might utilize:

Written case studies 

Written case studies offer readers a clear visual representation of data, which helps them quickly identify and focus on the information that matters most. 

Printed versions of case studies find their place at events like trade shows, where they serve as valuable sales collateral to engage prospective clients.  Even in the digital age, many businesses provide case studies in PDF format or as web-based landing pages, improving accessibility for their audience. 

Note: Landing pages , in particular, offer the flexibility to incorporate rich multimedia content, including images, charts, and videos. This flexibility in design makes landing pages an attractive choice for presenting detailed content to the audience.

Written case study advantages

Here are several significant advantages to leveraging case studies for your company:

• Hyperlink accessibility.  Whether in PDF or landing page format, written case studies allow for embedded hyperlinks, offering prospects easy access to additional information and contact forms.
• Flexible engagement.  Unlike video case studies, which may demand in-person arrangements, written case studies can be conducted via phone or video streaming, reducing customer commitment and simplifying scheduling.
• Efficient scanning . Well-structured written case studies with a scannable format cater to time-strapped professionals. Charts and callout boxes with key statistics enhance the ease of information retrieval.
• Printable for offline use.  Written case studies can be effortlessly printed and distributed at trade shows, sales meetings, and live events. This tangible format accommodates those who prefer physical materials and provides versatility in outreach, unlike video content, which is less portable.

Written case study disadvantages

Here are some drawbacks associated with the use of case studies:

• Reduced emotional impact.  Written content lacks the emotional punch of live video testimonials, which engage more senses and emotions, making a stronger connection.
• Consider time investment.  Creating a compelling case study involves editing, proofreading, and design collaboration, with multiple revisions commonly required before publication.
• Challenges in maintaining attention.  Attention spans are short in today's ad-saturated world. Using graphics, infographics, and videos more often is more powerful to incite the right emotions in customers.

Video case studies

Video case studies are the latest marketing trend. Unlike in the past, when video production was costly, today's tools make it more accessible for users to create and edit their videos. However, specific technical requirements still apply.

Like written case studies, video case studies delve into a specific customer's challenges and how your business provides solutions. Yet, the video offers a more profound connection by showcasing the person who faced and conquered the problem.

Video case studies can boost brand exposure when shared on platforms like YouTube. For example, Slack's engaging case study video with Sandwich Video illustrates how Slack transformed its workflow and adds humor, which can be challenging in written case studies focused on factual evidence.

Source : YouTube

This video case study has garnered nearly a million views on YouTube.

Video case study advantages

Here are some of the top advantages of video case studies. While video testimonials take more time, the payoff can be worth it. 

• Humanization and authenticity.  Video case studies connect viewers with real people, adding authenticity and fostering a stronger emotional connection.
• Engaging multiple senses.  They engage both auditory and visual senses, enhancing credibility and emotional impact. Charts, statistics, and images can also be incorporated.
• Broad distribution.  Videos can be shared on websites, YouTube, social media, and more, reaching diverse audiences and boosting engagement, especially on social platforms.

Video case study disadvantages

Before fully committing to video testimonials, consider the following:

• Technical expertise and equipment.  Video production requires technical know-how and equipment, which can be costly. Skilled video editing is essential to maintain a professional image. While technology advances, producing amateurish videos may harm your brand's perception.
• Viewer convenience.  Some prospects prefer written formats due to faster reading and ease of navigation. Video typically requires sound, which can be inconvenient for viewers in specific settings. Many people may not have headphones readily available to watch your content.
• Demand on case study participants.  On-camera interviews can be time-consuming and location-dependent, making scheduling challenging for case study participants. Additionally, being on screen for a global audience may create insecurities and performance pressure.
• Comfort on camera.  Not everyone feels at ease on camera. Nervousness or a different on-screen persona can impact the effectiveness of the testimonial, and discovering this late in the process can be problematic.

Written or video case studies: Which is right for you?

Now that you know the pros and cons of each, how do you choose which is right for you?

One of the most significant factors in doing video case studies can be the technical expertise and equipment required for a high level of production quality. Whether you have the budget to do this in-house or hire a production company can be one of the major deciding factors.

Still, written or video doesn't have to be an either-or decision. Some B2B companies are using both formats. They can complement each other nicely, minimizing the downsides mentioned above and reaching your potential customers where they prefer.

Let's say you're selling IT network security. What you offer is invaluable but complicated. You could create a short (three- or four-minute) video case study to get attention and touch on the significant benefits of your services. This whets the viewer's appetite for more information, which they could find in a written case study that supplements the video.

Should you decide to test the water in video case studies, test their effectiveness among your target audience. See how well they work for your company and sales team. And, just like a written case study, you can always find ways to improve your process as you continue exploring video case studies.

Case studies offer several distinctive advantages, making them an ideal tool for businesses to market their products to customers. However, their benefits extend beyond these qualities. 

Here's an overview of all the advantages of case studies:

Valuable sales support

Case studies serve as a valuable resource for your sales endeavors. Buyers frequently require additional information before finalizing a purchase decision. These studies provide concrete evidence of your product or service's effectiveness, assisting your sales representatives in closing deals more efficiently, especially with customers with lingering uncertainties.

Validating your value

Case studies serve as evidence of your product or service's worth or value proposition , playing a role in building trust with potential customers. By showcasing successful partnerships, you make it easier for prospects to place trust in your offerings. This effect is particularly notable when the featured customer holds a reputable status.

Unique and engaging content

By working closely with your customer success teams, you can uncover various customer stories that resonate with different prospects. Case studies allow marketers to shape product features and benefits into compelling narratives. 

Each case study's distinctiveness, mirroring the uniqueness of every customer's journey, makes them a valuable source of relatable and engaging content. Storytelling possesses the unique ability to connect with audiences on an emotional level, a dimension that statistics alone often cannot achieve. 

Spotlighting valuable customers

Case studies provide a valuable platform for showcasing your esteemed customers. Featuring them in these studies offers a chance to give them visibility and express your gratitude for the partnership, which can enhance customer loyalty . Depending on the company you are writing about, it can also demonstrate the caliber of your business.

Now is the time to get SaaS-y news and entertainment with our 5-minute newsletter,   G2 Tea , featuring inspiring leaders, hot takes, and bold predictions. Subscribe below!

It's important to consider limitations when designing and interpreting the results of case studies. Here's an overview of the limitations of case studies:

Challenges in replication

Case studies often focus on specific individuals, organizations, or situations, making generalizing their findings to broader populations or contexts challenging. 

Time-intensive process

Case studies require a significant time investment. The extensive data collection process and the need for comprehensive analysis can be demanding, especially for researchers who are new to this method.

Potential for errors

Case studies can be influenced by memory and judgment, potentially leading to inaccuracies. Depending on human memory to reconstruct a case's history may result in variations and potential inconsistencies in how individuals recall past events. Additionally, bias may emerge, as individuals tend to prioritize what they consider most significant, which could limit their consideration of alternative perspectives.

Challenges in verification

Confirming results through additional research can present difficulties. This complexity arises from the need for detailed and extensive data in the initial creation of a case study. Consequently, this process requires significant effort and a substantial amount of time.

While looking at case studies, you may have noticed a quote. This type of quote is considered a testimonial, a key element of case studies.

If a customer's quote proves that your brand does what it says it will or performs as expected, you may wonder: 'Aren't customer testimonials and case studies the same thing?' Not exactly.

Testimonials are brief endorsements designed to establish trust on a broad scale. In contrast, case studies are detailed narratives that offer a comprehensive understanding of how a product or service addresses a specific problem, targeting a more focused audience. 

Crafting case studies requires more resources and a structured approach than testimonials. Your selection between the two depends on your marketing objectives and the complexity of your product or service.

Case in point!

Case studies are among a company's most effective tools. You're  well on your way to mastering them.

Today's buyers are tackling much of the case study research methodology independently. Many are understandably skeptical before making a buying decision. By connecting them with multiple case studies, you can prove you've gotten the results you say you can. There's hardly a better way to boost your credibility and persuade them to consider your solution.

Case study formats and distribution methods might change as technology evolves. However, the fundamentals that make them effective—knowing how to choose subjects, conduct interviews, and structure everything to get attention—will serve you for as long as you're in business. 

We covered a ton of concepts and resources, so go ahead and bookmark this page. You can refer to it whenever you have questions or need a refresher.

Dive into market research to uncover customer preferences and spending habits.

Kristen McCabe

Kristen’s is a former senior content marketing specialist at G2. Her global marketing experience extends from Australia to Chicago, with expertise in B2B and B2C industries. Specializing in content, conversions, and events, Kristen spends her time outside of work time acting, learning nature photography, and joining in the #instadog fun with her Pug/Jack Russell, Bella. (she/her/hers)

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HBR’s Most-Read Articles of 2024 (So Far)

by Kelsey Hansen

Summary .   

HBR’s top five most popular articles of 2024 (so far), present an opportunity to reflect on the work you’ve done in the preceding months, and chart any necessary course changes. The list includes a case study of how Starbucks lost its way (and how it could pivot); a guide to how to shift your leadership style based on situation; and a playbook for assessing the quality of the questions you ask at work.

The waning days of summer present a prime opportunity to step back and reflect on the paths you’ve taken so far this year, whether they’re personal or professional, and ask yourself: Am I growing in the right direction? What are my blind spots? Where could I be doing better?

Partner Center

• Introduction
• Conclusions
• Article Information

AD indicates atopic dermatitis; OCS, oral corticosteroid.

a Rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, psoriasis, Crohn disease, ulcerative colitis, Sjögren syndrome, systemic sclerosis, dermatomyositis, polymyositis, thromboangiitis obliterans, Behçet disease, sarcoidosis, pemphigus, and vitiligo.

b Patients who received a diagnosis of the outcomes of interest (osteoporosis, fracture, type 2 diabetes, hyperlipidemia, hypertension, myocardial infarction, stroke, heart failure, avascular necrosis, cataract, or glaucoma) during 1 year before or 1 year after the cohort entry date were excluded.

OR indicates odds ratio.

a Modified definition of the exposure from cumulative duration of more than 30 days per year and more than 90 days per year to a cumulative duration of more than 60 days per year.

b The long-term use of oral corticosteroids was defined as a cumulative supply of more than 30 days or more than 90 days with a greater than 5-mg daily prednisolone-equivalent dose of oral corticosteroids, which places patients at risk of systemic adverse effects, and we assessed the long-term use of oral corticosteroids annually. To exclude potential use of oral corticosteroids for conditions other than atopic dermatitis, we restricted exposure to prescriptions for patients with a diagnosis of atopic dermatitis.

c Restricted to patients who could be followed up for at least 3 years from the cohort entry date.

d Restricted to patients who could be followed up for at least 5 years from the cohort entry date.

eTable 1. Demographic and Clinical Characteristics of Cases and Controls of Adult Patients (>18 Years) With Atopic Dermatitis for Composite Outcome

eTable 2. Codes Used to Define Exclusion Criteria, Exposures, Outcomes, and Covariates

eTable 3. Exposure Definition Regarding to Long-Term Oral Corticosteroid Usage in the Previous Studies

eTable 4. Demographic and Clinical Characteristics of Cases and Controls of Adult Patients (>18 Years) With Atopic Dermatitis, Comparison Between Ever Long-Term Use of OCS Over 30 Days vs 90 Days

eTable 5. Demographic and Clinical Characteristics of Cases and Controls of Adult Patients (>18 Years) With Atopic Dermatitis: Osteoporosis

eTable 6. Demographic and Clinical Characteristics of Cases and Controls of Adult Patients (>18 Years) With Atopic Dermatitis: Fracture

eTable 7. Demographic and Clinical Characteristics of Cases and Controls of Adult Patients (>18 Years) With Atopic Dermatitis: Type 2 Diabetes Mellitus

eTable 8. Demographic and Clinical Characteristics of Cases and Controls of Adult Patients (>18 Years) With Atopic Dermatitis: Hyperlipidemia

eTable 9. Demographic and Clinical Characteristics of Cases and Controls of Adult Patients (>18 Years) With Atopic Dermatitis: Hypertension

eTable 10. Demographic and Clinical Characteristics of Cases and Controls of Adult Patients (>18 Years) With Atopic Dermatitis: Myocardial Infarction

eTable 11. Demographic and Clinical Characteristics of Cases and Controls of Adult Patients (>18 Years) With Atopic Dermatitis: Stroke

eTable 12. Demographic and Clinical Characteristics of Cases and Controls of Adult Patients (>18 Years) With Atopic Dermatitis: Heart Failure

eTable 13. Demographic and Clinical Characteristics of Cases and Controls of Adult Patients (>18 Years) With Atopic Dermatitis: Avascular Necrosis

eTable 14. Demographic and Clinical Characteristics of Cases and Controls of Adult Patients (>18 Years) With Atopic Dermatitis: Cataract

eTable 15. Demographic and Clinical Characteristics of Cases and Controls of Adult Patients (>18 Years) With Atopic Dermatitis: Glaucoma

eTable 16. E-Values for Point Estimates of Different Outcomes of Interest for Primary Exposure: >30 Days a Year

eTable 17. E-Values for Point Estimates of Different Outcomes of Interest for Primary Exposure: >90 Days a Year

eFigure 1. Overall Design of This Nested-Case Control Study

eFigure 2. Case-Control Matching Using Risk-Set Sampling Method

eFigure 3 . Explanation for the Exposure Status According to 1) Ever Long-Term OCS, 2) Cumulative No. of Years of Long-Term OCS, 3) Consecutive No. of Years of Long-Term OCS for the Primary (>30 Days) and Secondary (>90 Days) Exposure Definition

eFigure 4. Subgroup Analysis According to the Age Stratification for Evaluating the Risk of Composite Adverse Outcomes Associated With Long-Term Use of OCS

eFigure 5. Subgroup Analysis According to the Sex Stratification for Evaluating the Risk of Composite Adverse Outcomes Associated With Long-Term Use of OCS

eFigure 6. Subgroup Analysis According to the Severity of AD Stratification for Evaluating the Risk of Composite Adverse Outcomes Associated With Long-Term Use of OCS

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Jang YH , Choi E , Lee H, et al. Long-Term Use of Oral Corticosteroids and Safety Outcomes for Patients With Atopic Dermatitis. JAMA Netw Open. 2024;7(7):e2423563. doi:10.1001/jamanetworkopen.2024.23563

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Long-Term Use of Oral Corticosteroids and Safety Outcomes for Patients With Atopic Dermatitis

• 1 Department of Dermatology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
• 2 School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
• 3 Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea
• 4 Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom
• 5 School of Pharmacy, Aston University, Birmingham, United Kingdom
• 6 Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
• 7 Department of Inflammation & Immunology Medical Affairs, Pfizer Pharmaceuticals Korea Ltd, Seoul, South Korea
• 8 Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
• 9 Department of Dermatology, Konkuk University School of Medicine, Seoul, South Korea

Question   What duration of oral corticosteroid use is associated with adverse effects among adult patients with atopic dermatitis?

Findings   In this nested case-control study including 1 025 270 patients with atopic dermatitis, use of oral corticosteroids for more than 90 days during 1 year was associated with a slightly increased risk of composite adverse outcomes. There was no increased risk with use of oral corticosteroids for more than 30 days.

Meaning   This study suggests that for patients with exacerbations of atopic dermatitis, limiting the duration of oral corticosteroid treatment to 90 days or less may limit adverse effects.

Importance   The use of oral corticosteroids for prolonged periods may be associated with adverse events (AEs). Nevertheless, the risk of AEs with oral corticosteroids, especially among patients with atopic dermatitis (AD), has not been comprehensively investigated and lacks evidence on duration of treatment.

Objective   To assess the association between long-term exposure to oral corticosteroids and AEs among adult patients with AD.

Design, Setting, and Participants   This nested case-control study used data from the Health Insurance Review and Assessment Service database of South Korea between January 1, 2012, and October 31, 2021, which included 1 year prior to the cohort entry date of January 1, 2013, for assessing exclusion criteria and baseline characteristics, and 1 year after the study end date of October 31, 2020, to ensure a minimum duration for assessing exposure. Among the population of adults with AD, patients diagnosed with any of 11 AEs were matched with patients who had never received a diagnosis of any of the 11 AEs.

Exposure   Long-term use of oral corticosteroids was defined as cumulative supply of more than 30 days or more than 90 days of oral corticosteroid prescription per year.

Main Outcomes and Measures   We used multivariable conditional logistic regression analyses to measure the risk of 11 individual outcomes (osteoporosis, fracture, type 2 diabetes, hyperlipidemia, hypertension, myocardial infarction, stroke, heart failure, avascular necrosis, cataract, or glaucoma) as the composite outcome, controlling for potential confounders. We further classified the composite outcome to individual outcomes to evaluate the AE-specific risk.

Results   Among 1 025 270 patients with AD between 2013 and 2020, 164 809 cases (mean [SD] age, 39.4 [14.8]; 56.9% women) were matched with 328 303 controls (mean [SD] age, 39.3 [14.7]; 56.9% women) for sex, age, cohort entry date, follow-up duration, and severity of AD, where the balance of most baseline characteristics was achieved. A total of 5533 cases (3.4%) and 10 561 controls (3.2%) were exposed to oral corticosteroids for more than 30 days, while 684 cases (0.4%) and 1153 controls (0.4%) were exposed to oral corticosteroids for more than 90 days. Overall, there was no increased risk of AEs with use of oral corticosteroids for more than 30 days (adjusted odds ratio [AOR], 1.00; 95% CI, 0.97-1.04), whereas the risk was slightly higher with use of oral corticosteroids for more than 90 days (AOR, 1.11; 95% CI, 1.01-1.23). The small elevation in experiencing an AE was observed with each cumulative or consecutive year of ever long-term use.

Conclusions and Relevance   This case-control study found a slightly increased risk of AEs associated with use of oral corticosteroids for more than 90 days per year, which warrants future research to fully elucidate the observed findings.

Atopic dermatitis (AD) is a chronic inflammatory disease that causes serious morbidity, such as pruritus, impaired quality of life, and a range of comorbidities. 1 , 2 AD is a lifelong condition that relapses chronically and needs constant care. 3 Although AD is considered primarily a pediatric disease, studies have shown high rates of AD among adults as well. 4 The prevalence of AD among adults ranged from 2.1% to 4.9% across countries, and up to 10% of adults required medication for moderate to severe AD due to inadequate response to topical therapies; the prevalence rates were higher among adult patients than among pediatric patients, of whom 1.5% required medication for moderate to severe AD. 5 - 7

As AD treatment strategies, international guidelines and expert opinions generally recommend that oral corticosteroids should generally be avoided or limited to the short term only as rescue therapy. 8 - 11 Nonetheless, given the benefits of oral corticosteroids, including their effectiveness in allergic diseases, short-term safety, and low cost, many patients with moderate to severe AD are treated with oral corticosteroids for prolonged periods, which may constitute inappropriate or excessive use. 12 , 13 However, oral corticosteroid treatment for prolonged periods could have an association with oral corticosteroid–related complications. 14 Hence, clinical evidence informing patients and practitioners regarding the management of AD exacerbations in routine clinical practice is warranted.

Although previous studies among patients with asthma or rheumatic disease have suggested associations between long-term use of oral corticosteroids and various adverse events (AEs), there are few studies of patients with AD, to our knowledge. 15 - 21 In addition, existing studies about corticosteroid use among patients with AD were conducted to evaluate the safety concerns primarily about topical corticosteroids. 22 - 29 Considering the frequent use of oral corticosteroids among adults with AD and the potential association between long-term use of oral corticosteroids and AEs, some of which are severe, there is a need to investigate the safety of the long-term use of oral corticosteroids among adults with AD. 6 , 30 , 31 Accordingly, we aimed to investigate the association between long-term use of oral corticosteroids and AEs among adult patients with AD in South Korea.

We used the nationwide Health Insurance Review and Assessment Service (HIRA) database of South Korea between January 1, 2012, and October 31, 2021, which included 1 year prior to the cohort entry date of January 1, 2013, for assessing exclusion criteria and baseline characteristics, and 1 year after the study end date of October 31, 2020, to ensure a minimum duration for assessing exposure. It encompasses comprehensive data on health care use for every resident of South Korea, ensuring that patient identifiers are anonymized. The database collects information on socioeconomic and demographic variables, diagnosis ( International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnostic code; setting of diagnosis; date of diagnosis; and others), and medications prescribed (national drug chemical code, days’ supply, dose, date of prescription, route of administration, and others) until the occurrence of emigration or death. A prior validation study examined diagnosis codes documented in the HIRA in comparison with those in electronic medical records and found an overall positive predictive value of 82.3%. 32 This study was approved by the institutional review board of Sungkyunkwan University, which waived the informed consent because only deidentified data were used in this study. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guideline. 33

The study cohort comprised patients who were prescribed oral corticosteroids at least once with an AD diagnosis code from January 1, 2013, to October 31, 2020. The cohort entry date was defined as the first date of the prescription of oral corticosteroids with an AD diagnosis within the study period to include the new users of oral corticosteroids. Eligible case and control groups were identified after excluding the following: (1) patients with a diagnosis of immune-mediated inflammatory diseases during a 1-year window of exclusion assessment before the cohort entry date, to evaluate the risk of AEs from oral corticosteroid use for AD; (2) patients with a diagnosis of any of 11 outcomes of interest during the exclusion assessment window of 1 year before and 1 year after the cohort entry date, to investigate the association of oral corticosteroid use with newly occurred outcomes; and (3) patients who were younger than 18 years of age on the cohort entry date, to include adult patients ( Figure 1 ).

Cases were defined as patients with AD who received a diagnosis of any of our outcomes of interest after the cohort entry date, and the index date was defined as the first date of outcome occurrence. The composite outcome of interest consisted of osteoporosis, fracture, type 2 diabetes, hyperlipidemia, hypertension, myocardial infarction, stroke, heart failure, avascular necrosis (AVN), cataract, and glaucoma. We defined controls as patients with AD who never received a diagnosis of our outcomes of interests after the cohort entry date. We matched each case with up to 2 controls without replacement, using risk-set sampling on the cohort entry date (±30 days), follow-up duration (between the cohort entry date and the index date [±30 days]), age, sex, and severity of AD. Disease severity of AD was classified as moderate to severe on the basis of the current treatment guidelines for AD. 7 Moderate to severe AD was defined as patients who were receiving at least 1 immunosuppressant, alitretinoin, intravenous immunoglobulin, dupilumab, or phototherapy during the 1 year prior to the cohort entry date. The index dates of the control group were aligned with the corresponding index date of their respective matched cases. For individual outcomes, each case was matched with up to 5 or 10 controls, using different numbers from the composite outcome for ensuring statistical power according to the size of cases for each outcome variable, using risk-set sampling as well (eFigure 2 in Supplement 1 ).

We defined the exposure ascertainment window as the period between the cohort entry date and the index date, segmenting the period into yearly intervals to assess exposure year by year to determine whether patients met the definition for long-term use of oral corticosteroids. Owing to the absence of consensus for a definition of long-term oral corticosteroid use among patients with AD, and even for other diseases, we set the classification of long-term oral corticosteroid use as follows: cumulatively more than 30 days as the primary definition for modest long-term use or more than 90 days as a secondary definition for extensive long-term use, both with greater than a 5-mg daily prednisolone-equivalent dose of oral corticosteroids per year, which places patients at risk of systemic adverse effects. 17 To exclude potential use of oral corticosteroids for related conditions other than AD, we restricted exposure to prescriptions of oral corticosteroids to patients with a diagnosis of AD. Ever long-term use was defined as patients with a history of long-term use of oral corticosteroids for at least 1 year, and all remaining patients were defined as no long-term use . Primarily, ever long-term use was defined as a binary variable using 2 thresholds (>30 days and >90 days). In addition, to examine the duration-response association with long-term use of oral corticosteroids, we used the year, which met the definition for the long-term use, as a continuous variable. We assessed the risk of each outcome associated with the number of cumulative years (considering all the intermittent years of long-term use of oral corticosteroids) throughout the exposure ascertainment period. We also evaluated the risk associated with the number of consecutive years (considering only the continuous years of long-term use of oral corticosteroids) within the exposure ascertainment period. Details of the exposure assessment are shown in eFigure 3 in Supplement 1 .

We discerned a sufficient collection of confounding variables that adequately accounted for potential biases in our analysis: demographic characteristics (eg, sex, age, and medical aid recipients), comorbidities (eg, allergic rhinitis, depression, chronic obstructive pulmonary disease, and thyroid disorders), comedications (eg, antidepressants, antibiotics, estrogens, and proton-pump inhibitors), proxies of overall health status (eg, history of hospitalization, number of outpatient visits, and Charlson Comorbidity Index score), and severity of AD. The characteristic assessment window was defined as the 1-year period before the cohort entry date (eFigure 1 in Supplement 1 ; the demographic characteristics [sex, age, insurance] were assessed on the cohort entry date and other characteristics such as comorbidities, comedications, proxies of health status, and severity of AD during the 1 year prior to cohort entry). The details of exclusion criteria, exposures, outcomes, and covariates are presented in eTable 2 in Supplement 1 .

The demographic characteristics of the cases and controls were presented as frequency (proportion) for categorical variables and as mean (SD) or median (IQR) values for continuous variables. The same analysis used to evaluate the demographic characteristics of the cases and controls of patients with AD were repeated for each of the 11 outcomes as secondary outcomes. Differences in baseline covariates between cases and controls were evaluated using the absolute standardized difference, where an absolute standardized difference greater than 0.1 indicates a statistical imbalance existing between 2 groups.

The association between long-term oral corticosteroid use and the risk of the composite and individual outcomes were investigated using multivariable conditional logistic regression analyses to estimate adjusted odds ratios (AORs) with 95% CIs, adjusting for unbalanced comorbidities, comedications, and proxies of health status after the matching. We conducted additional analyses by considering the number of cumulative or consecutive years of long-term use of oral corticosteroids throughout the entire exposure ascertainment window as continuous variables, to investigate the monotonic duration-response association.

The potential heterogeneity of long-term treatment adverse effects in selected subgroups of patients with AD was examined for the composite adverse outcomes according to age (18-39, 40-64, and ≥65 years), sex (male or female), and severity of AD (mild or moderate to severe AD). To evaluate the robustness of the main findings, sensitivity analyses were first conducted by modifying the definition of exposure from a cumulative duration of more than 30 days or more than 90 days per year to more than 60 days per year. Second, we restricted the population to patients who could be followed up for at least 3 years or 5 years from the cohort entry date. All statistical tests were 2 sided. Analyses were conducted using SAS Enterprise Guide, version 7.1 (SAS Institute Inc), provided by HIRA through a virtual access machine.

Of 1 025 270 patients with AD who had at least 1 prescription of oral corticosteroids between 2013 and 2020, we matched 164 809 cases (mean [SD] age, 39.4 [14.8]; 56.9% women and 43.1% men) with 328 303 controls (mean [SD] age, 39.3 [14.7]; 56.9% women and 43.1% men) ( Table 1 ) by 1:2 matching using risk-set sampling. Cases and controls were matched for sex, age, cohort entry date, follow-up duration, and severity of AD; balance was achieved for most covariates between the 2 groups, with an absolute standardized difference of less than 0.1 ( Table 1 ; whole baseline characteristics of cases and controls are presented in eTable 1 in Supplement 1 , individual outcomes in eTables 5-15 in Supplement 1 , and modest long-term [>30 days] vs extensive long-term [>90 days] in eTable 4 in Supplement 1 ). The most common comorbidity was allergic rhinitis (cases, 42.2%; controls, 38.7%), and the most prevalently prescribed concurrent medication was antibiotics (cases, 71.3% and controls, 66.8%). All the imbalanced variables of concurrent medication use and number of outpatient visits were additionally adjusted in the multivariable logistic regression.

Among the 164 809 cases and 328 303 controls, 5533 cases (3.4%) and 10 561 controls (3.2%) were exposed to oral corticosteroids over 30 days, and 684 cases (0.4%) and 1153 controls (0.4%) were exposed to oral corticosteroids over 90 days. Overall, the risk of AEs was not associated with use of oral corticosteroids exceeding 30 days (AOR, 1.00; 95% CI, 0.97-1.04) ( Table 2 ), while use of oral corticosteroids exceeding 90 days was associated with an 11% increased risk of the composite adverse outcome (AOR, 1.11; 95% CI, 1.01-1.23) ( Table 3 ). Each cumulative or consecutive additive year of long-term exposure (>90 days a year) was associated with a slightly increased risk of having an AE (AOR, 1.06; 95% CI, 1.00-1.13 and AOR, 1.06; 95% CI, 1.00-1.13, respectively).

In the analyses of individual outcomes, an increased risk for hypertension (AOR, 1.09; 95% CI, 1.03-1.15), AVN (AOR, 2.56; 95% CI, 1.82-3.62), and cataract (AOR, 3.22; 95% CI, 1.05-9.85) was associated with use of oral corticosteroids for more than 30 days ( Table 2 ). An increased risk for fracture (AOR, 1.22; 95% CI, 1.05-1.42), hyperlipidemia (AOR, 1.16; 95% CI, 1.03-1.30), myocardial infarction (AOR, 2.22; 95% CI, 1.17-4.22), and AVN (AOR, 6.88; 95% CI, 3.53-13.42) was associated with use of oral corticosteroids for more than 90 days ( Table 3 ). In our subgroup analysis, as compared with unexposed patients, the risk of composite AEs associated with long-term use of oral corticosteroids was generally consistent with the main analyses. No differences were observed in the stratified analyses according to the age group, sex, and severity of AD (eFigures 4-6 in Supplement 1 ). Furthermore, the results of composite outcomes demonstrated a high degree of consistency across all sensitivity analyses regarding the point estimates ( Figure 2 ).

We identified 164 809 cases and 328 303 controls of comparable patients with AD. The risk of composite adverse outcomes was not associated with with ever long-term use of oral corticosteroids exceeding 30 days, whereas the risk was slightly associated with ever long-term use exceeding 90 days. Also, the cumulative and consecutive years of ever long-term use throughout entire exposure ascertainment period was associated with a monotonic elevated risk of having an AE, although there was not a large discrepancy between the 2 distinctive analyses of additive years. Furthermore, small increased risks were identified in the examination of individual outcomes of fracture, hyperlipidemia, hypertension, myocardial infarction, AVN, and cataract. Generally consistent findings, with regard to point estimates, were observed across a range of sensitivity analyses.

Considering the overlapping pathogenetic mechanism between AD and asthma, we referred to studies of patients with asthma for comparison. One cohort study using Medicaid data found that the use of medium and high doses of systemic corticosteroids was associated with bone, cardiovascular, metabolic, and ocular AEs. 34 Another cohort study using 2000-2014 MarketScan data showed a similar increased risk of various AEs associated with the use of 1 to 3 oral corticosteroid prescriptions (AOR, 1.04; 95% CI, 1.01-1.06) and the use of 4 or more prescriptions (AOR, 1.29; 95% CI, 1.20-1.37); the cumulative burden also increased as the number of years accumulated. 20 Although previous research evaluated the frequency of oral corticosteroid use based on prescription numbers, our study provided more conclusive and valid clinical evidence by defining long-term use based on exact duration.

For individual outcomes, in line with previous studies, we also identified fracture, hypertension, hyperlipidemia, and myocardial infarction as AEs associated with long-term use of oral corticosteroids, owing to interruption of endocrine function and metabolism. 20 , 35 - 38 We observed risks of AVN and cataract with long-term oral corticosteroid use, although the risks of these 2 conditions were inconclusive in past studies. For the underlying mechanisms for AVN of the femoral head, the use of oral corticosteroids leads to intravascular coagulation that results in a inhibition of blood flow to the bones, which consequently triggers ischemic injury. 39 - 41 Although existing evidence regarding an association of AVN with duration of oral corticosteroid treatment is unclear, AVN could be induced from use of just over 30 days, and cumulative exposure is the important determining factor, as shown in our results. 39 Furthermore, although a complete elucidation remains uncertain, the mechanisms of new-onset cataract associated with modest long-term use of oral corticosteroids may be due to disturbances in osmotic equilibrium, oxidative detriment, and perturbations in lens growth factors. 42 , 43 Another potential hypothesis involves nonenzymatic Schiff base intermediates that form between the corticosteroid’s C-20 ketone group and its nucleophilic groups, undergoing Heyns rearrangement to produce stable amine-substituted adducts seen only in corticosteroid-induced posterior subcapsular cataracts. 44 , 45 No association or subtle increased hazard was observed with osteoporosis, glaucoma, stroke, or heart failure, implying that the dose and duration of corticosteroid treatment may not pose a risk for these conditions among patients with AD.

This study has some strengths. Concerns about conducting this study arose from the lack of consensus regarding the definition of long-term corticosteroid treatment, as different criteria have been used and variations have been observed (eTable 3 in Supplement 1 ). Accordingly, we combined the NICE (National Institute for Health and Care Excellence) guidelines 17 with the opinions of clinicians practicing in clinical settings. Even though evidence for a safe continuous duration of corticosteroid treatment was not available as we developed criteria for the definition of long-term treatment for the dichotomous variable, our criteria are expected to serve as a primary threshold for deciding the duration of treatment. In addition, although the long-term use of oral corticosteroids is not recommended in the guideline for treatment of AD, relatively prolonged use of oral corticosteroids is identified frequently in clinical practice. 12 Thus, this study addresses a significant gap in research by investigating the association between long-term oral corticosteroid use and a comprehensive range of AEs specifically among adults with AD. With its substantial sample size, the study provides robust statistical power to detect associations between oral corticosteroid use and relatively rare outcomes, adding to the existing evidence.

This study also has some limitations. First, disparities arose between the diagnoses recorded and the actual diseases a patient had. 46 In addition, HIRA data do not include clinical data; accordingly, the diagnostic standard criteria for AD, such as the Hanifin-Rajka criteria, 47 , 48 were infeasible. To comply with this issue, we included patients with AD who had at least 1 oral corticosteroid prescription and restricted prescriptions to patients with a diagnosis of AD. Second, due to the inbuilt characteristics of database recording drugs that are prescribed rather than drugs that are taken, the exposure measurement could be uncertain. However, we set the exposed group from the modest long term (>30 days) to the extensive long term (>90 days) and also included the numbers of cumulative or consecutive years of ever long-term use, from which the cumulative burden would be appropriately measured. Third, inhaled corticosteroids, which have some degree of systemic bioavailability, and topical and eye drop formulations of corticosteroids were not accounted for in this study. Fourth, for some of the individual study outcomes, we could not rule out the failure to detect the true effect due to the lack of statistical power; thus, future studies are warranted to corroborate these results. Fifth, due to the nature of the case-control design, it is not possible to completely exclude reverse causality. Sixth, although we considered moderate to severe AD using prescriptions of medication based on the treatment guideline, the influence of AD-related disease severity cannot be eliminated. Seventh, we addressed residual or unmeasured confounders by calculating E-values (eTables 16 and 17 in Supplement 1 ), but unmeasured confounders may be present, and the results should be interpreted with caution.

In this large population-based case-control study, we discovered that oral corticosteroid use of more than 90 days among individuals with AD was associated with a small increased risk of composite adverse outcomes. Future investigations are warranted to confirm this potential risk of AEs associated with long-term use of oral corticosteroids for patients with exacerbations of AD, and health care professionals should thoroughly weigh the benefits associated with oral corticosteroids against the observed small risk of AEs, while continuously monitoring for AEs.

Accepted for Publication: May 23, 2024.

Published: July 19, 2024. doi:10.1001/jamanetworkopen.2024.23563

Open Access: This is an open access article distributed under the terms of the CC-BY-NC-ND License . © 2024 Jang YH et al. JAMA Network Open .

Corresponding Authors: Ju-Young Shin, PhD, School of Pharmacy, Sungkyunkwan University, 2066 Saburo, Jangan-gu, Suwon, Gyeonggi-do 16419, South Korea ( [email protected] ); Yang Won Lee, MD, PhD, Department of Dermatology, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, South Korea ( [email protected] ).

Author Contributions: Drs Shin and Y. W. Lee had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Jang and Choi contributed equally to this work.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: H. Lee, Noh, Jeon, Yoo.

Drafting of the manuscript: Jang, Choi, Woo, Jeon, Yoo.

Critical review of the manuscript for important intellectual content: Jang, H. Lee, Woo, Park, Noh, Jeon, Yoo, Shin, Y. W. Lee.

Statistical analysis: Choi, H. Lee, Woo, Park.

Obtained funding: Jeon, Yoo, Shin.

Administrative, technical, or material support: Jeon, Yoo, Shin, Y. W. Lee.

Supervision: Jang, Shin.

Conflict of Interest Disclosures: Dr Park reported receiving support from the AIR@innoHK programme of the Government of Hong Kong Special Administrative Region Innovation and Technology Commission. Dr Noh reported receiving grants from the Ministry of Health and Welfare outside the submitted work. Drs Jeon and Yoo reported receiving personal fees from Pfizer Pharmaceuticals Korea Ltd outside the submitted work. Dr Shin reported receiving grants from the Ministry of Food and Drug Safety, the Ministry of Health and Welfare, the National Research Foundation of Korea, Celltrion, and SK Bioscience outside the submitted work. No other disclosures were reported.

Funding/Support: This work was supported by Pfizer Pharmaceuticals Korea Ltd.

Role of the Funder/Sponsor: Pfizer Pharmaceuticals Korea Ltd had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 2 .

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• Case report
• Open access
• Published: 30 August 2024

Extrahepatic intraabdominal hydatid cyst: a case report

• Nagham Bazzi 1 ,
• Hussein Baalbaki 2 ,
• Alain Njeim 2 ,
• Ali Hmede 2 ,
• Mohammad Chaaban 3 ,
• Mohammad Ali Almokdad   ORCID: orcid.org/0009-0009-1960-748X 4 ,
• Ali Alhousseini 5 &
• Gaby Abou Sleiman 6  

Journal of Medical Case Reports volume  18 , Article number:  399 ( 2024 ) Cite this article

Metrics details

Hydatid disease, also known as echinococcosis, is a zoonotic parasitic infection caused by the larvae of the Echinococcus tapeworm. It is endemic in various regions worldwide, particularly in rural areas of countries in southern South America, Central Asia, China, parts of Africa, the Mediterranean, and parts of the Middle East. The disease primarily affects the liver (60–70% of cases) and the lungs (10–25% of cases), but it can involve any organ, including the brain, bones, and rarely the pelvic region, as seen in our case report. Hydatid disease typically follows an asymptomatic course in the early stages of the primary infection and may remain so potentially for years or even permanently. If symptoms occur, they depend on various factors, such as the number, size, and location among other factors. Typically, hydatid disease presents with nonspecific symptoms. Common symptoms include abdominal pain, hepatomegaly, as well as anaphylaxis in case of cyst rupture. Extrahepatic intra-abdominal isolated hydatic cyst is a rare finding (6–11%).

Case presentation

In our case, a 70 year-old Asian white male presented with right thigh pain radiating to the lower leg, which is an atypical presentation for an extrahepatic intraabdominal hydatid cyst. Primary intraabdominal hydatid cysts involving the pelvic region are relatively rare, and such cases pose diagnostic and management challenges.

This case report underscores the challenges in diagnosing and managing extrahepatic intraabdominal hydatid cysts, particularly in atypical presentations. A combination of clinical evaluation, serological studies, and imaging techniques facilitates accurate diagnosis.

Peer Review reports

Introduction

Hydatid disease is a parasitic infection caused by the larval stage of the Echinococcus genus. The cystic form of the disease is most commonly caused by the Echinococcus granulosus tapeworm, which infects humans as an accidental intermediate host in its lifecycle. In the lifecycle, canines serve as definitive hosts while ungulates act as intermediate hosts. Definitive hosts become infected by ingesting contaminated meat and shed eggs or gravid proglottids in feces. Intermediate hosts are infected through oral uptake of these eggs, which release larvae in the small intestine and can be transported to various organs, including the liver and lungs. Humans are often infected as intermediate hosts owing to exposure to unwashed vegetables, infected animals, or contaminated soil [ 1 , 2 ]. Cystic hydatid disease exhibits a global distribution with a prevalence of 1–200/100,000; however, it is endemic in specific regions including South and Central America, the Middle East, and Mediterranean Countries, as well as certain sub-Saharan African countries. Although the disease can potentially manifest in any part of the body, it is predominantly observed in the liver (52–77% of cases) followed by the lungs (10–40%) [ 1 , 2 , 3 ]. Although rare, isolated extrahepatic intra-abdominal cysts can occur, but extrahepatic intra-abdominal cystic disease commonly coexists with hepatic involvement [ 2 ].

The purpose of this case report is to highlight the uncommon occurrence of isolated hydatid cysts in the right pelvic cavity. This rare presentation of the disease warrants consideration of a wide range of differential diagnoses and necessitates exploration of multiple treatment options for managing this potentially life-threatening condition.

A 70 year-old Asian white man presented to the hospital for right thigh pain radiating to the lower leg. The patient was in pain for 1 month and was unable to walk. His past medical history is confined to controlled hypothyroidism with no past surgical history. He is a nonsmoker, nonalcoholic, and denied any drug abuse.

On physical examination the patient was alert, conscious, and oriented. The patient had a regular heartbeat, good bilateral airway entry, and soft abdomen. The physical examination was insignificant except for a right thigh tenderness and a decrease range of motion. Vital signs were within the normal range. The computed tomography (CT) scan showed a large multi-loculated complex cystic lesion on the right pelvic cavity measuring 14 × 10 cm with multiple thick septae [Figure.  1 ]. The cysts have induced a remodeling of the subjacent right iliac and acetabular bones [Figure.  2 ]. It was attached to the right iliopsoas muscle. The cyst was extending to the level of the anorectal junction and involving the obturator internus muscle. The large mass was compressing the bladder and the rectosigmoid colon. Laboratory tests showed high anti-echinococcus-HAI level (1/2560), normocytic anemia: (HG: 0.8.4 g/dl, HCT: 25%), and eosinophilia (6%). The diagnosis of hydatid cyst stage CE3B (Gharbi classification) was confirmed. CT-scan of the head and chest was done to rule out the spread of cysts. Albendazole per Oz for 2 weeks was ordered followed by hydatid cyst removal under general anesthesia. An anterior approach with vertical incision from the xiphoid to the umbilicus was made, for optimal exposure and control given the complex and extensive nature of the lesion. The cyst was identified, and the surrounding tissues were covered with cetrimide-soaked pads. Cetrimide (a scolocidal agent) was injected in the cyst cavity and allowed to sit for 10 min, after which it was evacuated, and the cavity was irrigated with isotonic sodium chloride solution. The cyst was then evacuated using a strong suction device, and cetrimide was injected again into the cavity [Figure.  3 ]. After the second injection of cetrimide, the patient experienced bradycardia (20 heartbeats per minute) and hypotension. The patient was in anaphylactic shock. Surgery was paused and advanced cardiac life support (ACLS) treatment was started. After eight cycles of cardiac massage with the injection of atropine, adrenaline, sodium bicarbonate, and hydrocortisone, the patient resumed his cardiac function but with undetectable arterial pressure. Noradrenaline was started. Then, surgery was resumed rapidly where the cyst was removed, and part of the greater omentum was used to fill the defect (omentoplasty). The Patient was then transferred to the intensive care unit (ICU). In the ICU, the patient still had no detectable blood pressure, although the maximum dose of noradrenaline was given. After about 5 hours, owing to anaphylactic shock, the patient had a cardiac arrest and passed away.

Computed tomography of the abdominopelvis showing cystic lesions along the right pelvic cavity

Computed tomography scan showing the remodeling of the sub adjacent right iliac and acetabular caused by the cysts

Some intraoperative pictures during removal of the cyst

Hydatid disease is a parasitic infection caused by the larval stage of the Echinococcus genus. It is endemic in various regions worldwide, particularly in rural areas of countries in southern South America, Central Asia, China, parts of Africa, the Mediterranean, and parts of the Middle East [ 4 ]. The disease primarily affects the liver (60–70% of cases) and the lungs (10–25% of cases) [ 5 ], but it can involve any organ, including the brain, bones, and rarely, the pelvic region, as seen in our case report [ 4 ]. Extra-hepatic intra-abdominal isolated hydatic cyst is a rare finding (6–11%) [ 5 ]. It typically follows an asymptomatic course in the early stages of the primary infection and may remain so potentially for years or even permanently. If symptoms were to occur, they would depend on various factors such as the number, size, and location among other factors [ 6 ]. Typically, hydatid disease presents with non-specific symptoms. Common symptoms include abdominal pain, hepatomegaly, as well as anaphylaxis in case of cyst rupture [ 7 ].

In our case, a 70-year-old man with no significant medical history except controlled hypothyroidism presented with severe right thigh pain, decreased range of motion, and an inability to walk. The CT scan revealed a large multiloculated complex cystic lesion in the right pelvic cavity, measuring 14 × 10 cm, with multiple thick septae. The cyst was attached to the iliopsoas muscle, extending to the anorectal junction, and involving the obturator internus muscle. This extensive involvement resulted in compression of the bladder and the rectosigmoid colon. Laboratory tests demonstrated elevated anti- Echinococcus -HAI levels, normocytic anemia, and eosinophilia, consistent with the diagnosis of hydatid cyst stage CE3B (Gharbi classification) [ 8 ,  9 ].

The diagnosis of hydatid disease relies on a combination of clinical evaluation, serological studies, and imaging techniques. Serological tests, such as enzyme-linked immunosorbent assay (ELISA) and indirect hemagglutination assay (IHA), measure specific antibodies against Echinococcus and can aid in the diagnosis; however, their role is less important than imaging owing to high false negative rates [ 10 ].

Imaging modalities, including ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), play a crucial role in the diagnosis and assessment of hydatid cysts. Ultrasound is often the initial imaging modality of choice owing to its widespread availability, cost-effectiveness, and ability to differentiate cystic from solid lesions. Ultrasound is also the gold standard for staging hydatid disease. [ 10 ]. On the other hand, computed tomography (CT) scans excel at identifying calcification and involvement of the bones, while MRI may be useful in cases where soft tissue involvement or spinal cord compression is suspected [ 11 ].

The management of extrahepatic intraabdominal hydatid disease involves a multidisciplinary approach, integrating medical treatment and surgical intervention. The mainstay of medical treatment is the administration of benzimidazole derivatives, such as albendazole, to reduce the risk of recurrence and systemic dissemination [ 12 ]. A typical regimen involves a preoperative course of 2 weeks to minimize the risk of anaphylactic reactions during surgery, followed by a postoperative course for several months with a minimum overall duration of treatment of 3 months [ 4 ].

Surgical intervention is essential for the definitive treatment of hydatid cysts [ 13 ]. The choice of surgical approach depends on the cyst’s location, size, and involvement of adjacent structures. Pericystectomy, cystectomy, and total organ resection are commonly employed techniques to achieve complete cyst removal while preserving organ function [ 13 ]. However, surgical treatment carries potential risks, including infection, cyst rupture, anaphylactic shock, and recurrence. Other modalities of proposed treatments may include percutaneous approaches, such as the PAIR technique, radiofrequency thermo-ablation, or some even proposed a conservative approach where we monitor the disease progression. It is vital to note that a newer approach has emerged in recent years in the form of percutaneous operations, most important of which is the puncture, aspiration, injection, respiration (PAIR) technique. In the PAIR technique, half of the cyst volume is aspirated, 20% hypertonic saline solution is injected as one third of the initial cyst volume. After 20 minutes, the cyst volume is aspirated again. It is merely used for type I and II cysts below the size of 6 cm. Additionally, it is not applicable for cysts that are calcific and solid (15–18). The cysts in type III and those bigger than 6 cm are treated with percutaneous drainage catheter administration [ 14 , 15 , 16 ].

There is no global gold standard of a go-to treatment for hydatid disease, but rather the treatment choice should be individualized to each case with a discussion of the treatment options available with the patient [ 12 ]. The extraperitoneal approach with partial cystectomy to avoid damage to nervous structures is recommended for primary intraabdominal extra-hepatic cysts of the abdomen that involve the psoas muscle [ 5 ].

In our case, an anterior approach with a vertical incision from the xiphoid to the umbilicus was made. The cyst was identified and surrounded by cetrimide-soaked pads to minimize the risk of cyst rupture. Cetrimide, a scolicidal agent, was injected into the cyst cavity, and after evacuation, the cavity was irrigated with isotonic sodium chloride solution. However, the patient experienced an anaphylactic shock following the second injection of cetrimide. Prompt management restored cardiac function, and the cyst was removed. The patient, unfortunately, suffered a cardiac arrest and passed away 3 hours after the procedure.

Cetrimide is a potent disinfectant and effective scolicidal agent used to sterilize the cyst and prevent intraoperative dissemination of its contents [ 17 ]. Numerous scolicidal agents with different concentrations have been proposed for treatment in literature, but no guidelines to date exist on the acceptable volume and concentration that can be used safely. The present uncertainties in the use of scolicides, the difficulty of accurately estimating the volume of the hydatid cyst in situ, urge upon the surgeon the employment of the most potent safe scolicide available [ 18 ]. Although cetrimide is effective in very low concentrations, it is not devoid of complications. Dreadful side effects have been reported in literature, including methemoglobinemia and deep cyanosis that may ensue [ 19 ], chemically induced peritonitis with massive adhesions and bowel obstruction postoperatively [ 20 ], increasingly severe metabolic acidosis that can lead to cardiovascular collapse with vasoplegic collapse, low central venous pressure, oliguria, and abdominal tension, all attributed to third spacing [ 21 ], convulsions, and coma.

The recurrence rate of hydatid disease varies depending on several factors, including cyst characteristics and the extent of surgical resection. Reported recurrence rates for intraabdominal hydatid cysts range from 2 to 30% [ 4 ]. Regular follow-up, including clinical evaluation and imaging, is crucial for the early detection of recurrence. The follow-up typically involves the use of imaging at 3 month intervals for 3 years at least to detect the recurrence of cysts with monitoring of cyst size among other cyst characteristics. [ 4 ]

Postoperative events following hydatid cyst surgery can include pain, wound infection, cystic fluid collection, and abscess formation. In our case, anaphylactic shock during surgery was the major complication encountered, which was appropriately managed. However, the subsequent cardiac arrest led to the patient’s unfortunate demise.

On the basis of our experience, future cases of extrahepatic intraabdominal hydatid cysts should maintain a high index of suspicion for the disease, even in the absence of typical symptoms. The risks and benefits of scolicidal agents, including cetrimide, should be carefully considered, and alternative agents or approaches should be explored to minimize the risk of anaphylactic reactions. A multidisciplinary approach involving infectious disease specialists, surgeons, anesthesiologists, and critical care teams remains crucial for optimal patient management.

In conclusion, this case report underscores the challenges in diagnosing and managing extrahepatic intraabdominal hydatid cysts, particularly in atypical presentations. A combination of clinical evaluation, serological studies, and imaging techniques facilitates accurate diagnosis. The treatment approach involves a multidisciplinary strategy with medical therapy and surgical intervention, aiming for complete cyst removal while minimizing complications. Further research is needed to refine diagnostic and therapeutic strategies, improve patient outcomes, and reduce the burden of this rare but significant disease.

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NB, HB, and AN performed the research; NB, MC, HB, and AH designed the research study; MAM, MC, and GAS contributed essential tools; HB, AH, MAM, AN, and MC analyzed the data; NB, MAM, and HB wrote the paper. All authors read and approved the final manuscript.

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Bazzi, N., Baalbaki, H., Njeim, A. et al. Extrahepatic intraabdominal hydatid cyst: a case report. J Med Case Reports 18 , 399 (2024). https://doi.org/10.1186/s13256-024-04733-7

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Received : 07 June 2023

Accepted : 02 August 2024

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DOI : https://doi.org/10.1186/s13256-024-04733-7

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