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Case Study – Methods, Examples and Guide

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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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Methodology

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

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

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

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

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

Table of contents

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

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

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

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

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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.

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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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McCombes, S. (2023, November 20). What Is a Case Study? | Definition, Examples & Methods. Scribbr. Retrieved August 14, 2024, from https://www.scribbr.com/methodology/case-study/

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22 Case Study Research: In-Depth Understanding in Context

Helen Simons, School of Education, University of Southampton

• Published: 01 July 2014
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This chapter explores case study as a major approach to research and evaluation. After first noting various contexts in which case studies are commonly used, the chapter focuses on case study research directly Strengths and potential problematic issues are outlined and then key phases of the process. The chapter emphasizes how important it is to design the case, to collect and interpret data in ways that highlight the qualitative, to have an ethical practice that values multiple perspectives and political interests, and to report creatively to facilitate use in policy making and practice. Finally, it explores how to generalize from the single case. Concluding questions center on the need to think more imaginatively about design and the range of methods and forms of reporting requiredto persuade audiences to value qualitative ways of knowing in case study research.

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• Published: 27 June 2011

The case study approach

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

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

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

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Introduction

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

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

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

What is a case study?

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

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

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

What are case studies used for?

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

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

How are case studies conducted?

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

Defining the case

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

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

Selecting the case(s)

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

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

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

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

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

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

Collecting the data

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

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

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

Analysing, interpreting and reporting case studies

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

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

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

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

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

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

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

Conclusions

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

Yin RK: Case study research, design and method. 2009, London: Sage Publications Ltd., 4

Google Scholar  

Keen J, Packwood T: Qualitative research; case study evaluation. BMJ. 1995, 311: 444-446.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Sheikh A, Halani L, Bhopal R, Netuveli G, Partridge M, Car J, et al: Facilitating the Recruitment of Minority Ethnic People into Research: Qualitative Case Study of South Asians and Asthma. PLoS Med. 2009, 6 (10): 1-11.

Article   Google Scholar  

Pinnock H, Huby G, Powell A, Kielmann T, Price D, Williams S, et al: The process of planning, development and implementation of a General Practitioner with a Special Interest service in Primary Care Organisations in England and Wales: a comparative prospective case study. Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R&D (NCCSDO). 2008, [ http://www.sdo.nihr.ac.uk/files/project/99-final-report.pdf ]

Robertson A, Cresswell K, Takian A, Petrakaki D, Crowe S, Cornford T, et al: Prospective evaluation of the implementation and adoption of NHS Connecting for Health's national electronic health record in secondary care in England: interim findings. BMJ. 2010, 41: c4564-

Pearson P, Steven A, Howe A, Sheikh A, Ashcroft D, Smith P, the Patient Safety Education Study Group: Learning about patient safety: organisational context and culture in the education of healthcare professionals. J Health Serv Res Policy. 2010, 15: 4-10. 10.1258/jhsrp.2009.009052.

Article   PubMed   Google Scholar  

van Harten WH, Casparie TF, Fisscher OA: The evaluation of the introduction of a quality management system: a process-oriented case study in a large rehabilitation hospital. Health Policy. 2002, 60 (1): 17-37. 10.1016/S0168-8510(01)00187-7.

Stake RE: The art of case study research. 1995, London: Sage Publications Ltd.

Sheikh A, Smeeth L, Ashcroft R: Randomised controlled trials in primary care: scope and application. Br J Gen Pract. 2002, 52 (482): 746-51.

PubMed   PubMed Central   Google Scholar  

King G, Keohane R, Verba S: Designing Social Inquiry. 1996, Princeton: Princeton University Press

Doolin B: Information technology as disciplinary technology: being critical in interpretative research on information systems. Journal of Information Technology. 1998, 13: 301-311. 10.1057/jit.1998.8.

George AL, Bennett A: Case studies and theory development in the social sciences. 2005, Cambridge, MA: MIT Press

Eccles M, the Improved Clinical Effectiveness through Behavioural Research Group (ICEBeRG): Designing theoretically-informed implementation interventions. Implementation Science. 2006, 1: 1-8. 10.1186/1748-5908-1-1.

Article   PubMed Central   Google Scholar  

Netuveli G, Hurwitz B, Levy M, Fletcher M, Barnes G, Durham SR, Sheikh A: Ethnic variations in UK asthma frequency, morbidity, and health-service use: a systematic review and meta-analysis. Lancet. 2005, 365 (9456): 312-7.

Sheikh A, Panesar SS, Lasserson T, Netuveli G: Recruitment of ethnic minorities to asthma studies. Thorax. 2004, 59 (7): 634-

CAS   PubMed   PubMed Central   Google Scholar  

Hellström I, Nolan M, Lundh U: 'We do things together': A case study of 'couplehood' in dementia. Dementia. 2005, 4: 7-22. 10.1177/1471301205049188.

Som CV: Nothing seems to have changed, nothing seems to be changing and perhaps nothing will change in the NHS: doctors' response to clinical governance. International Journal of Public Sector Management. 2005, 18: 463-477. 10.1108/09513550510608903.

Lincoln Y, Guba E: Naturalistic inquiry. 1985, Newbury Park: Sage Publications

Barbour RS: Checklists for improving rigour in qualitative research: a case of the tail wagging the dog?. BMJ. 2001, 322: 1115-1117. 10.1136/bmj.322.7294.1115.

Mays N, Pope C: Qualitative research in health care: Assessing quality in qualitative research. BMJ. 2000, 320: 50-52. 10.1136/bmj.320.7226.50.

Mason J: Qualitative researching. 2002, London: Sage

Brazier A, Cooke K, Moravan V: Using Mixed Methods for Evaluating an Integrative Approach to Cancer Care: A Case Study. Integr Cancer Ther. 2008, 7: 5-17. 10.1177/1534735407313395.

Miles MB, Huberman M: Qualitative data analysis: an expanded sourcebook. 1994, CA: Sage Publications Inc., 2

Pope C, Ziebland S, Mays N: Analysing qualitative data. Qualitative research in health care. BMJ. 2000, 320: 114-116. 10.1136/bmj.320.7227.114.

Cresswell KM, Worth A, Sheikh A: Actor-Network Theory and its role in understanding the implementation of information technology developments in healthcare. BMC Med Inform Decis Mak. 2010, 10 (1): 67-10.1186/1472-6947-10-67.

Article   PubMed   PubMed Central   Google Scholar  

Malterud K: Qualitative research: standards, challenges, and guidelines. Lancet. 2001, 358: 483-488. 10.1016/S0140-6736(01)05627-6.

Article   CAS   PubMed   Google Scholar  

Yin R: Case study research: design and methods. 1994, Thousand Oaks, CA: Sage Publishing, 2

Yin R: Enhancing the quality of case studies in health services research. Health Serv Res. 1999, 34: 1209-1224.

Green J, Thorogood N: Qualitative methods for health research. 2009, Los Angeles: Sage, 2

Howcroft D, Trauth E: Handbook of Critical Information Systems Research, Theory and Application. 2005, Cheltenham, UK: Northampton, MA, USA: Edward Elgar

Book   Google Scholar  

Blakie N: Approaches to Social Enquiry. 1993, Cambridge: Polity Press

Doolin B: Power and resistance in the implementation of a medical management information system. Info Systems J. 2004, 14: 343-362. 10.1111/j.1365-2575.2004.00176.x.

Bloomfield BP, Best A: Management consultants: systems development, power and the translation of problems. Sociological Review. 1992, 40: 533-560.

Shanks G, Parr A: Positivist, single case study research in information systems: A critical analysis. Proceedings of the European Conference on Information Systems. 2003, Naples

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

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Case study research: opening up research opportunities

RAUSP Management Journal

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Article publication date: 30 December 2019

Issue publication date: 3 March 2020

The case study approach has been widely used in management studies and the social sciences more generally. However, there are still doubts about when and how case studies should be used. This paper aims to discuss this approach, its various uses and applications, in light of epistemological principles, as well as the criteria for rigor and validity.

Design/methodology/approach

This paper discusses the various concepts of case and case studies in the methods literature and addresses the different uses of cases in relation to epistemological principles and criteria for rigor and validity.

The use of this research approach can be based on several epistemologies, provided the researcher attends to the internal coherence between method and epistemology, or what the authors call “alignment.”

Originality/value

This study offers a number of implications for the practice of management research, as it shows how the case study approach does not commit the researcher to particular data collection or interpretation methods. Furthermore, the use of cases can be justified according to multiple epistemological orientations.

• Epistemology

Takahashi, A.R.W. and Araujo, L. (2020), "Case study research: opening up research opportunities", RAUSP Management Journal , Vol. 55 No. 1, pp. 100-111. https://doi.org/10.1108/RAUSP-05-2019-0109

Emerald Publishing Limited

Copyright © 2019, Adriana Roseli Wünsch Takahashi and Luis Araujo.

Published in RAUSP Management Journal . Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode

1. Introduction

The case study as a research method or strategy brings us to question the very term “case”: after all, what is a case? A case-based approach places accords the case a central role in the research process ( Ragin, 1992 ). However, doubts still remain about the status of cases according to different epistemologies and types of research designs.

Despite these doubts, the case study is ever present in the management literature and represents the main method of management research in Brazil ( Coraiola, Sander, Maccali, & Bulgacov, 2013 ). Between 2001 and 2010, 2,407 articles (83.14 per cent of qualitative research) were published in conferences and management journals as case studies (Takahashi & Semprebom, 2013 ). A search on Spell.org.br for the term “case study” under title, abstract or keywords, for the period ranging from January 2010 to July 2019, yielded 3,040 articles published in the management field. Doing research using case studies, allows the researcher to immerse him/herself in the context and gain intensive knowledge of a phenomenon, which in turn demands suitable methodological principles ( Freitas et al. , 2017 ).

Our objective in this paper is to discuss notions of what constitutes a case and its various applications, considering epistemological positions as well as criteria for rigor and validity. The alignment between these dimensions is put forward as a principle advocating coherence among all phases of the research process.

This article makes two contributions. First, we suggest that there are several epistemological justifications for using case studies. Second, we show that the quality and rigor of academic research with case studies are directly related to the alignment between epistemology and research design rather than to choices of specific forms of data collection or analysis. The article is structured as follows: the following four sections discuss concepts of what is a case, its uses, epistemological grounding as well as rigor and quality criteria. The brief conclusions summarize the debate and invite the reader to delve into the literature on the case study method as a way of furthering our understanding of contemporary management phenomena.

2. What is a case study?

The debate over what constitutes a case in social science is a long-standing one. In 1988, Howard Becker and Charles Ragin organized a workshop to discuss the status of the case as a social science method. As the discussion was inconclusive, they posed the question “What is a case?” to a select group of eight social scientists in 1989, and later to participants in a symposium on the subject. Participants were unable to come up with a consensual answer. Since then, we have witnessed that further debates and different answers have emerged. The original question led to an even broader issue: “How do we, as social scientists, produce results and seem to know what we know?” ( Ragin, 1992 , p. 16).

An important step that may help us start a reflection on what is a case is to consider the phenomena we are looking at. To do that, we must know something about what we want to understand and how we might study it. The answer may be a causal explanation, a description of what was observed or a narrative of what has been experienced. In any case, there will always be a story to be told, as the choice of the case study method demands an answer to what the case is about.

A case may be defined ex ante , prior to the start of the research process, as in Yin’s (2015) classical definition. But, there is no compelling reason as to why cases must be defined ex ante . Ragin (1992 , p. 217) proposed the notion of “casing,” to indicate that what the case is emerges from the research process:

Rather than attempt to delineate the many different meanings of the term “case” in a formal taxonomy, in this essay I offer instead a view of cases that follows from the idea implicit in many of the contributions – that concocting cases is a varied but routine social scientific activity. […] The approach of this essay is that this activity, which I call “casing”, should be viewed in practical terms as a research tactic. It is selectively invoked at many different junctures in the research process, usually to resolve difficult issues in linking ideas and evidence.

In other words, “casing” is tied to the researcher’s practice, to the way he/she delimits or declares a case as a significant outcome of a process. In 2013, Ragin revisited the 1992 concept of “casing” and explored its multiple possibilities of use, paying particular attention to “negative cases.”

According to Ragin (1992) , a case can be centered on a phenomenon or a population. In the first scenario, cases are representative of a phenomenon, and are selected based on what can be empirically observed. The process highlights different aspects of cases and obscures others according to the research design, and allows for the complexity, specificity and context of the phenomenon to be explored. In the alternative, population-focused scenario, the selection of cases precedes the research. Both positive and negative cases are considered in exploring a phenomenon, with the definition of the set of cases dependent on theory and the central objective to build generalizations. As a passing note, it is worth mentioning here that a study of multiple cases requires a definition of the unit of analysis a priori . Otherwise, it will not be possible to make cross-case comparisons.

These two approaches entail differences that go beyond the mere opposition of quantitative and qualitative data, as a case often includes both types of data. Thus, the confusion about how to conceive cases is associated with Ragin’s (1992) notion of “small vs large N,” or McKeown’s (1999) “statistical worldview” – the notion that relevant findings are only those that can be made about a population based on the analysis of representative samples. In the same vein, Byrne (2013) argues that we cannot generate nomothetic laws that apply in all circumstances, periods and locations, and that no social science method can claim to generate invariant laws. According to the same author, case studies can help us understand that there is more than one ideographic variety and help make social science useful. Generalizations still matter, but they should be understood as part of defining the research scope, and that scope points to the limitations of knowledge produced and consumed in concrete time and space.

Thus, what defines the orientation and the use of cases is not the mere choice of type of data, whether quantitative or qualitative, but the orientation of the study. A statistical worldview sees cases as data units ( Byrne, 2013 ). Put differently, there is a clear distinction between statistical and qualitative worldviews; the use of quantitative data does not by itself means that the research is (quasi) statistical, or uses a deductive logic:

Case-based methods are useful, and represent, among other things, a way of moving beyond a useless and destructive tradition in the social sciences that have set quantitative and qualitative modes of exploration, interpretation, and explanation against each other ( Byrne, 2013 , p. 9).

Other authors advocate different understandings of what a case study is. To some, it is a research method, to others it is a research strategy ( Creswell, 1998 ). Sharan Merrian and Robert Yin, among others, began to write about case study research as a methodology in the 1980s (Merrian, 2009), while authors such as Eisenhardt (1989) called it a research strategy. Stake (2003) sees the case study not as a method, but as a choice of what to be studied, the unit of study. Regardless of their differences, these authors agree that case studies should be restricted to a particular context as they aim to provide an in-depth knowledge of a given phenomenon: “A case study is an in-depth description and analysis of a bounded system” (Merrian, 2009, p. 40). According to Merrian, a qualitative case study can be defined by the process through which the research is carried out, by the unit of analysis or the final product, as the choice ultimately depends on what the researcher wants to know. As a product of research, it involves the analysis of a given entity, phenomenon or social unit.

Thus, whether it is an organization, an individual, a context or a phenomenon, single or multiple, one must delimit it, and also choose between possible types and configurations (Merrian, 2009; Yin, 2015 ). A case study may be descriptive, exploratory, explanatory, single or multiple ( Yin, 2015 ); intrinsic, instrumental or collective ( Stake, 2003 ); and confirm or build theory ( Eisenhardt, 1989 ).

both went through the same process of implementing computer labs intended for the use of information and communication technologies in 2007;

both took part in the same regional program (Paraná Digital); and

they shared similar characteristics regarding location (operation in the same neighborhood of a city), number of students, number of teachers and technicians and laboratory sizes.

However, the two institutions differed in the number of hours of program use, with one of them displaying a significant number of hours/use while the other showed a modest number, according to secondary data for the period 2007-2013. Despite the context being similar and the procedures for implementing the technology being the same, the mechanisms of social integration – an idiosyncratic factor of each institution – were different in each case. This explained differences in their use of resource, processes of organizational learning and capacity to absorb new knowledge.

On the other hand, multiple case studies seek evidence in different contexts and do not necessarily require direct comparisons ( Stake, 2003 ). Rather, there is a search for patterns of convergence and divergence that permeate all the cases, as the same issues are explored in every case. Cases can be added progressively until theoretical saturation is achieved. An example is of a study that investigated how entrepreneurial opportunity and management skills were developed through entrepreneurial learning ( Zampier & Takahashi, 2014 ). The authors conducted nine case studies, based on primary and secondary data, with each one analyzed separately, so a search for patterns could be undertaken. The convergence aspects found were: the predominant way of transforming experience into knowledge was exploitation; managerial skills were developed through by taking advantages of opportunities; and career orientation encompassed more than one style. As for divergence patterns: the experience of success and failure influenced entrepreneurs differently; the prevailing rationality logic of influence was different; and the combination of styles in career orientation was diverse.

A full discussion of choice of case study design is outside the scope of this article. For the sake of illustration, we make a brief mention to other selection criteria such as the purpose of the research, the state of the art of the research theme, the time and resources involved and the preferred epistemological position of the researcher. In the next section, we look at the possibilities of carrying out case studies in line with various epistemological traditions, as the answers to the “what is a case?” question reveal varied methodological commitments as well as diverse epistemological and ontological positions ( Ragin, 2013 ).

3. Epistemological positioning of case study research

Ontology and epistemology are like skin, not a garment to be occasionally worn ( Marsh & Furlong, 2002 ). According to these authors, ontology and epistemology guide the choice of theory and method because they cannot or should not be worn as a garment. Hence, one must practice philosophical “self-knowledge” to recognize one’s vision of what the world is and of how knowledge of that world is accessed and validated. Ontological and epistemological positions are relevant in that they involve the positioning of the researcher in social science and the phenomena he or she chooses to study. These positions do not tend to vary from one project to another although they can certainly change over time for a single researcher.

Ontology is the starting point from which the epistemological and methodological positions of the research arise ( Grix, 2002 ). Ontology expresses a view of the world, what constitutes reality, nature and the image one has of social reality; it is a theory of being ( Marsh & Furlong, 2002 ). The central question is the nature of the world out there regardless of our ability to access it. An essentialist or foundationalist ontology acknowledges that there are differences that persist over time and these differences are what underpin the construction of social life. An opposing, anti-foundationalist position presumes that the differences found are socially constructed and may vary – i.e. they are not essential but specific to a given culture at a given time ( Marsh & Furlong, 2002 ).

Epistemology is centered around a theory of knowledge, focusing on the process of acquiring and validating knowledge ( Grix, 2002 ). Positivists look at social phenomena as a world of causal relations where there is a single truth to be accessed and confirmed. In this tradition, case studies test hypotheses and rely on deductive approaches and quantitative data collection and analysis techniques. Scholars in the field of anthropology and observation-based qualitative studies proposed alternative epistemologies based on notions of the social world as a set of manifold and ever-changing processes. In management studies since the 1970s, the gradual acceptance of qualitative research has generated a diverse range of research methods and conceptions of the individual and society ( Godoy, 1995 ).

The interpretative tradition, in direct opposition to positivism, argues that there is no single objective truth to be discovered about the social world. The social world and our knowledge of it are the product of social constructions. Thus, the social world is constituted by interactions, and our knowledge is hermeneutic as the world does not exist independent of our knowledge ( Marsh & Furlong, 2002 ). The implication is that it is not possible to access social phenomena through objective, detached methods. Instead, the interaction mechanisms and relationships that make up social constructions have to be studied. Deductive approaches, hypothesis testing and quantitative methods are not relevant here. Hermeneutics, on the other hand, is highly relevant as it allows the analysis of the individual’s interpretation, of sayings, texts and actions, even though interpretation is always the “truth” of a subject. Methods such as ethnographic case studies, interviews and observations as data collection techniques should feed research designs according to interpretivism. It is worth pointing out that we are to a large extent, caricaturing polar opposites rather characterizing a range of epistemological alternatives, such as realism, conventionalism and symbolic interactionism.

If diverse ontologies and epistemologies serve as a guide to research approaches, including data collection and analysis methods, and if they should be regarded as skin rather than clothing, how does one make choices regarding case studies? What are case studies, what type of knowledge they provide and so on? The views of case study authors are not always explicit on this point, so we must delve into their texts to glean what their positions might be.

Two of the cited authors in case study research are Robert Yin and Kathleen Eisenhardt. Eisenhardt (1989) argues that a case study can serve to provide a description, test or generate a theory, the latter being the most relevant in contributing to the advancement of knowledge in a given area. She uses terms such as populations and samples, control variables, hypotheses and generalization of findings and even suggests an ideal number of case studies to allow for theory construction through replication. Although Eisenhardt includes observation and interview among her recommended data collection techniques, the approach is firmly anchored in a positivist epistemology:

Third, particularly in comparison with Strauss (1987) and Van Maanen (1988), the process described here adopts a positivist view of research. That is, the process is directed toward the development of testable hypotheses and theory which are generalizable across settings. In contrast, authors like Strauss and Van Maanen are more concerned that a rich, complex description of the specific cases under study evolve and they appear less concerned with development of generalizable theory ( Eisenhardt, 1989 , p. 546).

This position attracted a fair amount of criticism. Dyer & Wilkins (1991) in a critique of Eisenhardt’s (1989) article focused on the following aspects: there is no relevant justification for the number of cases recommended; it is the depth and not the number of cases that provides an actual contribution to theory; and the researcher’s purpose should be to get closer to the setting and interpret it. According to the same authors, discrepancies from prior expectations are also important as they lead researchers to reflect on existing theories. Eisenhardt & Graebner (2007 , p. 25) revisit the argument for the construction of a theory from multiple cases:

A major reason for the popularity and relevance of theory building from case studies is that it is one of the best (if not the best) of the bridges from rich qualitative evidence to mainstream deductive research.

Although they recognize the importance of single-case research to explore phenomena under unique or rare circumstances, they reaffirm the strength of multiple case designs as it is through them that better accuracy and generalization can be reached.

Likewise, Robert Yin emphasizes the importance of variables, triangulation in the search for “truth” and generalizable theoretical propositions. Yin (2015 , p. 18) suggests that the case study method may be appropriate for different epistemological orientations, although much of his work seems to invoke a realist epistemology. Authors such as Merrian (2009) and Stake (2003) suggest an interpretative version of case studies. Stake (2003) looks at cases as a qualitative option, where the most relevant criterion of case selection should be the opportunity to learn and understand a phenomenon. A case is not just a research method or strategy; it is a researcher’s choice about what will be studied:

Even if my definition of case study was agreed upon, and it is not, the term case and study defy full specification (Kemmis, 1980). A case study is both a process of inquiry about the case and the product of that inquiry ( Stake, 2003 , p. 136).

Later, Stake (2003 , p. 156) argues that:

[…] the purpose of a case report is not to represent the world, but to represent the case. […] The utility of case research to practitioners and policy makers is in its extension of experience.

Still according to Stake (2003 , pp. 140-141), to do justice to complex views of social phenomena, it is necessary to analyze the context and relate it to the case, to look for what is peculiar rather than common in cases to delimit their boundaries, to plan the data collection looking for what is common and unusual about facts, what could be valuable whether it is unique or common:

Reflecting upon the pertinent literature, I find case study methodology written largely by people who presume that the research should contribute to scientific generalization. The bulk of case study work, however, is done by individuals who have intrinsic interest in the case and little interest in the advance of science. Their designs aim the inquiry toward understanding of what is important about that case within its own world, which is seldom the same as the worlds of researchers and theorists. Those designs develop what is perceived to be the case’s own issues, contexts, and interpretations, its thick descriptions . In contrast, the methods of instrumental case study draw the researcher toward illustrating how the concerns of researchers and theorists are manifest in the case. Because the critical issues are more likely to be know in advance and following disciplinary expectations, such a design can take greater advantage of already developed instruments and preconceived coding schemes.

The aforementioned authors were listed to illustrate differences and sometimes opposing positions on case research. These differences are not restricted to a choice between positivism and interpretivism. It is worth noting that Ragin’s (2013 , p. 523) approach to “casing” is compatible with the realistic research perspective:

In essence, to posit cases is to engage in ontological speculation regarding what is obdurately real but only partially and indirectly accessible through social science. Bringing a realist perspective to the case question deepens and enriches the dialogue, clarifying some key issues while sweeping others aside.

cases are actual entities, reflecting their operations of real causal mechanism and process patterns;

case studies are interactive processes and are open to revisions and refinements; and

social phenomena are complex, contingent and context-specific.

Ragin (2013 , p. 532) concludes:

Lurking behind my discussion of negative case, populations, and possibility analysis is the implication that treating cases as members of given (and fixed) populations and seeking to infer the properties of populations may be a largely illusory exercise. While demographers have made good use of the concept of population, and continue to do so, it is not clear how much the utility of the concept extends beyond their domain. In case-oriented work, the notion of fixed populations of cases (observations) has much less analytic utility than simply “the set of relevant cases,” a grouping that must be specified or constructed by the researcher. The demarcation of this set, as the work of case-oriented researchers illustrates, is always tentative, fluid, and open to debate. It is only by casing social phenomena that social scientists perceive the homogeneity that allows analysis to proceed.

In summary, case studies are relevant and potentially compatible with a range of different epistemologies. Researchers’ ontological and epistemological positions will guide their choice of theory, methodologies and research techniques, as well as their research practices. The same applies to the choice of authors describing the research method and this choice should be coherent. We call this research alignment , an attribute that must be judged on the internal coherence of the author of a study, and not necessarily its evaluator. The following figure illustrates the interrelationship between the elements of a study necessary for an alignment ( Figure 1 ).

In addition to this broader aspect of the research as a whole, other factors should be part of the researcher’s concern, such as the rigor and quality of case studies. We will look into these in the next section taking into account their relevance to the different epistemologies.

4. Rigor and quality in case studies

Traditionally, at least in positivist studies, validity and reliability are the relevant quality criteria to judge research. Validity can be understood as external, internal and construct. External validity means identifying whether the findings of a study are generalizable to other studies using the logic of replication in multiple case studies. Internal validity may be established through the theoretical underpinning of existing relationships and it involves the use of protocols for the development and execution of case studies. Construct validity implies defining the operational measurement criteria to establish a chain of evidence, such as the use of multiple sources of evidence ( Eisenhardt, 1989 ; Yin, 2015 ). Reliability implies conducting other case studies, instead of just replicating results, to minimize the errors and bias of a study through case study protocols and the development of a case database ( Yin, 2015 ).

Several criticisms have been directed toward case studies, such as lack of rigor, lack of generalization potential, external validity and researcher bias. Case studies are often deemed to be unreliable because of a lack of rigor ( Seuring, 2008 ). Flyvbjerg (2006 , p. 219) addresses five misunderstandings about case-study research, and concludes that:

[…] a scientific discipline without a large number of thoroughly executed case studies is a discipline without systematic production of exemplars, and a discipline without exemplars is an ineffective one.

theoretical knowledge is more valuable than concrete, practical knowledge;

the case study cannot contribute to scientific development because it is not possible to generalize on the basis of an individual case;

the case study is more useful for generating rather than testing hypotheses;

the case study contains a tendency to confirm the researcher’s preconceived notions; and

it is difficult to summarize and develop general propositions and theories based on case studies.

These criticisms question the validity of the case study as a scientific method and should be corrected.

The critique of case studies is often framed from the standpoint of what Ragin (2000) labeled large-N research. The logic of small-N research, to which case studies belong, is different. Cases benefit from depth rather than breadth as they: provide theoretical and empirical knowledge; contribute to theory through propositions; serve not only to confirm knowledge, but also to challenge and overturn preconceived notions; and the difficulty in summarizing their conclusions is because of the complexity of the phenomena studies and not an intrinsic limitation of the method.

Thus, case studies do not seek large-scale generalizations as that is not their purpose. And yet, this is a limitation from a positivist perspective as there is an external reality to be “apprehended” and valid conclusions to be extracted for an entire population. If positivism is the epistemology of choice, the rigor of a case study can be demonstrated by detailing the criteria used for internal and external validity, construct validity and reliability ( Gibbert & Ruigrok, 2010 ; Gibbert, Ruigrok, & Wicki, 2008 ). An example can be seen in case studies in the area of information systems, where there is a predominant orientation of positivist approaches to this method ( Pozzebon & Freitas, 1998 ). In this area, rigor also involves the definition of a unit of analysis, type of research, number of cases, selection of sites, definition of data collection and analysis procedures, definition of the research protocol and writing a final report. Creswell (1998) presents a checklist for researchers to assess whether the study was well written, if it has reliability and validity and if it followed methodological protocols.

In case studies with a non-positivist orientation, rigor can be achieved through careful alignment (coherence among ontology, epistemology, theory and method). Moreover, the concepts of validity can be understood as concern and care in formulating research, research development and research results ( Ollaik & Ziller, 2012 ), and to achieve internal coherence ( Gibbert et al. , 2008 ). The consistency between data collection and interpretation, and the observed reality also help these studies meet coherence and rigor criteria. Siggelkow (2007) argues that a case study should be persuasive and that even a single case study may be a powerful example to contest a widely held view. To him, the value of a single case study or studies with few cases can be attained by their potential to provide conceptual insights and coherence to the internal logic of conceptual arguments: “[…] a paper should allow a reader to see the world, and not just the literature, in a new way” ( Siggelkow, 2007 , p. 23).

Interpretative studies should not be justified by criteria derived from positivism as they are based on a different ontology and epistemology ( Sandberg, 2005 ). The rejection of an interpretive epistemology leads to the rejection of an objective reality: “As Bengtsson points out, the life-world is the subjects’ experience of reality, at the same time as it is objective in the sense that it is an intersubjective world” ( Sandberg, 2005 , p. 47). In this event, how can one demonstrate what positivists call validity and reliability? What would be the criteria to justify knowledge as truth, produced by research in this epistemology? Sandberg (2005 , p. 62) suggests an answer based on phenomenology:

This was demonstrated first by explicating life-world and intentionality as the basic assumptions underlying the interpretative research tradition. Second, based on those assumptions, truth as intentional fulfillment, consisting of perceived fulfillment, fulfillment in practice, and indeterminate fulfillment, was proposed. Third, based on the proposed truth constellation, communicative, pragmatic, and transgressive validity and reliability as interpretative awareness were presented as the most appropriate criteria for justifying knowledge produced within interpretative approach. Finally, the phenomenological epoché was suggested as a strategy for achieving these criteria.

From this standpoint, the research site must be chosen according to its uniqueness so that one can obtain relevant insights that no other site could provide ( Siggelkow, 2007 ). Furthermore, the view of what is being studied is at the center of the researcher’s attention to understand its “truth,” inserted in a given context.

The case researcher is someone who can reduce the probability of misinterpretations by analyzing multiple perceptions, searches for data triangulation to check for the reliability of interpretations ( Stake, 2003 ). It is worth pointing out that this is not an option for studies that specifically seek the individual’s experience in relation to organizational phenomena.

In short, there are different ways of seeking rigor and quality in case studies, depending on the researcher’s worldview. These different forms pervade everything from the research design, the choice of research questions, the theory or theories to look at a phenomenon, research methods, the data collection and analysis techniques, to the type and style of research report produced. Validity can also take on different forms. While positivism is concerned with validity of the research question and results, interpretivism emphasizes research processes without neglecting the importance of the articulation of pertinent research questions and the sound interpretation of results ( Ollaik & Ziller, 2012 ). The means to achieve this can be diverse, such as triangulation (of multiple theories, multiple methods, multiple data sources or multiple investigators), pre-tests of data collection instrument, pilot case, study protocol, detailed description of procedures such as field diary in observations, researcher positioning (reflexivity), theoretical-empirical consistency, thick description and transferability.

5. Conclusions

The central objective of this article was to discuss concepts of case study research, their potential and various uses, taking into account different epistemologies as well as criteria of rigor and validity. Although the literature on methodology in general and on case studies in particular, is voluminous, it is not easy to relate this approach to epistemology. In addition, method manuals often focus on the details of various case study approaches which confuse things further.

Faced with this scenario, we have tried to address some central points in this debate and present various ways of using case studies according to the preferred epistemology of the researcher. We emphasize that this understanding depends on how a case is defined and the particular epistemological orientation that underpins that conceptualization. We have argued that whatever the epistemological orientation is, it is possible to meet appropriate criteria of research rigor and quality provided there is an alignment among the different elements of the research process. Furthermore, multiple data collection techniques can be used in in single or multiple case study designs. Data collection techniques or the type of data collected do not define the method or whether cases should be used for theory-building or theory-testing.

Finally, we encourage researchers to consider case study research as one way to foster immersion in phenomena and their contexts, stressing that the approach does not imply a commitment to a particular epistemology or type of research, such as qualitative or quantitative. Case study research allows for numerous possibilities, and should be celebrated for that diversity rather than pigeon-holed as a monolithic research method.

The interrelationship between the building blocks of research

Byrne , D. ( 2013 ). Case-based methods: Why We need them; what they are; how to do them . Byrne D. In D Byrne. and C.C Ragin (Eds.), The SAGE handbooks of Case-Based methods , pp. 1 – 10 . London : SAGE Publications Inc .

Creswell , J. W. ( 1998 ). Qualitative inquiry and research design: choosing among five traditions , London : Sage Publications .

Coraiola , D. M. , Sander , J. A. , Maccali , N. & Bulgacov , S. ( 2013 ). Estudo de caso . In A. R. W. Takahashi , (Ed.), Pesquisa qualitativa em administração: Fundamentos, métodos e usos no Brasil , pp. 307 – 341 . São Paulo : Atlas .

Dyer , W. G. , & Wilkins , A. L. ( 1991 ). Better stories, not better constructs, to generate better theory: a rejoinder to Eisenhardt . The Academy of Management Review , 16 , 613 – 627 .

Eisenhardt , K. ( 1989 ). Building theory from case study research . Academy of Management Review , 14 , 532 – 550 .

Eisenhardt , K. M. , & Graebner , M. E. ( 2007 ). Theory building from cases: Opportunities and challenges . Academy of Management Journal , 50 , 25 – 32 .

Flyvbjerg , B. ( 2006 ). Five misunderstandings about case-study research . Qualitative Inquiry , 12 , 219 – 245 .

Freitas , J. S. , Ferreira , J. C. A. , Campos , A. A. R. , Melo , J. C. F. , Cheng , L. C. , & Gonçalves , C. A. ( 2017 ). Methodological roadmapping: a study of centering resonance analysis . RAUSP Management Journal , 53 , 459 – 475 .

Gibbert , M. , Ruigrok , W. , & Wicki , B. ( 2008 ). What passes as a rigorous case study? . Strategic Management Journal , 29 , 1465 – 1474 .

Gibbert , M. , & Ruigrok , W. ( 2010 ). The “what” and “how” of case study rigor: Three strategies based on published work . Organizational Research Methods , 13 , 710 – 737 .

Godoy , A. S. ( 1995 ). Introdução à pesquisa qualitativa e suas possibilidades . Revista de Administração de Empresas , 35 , 57 – 63 .

Grix , J. ( 2002 ). Introducing students to the generic terminology of social research . Politics , 22 , 175 – 186 .

Marsh , D. , & Furlong , P. ( 2002 ). A skin, not a sweater: ontology and epistemology in political science . In D Marsh. , & G Stoker , (Eds.), Theory and Methods in Political Science , New York, NY : Palgrave McMillan , pp. 17 – 41 .

McKeown , T. J. ( 1999 ). Case studies and the statistical worldview: Review of King, Keohane, and Verba’s designing social inquiry: Scientific inference in qualitative research . International Organization , 53 , 161 – 190 .

Merriam , S. B. ( 2009 ). Qualitative research: a guide to design and implementation .

Ollaik , L. G. , & Ziller , H. ( 2012 ). Distintas concepções de validade em pesquisas qualitativas . Educação e Pesquisa , 38 , 229 – 241 .

Picoli , F. R. , & Takahashi , A. R. W. ( 2016 ). Capacidade de absorção, aprendizagem organizacional e mecanismos de integração social . Revista de Administração Contemporânea , 20 , 1 – 20 .

Pozzebon , M. , & Freitas , H. M. R. ( 1998 ). Pela aplicabilidade: com um maior rigor científico – dos estudos de caso em sistemas de informação . Revista de Administração Contemporânea , 2 , 143 – 170 .

Sandberg , J. ( 2005 ). How do we justify knowledge produced within interpretive approaches? . Organizational Research Methods , 8 , 41 – 68 .

Seuring , S. A. ( 2008 ). Assessing the rigor of case study research in supply chain management. Supply chain management . Supply Chain Management: An International Journal , 13 , 128 – 137 .

Siggelkow , N. ( 2007 ). Persuasion with case studies . Academy of Management Journal , 50 , 20 – 24 .

Stake , R. E. ( 2003 ). Case studies . In N. K. , Denzin , & Y. S. , Lincoln (Eds.). Strategies of Qualitative Inquiry , London : Sage Publications . pp. 134 – 164 .

Takahashi , A. R. W. , & Semprebom , E. ( 2013 ). Resultados gerais e desafios . In A. R. W. , Takahashi (Ed.), Pesquisa qualitativa em administração: Fundamentos, métodos e usos no brasil , pp. 343 – 354 . São Paulo : Atlas .

Ragin , C. C. ( 1992 ). Introduction: Cases of “what is a case? . In H. S. , Becker , & C. C. Ragin and (Eds). What is a case? Exploring the foundations of social inquiry , pp. 1 – 18 .

Ragin , C. C. ( 2013 ). Reflections on casing and Case-Oriented research . In D , Byrne. , & C. C. Ragin (Eds.), The SAGE handbooks of Case-Based methods , London : SAGE Publications , pp. 522 – 534 .

Yin , R. K. ( 2015 ). Estudo de caso: planejamento e métodos , Porto Alegre : Bookman .

Zampier , M. A. , & Takahashi , A. R. W. ( 2014 ). Aprendizagem e competências empreendedoras: Estudo de casos de micro e pequenas empresas do setor educacional . RGO Revista Gestão Organizacional , 6 , 1 – 18 .

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The case study as a research strategy

Affiliation.

• 1 Centre for Health Promotion Research, Halmstad University, Sweden.
• PMID: 9275815
• DOI: 10.1111/j.1471-6712.1997.tb00423.x

A research strategy seldom used in the caring sciences is the case study. A case study is an empirical in-depth inquiry about an individual, family, group or organization. It is preferable when 'how' and 'why' questions are asked. The case study is mainly used to explain those causal links in real-life intervention that are too complex for either the survey or experimental strategies. Like other research strategies, its design includes questions or propositions, units of analysis, the logic linking the data to the questions or propositions, and the interpretations of the outcomes. A case study can be reported as a single case or as a compilation of a series of cases. In conclusion, a case study is a simple and excellent way for a care professional to present him or herself to the scientific world.

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A new strategy model for reducing industrial pollutants using structural equation modeling (SEM): a case study

• Research Article
• Published: 14 August 2024

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• Pegah Faghani Kondori 1 ,
• Ali Mostafaeipour   ORCID: orcid.org/0000-0002-2195-4511 2 , 3 ,
• Ttu Le 2 , 3 &
• Saba Javanpour 1  

Economic developments over recent decades have led to environmental issues. Industries have been introduced among the main causes of environmental degradation. From this perspective, this research work identifies strategies for reducing industrial pollutants. In the first part, the factors concerned and their impacts on mitigating industrial pollutants are identified. Then, the initial model is developed. The case examined here is Mashhad Industrial Zone, Mashhad, Iran, wherein the questionnaire was distributed. Given the non-normal data in this study, the initial model fit is further measured by structural equation modeling (SEM), using SmartPLS. Upon the model fit confirmation, the research hypotheses, i.e., the factors affecting the reduction of industrial pollutants, are assessed. The results indicated that, among the variables examined, seven components can significantly prevent industrial pollutants. In view of this, green industry status quo with the effect size of 0.3 has the greatest possible impact on diminishing industrial pollutants. The next uppermost strategies for this purpose are government incentives, management commitment, green product marketing, competitive strategies, government oversight, and political issues, with the effect size values of 0.21, 0.20, 0.19, 0.15, 0.12, and 0.09, respectively. Financial issues and government regulations are not directly linked with lowering pollutants emanating from industries.

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Adeyemi AA, Ojekunle ZO (2021) Concentrations and health risk assessment of industrial heavy metals pollution in groundwater in Ogun state, Nigeria. Sci Afr 11(1):666. https://doi.org/10.1016/j.sciaf.2020.e00666

Article   CAS   Google Scholar  

Ali ANA, Jainudin NA, Tawie R, Jugah I (2016) Green initiatives in Kota Kinabalu construction industry. Procedia Soc Behav Sci 224:626–631. https://doi.org/10.1016/j.sbspro.2016.05.453

Article   Google Scholar  

Almutairi K, Hosseini Dehshiri S, Hosseini Dehshiri S et al (2023) Blockchain technology application challenges in renewable energy supply chain management. Environ Sci Pollut Res 30:72041–72058. https://doi.org/10.1007/s11356-021-18311-7

Barclay D, Higgins C, Thompson R (1995) The partial least squares (PLS) approach to casual modeling: personal computer adoption and use as an illustration. Technol Stud 2(2):285–309

Google Scholar  

Bertoldo G, Callegher C Z, Altoè G (2022) Designing studies and evaluating research results: type M and type S errors for Pearson correlation coefficient. Meta-Psychology 6 https://doi.org/10.15626/MP.2020.2573

Chan EH, Qian QK, Lam PT (2009) The market for green building in developed Asian cities—the perspectives of building designers. Energy Policy 37(8):3061–3070. https://doi.org/10.1016/j.enpol.2009.03.057

Chin WW (1998) The partial least squares approach for structural equation modeling. In: Marcoulides GA (ed) Modern methods for business research, 1st edn. Lawrence Erlbaum Associates, Mahwah, pp 295–336

Cronbach LJ (1951) Coefficient alpha and the internal structure of tests. Psychometrika 16(3):297–334

Dahui XXW (1999) Reducing greenhouse gas emissions from energy consumption activities by the iron and steel industry in East China. Energy Sources 21(6):541–546. https://doi.org/10.1080/00908319950014669

Daştan M, Eygü H (2023) An empirical investigation of the link between economic growth, unemployment, and ecological footprint in Turkey Bridging the EKC and EPC hypotheses. Environ Dev Sustain. https://doi.org/10.1007/s10668-023-04106-y

Davies P, Osmani M (2011) Low carbon housing refurbishment challenges and incentives: architects’ perspectives. Build Environ 46(8):1691–1698. https://doi.org/10.1016/j.buildenv.2011.02.011

Demirbas T, Demirbas AH (2010) Bioenergy, green energy. Biomass and biofuels. Energy Sources Part A: Recov Util Environ Eff 32(12):1067–1075. https://doi.org/10.1080/15567030903058600

Deng W, Yang T, Tang L, Tang YT (2018) Barriers and policy recommendations for developing green buildings from local government perspective: a case study of Ningbo China. Intell Build Int 10(2):61–77. https://doi.org/10.1080/17508975.2016.1248342

DiLalla LF (2000) Structural equation modeling: uses and issues. Handbook of applied multivariate statistics and mathematical modelling. Academic, pp 439–464. https://doi.org/10.1016/B978-012691360-6/50016-1

Each country’s share of CO 2 emissions (2020) Retrieved from. https://www.ucsusa.org/resources/each-countrys-share-co2-emissions

Eygü H, Eygü S (2022) Factors affecting perceived learning satisfaction in distance education in Turkey. Çukurova Üniversitesi Eğitim Fakültesi Dergisi 51(3):1769–1790.  https://dergipark.org.tr/tr/pub/cuefd . Accessed 24 June 2024

Eygu H, Soğukpınar F (2023) Investigation of the relationship between renewable energy, natural gas, and coal consumption with economic growth in Turkey: evidence from augmented ARDL approach. Environ Sci Pollut Res 30:58213–58225. https://doi.org/10.1007/s11356-023-26551-y

Fornell C, Larcker DF (1981) Evaluating structural equation models with unobservable variables and measurement error. J Mark Res 18(1):39–50. https://doi.org/10.2307/3151312

Gelman A, Carlin J (2014) Beyond power calculations: assessing type S (Sign) and type M (magnitude) errors. Perspect Psychol Sci 9(6):641–651. https://doi.org/10.1177/1745691614551642

Gelman A, Tuerlinckx F (2000) Type S error rates for classical and Bayesian single and multiple comparison procedures. Comput Stat 15:373–390

Guan L, Abbasi A, Ryan MJ (2020) Analyzing green building project risk interdependencies using Interpretive Structural Modeling. J Clean Prod 256:120372. https://doi.org/10.1016/j.jclepro.2020.120372

Guo F, Zhou M, De L et al (2023) What is affecting the improvement of green innovation efficiency in the old industrial base: evidence from Northeast China. Environ Sci Pollut Res 30:117759–117771. https://doi.org/10.1007/s11356-023-30525-5

Han Q, Liu Y, Feng X, Mao P, Sun A, Wang M, Wang M (2021) Pollution effect assessment of industrial activities on potentially toxic metal distribution in windowsill dust and surface soil in central China. Sci Total Environ 759:144023. https://doi.org/10.1016/j.scitotenv.2020.144023

Hasan MSMS (2016) Green policy development and its impact on the construction industry in China. Br J Appl Sci Technol 17(4):1–11. https://doi.org/10.9734/BJAST/2016/28983

Hayashi K, Bentler PM, Yuan KH (2007) Structural equation modeling. Handbook of statistics vol. 27. Elsevier, pp 395-428

Henseler J, Ringle CM, Sinkovics RR (2009) The use of partial least squares path modeling in international marketing. In: New challenges to international marketing. Emerald Group Publishing Limited. https://doi.org/10.1108/S1474-7979(2009)0000020014

Hosseini S M, Shirmohammadi R, Aslani A (2020) Achieving to a low carbon-energy commercial building in the hot-dry climate area. Energy Sources Part A: Recov Util Environ Eff 1–19.‏ https://doi.org/10.1080/15567036.2020.1826013

Hsu SH, Chen WH, Hsieh MJ (2006) Robustness testing of PLS, LISREL, EQS and ANN-based SEM for measuring customer satisfaction. Total Qual Manag Bus Excell 17(3):355–372. https://doi.org/10.1080/14783360500451465

Jiang P, Tovey NK (2009) Opportunities for low carbon sustainability in large commercial buildings in China. Energy Policy 37(11):4949–4958. https://doi.org/10.1016/j.enpol.2009.06.059

Kirikkaleli (2023) Environmental taxes and environmental quality in Canada. Environ Sci Pollut Res 30:117862–117870. https://doi.org/10.1007/s11356-023-30616-3

Kishore K, Gupta N (2020) Application of domestic & industrial waste materials in concrete: a review. Mater Today: Proc 26:2926–2931. https://doi.org/10.1016/j.matpr.2020.02.604

Lai X, Liu J, Shi Q, Georgiev G, Wu G (2017) Driving forces for low carbon technology innovation in the building industry: a critical review. Renew Sustain Energy Rev 74:299–315

Li Y, Song H, Sang P, Chen PH, Liu X (2019) Review of critical success factors (CSFs) for green building projects. Build Environ 158:182–191. https://doi.org/10.1016/j.buildenv.2019.05.020

Liu Y, Sun X, Sun T, Liu J (2019) Promoting green residential buildings by increasing homebuyers’ willingness to pay: evidence from Sino-Singapore Tianjin Eco-city in China. J Clean Prod 238:117884. https://doi.org/10.1016/j.jclepro.2019.117884

Liu S, Wang X, Guo G, Yan Z (2021) Status and environmental management of soil mercury pollution in China: a review. J Environ Manag 277:111442. https://doi.org/10.1016/j.jenvman.2020.111442

Mostafaeipour A, Rezaei M, Jahangiri M, Qolipour M (2020) Feasibility analysis of a new tree-shaped wind turbine for urban application: a case study. Energy Environ 31(7):1230–1256. https://doi.org/10.1177/0958305X19888878

Mostafaeipour A, Abesi S (2010) Wind turbine productivity and development in Iran. In Proceedings of the 2010 International Conference on Biosciences (BIOSCIENCESWORLD '10). IEEE Computer Society, USA, 112–118. https://doi.org/10.1109/BioSciencesWorld.2010.30

Noranarttakun P, Pharino C (2021) Strategic implementation to enhance green industry practices in SMEs: lesson learned from Thailand. Environ Asia 14(1):93–105. https://doi.org/10.14456/ea.2021.10

Osmani M, O’Reilly A (2009) Feasibility of zero carbon homes in England by 2016: a house builder’s perspective. Build Environ 44(9):1917–1924. https://doi.org/10.1016/j.buildenv.2009.01.005

Prosser H, Moss S, Costello H, Simpson N, Patel P, Rowe S (1998) Reliability and validity of the Mini PAS-ADD for assessing psychiatric disorders in adults with intellectual disability. J Intellect Disabil Res 42(4):264–272. https://doi.org/10.1046/j.1365-2788.1998.00146.x

Putra INM, Martono DN, Nurcahyo R (2020) Factors that affect the interest of the manufacturing industries to implement the green industry certification regulation in Indonesia. In: E3S Web of Conferences, vol 202. EDP Sciences, Article number 03032. Section: Environmental Policy, Planning and Education. ‏ https://doi.org/10.1051/e3sconf/202020203032

Qi GY, Shen LY, Zeng SX, Jorge OJ (2010) The drivers for contractors’ green innovation: an industry perspective. J Clean Prod 18(14):1358–1365. https://doi.org/10.1016/j.jclepro.2010.04.017

Samadianfard S, Hashemi S, Kargar K, Izadyar M, Mostafaeipour A, Mosavi A, Nabipour N, Shamshirband S (2020) Wind speed prediction using a hybrid model of the multi-layer perceptron and whale optimization algorithm. Energy Rep 6:1147–1159. https://doi.org/10.1016/j.egyr.2020.05.001

Sinan W, Ruiping L, Yingjie W, Wenjun W (2023) Estimation of surface soil moisture by combining a structural equation model and an artificial neural network (SEM-ANN). Sci Total Environ 876:62558. https://doi.org/10.1016/j.scitotenv.2023.162558

Song L, Zhou X (2021) Does the green industry policy reduce industrial pollution emissions?—Evidence from China’s national eco-industrial park. Sustainability 13(11):6343. https://doi.org/10.3390/su13116343

Taleghani A, Almassi M, Ghahderijani M (2020) Energy sources analysis and optimization of energy efficiency and greenhouse gases in production of farm crops. Energy Sources Part A: Recov Util Environ Eff 1–15.‏ https://doi.org/10.1080/15567036.2020.1832160

Tong B (2023) Green tourism to green environment: unleashing green pro-tourism behavior for green tourism competitiveness in China. Environ Sci Pollut Res 30:117923–117931. https://doi.org/10.1007/s11356-023-30395-x

Wang X, Hua C, Miao J (2022) The spatial effect of factor market distortion on green agriculture development in China. Energy Sources Part A: Recov Util Environ Eff 1–17. https://doi.org/10.1080/15567036.2022.2027579

Wang X, Zhou D (2021) Spatial agglomeration and driving factors of environmental pollution: a spatial analysis. J Clean Prod 279:123839. https://doi.org/10.1016/j.jclepro.2020.123839

Wetzels M, Odekerken-Schröder G, Van Oppen C (2009) Using PLS path modeling for assessing hierarchical construct models: guidelines and empirical illustration. MIS Q 33(1):177–195. https://doi.org/10.2307/20650284

Wong PS, Owczarek A, Murison M, Kefalianos Z, Spinozzi J (2014) Driving construction contractors to adopt carbon reduction strategies–an Australian approach. J Environ Plan Manag 57(10):1465–1483. https://doi.org/10.1080/09640568.2013.811402

Wu Y, Yu J, Song M, Chen J, Hou W (2021) Shadow prices of industrial air pollutant emissions in China. Econ Model 94:726–736. https://doi.org/10.1016/j.econmod.2020.02.014

Yang X, Zhang J, Ren S, Ran Q (2021) Can the new energy demonstration city policy reduce environmental pollution? Evidence from a quasi-natural experiment in China. J Clean Prod 287:125015. https://doi.org/10.1016/j.jclepro.2020.125015

Yas Z, Jaafer K (2020) Factors influencing the spread of green building projects in the UAE. J Build Eng 27:100894. https://doi.org/10.1016/j.jobe.2019.100894

Ye H, Ren Q, Shi L, Song J, Hu X, Li X, Zhang G, Lin T, Xue X (2018) The role of climate, construction quality, microclimate, and socio-economic conditions on carbon emissions from office buildings in China. J Clean Prod 171:911–916. https://doi.org/10.1016/j.jclepro.2017.10.099

Yıldırım MŞ, Baycan İO (2023) Analyzing the effects of energy productivity: the case of European Union countries. Environ Sci Pollut Res 30:117519–117530. https://doi.org/10.1007/s11356-023-30516-6

Zeng J, He Q (2019) Does industrial air pollution drive health care expenditures? Spatial evidence from China. J Clean Prod 218:400–408. https://doi.org/10.1016/j.jclepro.2019.01.288

Zhang Q (2023) Modeling the city-level synergistic effect of low-carbon economic development in China’s Yangtze River Delta. Environ Sci Pollut Res 30:117302–117324. https://doi.org/10.1007/s11356-023-30338-6

Zhang L, Zhou J (2016) The effect of carbon reduction regulations on contractors’ awareness and behaviors in China’s building sector. J Clean Prod 113:93–101. https://doi.org/10.1016/j.jclepro.2015.12.032

Zhang L, Li Q, Zhou J (2017) Critical factors of LC building development in China’s urban area. J Clean Prod 142:3075–3082. https://doi.org/10.1016/j.jclepro.2016.10.16010.1016/j.rser.2017.02.044

Zhang J, Ouyang Y, Ballesteros-Pérez P, Li H, Philbin SP, Li Z, Skitmore M (2021) Understanding the impact of environmental regulations on green technology innovation efficiency in the construction industry. Sustain Cities Soc 65:102647. https://doi.org/10.1016/j.scs.2020.102647

Zuo J, Read B, Pullen S, Shi Q (2012) Achieving carbon neutrality in commercial building developments–perceptions of the construction industry. Habitat Int 36(2):278–286. https://doi.org/10.1016/j.habitatint.2011.10.010

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Pegah Faghani Kondori & Saba Javanpour

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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Ali Mostafaeipour, Pegah Faghani Kondori, Ttu Le, and Saba Javanpour. The first draft of the manuscript was written by Pegah Faghani Kondori and Ali Mostafaeipour and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Faghani Kondori, P., Mostafaeipour, A., Le, T. et al. A new strategy model for reducing industrial pollutants using structural equation modeling (SEM): a case study. Environ Sci Pollut Res (2024). https://doi.org/10.1007/s11356-024-34610-1

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Received : 14 December 2023

Accepted : 30 July 2024

Published : 14 August 2024

DOI : https://doi.org/10.1007/s11356-024-34610-1

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UrbanLuxe Cosmetics: Embracing S&OP/IBP

The case is seen through the eyes of the newly appointed supply chain director at a cosmetics company based in Berlin. The general manager has tasked the new supply chain director to provide bold process recommendations to improve the poor service, high inventory and rampant use of overtime. To understand the issues at play, the supply chain director meets with the CFO, the factory manager, the chief procurement officer and chief revenue officer and their feedback constitutes the body of the case. Each individual offers a different perspective, though none take any responsibility. The CFO is unhappy with the high inventory levels. The factory manager feels helpless in the situation. The chief procurement officer is proud of the savings he has generated by shifting to Asia. The chief revenue officer appears altogether disinterested and not concerned by the problem. The supply chain director must integrate this feedback and propose a new process that will address the performance shortcomings, define the roles and responsibilities of each, along with KPIs to monitor progress.

The participant will learn:

• The elements of a robust S&OP process
• The challenges involved when defining an end-to-end planning governance structure
• The roles each actor in a company may play and their related responsibilities
• The ways in which different steps in planning impact performance
• The KPIs that can capture performance and progress

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PLANTING SEEDS OF BELONGING: A CASE STUDY

At present, formal and non-formal agricultural spaces, including agricultural education, do not provide opportunities for individuals from historically and contemporarily marginalized communities to develop a strong sense of belonging. An increase in sense of belonging may increase retention for all individuals interacting with agricultural programs and more effectively disseminate tools and resources to a wider audience, which can help solve agricultural issues such as the hunger crisis. The Garden Sun Institute (GSI) is a non-formal agricultural education program that is changing this narrative, with many staff and students of marginalized populations expressing a deep sense of belonging not only with others at GSI but also feeling a sense of belonging in the field of agriculture. The purpose of this case study was to explore whether there is a sense of belonging at this location and to determine what factors may contribute to it. The questions guiding this study are: 1) How do youth describe a sense of belonging at GSI? 2) How does GSI engage with youth, family, and staff? and 3) How do those engaging with GSI describe a sense of belonging within agriculture broadly? Results from this study showed that utilizing elements of the Critical Pedagogy of Agriculture along with practices such as trauma-informed pedagogy, student-led and student-centered learning, and gentle parenting have led to this program developing a culture of belonging. Future research recommendations include determining accountability strategies and investigating the impacts of the incorporation of strategies into formal education programs.

Degree Type

• Master of Science
• Agricultural Sciences Education and Communication

Campus location

• West Lafayette

Advisor/Supervisor/Committee Chair

Additional committee member 2, additional committee member 3, additional committee member 4, usage metrics.

• Secondary education
• Inclusive education
• Other agricultural, veterinary and food sciences not elsewhere classified

9 Best Marketing Research Methods to Know Your Buyer Better [+ Examples]

Published: August 08, 2024

One of the most underrated skills you can have as a marketer is marketing research — which is great news for this unapologetic cyber sleuth.

From brand design and product development to buyer personas and competitive analysis, I’ve researched a number of initiatives in my decade-long marketing career.

And let me tell you: having the right marketing research methods in your toolbox is a must.

Market research is the secret to crafting a strategy that will truly help you accomplish your goals. The good news is there is no shortage of options.

How to Choose a Marketing Research Method

Thanks to the Internet, we have more marketing research (or market research) methods at our fingertips than ever, but they’re not all created equal. Let’s quickly go over how to choose the right one.

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1. Identify your objective.

What are you researching? Do you need to understand your audience better? How about your competition? Or maybe you want to know more about your customer’s feelings about a specific product.

Before starting your research, take some time to identify precisely what you’re looking for. This could be a goal you want to reach, a problem you need to solve, or a question you need to answer.

For example, an objective may be as foundational as understanding your ideal customer better to create new buyer personas for your marketing agency (pause for flashbacks to my former life).

Or if you’re an organic sode company, it could be trying to learn what flavors people are craving.

2. Determine what type of data and research you need.

Next, determine what data type will best answer the problems or questions you identified. There are primarily two types: qualitative and quantitative. (Sound familiar, right?)

• Qualitative Data is non-numerical information, like subjective characteristics, opinions, and feelings. It’s pretty open to interpretation and descriptive, but it’s also harder to measure. This type of data can be collected through interviews, observations, and open-ended questions.
• Quantitative Data , on the other hand, is numerical information, such as quantities, sizes, amounts, or percentages. It’s measurable and usually pretty hard to argue with, coming from a reputable source. It can be derived through surveys, experiments, or statistical analysis.

Understanding the differences between qualitative and quantitative data will help you pinpoint which research methods will yield the desired results.

For instance, thinking of our earlier examples, qualitative data would usually be best suited for buyer personas, while quantitative data is more useful for the soda flavors.

However, truth be told, the two really work together.

Qualitative conclusions are usually drawn from quantitative, numerical data. So, you’ll likely need both to get the complete picture of your subject.

For example, if your quantitative data says 70% of people are Team Black and only 30% are Team Green — Shout out to my fellow House of the Dragon fans — your qualitative data will say people support Black more than Green.

(As they should.)

Primary Research vs Secondary Research

You’ll also want to understand the difference between primary and secondary research.

Primary research involves collecting new, original data directly from the source (say, your target market). In other words, it’s information gathered first-hand that wasn’t found elsewhere.

Some examples include conducting experiments, surveys, interviews, observations, or focus groups.

Meanwhile, secondary research is the analysis and interpretation of existing data collected from others. Think of this like what we used to do for school projects: We would read a book, scour the internet, or pull insights from others to work from.

So, which is better?

Personally, I say any research is good research, but if you have the time and resources, primary research is hard to top. With it, you don’t have to worry about your source's credibility or how relevant it is to your specific objective.

You are in full control and best equipped to get the reliable information you need.

3. Put it all together.

Once you know your objective and what kind of data you want, you’re ready to select your marketing research method.

For instance, let’s say you’re a restaurant trying to see how attendees felt about the Speed Dating event you hosted last week.

You shouldn’t run a field experiment or download a third-party report on speed dating events; those would be useless to you. You need to conduct a survey that allows you to ask pointed questions about the event.

This would yield both qualitative and quantitative data you can use to improve and bring together more love birds next time around.

Best Market Research Methods for 2024

Now that you know what you’re looking for in a marketing research method, let’s dive into the best options.

Note: According to HubSpot’s 2024 State of Marketing report, understanding customers and their needs is one of the biggest challenges facing marketers today. The options we discuss are great consumer research methodologies , but they can also be used for other areas.

Primary Research

1. interviews.

Interviews are a form of primary research where you ask people specific questions about a topic or theme. They typically deliver qualitative information.

I’ve conducted many interviews for marketing purposes, but I’ve also done many for journalistic purposes, like this profile on comedian Zarna Garg . There’s no better way to gather candid, open-ended insights in my book, but that doesn’t mean they’re a cure-all.

What I like: Real-time conversations allow you to ask different questions if you’re not getting the information you need. They also push interviewees to respond quickly, which can result in more authentic answers.

What I dislike: They can be time-consuming and harder to measure (read: get quantitative data) unless you ask pointed yes or no questions.

Best for: Creating buyer personas or getting feedback on customer experience, a product, or content.

2. Focus Groups

Focus groups are similar to conducting interviews but on a larger scale.

In marketing and business, this typically means getting a small group together in a room (or Zoom), asking them questions about various topics you are researching. You record and/or observe their responses to then take action.

They are ideal for collecting long-form, open-ended feedback, and subjective opinions.

One well-known focus group you may remember was run by Domino’s Pizza in 2009 .

After poor ratings and dropping over $100 million in revenue, the brand conducted focus groups with real customers to learn where they could have done better.

It was met with comments like “worst excuse for pizza I’ve ever had” and “the crust tastes like cardboard.” But rather than running from the tough love, it took the hit and completely overhauled its recipes.

The team admitted their missteps and returned to the market with better food and a campaign detailing their “Pizza Turn Around.”

The result? The brand won a ton of praise for its willingness to take feedback, efforts to do right by its consumers, and clever campaign. But, most importantly, revenue for Domino’s rose by 14.3% over the previous year.

The brand continues to conduct focus groups and share real footage from them in its promotion:

What I like: Similar to interviewing, you can dig deeper and pivot as needed due to the real-time nature. They’re personal and detailed.

What I dislike: Once again, they can be time-consuming and make it difficult to get quantitative data. There is also a chance some participants may overshadow others.

Best for: Product research or development

Pro tip: Need help planning your focus group? Our free Market Research Kit includes a handy template to start organizing your thoughts in addition to a SWOT Analysis Template, Survey Template, Focus Group Template, Presentation Template, Five Forces Industry Analysis Template, and an instructional guide for all of them. Download yours here now.

3. Surveys or Polls

Surveys are a form of primary research where individuals are asked a collection of questions. It can take many different forms.

They could be in person, over the phone or video call, by email, via an online form, or even on social media. Questions can be also open-ended or closed to deliver qualitative or quantitative information.

A great example of a close-ended survey is HubSpot’s annual State of Marketing .

In the State of Marketing, HubSpot asks marketing professionals from around the world a series of multiple-choice questions to gather data on the state of the marketing industry and to identify trends.

The survey covers various topics related to marketing strategies, tactics, tools, and challenges that marketers face. It aims to provide benchmarks to help you make informed decisions about your marketing.

It also helps us understand where our customers’ heads are so we can better evolve our products to meet their needs.

Apple is no stranger to surveys, either.

In 2011, the tech giant launched Apple Customer Pulse , which it described as “an online community of Apple product users who provide input on a variety of subjects and issues concerning Apple.”

"For example, we did a large voluntary survey of email subscribers and top readers a few years back."

While these readers gave us a long list of topics, formats, or content types they wanted to see, they sometimes engaged more with content types they didn’t select or favor as much on the surveys when we ran follow-up ‘in the wild’ tests, like A/B testing.”  

Pepsi saw similar results when it ran its iconic field experiment, “The Pepsi Challenge” for the first time in 1975.

The beverage brand set up tables at malls, beaches, and other public locations and ran a blindfolded taste test. Shoppers were given two cups of soda, one containing Pepsi, the other Coca-Cola (Pepsi’s biggest competitor). They were then asked to taste both and report which they preferred.

People overwhelmingly preferred Pepsi, and the brand has repeated the experiment multiple times over the years to the same results.

What I like: It yields qualitative and quantitative data and can make for engaging marketing content, especially in the digital age.

What I dislike: It can be very time-consuming. And, if you’re not careful, there is a high risk for scientific error.

Best for: Product testing and competitive analysis

Pro tip:  " Don’t make critical business decisions off of just one data set," advises Pamela Bump. "Use the survey, competitive intelligence, external data, or even a focus group to give you one layer of ideas or a short-list for improvements or solutions to test. Then gather your own fresh data to test in an experiment or trial and better refine your data-backed strategy."

Secondary Research

8. public domain or third-party research.

While original data is always a plus, there are plenty of external resources you can access online and even at a library when you’re limited on time or resources.

Some reputable resources you can use include:

• Pew Research Center
• McKinley Global Institute
• Relevant Global or Government Organizations (i.e United Nations or NASA)

It’s also smart to turn to reputable organizations that are specific to your industry or field. For instance, if you’re a gardening or landscaping company, you may want to pull statistics from the Environmental Protection Agency (EPA).

If you’re a digital marketing agency, you could look to Google Research or HubSpot Research . (Hey, I know them!)

What I like: You can save time on gathering data and spend more time on analyzing. You can also rest assured the data is from a source you trust.

What I dislike: You may not find data specific to your needs.

Best for: Companies under a time or resource crunch, adding factual support to content

Pro tip: Fellow HubSpotter Iskiev suggests using third-party data to inspire your original research. “Sometimes, I use public third-party data for ideas and inspiration. Once I have written my survey and gotten all my ideas out, I read similar reports from other sources and usually end up with useful additions for my own research.”

9. Buy Research

If the data you need isn’t available publicly and you can’t do your own market research, you can also buy some. There are many reputable analytics companies that offer subscriptions to access their data. Statista is one of my favorites, but there’s also Euromonitor , Mintel , and BCC Research .

What I like: Same as public domain research

What I dislike: You may not find data specific to your needs. It also adds to your expenses.

Best for: Companies under a time or resource crunch or adding factual support to content

Which marketing research method should you use?

You’re not going to like my answer, but “it depends.” The best marketing research method for you will depend on your objective and data needs, but also your budget and timeline.

My advice? Aim for a mix of quantitative and qualitative data. If you can do your own original research, awesome. But if not, don’t beat yourself up. Lean into free or low-cost tools . You could do primary research for qualitative data, then tap public sources for quantitative data. Or perhaps the reverse is best for you.

Whatever your marketing research method mix, take the time to think it through and ensure you’re left with information that will truly help you achieve your goals.

Don't forget to share this post!

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Title Case Capitalization

APA Style uses two types of capitalization for titles of works (such as paper titles ) and headings within works : title case and sentence case .

In title case, major words are capitalized, and most minor words are lowercase. In sentence case, most major and minor words are lowercase ( proper nouns are an exception in that they are always capitalized).

• major words: Nouns, verbs (including linking verbs), adjectives, adverbs, pronouns, and all words of four letters or more are considered major words.
• minor words: Short (i.e., three letters or fewer) conjunctions, short prepositions, and all articles are considered minor words.

Title case capitalization is covered in the seventh edition APA Style manuals in the Publication Manual Section 6.17 and the Concise Guide Section 5.7

How to implement title case

In title case, capitalize the following words in a title or heading:

• the first word of the title or heading, even if it is a minor word such as “The” or “A”
• the first word of a subtitle
• the first word after a colon, em dash, or end punctuation in a heading
• major words, including the second part of hyphenated major words (e.g., “Self-Report,” not “Self-report”)
• words of four letters or more (e.g., “With,” “Between,” “From”)

Lowercase only minor words that are three letters or fewer in a title or heading (except the first word in a title or subtitle or the first word after a colon, em dash, or end punctuation in a heading):

• short conjunctions (e.g., “and,” “as,” “but,” “for,” “if,” “nor,” “or,” “so,” “yet”)
• articles (“a,” “an,” “the”)
• short prepositions (e.g., “as,” “at,” “by,” “for,” “in,” “of,” “off,” “on,” “per,” “to,” “up,” “via”)

When to use title case

Use title case for the following:

• titles of articles, books, reports, and other works appearing in text

In the book Train Your Mind for Peak Performance: A Science-Based Approach for Achieving Your Goals

In the article “Turning Frowns (and Smiles) Upside Down: A Multilevel Examination of Surface Acting Positive and Negative Emotions on Well-Being”

• titles of tests or measures, including subscales

Beck Depression Inventory–II

• all headings within a work (Levels 1–5; these are also bold or bold italic)
• the title of your own paper and of named sections and subsections within it

the Results section

• titles of periodicals (these are also italicized)

Journal of Latinx Psychology

Chicago Tribune

• table titles (these are also italicized)
• figure titles (these are also italicized), axis labels, and legends

• Systematic Review
• Open access
• Published: 07 August 2024

Prevalence, incidence, and case fatality of tuberculous meningitis in adults living with HIV: a systematic review and meta-analysis

• Xue Chen 1 , 2   na1 ,
• Jiaqi Wei 1   na1 ,
• Mei Zhang 1   na1 ,
• Meixin Ren 1 ,
• Miaotian Cai 3 ,
• Yulin Zhang 3 , 4 &
• Tong Zhang 1  

BMC Public Health volume  24 , Article number:  2145 ( 2024 ) Cite this article

215 Accesses

Metrics details

Tuberculous meningitis (TBM) emerges as a grave complication of tuberculosis in people living with HIV (PLWH). The diagnosis and treatment of TBM pose significant challenges, leading to elevated mortality rates. To comprehensively grasp the epidemiological landscape of TBM in PLWH, a systematic review and meta-analysis were meticulously undertaken.

We performed a comprehensive search in PubMed, Embase, and Web of Science from database inception to September 19th, 2023, with no limitations on the publication type. The search terms were HIV/AIDS terms (AIDS OR HIV OR PLWH) and TBM-related terms (tuberculous meningitis OR TBM). Studies included in this meta-analysis evaluated the incidence of TBM among PLWH, or we were able to calculate the incidence of TBM among PLWH from the research.

The analysis revealed that the prevalence of TBM among PLWH was 13.6% (95% CI: 6.6–25.9%), with an incidence rate of 1.5 cases per 1000 persons per year. The case fatality rate was found to be 38.1% (95% CI: 24.3–54.1%). No significant publication bias was observed. Meta-regression analysis identified the proportion of females and finance situation as factors influencing the outcomes.

Conclusions

Our study highlights TBM as a prevalent opportunistic infection that targets the central nervous system in PLWH. The elevated case fatality rate is especially prominent among PLWH in impoverished regions, underscores the pressing necessity for enhanced management strategies for PLWH suffering from TBM.

Trial registration

PROSPERO; No: CRD42022338586.

Peer Review reports

Tuberculous meningitis (TBM) is a common neurological disorder in young children and people living with HIV (PLWH), and it accounts for approximately 1% of all cases of tuberculous (TB) [ 1 , 2 ]. Moreover, TBM is a fatal form of TB that kills or severely disables up to 50% of infected individuals [ 3 , 4 , 5 ]. In many regions around the world, especially in countries with TB epidemics, TB is the predominant cause of bacterial meningitis due to the protective effects of vaccination against other forms of meningitis. Moreover, the challenge of diagnosis and treatment delay is compounded by the lack of specific clinical features and the insensitivity of laboratory tests, ultimately contributing to its elevated mortality rate [ 6 ]. Critical risk factors for TBM, including age, anti-TB regimens, disease duration, and HIV infection, may contribute to the incidence and outcomes of TBM [ 7 , 8 ].

PLWHs have an increased risk of developing all forms of TB [ 9 ], coinfection with TB influences the pathogenesis of HIV and increases HIV‑1 replication in PLWH [ 10 ]. In adults, HIV-1 coinfection is the most significant risk factor for TBM. Additionally, TBM has become a severe HIV-associated CNS opportunistic infection and has increased the relative risk of death from two- to three-fold in PLWH, even with the introduction of antiretroviral therapy (ART) [ 11 ]. In the context of HIV infection, the pathological, clinical, and laboratory findings in patients with TBM are influenced in various ways, and the outcomes of TBM may be poor [ 12 ]. Although previous studies have shown that TBM is linked to a significant risk of neurological complications and death [ 13 , 14 , 15 ], and Purmohamad et al. found a high incidence of TBM-HIV coinfection [ 16 ], there is currently a lack of systematic analysis of the incidence, prevalence, and mortality rates of TBM infection in adult PLWH.

In this study, we performed a systematic review and meta-analysis to understand the global prevalence, incidence and case fatality of PLWH with TBM. Additionally, we aimed to analyse the potential risks of death associated with TBM in PLWH, providing new insights into strategies for diagnosing and treating the disease.

This study is registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration No: CRD42022338586). Furthermore, this study was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines [ 17 ]. The PRISMA checklist is provided in Supplement Table  1 .

Search strategy

We performed a comprehensive search in PubMed, Embase, and Web of Science from database inception to September 19th, 2023, with no limitations on the publication type. To avoid bias due to language barriers, we only searched the articles written in English. The search terms were HIV/AIDS terms (AIDS OR HIV OR PLWH) and TBM-related terms (tuberculous meningitis OR TBM). We further screened the reference lists of the selected articles to identify missing studies. A detailed description of the search strategies is provided in Supplement Table  2 .

Selection criteria

Studies included in this meta-analysis evaluated the incidence of TBM among PLWH, or provided data that allow for the calculation of the incidence of TBM among PLWH from the presented research. We excluded the following types of studies: (1) not related to HIV/AIDS; (2) research protocols or feedback reports; (3) case reports; (4) review articles; (5) children-oriented; (6) comparative study; (7) the prevalence or the incidence of TBM among PLWH could not be extracted; (8) participants less than 20. Researchers (XC and JW) removed duplicate studies using EndNote X9 software, selected preliminary search results through title and abstract, and then further determined the remaining articles by assessing full-text. Disagreements between reviewers about eligibility were resolved by discussion with TZ and YZ.

Data extraction

Two researchers (XC and JW) independently extracted and cross-checked relevant data using an Excel spreadsheet. The main information was the prevalence, incidence, and case fatality of TBM among PLWH. Additionally, we extracted other information from these articles, including authorship, year of publication, type of study, study location, sample size, mean age of participants, sex distribution, and current CD4 + T cell count from the total PLWH population and the TBM population.

Statistical analysis

Comprehensive Meta-Analysis (CMA) Version 3.0 (Biostat, Englewood, New Jersey) was adopted for quantitative analysis. Firstly, we calculated the combined event rate (ER) using the prevalence and death of TBM, and the total number of samples included. Next, the number of cases in the cohort articles was divided by the number of months of surveillance and then multiplied by 12 to calculate the number of cases per year [ 18 ]. Person-years were represented by the total number of HIV cases in each country during the study year, obtained from the UNAIDS website ( https://www.unaids.org/en/regionscountries/countries ). The rate was the number of cases per year multiplied by person per year. In addition, we conducted a random effects meta-analysis using the ER to estimate the prevalence and the case fatality of TBM among PLWH and used the rate to estimate the incidence of TBM among PLWH. Additionally, the Egger ranks correlation test was adopted to assess publication bias across studies. The I 2 and Q-tests were used to evaluate the proportion and statistical significance of heterogeneity. The threshold for statistical significance was 2-tailed p  < 0.05.

Quality assessment

Two researchers (XC and JW) used the Agency of Healthcare Research and Quality (AHRQ) methodology checklist ( http://www.ncbi.nlm.nih.Gov/books/NBK35156/ ) for cross-sectional studies and independently assessed the individual studies. The checklist contained 11 items: (1) information source, (2) study criteria, (3) study period, (4) sampling, (5) interview method, (6) instrument validation, (7) exclusion criteria, (8) the measurement of confounding effects, (9) the process of dealing with missing values, (10) response rate, and (11) the use of follow-up assessment. According to this standard, studies were divided into three levels: high-quality (over 8 points), moderate-quality (4–7 points), and low-quality (0–3 points).

Meta regression

The primary outcome of our study was the prevalence and incidence of TBM among PLWH, and the secondary outcome was the case fatality of TBM among PLWH. The predefined continuous moderators were age, gender (the proportion of women), the current median/mean CD4 + T cell counts among PLWH and TBM, finance situation (Per capita gross domestic product (GDP) was obtained from the world bank website: https://data.worldbank.org.cn ), and study quality. The categorical moderators were the study period, and the study design. Restricted ML meta-regression was used to evaluate associations. The results with p  < 0.05 were considered as significance-level factors.

Search results

After removing all duplicates from the 1824 records, 1821 studies were screened. Of these, 1779 records were excluded based on the title and abstract, and 42 full-text articles were assessed for eligibility. Overall, 17 eligible studies were included in the meta-analysis. A flowchart of the study selection is shown in Fig.  1 , and the details of the excluded articles are shown in Supplementary Table 3 .

The flowchart of study selection

Study characteristics

Among the 17 studies included, 9 were retrospective, and 7 were prospective. The remaining studies were a combination of retrospective and prospective designs. In addition, 12 were cross-sectional studies, and five were cohort studies. Studies included data from Africa, Europe, Asia, and South America, comprising 6561 participants. Thirteen studies reported a mean age of 35 (range, 28–39) years; the mean female proportion was 36% (range, 14–68%). The current CD4 + T cell counts was 13–158 cells/µl in PLWH and 14–142 cells/µl in TBM. Six studies were considered moderate-quality studies, whereas the remaining were high-quality (Supplementary Table 4 ). Additional characteristics of the included studies and their corresponding participants are presented in Table  1 .

Meta-analysis of prevalence, incidence and case fatality of TBM

Twelve studies reported the prevalence of TBM among PLWH. The combined ER of TBM was 13.6% (95% confidence interval [CI]: 6.6–25.9%). Significant heterogeneity was detected (Q: 520.4; I 2 : 97.9%; p  < 0.001). Publication bias of the included studies had no statistical significance (intercept: -0.1, 95% CI: -114.4 to 14.3; p  = 0.9) (Fig.  2 ).

Five studies reported the incidence of TBM among PLWH. The combined rate of TBM was 1.5 per 1000 per year (95% CI: 0.6–2.5 per 1000 per year). Significant heterogeneity was detected (Q: 43.9; I 2 : 90.9%; p  < 0.001). Publication bias of the included studies had no statistical significance (intercept: 5.6, 95% CI: -2.5 to 13.7; p  = 0.1) (Fig.  3 ).

Case fatality

Twelve studies reported on the case fatality of patients with TBM. The combined ER was 38.1% (95% CI: 24.3–54.1%), and a significant heterogeneity was detected (Q: 69.1; I 2 : 84.1%; p  < 0.001). No significant publication bias was found (intercept: -1.5, 95% CI: -5.8 to 2.8; p  = 0.4). The detailed results of the meta-analysis are presented in Fig.  4 .

Meta-regression

We conducted meta-regressions on all factors extracted from the studies to analyse the prevalence and case fatality among patients with TBM. While no significant results were found for prevalence, two factors produced substantial changes in outcomes: female proportion (coefficient: 0.05; p  < 0.01) and finance situation (coefficient: -1.16; p  = 0.02). The detailed results for the meta-regression are available in Supplementary Table 5 .

This comprehensive systematic review and meta-analysis was conducted to elucidate the prevalence incidence of TBM in PLWH and the corresponding case fatality in this population. We found that the prevalence, incidence and case fatality were approximately 13.6%, 1.5 per 1000 per year, and 38.1%, respectively, indicating that the prevalence and incidence of TBM were relatively low, while TBM-associated case fatality was high in PLWH. Moreover, the results of the meta-regression analysis suggested that the proportion of females and the finance situation may have substantial impacts on the outcomes.

PLWH are approximately 14 times more likely to develop TB, and face more than double the mortality rate during TB treatment compared to the general population [ 19 ]. PLWH are at heightened risk for TBM, particularly at more advanced stages of immunosuppression [ 20 ]. Moreover, TBM in PLWH has a poor prognosis, with no appreciable difference in survival probability based on ART timing [ 21 ]. Navarro-Flores et al. found that the prevalence of HIV was positively associated with the prevalence of TBM, identifying HIV infection as a moderator in the prevalence of TBM among hospitalized patients [ 13 ]. Moreover, a meta-analysis conducted by Stadelman et al. also suggested that the mortality of adult TBM was high and is influenced by HIV status [ 22 ]. Our study demonstrated that TMB-associated case fatality is high in PLWH, consistent with previous research on patients with TB [ 4 ].

Several risk factors influence the outcomes of CNS OIs in PLWH, including region distribution, age, sex, prophylactic history, and CD4 + T cell counts [ 23 ]. Our study analysed the related risk factors, including age, sex (the proportion of women), the current median/mean CD4 + T cell counts, and financial situation among PLWH and TBM. However, we did not find significant results for prevalence.

In addition, we found a marginal correlation effect (coefficient: -1.16; p  = 0.02) between case fatality and socioeconomic status, indirectly indicating the region’s impact on case fatality. The changes in outcomes influenced by regional distribution are consistent with previous studies on TB/HIV coinfection, which showed that high morbidity and mortality rates were observed among PLWH and TB in resource-limited countries such as those in sub-Saharan Africa [ 24 ].

In our study, another factor influencing case fatality was the proportion of females, which suggests that as the proportion of females increases, so does the case fatality rate. The worldwide incidence of TB has consistently been higher in men compared with women, although the male-to-female ratio varies per region [ 25 ]. However, HIV infection significantly contributed to the epidemic rates of TB in women, leading to a 5.3-fold increase, which was notably higher compared to men. Since there are only a few studies on sex in patients with TBM, we speculate that our findings could be attributed to the increased rates of TBM in women with the onset of HIV and more susceptibility to HIV.

In certain cohorts, the mortality rate among HIV patients coinfected with TBM exceeds 50% [ 26 ]. Important contributing factors include the level of immunosuppression due to HIV and immune reconstitution inflammatory syndrome (IRIS) resulting from ART [ 27 , 28 ]. In our study, we used CD4 + T cell counts to measure the degree of immunosuppression in PLWH and found that the current CD4 + T cell counts ranged from 13 to 96 cells/µl among PLWH and 12–142 cells/µl among PLWH with TBM, suggesting that these populations are severely immunocompromised. The CD4 + T cell counts may be associated with the case fatality of PLWH and TBM in our study. However, our study did not mention other potential risk factors among PLWH and TBM, such as drug-resistant TB, specific anti-TB regimens, disease duration, and the presence of accompanying pulmonary TB or other systemic TB, which could also be critical in determining the case fatality rate.

This study had several limitations. First, the number of included studies was limited, which restricted the generalizability of the results. Second, PLWH with TBM typically experience severe immunosuppression, characterized by significantly low CD4 + T cell counts. Therefore, it may affect the generalization of our findings to all PLWH. Third, the incomplete and discrepant data in the original articles, coupled with a dearth of detailed information from individual studies, resulted in inadequate subgroup analyses. For example, age and CD4 + T cell counts showed no remarkable difference in the prevalence and case fatality. This lack of significance could be attributed to several factors: (1) in all studies, the mean age was approximately 30 years, which is consistent with the peak age at onset of TB; and (2) since the population in our study was PLWH and TBM, the CD4 + T cell counts in each study were relatively low, with the highest not exceeding 150 cells/µl, leading to low statistical power in this subgroup analysis. In addition, the regional distribution is limited owing to few relevant studies. Thus, our findings of regional differences do not reflect the global distribution and lack validity and generalizability. For example, the outcomes of the regional distribution in the population suggested that Europe has the most significant number of studies, the prevalence of TBM in PLWH is generally high (up to 13%), and the prevalence in Africa and South America is nearly 10%. In contrast, the prevalence in Asia is as high as 55.3% (Supplement Fig.  1 ); the case fatality in Africa was the highest (up to 60%); this disparity may be linked to limited access to treatment, poverty, gender inequality, and societal stigma towards HIV in Africa [ 29 , 30 ]. When compared to other regions, this situation is more widespread in Africa [ 31 , 32 ] (Supplement Fig.  2 ). Fourth, the heterogeneity in this meta-analysis was high (Q: 72.081; I²: 81.97%; p  < 0.001), likely due to significant differences in study design, including variations in sample sizes, methodologies, and population characteristics. This heterogeneity may contribute to limited generalizability and potential biases in our study.

Meta-analysis of prevalence of TBM among PLWH

Meta-analysis of incidence of TBM among PLWH

Meta-analysis of case fatality of TBM among PLWH

In conclusion, this systematic review and meta-analysis provided a comprehensive epidemiological landscape of TBM in PLWH exhibiting low prevalence and incidence rates alongside high case fatality rates, particularly those from economically disadvantaged areas. Additionally, meta-regressions were performed to investigate the pertinent risk factors influencing TBM prevalence and case fatality rates among PLWH. Notably, the financial situation and the proportion of females were identified as significant factors influencing these outcomes. This study underscores the critical necessity for immediate public health interventions to enhance patient care for individuals affected by PLWH and TBM.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

• Tuberculous meningitis

Tuberculous

People living with HIV

Central nervous system

Opportunistic infections

Antiretroviral therapy

Preferred Reporting Items for Systematic Reviews and Meta-Analysis

Comprehensive Meta-Analysis

Agency of Healthcare Research and Quality

Gross domestic product

Progressive multifocal leukoencephalopathy

Immune reconstitution inflammatory syndrome

Jain S, Tobin D, Tucker E, Venketaraman V, Ordonez A, Jayashankar L, Siddiqi O, Hammoud D, Prasadarao N, Sandor M, et al. Tuberculous meningitis: a roadmap for advancing basic and translational research. Nat Immunol. 2018;19(6):521–5.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Marais S, Thwaites G, Schoeman J, Török M, Misra U, Prasad K, Donald P, Wilkinson R, Marais B. Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis. 2010;10(11):803–12.

Article   PubMed   Google Scholar  

Wilkinson R, Rohlwink U, Misra U, van Crevel R, Mai N, Dooley K, Caws M, Figaji A, Savic R, Solomons R, et al. Tuberculous meningitis. Nat Reviews Neurol. 2017;13(10):581–98.

Article   Google Scholar  

Graham S, Donald P. Death and disability: the outcomes of tuberculous meningitis. Lancet Infect Dis. 2014;14(10):902–4.

Dian S, Rahmadi R, van Laarhoven A, Ganiem A, van Crevel R. Predicting Mortality of Tuberculous Meningitis. Clin Infect Diseases: Official Publication Infect Dis Soc Am. 2018;67(12):1954–5.

Thwaites G, van Toorn R, Schoeman J. Tuberculous meningitis: more questions, still too few answers. Lancet Neurol. 2013;12(10):999–1010.

Article   CAS   PubMed   Google Scholar  

Huynh J, Donovan J, Phu N, Nghia H, Thuong N, Thwaites G. Tuberculous meningitis: progress and remaining questions. Lancet Neurol. 2022;21(5):450–64.

Tenforde M, Mokomane M, Leeme T, Tlhako N, Tsholo K, Chebani T, Stephenson A, Hutton J, Mitchell H, Patel R, et al. Mortality in adult patients with culture-positive and culture-negative meningitis in the Botswana national meningitis survey: a prevalent cohort study. Lancet Infect Dis. 2019;19(7):740–9.

Article   PubMed   PubMed Central   Google Scholar  

Berenguer J, Moreno S, Laguna F, Vicente T, Adrados M, Ortega A, González-LaHoz J, Bouza E. Tuberculous meningitis in patients infected with the human immunodeficiency virus. N Engl J Med. 1992;326(10):668–72.

Bell L, Noursadeghi M. Pathogenesis of HIV-1 and Mycobacterium tuberculosis co-infection. Nat Rev Microbiol. 2018;16(2):80–90.

Heemskerk A, Bang N, Mai N, Chau T, Phu N, Loc P, Chau N, Hien T, Dung N, Lan N, et al. Intensified antituberculosis therapy in adults with tuberculous meningitis. N Engl J Med. 2016;374(2):124–34.

Garg R, Sinha M. Tuberculous meningitis in patients infected with human immunodeficiency virus. J Neurol. 2011;258(1):3–13.

Navarro-Flores A, Fernandez-Chinguel JE, Pacheco-Barrios N, Soriano-Moreno DR, Pacheco-Barrios K. Global morbidity and mortality of central nervous system tuberculosis: a systematic review and meta-analysis. J Neurol. 2022;269(7):3482–94.

Nataprawira HM, Gafar F, Risan NA, Wulandari DA, Sudarwati S, Marais BJ, Stevens J, Alffenaar J-WC, Ruslami R. Treatment outcomes of Childhood Tuberculous meningitis in a real-world retrospective cohort, Bandung, Indonesia. Emerg Infect Dis. 2022;28(3):660–71.

Merkler AE, Reynolds AS, Gialdini G, Morris NA, Murthy SB, Thakur K, Kamel H. Neurological complications after tuberculous meningitis in a multi-state cohort in the United States. J Neurol Sci. 2017;375:460–3.

Purmohamad A, Azimi T, Nasiri MJ, Goudarzi M, Zangiabadian M, Sedighian H, Fooladi AAI. HIV-Tuberculous meningitis Co-infection: a systematic review and Meta-analysis. Curr Pharm Biotechnol. 2021;22(7):960–8.

Moher D, Liberati A, Tetzlaff J, Altman D. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

Shrestha DB, Budhathoki P, Gurung B, Subedi S, Aryal S, Basukala A, Aryal B, Adhikari A, Poudel A, Yadav GK et al. Epidemiology of dengue in SAARC territory: a systematic review and meta-analysis. Parasite Vector 2022, 15(1).

WHO. Global tuberculosis report 2023. 2023.

Vinnard C, Macgregor RR. Tuberculous meningitis in HIV-infected individuals. Curr HIV/AIDS Rep. 2009;6(3):139–45.

Lawn S, Wood R. Poor prognosis of HIV-associated tuberculous meningitis regardless of the timing of antiretroviral therapy. Clin Infect Diseases: Official Publication Infect Dis Soc Am. 2011;52(11):1384–7.

Stadelman AM, Ellis J, Samuels THA, Mutengesa E, Dobbin J, Ssebambulidde K, Rutakingirwa MK, Tugume L, Boulware DR, Grint D, et al. Treatment outcomes in adult tuberculous meningitis: a systematic review and Meta-analysis. Open Forum Infect Dis. 2020;7(8):ofaa257.

Agnihotri S. Central Nervous System opportunistic infections. Semin Neurol. 2019;39(3):383–90.

Osman M, Welte A, Dunbar R, Brown R, Hoddinott G, Hesseling A, Marx F. Morbidity and mortality up to 5 years post tuberculosis treatment in South Africa: a pilot study. Int J Infect Diseases: IJID : Official Publication Int Soc Infect Dis. 2019;85:57–63.

Google Scholar  

WHO. Global tuberculosis report. 2021.

Thao LTP, Heemskerk AD, Geskus RB, Mai NTH, Ha DTM, Chau TTH, Phu NH, Chau NVV, Caws M, Lan NH, et al. Prognostic models for 9-Month Mortality in Tuberculous Meningitis. Clin Infect Diseases: Official Publication Infect Dis Soc Am. 2018;66(4):523–32.

Article   CAS   Google Scholar  

Marais S, Lai RPJ, Wilkinson KA, Meintjes G, O’Garra A, Wilkinson RJ. Inflammasome Activation Underlying Central Nervous System Deterioration in HIV-Associated Tuberculosis. J Infect Dis. 2017;215(5):677–86.

CAS   PubMed   Google Scholar  

Thwaites GE, N DB, N HD, H TQ, D TTO, N TCT, N QH, N TT, N NH, N TNL, et al. The influence of HIV infection on clinical presentation, response to treatment, and outcome in adults with tuberculous meningitis. J Infect Dis. 2005;192(12):2134–41.

Harrison A, Colvin CJ, Kuo C, Swartz A, Lurie M. Sustained high HIV incidence in Young Women in Southern Africa: social, behavioral, and structural factors and emerging intervention approaches. Curr HIV/AIDS Rep. 2015;12(2):207–15.

Delva W, Abdool Karim Q. The HIV epidemic in Southern Africa - is an AIDS-free generation possible? Curr HIV/AIDS Rep 2014, 11(2).

Shah G, Ewetola R, Etheredge G, Maluantesa L, Waterfield K, Engetele E, Kilundu A. Risk factors for TB/HIV coinfection and consequences for patient outcomes: evidence from 241 clinics in the Democratic Republic of Congo. Int J Environ Res Public Health 2021, 18(10).

Dong K, Thabethe Z, Hurtado R, Sibaya T, Dlwati H, Walker B, Wilson D. Challenges to the success of HIV and Tuberculosis care and treatment in the public health sector in South Africa. J Infect Dis 2007:S491–496.

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Acknowledgements

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This research was funded by the Beijing Natural Science Foundation (Z220018, 7222095); the Capital’s Funds for Health Improvement and Research (2022-1-1151), the National Key R&D Program of China (2023YFE0116000, 2023YFC2308300), the National Natural Science Foundation of China (81571178, 81873761, 82072271); the Climbing the Peak (Deng feng) Talent Training Program of the Beijing Hospitals Authority (DFL20191701); the Beijing Health Technologies Promotion Program (BHTPP2020); and the Beijing Key Laboratory for HIV/AIDS Research (BZ0089); Beijing research center for respiratory infectious diseases project (BJRID2024-001).

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Xue Chen, Jiaqi Wei, Mei Zhang these authors contributed equally to this work.

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Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Beijing Key Laboratory for HIV/AIDS Research, Capital Medical University, Beijing, 100069, China

Xue Chen, Jiaqi Wei, Mei Zhang, Bin Su, Meixin Ren & Tong Zhang

Beijing Youan Hospital, Beijing Institute of Hepatology, Capital Medical University, Beijing, 100069, China

Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China

Miaotian Cai & Yulin Zhang

Beijing Research Center for Respiratory Infectious Diseases, Beijing, 100069, China

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Conceptualization: XC, JW; methodology and software; analysis: JW and MZ; writing—original draft preparation: XC, JW; writing—review and editing: XC, MR, BS and MC; supervision and funding acquisition: YZ, TZ. All authors have read and agreed to the published version of the manuscript.

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Chen, X., Wei, J., Zhang, M. et al. Prevalence, incidence, and case fatality of tuberculous meningitis in adults living with HIV: a systematic review and meta-analysis. BMC Public Health 24 , 2145 (2024). https://doi.org/10.1186/s12889-024-19683-4

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DOI : https://doi.org/10.1186/s12889-024-19683-4

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