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CHAPTER 14

Teaching Research Methods in the Humanities and Social Sciences

How to do Case Study Research

Donna M. Zucker

Introduction

There are multiple definitions and understandings of the case study. According

to Bromley (1990), it is a “systematic inquiry into an event or a set of related events

which aims to describe and explain the phenomenon of interest” (p. 302). The unit of

analysis can vary from an individual to a corporation. While there is utility in applying

this method retrospectively, it is most often used prospectively. Data come largely

from documentation, archival records, interviews, direct observations, participant

observation and physical artifacts (Yin, 1994).

The terms “case study”, “case review” and “case report” are used loosely in

the scientific and professional literature. The key features of a “case study” are its

scientific credentials and its evidence base for professional applications. A “case

review” might emphasize a critical reappraisal of a case. A “case report” might refer

to a summary of a case or to the document reporting a case, as in case law or

medicine. Case studies of individuals in health care research (to take one example)

often involve in-depth interviews with participants and key informants, review of the

medical records, observation, and excerpts from patients’ personal writings and

diaries. Case studies in nursing, for example, have a practical function in that they

can be immediately applicable to the participant’s diagnosis or treatment.

Case study as a research method is often indexed in most undergraduate

research textbooks as neither quantitative nor qualitative. Little attention is paid to

the usefulness of this method, with an average of two pages devoted to this research

approach (Burns & Grove, 1999). This chapter will provide a step-by-step guide to

this research method. The goal of this chapter is to translate this step-wise approach

into a “curriculum” for teaching case study method.

In Preparation

Case study method is indexed in many introductory research textbooks and is

often taught in qualitative research methods courses that discuss a variety of

methods. These may include grounded theory, phenomenology, discourse analysis

and case study, for example. Reasonable goals for the learner would be to explore

and understand the philosophical and aesthetic paradigms that are foundational to

qualitative research methods, compare and contrast the distinctions among selected

methods, evaluate traditional and emerging qualitative designs within their

disciplinary area, and to apply methods and techniques. Using a step-wise approach

students will learn how to design studies, generate data, analyze and interpret the

data and disseminate findings. The teacher creates a teaching and learning

environment to meet those outcomes.

Pedagogical approaches commonly blend learning and doing: these include

seminar participation wherein students are responsible for researching and

presenting a didactic lesson, discussing and critiquing qualitative research reports,

engaging in field work activities, presenting findings to their class and writing a report.

In most cases generating a proposal for the review of human subjects and obtaining

university approval for the field experience is required.

Prior to Beginning

Students should form a list of possible methods in their mind when reviewing

their research question, and ask how can I get the information I am looking for?

There are many considerations prior to embarking on case study method but at the

onset it should be clear that no other descriptive method is possible or will get the

level of description the researcher is looking for, except case study method. Time in

the field, lengthy interviews and transcription and analysis are all factors that should

be thought out well in advance of engaging with participants.

In teaching case study method a primary aim is to define what case study is

and what it is not. Various authors of case study methods discuss and demonstrate

a variety of paradigmatic perspectives. I will discuss the most commonly cited

perspectives. According to Yin (1994) the case study design must have five

components: the research question(s), its propositions, its unit(s) of analysis, a

determination of how the data are linked to the propositions and criteria to interpret

the findings. Yin concluded that operationally defining the unit of analysis assists

with replication and efforts at case comparison.

Stake (1995) emphasized that the number and type of case studies depends

upon the purpose of the inquiry: an instrumental case study is used to provide insight

into an issue; an intrinsic case study is undertaken to gain a deeper understanding of

the case; and the collective case study is the study of a number of cases in order to

inquire into a particular phenomenon. Stake recognizes that there are many other

types of case studies based on their specific purpose, such as the teaching case

study or the biography. Feigin, Orum and Sjoberg (1991) state that irrespective of

the purpose, unit of analysis, or design, rigour is a central concern. They suggest

that, while proponents of multiple case studies may argue for replication, using more

than one case may dilute the importance and meaning of the single case. Yin (1994)

points out that case studies are the preferred strategy when “how” and “why”

questions are posed.

Guba and Lincoln (1981) describe case study “types”. These types are

factual, interpretative and evaluative. Each case study must outline the purpose,

then depending on the type of case study and the actions proposed by the

researcher, the researcher could determine the possible products of the study. For

example, research undertaken to describe men’s experience in living with chronic

coronary heart disease (CHD) could be placed in both factual and interpretative

categories (Zucker, 2001). The researcher’s actions include recording, constructing

and presenting, and producing a chronicle, a profile or facts. Additionally the

researcher is construing, synthesizing and clarifying, and producing a history,

meanings and understandings. A student’s understanding of such activities helps

him/her form the stages of the case study method.

In summary the purposes of case study research may be exploratory,

descriptive, interpretive and explanatory (Mariano, 1993). Articulating the purpose of

the research will inform the remainder of the case study design.

Strategies

In order for students to develop some confidence and competence in learning

case study method a variety of tools are made available for student examination, use

and critique. Yin (1994) offers a very straightforward protocol approach for case

study emphasizing field procedures, case study questions, and a guide for the final

write up. This “tool” is intended to 1) assist the researcher carry out the case study

and 2) increase reliability of the research. Similarly Stake (1995) has proposed a

series of necessary steps for completing the case method, including posing research

questions, gathering data, data analysis and interpretation. A remarkable distinction

is Stakes’ emphasis on a more naturalistic approach, the importance of the

philosophical underpinnings of case method, and the importance of the description of

contexts. Developing a protocol will serve as a frame of operation and include all the

necessary elements in the proper conduct of students’ research. The following list

illustrates a common case study protocol that guides the researcher’s methodology:

• Purpose and rationale for case study

• Significance of the phenomena of interest

• Research questions

• Design based on the unit of analysis and research purpose

• Data collection and management techniques

• Field methods

• Transcribed notes and interviews

• Mapping of major concepts

• Building typologies

• Member checking

• Describe the full case

• Focus the analysis built on themes linked to purpose and unit of analysis

• Analyze findings based on the purpose, rationale, and research questions

• Case perspective

• Disciplinary perspective

• Cross-case comparison

• Write up the case from an emic perspective

• Biography, autobiography, narratives

• Establishing rigor

• Credibility

• Transferability

• Dependability

• Confirmability

Developing a protocol will serve as a frame of operation and include all the

necessary elements in the proper conduct of students’ research.

Sample

Another important component in teaching case study method is to emphasize

unit of analysis and description of the sample. When the unit of analysis is an

individual, for example, an important concept to consider is life history. Bromley

states, "The case study emphasizes the proximal causes of the behaviour and

circumstances, where as life history emphasizes the remote origins, and the

continuities and discontinuities in the organization of behavior over a relatively long

period of time" (1991, p. 86). According to Stake (1995) the case study researcher

may be somewhat of a biographer focused on a phase or segment of the life of an

individual. Various reports in psychology (Bromley, 1986), sociology (Creswell, 1997;

Yin, 1984, 1994), and education (Stake, 1978, 1995) have studied the individual as

the unit of analysis, and have used the case study method to develop rich and

comprehensive understandings about people. Yin (1994) describes single and

multiple case designs. One rationale for these designs is to identify an extreme or

unique case. The single case may focus on/employ a single unit of analysis or

multiple units of analysis. This contrasts to multiple (comparative) case studies,

which Yin describes as analogous to multiple experiments; they follow a “replication

logic.” The “logic” underlying the use of multiple-case studies is: each case must be

selected so that it either 1) predicts similar results (a literal replication) or 2) produces

contrasting results but for predictable reasons (a theoretical replication) (Lee, 2006).

Methods and Analysis: Iterative Processes

An important component of teaching case method is to allow students an

opportunity to move in and out of the literature before, during and after the case

study has begun. It is important for students to understand that method and analysis

occur simultaneously in case study research. For the remainder of this discussion

this example will focus the reader on the following three stages to illustrate this

process:

Stage 1 - Describing Experience

Stage 2 - Describing Meaning

Stage 3 - Focus of the Analysis

Stage 1 - Describing Experience

In this stage the researcher creates interview questions prior to the first

interview, which serve as a script for moving the interviewer closer to eliciting

experience and meaning from participants in each succeeding interview. The

questions should be broad and loosely structured, following the intent of the research

questions. Using techniques suggested by Schatzman and Strauss (1973) journals

and logs are kept to track methodological, observational and theoretical field notes

during data collection.

Next, the interview questions are accompanied by a list of possible sources of

data. Using the example of describing the experience of living with chronic CHD

across 10 to 15 years, a list of potential sources was made that included the

participant, his spouse, physicians, and nurses and other possible significant key

informants. The medical records in at least three settings had to be located; hospital

archives, doctors' offices and outpatient rehabilitation centres and clinics. The

medical and nursing literature can be a rich source of information on patient

experiences in the form of standards of practice, most of them in classic texts that are

updated every one to three years. Additional standards were found in published

discipline-specific guidelines. Because experience across time was an important

feature of this study, the researcher had to be mindful of advances in cardiac

interventions after 1985. Experts were consulted from nursing and medicine to

validate the current standard of care.

Finally, the literature was reviewed for definitions of experience, particularly as

they related to chronic CHD. For example, Strauss and colleagues (1984) and Miller

(1992) referred to patients' illness experiences as their illness trajectory. Literature

from the disciplines of nursing and medicine revealed a common trajectory for

patients with CHD. The literature was revisited between interviews to gain a better

understanding of new data. Clear conceptualizations assisted in taking definitions

into the study, and combined with the other sources of data, comprised the mass of

data available to study the phenomenon of interest. Thinking in metaphors, and

creating simplistic models and thematic maps were essential activities in data

management.

Mapping the data from multiple data sources is an important task. In this

study, principal data were derived from two to three lengthy interviews lasting from

two to two and one half hours. Assembling tables, charts and grids assisted with

clustering of concepts. For example, after the first two interviews it became clear that

acute cardiac experiences did not occur in isolation, rather three large dimensions of

experience emerged. Experience was coded by colour in the transcripts; for example

red for cardiac experiences, green for health and illness experiences, and blue for life

experiences. Various perspectives were bolded (spouse) or underlined (nurse or

doctor) to distinguish them from the patients' (normal typeface). Finally all of these

data sources were read, summarized and organized. Interviews were transcribed by

a professional transcriptionist. Early models such as the one seen in Figure 2 were

constructed to assist in conceptualizing dimensions and ideas that clustered

together.

Figure 1. Mapping Experience

Experiences were further categorized as physiological, sociological and

psychological within each dimension. Colour codes, taxonomies and chronological

ordering were used to manage the data that were assembled in large tables first on

newsprint, then in the word processor.

Stage 2 - Describing Meaning

In this stage the researcher consults the literature and links the research

questions and methods to the philosophical framework. Because the meaning of

experience was also central to this study, the literature on meaning that had the most

relevance for this population was reviewed. Multiple perspectives were reviewed from

social constructionism, medical sociology, existential analysis and symbolic

interactionism. Processes similar to those used to explore and describe experience

were used to study the importance of the concept of meaning. Burbank (1988)

studied the meaning in life of older adults from a symbolic interaction perspective,

and described a hierarchical model of meaning. The first level is labelled "meaning of

signs and symbols" and represents a micro-level perspective on meaning. This level

is considered a foundation or beginning of creating meaning. For patients with CHD

this may refer to what they see and read in print or in the visual inspection of persons

with known heart disease. Powerful words such as “CPR”, “Chest pain” or “MI” are a

few that convey meanings about absolute life and death.

The second level is "meaning of people, things and events in a person's life."

This "mid level" of meaning builds on the first and assumes that '"a variety of things

may be meaningful in varying degrees to different people'" (Burbank, 1988, p. 13).

Meaning in life for patients with CHD may correspond to the crises or episodes of

illness, significant others before, during or after the illness, and quality of life issues

which include work, intimacy and freedom to live according to one’s own desires.

Examples of events or treatments include angioplasty, stents and heart surgery.

The final level of meaning is an abstract, macro-level, labelled "the meaning of

life as a whole." Individuals may have no conscious awareness of this level of

meaning, but rather function within a set of values and beliefs about life's meaning.

This existential or cosmic meaning differs from the query, "what is the meaning of my

own life" which reflects one's need to have purpose in living. The latter may assist the

patient with CHD to plan for the future given his current physical and psychological

circumstances. Burbank equates “meaning of life” as a whole, as interrelated to the

other two levels and is seen as one’s worldview. In conclusion these levels of

meaning may encompass humankind’s capacity to find importance in the

experiences of living.

In the study of CHD patients’ experiences, the midlevel of meaning was most

helpful due to the preponderance of participants' events and situations noted in the

transcripts, archives and medical records, as well as interactions with others and self.

Burbank's model was not fully supported in this study, as there were periods when no

meaning could be found in either of the cases. Again the use of a simple model

assists in pulling together data from the case study and tying it to meaning making.

In this instance support from existential analysis was helpful. See Figure 3 for a basic

model of meaning based on Burbank's work.

Figure 2. Mapping Meaning (Based on Burbank, 1988)

Interestingly, in the case study of the experience and meaning of men living

with chronic CHD, two cases emerged that differed widely, one being the more

"textbook" case, the other the more idiosyncratic. Rather than following a traditional

approach to case analysis using replication logic (Yin, 1994), efforts were focused on

drawing comparisons between the two cases. Prior to analyzing instances of

meaning from these cases, the original transcripts were once again reviewed and

marked with a small "m" for each instance of meaning. Particular words, sentences,

and passages were noted in a separate journal. Interpretations of what patients were

thinking, doing and feeling added to an understanding of the meaning of their

experiences. This experience of reading and rereading, refining the methodology as

data is received as an important set of activities in case study research.

Stage 3 - Focus of the Analysis

Generalization of case study findings is limited to the case itself or types of

cases. However, attention to selected details enhances the analysis and increases

clarity of reasoning. Some general techniques are mentioned that have been useful

in focusing the analysis of the example used here. According to Yin (1994) analysis

hinges on linking the data to the propositions and explicating the criteria by which

findings are to be interpreted. While generalization limits the use of case study

method by some social scientists, Yin (1984) argues that theoretical generalization is

to the domain of case study what statistical generalization is to the true experiment.

An important technique used to incorporate rigour into the study design is the use of

the negative case to serve as a study "control". The use of the extreme case, the

deviant case, and the normal case are helpful for making points of comparison.

The stand taken by Stake (1978) focuses on context-specific or "naturalistic"

generalization. Such an approach resonates with readers' tacit knowledge, which

helps people make connections and associations without the benefit of words. It is

believed that people have the capacity for this kind of knowledge, and from it they

build understandings.

In the example of the experience and meaning of men with chronic CHD,

major themes identified with the use of maps and typologies emerged as focal areas

of the analysis. The metaphor "journey" became a central organizing concept, and

was linked to a variety of sub-concepts, and relationships among them were sought.

Two complete cases were reviewed. Each case was analyzed separately with an eye

toward describing experience and meaning. According to Feigin, Orum and

Sjoberg's (1991) description, one appeared as a "normal" case and one an "extreme"

case. The strategy was to focus the analysis on the journey, by concentrating on how

it: 1) was tied to a physiologic state, 2) carried consequences and 3) compared with

the typical health/illness trajectory.

Examining Rigour

It is the role of the case study researcher to test and confirm his/her findings in

order to indicate the findings are valid and the procedures are rigourous. Rigour is

built into this process by focusing the strategies used to generate meaning from the

qualitative data. See Table 2 for these strategies. Those strategies in italics were

selected for the example case study.

Table 1. Strategies Used to Generate Meaning (Miles & Huberman, 1994)

What Goes with What?

Noting Patterns

Clustering

Seeing Plausibility

Integration Among Diverse Pieces of

Data

Making Metaphors

What's There?

Counting

Sharpen our Understanding

Making Comparisons

Partitioning Variables

See Things and Their Relationships

More Abstractly

Subsuming Particulars Into the General

Factoring

Noting Relations Between Variables

Finding Intervening Variables

Assemble a Coherent

Understanding of the Data

Building a Logical Chain of Evidence

Making Conceptual/Theoretical

Coherence

Investigators within a constructivist paradigm, such as that used by case study

research, attempt to reconstruct participants’ understanding of the social world

(Denzin & Lincoln, 2000). Thus, traditional criteria of internal and external validity are

replaced by such terms as trustworthiness and authenticity. Guba and Lincoln

(1981) suggest an alternate view of establishing rigour based on a critical realist

paradigm that is juxtaposed to a more traditional view. In this case reliability is

contrasted with dependability or auditability. In this sense we are asking if the

researcher’s processes were consistent and reasonably stable over time and across

researchers and methods. Internal validity can be contrasted with credibility or

authenticity. Here we aim to answer the questions, do the findings of the study make

sense? Are they credible to the people we study themselves or others? Finally we

want to know if our conclusions are transferable to other contexts? How far can they

be generalized? Here we contrast external validity to transferability or fittingness

(Miles & Huberman, 1994).

Quality standards for case studies in psychology, for example, have been

developed emphasizing the scientific and professional benefits to other disciplines.

Fishman (1999) describes such standards, outlining quality of knowledge issues

across three paradigms: the positivist model, the pragmatic model and the

hermeneutic model. Procedural guidelines for fulfilling these criteria rely heavily on

methodological arguments and techniques - sampling diversity, triangulation or

agreement, and monitoring bias. Lincoln (1995) argues that quality also involves

ethics. The researcher’s decision whether to embark upon the research must be

considered in relation to the risk of harm to participants or their families. Using an

outside auditor is required to check each step as the case study is developing. Thus

attention to quality control must be incorporated into the case study protocol.

Writing Up the Case

There are some suggestions new case study researchers may find useful prior

to writing up their findings. The first is to spend some time at the outset reading

“good” case studies. Course assignments should include adequate time and support

for students to complete pilot studies and practice writing, both excellent ways to

develop the "artistic" expertise required of such writing. Other strategies include

joining a writing group, participating in writing retreats and soliciting English or

literature experts to begin reading one’s writing. Decisions about writing style will

become clearer as the intent of one’s audience is determined. For example a

narrative, biographical or autobiographical approach may be useful for dramatic

effect, while a full description may be well suited to an organization. In any event, the

goal is to tell the story and its findings clearly separated from conclusions or

interpretations.

In the example of the experience and meaning of men living with chronic CHD,

the writing began with a review of the stages of analysis. The first stage defined the

typical trajectory and mapped the cases' experiences. Definitions came from the

literature, experience, and nursing practice. Patient interviews and other sources of

information revealed three phases of experiences common to patients with CHD.

Exploration of interview data and medical records uncovered three dimensions of

experience and three categories of experience that could be viewed within each

dimension. This analytic stage also ordered the data chronologically and placed them

within the frame of reference of the data source.

The second stage of analysis focused on mapping meaning. Here theoretical

support came from a model based on the symbolic interaction perspective. This

model assisted in mapping the meaning demonstrated in the transcripts across the

three phases of the trajectory and across the levels of meaning. The third stage

focused the analysis on three important notions: how experience was tied to a

physiologic state, how it carried consequences, and how it compared with the typical

illness trajectory. Both case studies included in-depth descriptions of individuals

whose adult lives had been significantly impacted by CHD. Physiological processes,

while central to experience, were only a portion of that experience. This level of

analysis assisted in bringing together the notions of experience and meaning as seen

within the context of life. Putting all the pieces together helped create a beginning

model that informed the trajectory of living with chronic CHD. This process assisted

in developing a logical chain of factors contributing to the understanding of the data.

The result was a series of maps and typologies representing perspectives about the

meaning of experience, from all data sources. A beginning model emerged

describing the trajectory of chronic coronary heart disease (See Figure 3).

The “style” of the manuscript in this case was biographical using a

chronological flow. Participants’ own language was used whenever possible

throughout the manuscript in an effort to retain the integrity of their stories and

meanings.

Conclusion Case study method can be a creative alternative to traditional approaches to description (quantitative descriptive and descriptive correlational descriptive designs)

emphasizing the participant’s perspective as central to the process. In the example

used here the value of the case study was the findings. Theoretical implications

informed nursing practice directly. Case study conclusions created opportunities for

nurses to adapt their model of care to incorporate all three phases of the chronic

illness trajectory. For example, changes in history taking and follow up as well as

ongoing provision of support to the patient and family were emphasized. At the

organizational level such findings require resources and administrative action for

implementing a transitional model of care. Other implications, no less important,

include the impact of the method itself on moving description of a phenomenon to

intervention. Finally the utility of a case study is that it encourages educators to

consider additional steps in a caring educational curriculum that emphasizes

communication and relationships between human beings (Scott, 2005).

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