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What is a Case Study in Research? Definition, Methods, and Examples

Case study methodology offers researchers an exciting opportunity to explore intricate phenomena within specific contexts using a wide range of data sources and collection methods. It is highly pertinent in health and social sciences, environmental studies, social work, education, and business studies. Its diverse applications, such as advancing theory, program evaluation, and intervention development, make it an invaluable tool for driving meaningful research and fostering positive change.[ 1]  

Table of Contents

What is a Case Study?  

A case study method involves a detailed examination of a single subject, such as an individual, group, organization, event, or community, to explore and understand complex issues in real-life contexts. By focusing on one specific case, researchers can gain a deep understanding of the factors and dynamics at play, understanding their complex relationships, which might be missed in broader, more quantitative studies.  

When to do a Case Study?  

A case study design is useful when you want to explore a phenomenon in-depth and in its natural context. Here are some examples of when to use a case study :[ 2]  

• Exploratory Research: When you want to explore a new topic or phenomenon, a case study can help you understand the subject deeply. For example , a researcher studying a newly discovered plant species might use a case study to document its characteristics and behavior.  
• Descriptive Research: If you want to describe a complex phenomenon or process, a case study can provide a detailed and comprehensive description. For instance, a case study design   could describe the experiences of a group of individuals living with a rare disease.  
• Explanatory Research: When you want to understand why a particular phenomenon occurs, a case study can help you identify causal relationships. A case study design could investigate the reasons behind the success or failure of a particular business strategy.  
• Theory Building: Case studies can also be used to develop or refine theories. By systematically analyzing a series of cases, researchers can identify patterns and relationships that can contribute to developing new theories or refining existing ones.  
• Critical Instance: Sometimes, a single case can be used to study a rare or unusual phenomenon, but it is important for theoretical or practical reasons. For example , the case of Phineas Gage, a man who survived a severe brain injury, has been widely studied to understand the relationship between the brain and behavior.  
• Comparative Analysis: Case studies can also compare different cases or contexts. A case study example involves comparing the implementation of a particular policy in different countries to understand its effectiveness and identifying best practices.  

How to Create a Case Study – Step by Step  

Step 1: select a case  .

Careful case selection ensures relevance, insight, and meaningful contribution to existing knowledge in your field. Here’s how you can choose a case study design :[ 3]  

• Define Your Objectives: Clarify the purpose of your case study and what you hope to achieve. Do you want to provide new insights, challenge existing theories, propose solutions to a problem, or explore new research directions?  
• Consider Unusual or Outlying Cases: Focus on unusual, neglected, or outlying cases that can provide unique insights.  
• Choose a Representative Case: Alternatively, select a common or representative case to exemplify a particular category, experience, or phenomenon.   
• Avoid Bias: Ensure your selection process is unbiased using random or criteria-based selection.  
• Be Clear and Specific: Clearly define the boundaries of your study design , including the scope, timeframe, and key stakeholders.   
• Ethical Considerations: Consider ethical issues, such as confidentiality and informed consent.  

Step 2: Build a Theoretical Framework  

To ensure your case study has a solid academic foundation, it’s important to build a theoretical framework:   

• Conduct a Literature Review: Identify key concepts and theories relevant to your case study .  
• Establish Connections with Theory: Connect your case study with existing theories in the field.  
• Guide Your Analysis and Interpretation: Use your theoretical framework to guide your analysis, ensuring your findings are grounded in established theories and concepts.   

Step 3: Collect Your Data  

To conduct a comprehensive case study , you can use various research methods. These include interviews, observations, primary and secondary sources analysis, surveys, and a mixed methods approach. The aim is to gather rich and diverse data to enable a detailed analysis of your case study .  

Step 4: Describe and Analyze the Case  

How you report your findings will depend on the type of research you’re conducting. Here are two approaches:   

• Structured Approach: Follows a scientific paper format, making it easier for readers to follow your argument.  
• Narrative Approach: A more exploratory style aiming to analyze meanings and implications.  

Regardless of the approach you choose, it’s important to include the following elements in your case study :   

• Contextual Details: Provide background information about the case, including relevant historical, cultural, and social factors that may have influenced the outcome.  
• Literature and Theory: Connect your case study to existing literature and theory in the field. Discuss how your findings contribute to or challenge existing knowledge.  
• Wider Patterns or Debates: Consider how your case study fits into wider patterns or debates within the field. Discuss any implications your findings may have for future research or practice.  

What Are the Benefits of a Case Study   

Case studies offer a range of benefits , making them a powerful tool in research.  

1. In-Depth Analysis  

• Comprehensive Understanding: Case studies allow researchers to thoroughly explore a subject, understanding the complexities and nuances involved.  
• Rich Data: They offer rich qualitative and sometimes quantitative data, capturing the intricacies of real-life contexts.  

2. Contextual Insight  

• Real-World Application: Case studies provide insights into real-world applications, making the findings highly relevant and practical.  
• Context-Specific: They highlight how various factors interact within a specific context, offering a detailed picture of the situation.  

3. Flexibility  

• Methodological Diversity: Case studies can use various data collection methods, including interviews, observations, document analysis, and surveys.  
• Adaptability: Researchers can adapt the case study approach to fit the specific needs and circumstances of the research.  

4. Practical Solutions  

• Actionable Insights: The detailed findings from case studies can inform practical solutions and recommendations for practitioners and policymakers.  
• Problem-Solving: They help understand the root causes of problems and devise effective strategies to address them.  

5. Unique Cases  

• Rare Phenomena: Case studies are particularly valuable for studying rare or unique cases that other research methods may not capture.  
• Detailed Documentation: They document and preserve detailed information about specific instances that might otherwise be overlooked.  

What Are the Limitations of a Case Study   

While case studies offer valuable insights and a detailed understanding of complex issues, they have several limitations .  

1. Limited Generalizability  

• Specific Context: Case studies often focus on a single case or a small number of cases, which may limit the generalization of findings to broader populations or different contexts.  
• Unique Situations: The unique characteristics of the case may not be representative of other situations, reducing the applicability of the results.  

2. Subjectivity  

• Researcher Bias: The researcher’s perspectives and interpretations can influence the analysis and conclusions, potentially introducing bias.  
• Participant Bias: Participants’ responses and behaviors may be influenced by their awareness of being studied, known as the Hawthorne effect.  

3. Time-Consuming  

• Data Collection and Analysis: Gathering detailed, in-depth data requires significant time and effort, making case studies more time-consuming than other research methods.  
• Longitudinal Studies: If the case study observes changes over time, it can become even more prolonged.  

4. Resource Intensive  

• Financial and Human Resources: Conducting comprehensive case studies may require significant financial investment and human resources, including trained researchers and participant access.  
• Access to Data: Accessing relevant and reliable data sources can be challenging, particularly in sensitive or proprietary contexts.  

5. Replication Difficulties  

• Unique Contexts: A case study’s specific and detailed context makes it difficult to replicate the study exactly, limiting the ability to validate findings through repetition.  
• Variability: Differences in contexts, researchers, and methodologies can lead to variations in findings, complicating efforts to achieve consistent results.  

By acknowledging and addressing these limitations , researchers can enhance the rigor and reliability of their case study findings.  

Key Takeaways  

Case studies are valuable in research because they provide an in-depth, contextual analysis of a single subject, event, or organization. They allow researchers to explore complex issues in real-world settings, capturing detailed qualitative and quantitative data. This method is useful for generating insights, developing theories, and offering practical solutions to problems. They are versatile, applicable in diverse fields such as business, education, and health, and can complement other research methods by providing rich, contextual evidence. However, their findings may have limited generalizability due to the focus on a specific case.  

Frequently Asked Questions  

Q: What is a case study in research?  

A case study in research is an impactful tool for gaining a deep understanding of complex issues within their real-life context. It combines various data collection methods and provides rich, detailed insights that can inform theory development and practical applications.  

Q: What are the advantages of using case studies in research?  

Case studies are a powerful research method, offering advantages such as in-depth analysis, contextual insights, flexibility, rich data, and the ability to handle complex issues. They are particularly valuable for exploring new areas, generating hypotheses, and providing detailed, illustrative examples that can inform theory and practice.  

Q: Can case studies be used in quantitative research?  

While case studies are predominantly associated with qualitative research, they can effectively incorporate quantitative methods to provide a more comprehensive analysis. A mixed-methods approach leverages qualitative and quantitative research strengths, offering a powerful tool for exploring complex issues in a real-world context. For example , a new medical treatment case study can incorporate quantitative clinical outcomes (e.g., patient recovery rates and dosage levels) along with qualitative patient interviews.  

Q: What are the key components of a case study?  

A case study typically includes several key components:   

• Introductio n, which provides an overview and sets the context by presenting the problem statement and research objectives;  
• Literature review , which connects the study to existing theories and prior research;  
• Methodology , which details the case study design , data collection methods, and analysis techniques;   
• Findings , which present the data and results, including descriptions, patterns, and themes;   
• Discussion and conclusion , which interpret the findings, discuss their implications, and offer conclusions, practical applications, limitations, and suggestions for future research.  

Together, these components ensure a comprehensive, systematic, and insightful exploration of the case.  

References  

• de Vries, K. (2020). Case study methodology. In  Critical qualitative health research  (pp. 41-52). Routledge.  
• Fidel, R. (1984). The case study method: A case study.  Library and Information Science Research ,  6 (3), 273-288.  
• Thomas, G. (2021). How to do your case study.  How to do your case study , 1-320.  

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

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

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

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

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

Table of contents

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Research bias

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

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

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

Research question

• Conceptual framework
• Conceptual vs. theoretical framework

Data collection

• Qualitative research methods
• Focus groups
• Observational research

What is a case study?

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

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

Case studies

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

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

Definition of a case study

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

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

Characteristics of case studies

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

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

The role of case studies in research

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

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

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

What is the purpose of a case study?

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

Why use case studies in qualitative research?

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

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

The explanatory, exploratory, and descriptive roles of case studies

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

The impact of case studies on knowledge development

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

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

Types of case studies

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

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

Exploratory case studies

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

Descriptive case studies

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

Explanatory case studies

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

Intrinsic, instrumental, and collective case studies

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

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

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

Critical information systems research

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

Health research

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

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

Asthma research studies

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

Other fields

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

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

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

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

Propositions

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

Units of analysis

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

Argumentation

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

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

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

Defining the research question

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

Selecting and defining the case

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

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

Developing a detailed case study protocol

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

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

Collecting data

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

Analyzing and interpreting data

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

Writing the case study report

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

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

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

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

Observations

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

Documents and artifacts

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

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

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

Ensuring the quality of data collection

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

Data analysis

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

Organizing the data

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

Categorizing and coding the data

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

Identifying patterns and themes

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

Interpreting the data

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

Verification of the data

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

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

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

Benefits include the following:

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

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

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

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

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What is case study research?

Last updated

8 February 2023

Reviewed by

Cathy Heath

Short on time? Get an AI generated summary of this article instead

Suppose a company receives a spike in the number of customer complaints, or medical experts discover an outbreak of illness affecting children but are not quite sure of the reason. In both cases, carrying out a case study could be the best way to get answers.

Organization

Case studies can be carried out across different disciplines, including education, medicine, sociology, and business.

Most case studies employ qualitative methods, but quantitative methods can also be used. Researchers can then describe, compare, evaluate, and identify patterns or cause-and-effect relationships between the various variables under study. They can then use this knowledge to decide what action to take. 

Another thing to note is that case studies are generally singular in their focus. This means they narrow focus to a particular area, making them highly subjective. You cannot always generalize the results of a case study and apply them to a larger population. However, they are valuable tools to illustrate a principle or develop a thesis.

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• What are the different types of case study designs?

Researchers can choose from a variety of case study designs. The design they choose is dependent on what questions they need to answer, the context of the research environment, how much data they already have, and what resources are available.

Here are the common types of case study design:

Explanatory

An explanatory case study is an initial explanation of the how or why that is behind something. This design is commonly used when studying a real-life phenomenon or event. Once the organization understands the reasons behind a phenomenon, it can then make changes to enhance or eliminate the variables causing it. 

Here is an example: How is co-teaching implemented in elementary schools? The title for a case study of this subject could be “Case Study of the Implementation of Co-Teaching in Elementary Schools.”

Descriptive

An illustrative or descriptive case study helps researchers shed light on an unfamiliar object or subject after a period of time. The case study provides an in-depth review of the issue at hand and adds real-world examples in the area the researcher wants the audience to understand. 

The researcher makes no inferences or causal statements about the object or subject under review. This type of design is often used to understand cultural shifts.

Here is an example: How did people cope with the 2004 Indian Ocean Tsunami? This case study could be titled "A Case Study of the 2004 Indian Ocean Tsunami and its Effect on the Indonesian Population."

Exploratory

Exploratory research is also called a pilot case study. It is usually the first step within a larger research project, often relying on questionnaires and surveys . Researchers use exploratory research to help narrow down their focus, define parameters, draft a specific research question , and/or identify variables in a larger study. This research design usually covers a wider area than others, and focuses on the ‘what’ and ‘who’ of a topic.

Here is an example: How do nutrition and socialization in early childhood affect learning in children? The title of the exploratory study may be “Case Study of the Effects of Nutrition and Socialization on Learning in Early Childhood.”

An intrinsic case study is specifically designed to look at a unique and special phenomenon. At the start of the study, the researcher defines the phenomenon and the uniqueness that differentiates it from others. 

In this case, researchers do not attempt to generalize, compare, or challenge the existing assumptions. Instead, they explore the unique variables to enhance understanding. Here is an example: “Case Study of Volcanic Lightning.”

This design can also be identified as a cumulative case study. It uses information from past studies or observations of groups of people in certain settings as the foundation of the new study. Given that it takes multiple areas into account, it allows for greater generalization than a single case study. 

The researchers also get an in-depth look at a particular subject from different viewpoints.  Here is an example: “Case Study of how PTSD affected Vietnam and Gulf War Veterans Differently Due to Advances in Military Technology.”

Critical instance

A critical case study incorporates both explanatory and intrinsic study designs. It does not have predetermined purposes beyond an investigation of the said subject. It can be used for a deeper explanation of the cause-and-effect relationship. It can also be used to question a common assumption or myth. 

The findings can then be used further to generalize whether they would also apply in a different environment.  Here is an example: “What Effect Does Prolonged Use of Social Media Have on the Mind of American Youth?”

Instrumental

Instrumental research attempts to achieve goals beyond understanding the object at hand. Researchers explore a larger subject through different, separate studies and use the findings to understand its relationship to another subject. This type of design also provides insight into an issue or helps refine a theory. 

For example, you may want to determine if violent behavior in children predisposes them to crime later in life. The focus is on the relationship between children and violent behavior, and why certain children do become violent. Here is an example: “Violence Breeds Violence: Childhood Exposure and Participation in Adult Crime.”

Evaluation case study design is employed to research the effects of a program, policy, or intervention, and assess its effectiveness and impact on future decision-making. 

For example, you might want to see whether children learn times tables quicker through an educational game on their iPad versus a more teacher-led intervention. Here is an example: “An Investigation of the Impact of an iPad Multiplication Game for Primary School Children.” 

• When do you use case studies?

Case studies are ideal when you want to gain a contextual, concrete, or in-depth understanding of a particular subject. It helps you understand the characteristics, implications, and meanings of the subject.

They are also an excellent choice for those writing a thesis or dissertation, as they help keep the project focused on a particular area when resources or time may be too limited to cover a wider one. You may have to conduct several case studies to explore different aspects of the subject in question and understand the problem.

• What are the steps to follow when conducting a case study?

1. Select a case

Once you identify the problem at hand and come up with questions, identify the case you will focus on. The study can provide insights into the subject at hand, challenge existing assumptions, propose a course of action, and/or open up new areas for further research.

2. Create a theoretical framework

While you will be focusing on a specific detail, the case study design you choose should be linked to existing knowledge on the topic. This prevents it from becoming an isolated description and allows for enhancing the existing information. 

It may expand the current theory by bringing up new ideas or concepts, challenge established assumptions, or exemplify a theory by exploring how it answers the problem at hand. A theoretical framework starts with a literature review of the sources relevant to the topic in focus. This helps in identifying key concepts to guide analysis and interpretation.

3. Collect the data

Case studies are frequently supplemented with qualitative data such as observations, interviews, and a review of both primary and secondary sources such as official records, news articles, and photographs. There may also be quantitative data —this data assists in understanding the case thoroughly.

4. Analyze your case

The results of the research depend on the research design. Most case studies are structured with chapters or topic headings for easy explanation and presentation. Others may be written as narratives to allow researchers to explore various angles of the topic and analyze its meanings and implications.

In all areas, always give a detailed contextual understanding of the case and connect it to the existing theory and literature before discussing how it fits into your problem area.

• What are some case study examples?

What are the best approaches for introducing our product into the Kenyan market?

How does the change in marketing strategy aid in increasing the sales volumes of product Y?

How can teachers enhance student participation in classrooms?

How does poverty affect literacy levels in children?

Case study topics

Case study of product marketing strategies in the Kenyan market

Case study of the effects of a marketing strategy change on product Y sales volumes

Case study of X school teachers that encourage active student participation in the classroom

Case study of the effects of poverty on literacy levels in children

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What Is Another Way to Say “Case Study”?

January 1, 2024

Linda Brown

Looking for synonyms for case study ? We’ve got you covered!

Here’s a list of other ways to say case study .

• Examination
• Investigation
• Research study
• Detailed study
• Exploration
• Observational study
• Case report
• Case analysis

Want to learn how to say case study professionally? Keep reading for examples and use cases.

1. Analysis

“Analysis” is used when a detailed examination of the elements or structure of something is conducted. It’s appropriate in scientific, business, and academic contexts. Example: The team conducted an analysis of market trends for the new product launch.

“Report” refers to a formal account or statement describing the findings of an investigation or research. It’s used in professional, academic, and governmental contexts. Example: She compiled a comprehensive report on the company’s financial health over the past year.

3. Examination

“Examination” is used when referring to a detailed inspection or analysis of a subject or phenomenon. It’s suitable in medical, academic, and technical fields. Example: The doctor conducted a thorough examination of the patient’s case history.

4. Investigation

“Investigation” implies a systematic or formal inquiry to discover facts or information. It’s commonly used in law enforcement, scientific research, and journalism. Example: The environmental agency launched an investigation into the cause of the pollution.

“Profile” refers to an analysis or description of a particular thing or person. It’s often used in journalism, psychology, and marketing. Example: The magazine published a detailed profile of the innovative tech startup.

“Survey” is used for a comprehensive examination or review of a particular area or subject. It’s suitable in research, social sciences, and market analysis. Example: The city conducted a survey to understand the housing needs of its residents.

7. Research Study

“Research study” refers to a detailed and systematic examination of a subject to discover new information or reach new understandings. It’s used in academic and scientific contexts. Example: The research study provided new insights into the effects of climate change on agriculture.

“Inquiry” implies a formal investigation or examination. It’s often used in academic research, legal contexts, and public policy. Example: The committee launched an inquiry into the effectiveness of the new health policy.

9. Assessment

“Assessment” is the evaluation or analysis of the nature, quality, or ability of someone or something. It’s used in educational, professional, and healthcare settings. Example: The consultant did an assessment of the project’s risks and opportunities.

“Review” involves a formal assessment or examination of a subject or situation. It’s appropriate in academic, professional, and critical analysis contexts. Example: The team conducted a review of the existing literature on renewable energy technologies.

11. Detailed Study

“Detailed study” refers to an in-depth examination and analysis of a subject. It’s used in contexts where comprehensive understanding is required. Example: A detailed study of the region’s history revealed unknown cultural influences.

12. Exploration

“Exploration” is used to describe a thorough analysis or discussion of a subject, often in a more open or investigative manner. It’s suitable in scientific and academic research. Example: His book is an exploration into the psychological impacts of social media.

13. Observational Study

“Observational study” refers to research where the investigator observes subjects without manipulation. It’s commonly used in social sciences and medicine. Example: The observational study focused on children’s behavior in different learning environments.

14. Case Report

“Case report” is a detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient. It’s used in medical and clinical contexts. Example: The doctor published a case report on the rare genetic disorder.

15. Case Analysis

“Case analysis” involves a detailed examination of a case in order to understand its various aspects. It’s often used in business, law, and academic settings. Example: The business school students performed a case analysis of the company’s strategic turnaround.

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• What Is Another Way to Say “Easy to Understand”?
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• What Is Another Way to Say “Better Understanding”?
• What Is Another Way to Say “Carrying Out”?
• What Is Another Way to Say “Excited for What’s to Come”?
• What Is Another Way to Say “As You Can See”?
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noun as in case history

Strongest match

• medical history

Weak matches

• medical record
• psychiatric history

Example Sentences

In a case study from Metric Theory, Target Impression Share bidding, the total cost per click increased with both mobile and desktop devices.

It would also become the subject of a fair number of business school case studies.

Not just blog posts, you can also share other resources like case studies, podcast episodes, and webinars via Instagram Stories.

They become the architecture for a case study of Flint, expressed in a more personal and poetic way than a straightforward investigation could.

The Creek Fire was a case study in the challenge facing today’s fire analysts, who are trying to predict the movements of fires that are far more severe than those seen just a decade ago.

A case study would be your Twilight director Catherine Hardwicke.

A good case study for the minority superhero problem is Luke Cage.

He was asked to review a case study out of Lebanon that had cited his work.

Instead, now we have a political science case-study proving how political fortunes can shift and change at warp speed.

One interesting case study is Sir Arthur Evans, the original excavator and “restorer” of the Minoan palace of Knossos on Crete.

As this is a case study, it should be said that my first mistake was in discrediting my early religious experience.

The author of a recent case study of democracy in a frontier county commented on the need for this kind of investigation.

How could a case study of Virginia during this period illustrate these developments?

Related Words

Words related to case study are not direct synonyms, but are associated with the word case study . Browse related words to learn more about word associations.

noun as in record of what happened

From Roget's 21st Century Thesaurus, Third Edition Copyright © 2013 by the Philip Lief Group.

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• Methodology
• Case Study | Definition, Examples & Methods

Case Study | Definition, Examples & Methods

Published on 5 May 2022 by Shona McCombes . Revised on 30 January 2023.

A case study is a detailed study of a specific subject, such as a person, group, place, event, organisation, 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 analyse the case.

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

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.

If you find yourself aiming to simultaneously investigate and solve an issue, consider conducting action research . As its name suggests, action research conducts research and takes action at the same time, and is highly iterative and flexible. 

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

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 .

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

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

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

Others are written in a more narrative style, aiming to explore the case from various angles and analyse 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.

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Home » Case Study – Methods, Examples and Guide

Case Study – Methods, Examples and Guide

Table of Contents

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

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

Types of Case Study

Types and Methods of Case Study are as follows:

Single-Case Study

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

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

Multiple-Case Study

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

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

Exploratory Case Study

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

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

Descriptive Case Study

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

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

Instrumental Case Study

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

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

Case Study Data Collection Methods

Here are some common data collection methods for case studies:

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

Observations

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

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

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

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

How to conduct Case Study Research

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

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

Examples of Case Study

Here are some examples of case study research:

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

Application of Case Study

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

Business and Management

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

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

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

Social Sciences

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

Law and Ethics

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

Purpose of Case Study

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

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

Case studies can also serve other purposes, including:

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

Advantages of Case Study Research

There are several advantages of case study research, including:

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

Limitations of Case Study Research

There are several limitations of case study research, including:

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

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Muhammad Hassan

Researcher, Academic Writer, Web developer

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What is a Case Study? Definition & Examples

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Case Study Definition

A case study is an in-depth investigation of a single person, group, event, or community. This research method involves intensively analyzing a subject to understand its complexity and context. The richness of a case study comes from its ability to capture detailed, qualitative data that can offer insights into a process or subject matter that other research methods might miss.

A case study strives for a holistic understanding of events or situations by examining all relevant variables. They are ideal for exploring ‘how’ or ‘why’ questions in contexts where the researcher has limited control over events in real-life settings. Unlike narrowly focused experiments, these projects seek a comprehensive understanding of events or situations.

In a case study, researchers gather data through various methods such as participant observation, interviews, tests, record examinations, and writing samples. Unlike statistically-based studies that seek only quantifiable data, a case study attempts to uncover new variables and pose questions for subsequent research.

A case study is particularly beneficial when your research:

• Requires a deep, contextual understanding of a specific case.
• Needs to explore or generate hypotheses rather than test them.
• Focuses on a contemporary phenomenon within a real-life context.

Learn more about Other Types of Experimental Design .

Case Study Examples

Various fields utilize case studies, including the following:

• Social sciences : For understanding complex social phenomena.
• Business : For analyzing corporate strategies and business decisions.
• Healthcare : For detailed patient studies and medical research.
• Education : For understanding educational methods and policies.
• Law : For in-depth analysis of legal cases.

For example, consider a case study in a business setting where a startup struggles to scale. Researchers might examine the startup’s strategies, market conditions, management decisions, and competition. Interviews with the CEO, employees, and customers, alongside an analysis of financial data, could offer insights into the challenges and potential solutions for the startup. This research could serve as a valuable lesson for other emerging businesses.

See below for other examples.

Types of Case Studies

Several standard types of case studies exist that vary based on the objectives and specific research needs.

Illustrative Case Study : Descriptive in nature, these studies use one or two instances to depict a situation, helping to familiarize the unfamiliar and establish a common understanding of the topic.

Exploratory Case Study : Conducted as precursors to large-scale investigations, they assist in raising relevant questions, choosing measurement types, and identifying hypotheses to test.

Cumulative Case Study : These studies compile information from various sources over time to enhance generalization without the need for costly, repetitive new studies.

Critical Instance Case Study : Focused on specific sites, they either explore unique situations with limited generalizability or challenge broad assertions, to identify potential cause-and-effect issues.

Pros and Cons

As with any research study, case studies have a set of benefits and drawbacks.

• Provides comprehensive and detailed data.
• Offers a real-life perspective.
• Flexible and can adapt to discoveries during the study.
• Enables investigation of scenarios that are hard to assess in laboratory settings.
• Facilitates studying rare or unique cases.
• Generates hypotheses for future experimental research.
• Time-consuming and may require a lot of resources.
• Hard to generalize findings to a broader context.
• Potential for researcher bias.
• Cannot establish causality .
• Lacks scientific rigor compared to more controlled research methods .

Crafting a Good Case Study: Methodology

While case studies emphasize specific details over broad theories, they should connect to theoretical frameworks in the field. This approach ensures that these projects contribute to the existing body of knowledge on the subject, rather than standing as an isolated entity.

The following are critical steps in developing a case study:

• Define the Research Questions : Clearly outline what you want to explore. Define specific, achievable objectives.
• Select the Case : Choose a case that best suits the research questions. Consider using a typical case for general understanding or an atypical subject for unique insights.
• Data Collection : Use a variety of data sources, such as interviews, observations, documents, and archival records, to provide multiple perspectives on the issue.
• Data Analysis : Identify patterns and themes in the data.
• Report Findings : Present the findings in a structured and clear manner.

Analysts typically use thematic analysis to identify patterns and themes within the data and compare different cases.

• Qualitative Analysis : Such as coding and thematic analysis for narrative data.
• Quantitative Analysis : In cases where numerical data is involved.
• Triangulation : Combining multiple methods or data sources to enhance accuracy.

A good case study requires a balanced approach, often using both qualitative and quantitative methods.

The researcher should constantly reflect on their biases and how they might influence the research. Documenting personal reflections can provide transparency.

Avoid over-generalization. One common mistake is to overstate the implications of a case study. Remember that these studies provide an in-depth insights into a specific case and might not be widely applicable.

Don’t ignore contradictory data. All data, even that which contradicts your hypothesis, is valuable. Ignoring it can lead to skewed results.

Finally, in the report, researchers provide comprehensive insight for a case study through “thick description,” which entails a detailed portrayal of the subject, its usage context, the attributes of involved individuals, and the community environment. Thick description extends to interpreting various data, including demographic details, cultural norms, societal values, prevailing attitudes, and underlying motivations. This approach ensures a nuanced and in-depth comprehension of the case in question.

Learn more about Qualitative Research and Qualitative vs. Quantitative Data .

Morland, J. & Feagin, Joe & Orum, Anthony & Sjoberg, Gideon. (1992). A Case for the Case Study . Social Forces. 71(1):240.

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Bias Assessment in Case–Control and Cohort Studies for Hazard Identification (Statistical Methods in Cancer Research, Volume V)

A new Scientific Publication from the International Agency for Research on Cancer (IARC) summarizes practical methods that can be used to assess the potential impact of confounding, information bias, or selection bias on the results of an epidemiological study. The publication, Bias Assessment in Case–Control and Cohort Studies for Hazard Identification (Volume V in the IARC Statistical Methods in Cancer Research series), presents these methods in a way that is accessible to epidemiologists and other research workers who do not have extensive statistical training, as well as to statisticians who do not have extensive epidemiological training.

Concepts are illustrated with numerous practical examples, taken from cancer epidemiology, as well as links to online code or spreadsheets. The book also outlines the process for integrating these bias assessments into the evidence synthesis. The process that is outlined uses the wide array of methods described in the book to consider all informative studies.

This Scientific Publication was supported by a scientific workshop on epidemiological bias assessment in hazard identification with 37 scientists from 12 countries convened by IARC and funded in part by the United States National Cancer Institute.

Berrington de González A, Richardson DB, Schubauer-Berigan MK, editors. Bias Assessment in Case–Control and Cohort Studies for Hazard Identification (Statistical Methods in Cancer Research, Volume V) IARC Scientific Publication No. 171

See Bias Assessment in Case–Control and Cohort Studies for Hazard Identification (Statistical Methods in Cancer Research, Volume V)

Published in section: IARC News

Publication date: 30 September, 2024, 0:55

Direct link: https://www.iarc.who.int/news-events/bias-assessment-in-case-control-and-cohort-studies-for-hazard-identification/

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Office of the Assistant Secretary for Planning and Evaluation

Supporting Child and Family Well-Being: Case Studies

The Office of the Assistant Secretary for Planning and Evaluation (ASPE) in the U.S. Department of Health and Human Services (HHS) seeks to understand efforts to promote child and family well-being in jurisdictions across the country. ASPE contracted with Mathematica and Child Trends, two independent research organizations, to conduct case studies about states and localities that developed and implemented child and family well-being agendas that guide their approach to human services. Three case studies highlight exemplary states and localities that have implemented a child and family well-being agenda.

Available Reports:

• A Snapshot of San Diego County's Department of Human Services' Well-Being Agenda: Live Well San Diego
• A Snapshot of Maryland Department of Human Services' Well-Being Agenda: Integrated Practice Model for Child Welfare and Adult Services
• A Snapshot of Two Minnesota Counties' Well-Being Agenda: Pathways to Prosperity and Well-Being

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• Participant Experiences with Improving Well-Being Through Human Services Programs

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Synonyms for Case study approach

39 other terms for case study approach - words and phrases with similar meaning.

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• Open access
• Published: 27 September 2024

Exploring challenges and innovation in memory assessment services in England and Wales – a national survey and case study approach

• Sarah Jane Smith   ORCID: orcid.org/0000-0002-1561-9485 1 &
• Claire Surr   ORCID: orcid.org/0000-0002-4312-6661 1  

BMC Health Services Research volume  24 , Article number:  1143 ( 2024 ) Cite this article

41 Accesses

Metrics details

To explore the design, delivery models and identify good and innovative practices in Memory Assessment Services (MAS) in England and Wales.

A two-stage service evaluation comprising (1) on-line survey of MAS providers to identify features of the commissioning models, service design, delivery, and challenges alongside examples of good/innovative practice; (2) qualitative case studies using video/telephone interviews with key staff and people who had used the service.

The 49 respondents to the survey reported a shift in delivery of MAS post COVID and identified key areas for improvement, including a need for specialist staff, support for MCI and rarer dementias, and capacity for post diagnostic support. The 15 case studies illustrated good practice and innovation focusing on post diagnostic support, equity of access, working with external services/service location, MCI and rarer dementia and involving specialist staff.

Conclusions

The evaluation speaks to the importance of (re)evaluation of services to identify local need and the importance of commissioning based on local need and innovative approaches that my sit outside of ‘typical’ MAS pathways.

Peer Review reports

Timely dementia diagnosis enables people to receive early treatment and support that brings benefits for the planning of future care, access to dementia medications, better symptom management, implementation of co-ordinated care, postponement of the need for institutional care and greater support for carers [ 1 , 2 ]. There is also evidence to suggest receiving a timely diagnosis and post-diagnostic support can improve quality of life [ 3 , 4 ]. Access to a timely dementia diagnosis is a global priority with the WHO global action plan on dementia [ 5 ] setting a target of at least 50% of countries having at least 50% of the estimated people with dementia formally diagnosed by 2025. Given an estimated 57.4 million people worldwide were living with dementia in 2019, a number set to triple by 2050 [ 6 ], it is important to establish effective, person centred and timely routes and services for diagnosis.

In England timely diagnosis of dementia is driven by policy [ 7 ], and dementia-specific clinical guidelines [ 8 ] and pathways [ 9 , 10 ] and memory assessment services (MASs) are the primary means for gaining a dementia diagnosis. Diagnostic procedure and services offered is guided by National Institute of Clinical Excellence (NICE) [ 8 ] guidance. This guidance, aimed at practitioners and commissioners, covers diagnosing and managing dementia and includes recommendations on: the process and best practice concerning assessment and diagnosis, psychosocial and pharmacological interventions and managing non-cognitive symptoms. In line with advances in our ability to offer earlier and offer etiological diagnosis [ 7 ] clinics increasingly also offer biomarkers and generic testing alongside neuropsychological evaluation to inform diagnosis and post diagnostic support.

MASs were first established in the UK in the 1980s with numbers growing rapidly in the 1990s and 2000s as a means to enhance diagnostic rates in response to national policy and initiatives [ 11 ]. As in the UK, the diagnosis and management of people with cognitive impairment typically takes place in memory clinics in most high-income countries (HIC) [ 12 ]. For example, in Australia, although there is variation across jurisdictions, typically diagnosis occurs in an outpatient service memory clinic staffed by specialists [ 13 ]. Similarly, to the UK, although diagnosis does not occur in Primary Care, research has indicated that the referring GP is an integral part of the diagnostic pathway informing and influencing patient experience and outcomes [ 13 ].

Although there are relatively well-established routes to diagnosis in HIC, more than two thirds of people living with dementia are in low and middle income countries (LMIC) [ 14 ]. Lower diagnostic rates in LMIC have been attributed to perceptions of dementia being part of the normal aging process, as well as stigmatising views about the condition – hence an avoidance of diagnostic labels [ 12 , 15 ]. These barriers are often coupled with a lack of diagnostic and post-diagnostic services and resources. Furthermore, the diagnostic standards and criteria (e.g. DSM V) applied in HIC can be difficult to apply in LMIC as neuropsychological tests and diagnostic criteria rely on population norms that are not available in many LMICs [ 12 ]. However, as awareness about the importance and value of diagnosis increases so do evidence-based applications of services and tools to enhance diagnosis rates in LMIC countries. For example, in 2016 the World Alzheimer Report advocated the use of community mental health workers as a means to increase diagnosis rates in LMIC [ 16 ]. Researchers have also explored the utility and applicably of cognitive assessment tools in LMIC finding that, subject to further research and validation, simple digital tools used in HIC could be useful for the detection of dementia in LMIC [ 12 ]. Thus, investigations of practice in HIC, may prove useful for informing future practice in LMICs.

There are approximately 330 MASs in England and a further 22 in Wales. MASs are primarily based in NHS Trusts or primary care organisations, follow a range of models of service design and are commissioned to meet local needs [ 17 ]. In England, there is also an optional accreditation route for services. The Memory Services National Accreditation Programme (MSNAP) was established in 2009 to support local service improvement of memory services in the UK. MSNAP developed a set of a quality standards for memory services which are underpinned by research, best practice guidance and legislation. Memory services participate in MSNAP to achieve accreditation against these standards, however in 2021–2023 only 71 services were accredited or working toward accreditation [ 18 ]. This is not necessarily reflective of poor-quality MAS in England, but of the optional nature of accreditation and limited incentives for services to become accredited. Thus, there is a limited picture of what MAS services look like across England.

Although a dedicated clinic is the preferred model of care in England, despite attempts to standardised approaches [ 19 ], the design and service provision of MAS in England remains difficult to determine with services commissioned and operating in different ways [ 20 ]. A study of MASs in England [ 21 ] attempted to develop a MAS typology according to characteristics like structure and processes of care but found that variation meant this was not possible. There is greater consistency in MAS provision in Wales, thought to be driven by the way services are commissioned, with 86% of memory clinics provided as part of a wider service such as Community Mental Health Teams for Older People, as opposed to stand-alone clinics. However, variations in post-diagnostic support are still evident [ 22 ].

Variability in service design has the benefit of enabling services to be commissioned based on local need but can mean patients may have different services available to them based on postcode. The impact of MAS service structure and on patient outcomes remains unclear [ 23 ]. Attempts to address lack of consistency in England include development of quality standards through the Royal College of Psychiatrists, although currently less than 20% of MAS have sought and are accredited through a voluntary process in England [ 20 ].

Reports of evidence-based service improvement in MAS in the UK remain limited A regional audit in London found service variation across a range of areas of practice [ 24 ], with findings subsequently used to deliver four service improvement projects targeting aspects of service variation and promoting best practice. However, the COVID-19 pandemic had a significant impact on MAS operations with the majority of services closed for a period of months, and on reopening having to quickly establish new ways of remote working, including establishment of guidance to underpin this [ 25 ]. Whilst remote assessment and diagnostic methods offer a range of potential benefits in certain circumstances [ 26 ], they are not suitable or accessible for all [ 27 ].

The available literature on MAS in England and Wales indicates that services are diverse in their provision, there are recognised gaps in service provision and a limited evidence-base to inform practice. COVID-19 has impacted service delivery and necessitated a change in delivery methods. The recent return to usual ways of working provides MAS with a unique opportunity to consider service models and make decisions about longer terms plans for service design, delivery, and improvement. Services need a contemporary evidence-base to do this. This mixed methods study sought to address this need and provide, via a national survey, an overview of the nature of MAS in England and Wales including service models, the impact of COVID-19, the challenges that MAS are facing, perceived gaps in current provision. Using a case study approach we provide examples of innovative service delivery which could be used to inform national and international service development.

A mixed-methods service evaluation [ 28 ] underpinned by a positive deviance approach [ 29 ] comprised of (1) a national survey and subsequent (2) multiple case studies [ 30 ] selected from survey respondents.

Ethical approval for the service evaluation was obtained from the Research Ethics Committee at Leeds Beckett University on 21.9.21 (survey) and 29.11.21 (case studies), with the survey approved as an audit and the case studies as service evaluation under the Health Research Authority definitions [ 31 ]. The service evaluation included human participants and informed consent was obtain and all procedures carried out in accordance with the Declaration of Helsinki and approved by the aforementioned research ethics committee.

National survey

A survey of MAS was conducted to (1) provide an overview of the range of service delivery models operating (2) identify areas of need/concern (3) identify innovative practice to inform case study selection (part 2).

Survey design

The survey design was informed by an expert steering group and public advisory group. The survey included two parts: Part 1 - service model, commissioning, staffing and services. Part 2 - innovative practice across 13 areas of practice interest including examples. The areas of practice interest were identified by advisory groups, drawn from a guide to continual improvement in MAS [ 32 ]. Respondents were asked to indicate in the survey if they would be happy to be approached to participate as a case study site.

The survey was completed electronically and distributed via e-mail by the NHS England Clinical Networks and Improvement Cymru to staff who were on their e-mails lists as associated with MAS and was promoted via social media and webinar/conference presentations where MAS staff attended. Due to the way the survey was distributed it is not possible to know the numbers of MAS staff or services reached and thus response rates. Given the primary purpose of the survey was to describe a variety of service models and identify common practice challenges and good practices with MAS, the underpinning sampling approach was thus positive deviance [ 29 ]. Therefore, it was not our aim to recruit a representative sample. The survey opened in September 2021 and closed in January 2022.

Multiple case studies

We adopted a multiple case study approach following Stake’s [ 33 ] approach to case study methodology. The quintain or phenomenon of study was how MAS in the UK have innovated their practice to meet local needs in the context of current commissioning models. We adopted the case site selection criteria of particularisation [ 33 ] where the power of each site comes from its representation of the local situation rather than its generalisability. This was underpinned by a positive deviance approach, where cases are selected for their ability to provide potential solutions to common problems through approaches already being practised in the community [ 29 ]. Our underpinning philosophical stance was pragmatism where applied knowledge is seen as constructed and interpreted based on its application to help solve particular problems [ 34 ].

Case study sites in England and Wales were identified based on responses to part two of the survey. Respondents identified and reported on their own interpretation of innovative practice in the survey. Clear indication was provided in the survey as to what elements and types of practice considered good and/or innovative. These topics were based on previously published good practice guide, developed by the authors, an expert consensus group and published with NHS England [ 32 ]. For site selection the following criteria were applied:

Demonstrates at least one example of good or innovative local practice.

Delivers an example of good practice that is judged by advisory group members to be strong, significant, innovative and potentially replicable in other situations.

Represents a range of geographic locations/regions.

Represents a range of MAS commissioning/delivery models.

Anonymised survey data were discussed with the public and expert steering groups where consensus was reached sites were approached to take part.

Case study data collection and analysis

At each site agreement to take part as a site was obtained from the initial respondent who took responsibility for the identification of participants at each site which comprised two groups (1) Staff who had worked in the service for at least four-months (2) Service recipients and/or their relative/carer who had accessed the MAS in the last two-years.

One-to-one or small group interviews were conducted remotely via Microsoft Teams, or telephone. Interviews took place between March and November 2022. Interviews were conducted by research team comprising the two authors (CS/SS), and two researchers (LG/SB). Each case study site had a team member assigned as the lead for the site (CS/SS/LG or SB) coordinating all communication and data collection and conducting the majority of interviews – a small number of sites had interviews conducted by two researchers due to workloads and timing of interviews to meet practitioner availability. Where appropriate documentary and other secondary evidence was also gathered. The interviews were semi-structured, conversational in style and focused on drawing out key information about the area(s) of good practice and how these had been achieved. All interviews were audio recorded or video recorded on Microsoft teams and later transcribed. They followed a topic guide used by all researchers flexibly and aimed to address the following ‘issue questions’ related to innovative service delivery [ 33 ]:

What were the drivers for the localised practice change?

What process was gone through to make the change? What were the barriers and facilitators to change?

What impacts has this had on service delivery and for patients?

If and how have you been able to sustain this service?

What advice would you have for another service who may wish to adopt a similar practice change?

Participants were asked to discuss the specific area(s) of good practice identified via the survey response about their MAS, but were also given the opportunity to identify and discuss additional aspects of practice they felt were good or innovative in their service. In this way each case study was not limited to only including practices related to the area of innovation identified in the initial survey response.

For each case the interview transcripts were brought together to compile a detailed description of the case [ 35 ] including direct quotations. The initial case was written by the lead member for that site (CS/SS/LG or SB) and then all cases were also reviewed by the first or second author (CS or SS) alongside the interview transcripts to check accuracy and consistency of presentation across cases. Following this a cross case analysis [ 30 ] was conducted by the first author (SS) using deductive thematic analysis where thematic categories related to innovative approaches to addressing service challenges which also aligned to features of a person centred MAS pathway identified in the guide for innovative practice previously published by the authors [ 32 ]. The innovative practices were then compared across cases, with common and unique features identified and presented in this paper. Since the interviewees were not limited to only identifying the innovative practice first reported in the survey, each site features multiple elements of innovative practice that emerged from the data. The final themes were reviewed and agreed by the second author (CS). The full case studies are provided in a separate report [ 36 ].

Respondents to the survey came from England and Wales. There were 88 responses in total, although 39 were removed for incompletion or representing duplicate responses; 34 consented to take part in the survey but did not complete any substantive part of the survey and 5 responses were identified as duplicates.

Forty responses from England and nine from Wales were included in the analysis of the survey. Twenty-four participants agreed to be approached for participation in a case study. Following review of the site responses concerning innovative practice and consultation with the expert group, sixteen sites were approached to participate in the case studies. One site did not respond to follow up. Fifteen sites took part in case study data collection.

There was a broad geographical spread of respondents (see Table  1 ) with the greatest representation from the North East and Yorkshire region.

Service design

In England, the majority of the respondents (77%) were reporting for an individual MAS rather than on behalf of all MAS within their organisation (e.g. all MAS within a Trust). In Wales about half were reporting for an individual service (56%) and half for their organisation (44%) (see Table  2 ).

In England, 38% of the services reported were MAS that were embedded with Community Mental Health Teams, and in Wales this was 56%. There was a fairly even split between services with independent (England 50%, Wales 44%) and unified management structures (England 48% Wales 56%).

Format of MAS service appointments

The respondents were asked the about the format of their assessments and consultation appointments, as they were currently (December 2021) being delivered in their service(s) by stating what percentages of appointments were being delivered using each listed modality.

An overview of the way that appointments are delivered (December 2021)

Few services were offering appointments within outreach clinics such as primary care or non-NHS settings (Fig.  1 ). The most common modalities for appointments were consultation in the patient’s own home or attending the hospitals. Few services reported that appointments were delivered in a single modality (e.g., over 90% of services being delivered in one modality). Where this was the case, this tended to be using the patient’s own home. Where a mix of modalities were being used, these included telephone, video conferencing and hospital-based appointments as relatively common choices. Non-NHS settings and primary care were the least frequently used appointment settings.

The impact of COVID-19 on modes of delivery

Participant responses to an open-text question about how appointments were delivered at the point of survey completion generally alluded to changes that had been made in response to the COVID pandemic. For most respondents the approaches that had been adopted in the peak of the COVID pandemic were still influencing practice, particularly with regards to adopting and retaining blended approaches to appointment mode.

“The assessment is carried out face to face however, feedback of diagnosis has been delivered via telephone or video consultation.” “ Following the covid outbreak appointments are now and will continue to be offered, remotely via Microsoft teams, face-to-face at home or in clinic, or over the telephone. Where a telephone appointment is deemed appropriate and no other option available, outcomes are always discussed in the weekly multi-disciplinary team meeting to ensure enough information is available to go ahead with a diagnostic appointment or decide if further assessment is required at home. We have found the majority of our service users prefer to come to clinic for initial assessment.”

Respondents were asked if the currently delivery model was different to their pre-COVID-19 model of delivery and if so how. In Wales, all respondents to this question indicated yes ( n  = 7), in England two thirds ( n  = 28/38) said the model was different.

Some respondents indicated how COVID had interrupted or delayed service changes that were already in the pipeline or being implemented.

“Pre-COVID one part of the service was embedded in the CMHT. The decision had been made to make it a stand-alone service…but managed jointly with the already established MAS in the other half of the Trust which is commissioned by a different CCG [Clinical Commissioning Group]. A model had been agreed pre-COVID for the new service but this had to be re visited due to the situation.” “Pre-COVID the service had began to implement a “Market Place” event, bringing together services/agencies who can offer a service to those living with dementia. This is something we plan to grow and develop as soon as .restrictions on service delivery are lifted.”

Other respondents referred to the impact of COVID-19 on the rapid adoption of technology for remote consultations and blended approaches. This had streamlined services and offered more options to meet patient preferences. Although some respondents noted the increased use of technology was at the “cost’ of reducing face to face contact, which was not regarded as favourable.

“We have now re-opened our clinic and are seeing most patients either in clinic or in home visit appointments, however, our team are now confident to offer remote and telephone assessments on rare occasions when it is needed.”

In other services the impact of COVID was more temporary with modes of delivery returning to a pre-COVID models.

“Staff have generally returned to their normal practice and preference which is to assess people in their home environment or within clinic."

Respondents were asked if the current model reflected how they plan to deliver the service moving forwards. Most respondents in England ( n  = 30/38) and Wales ( n  = 5/6) indicated that this was how they plan to deliver the service moving forwards, although 21% of respondents in England said this was not the case.

Most respondents indicated that the elements of change they planned to retain related to offering optionality for patients.

“We have found that family members and carers tend to prefer telephone consultations as they are more convenient. Home visits have also been found to improve access to the service for people with mobility issues or those who are concerned about attending hospital appointments. Looking at developing model that incorporates different consultation modes dependent upon need.”

Memory assessment service workforce

The survey asked which staff groups were represented within their MAS commissioned services (Table  3 ). All MAS based in Mental Health and Community Trusts included old age psychiatrists in their workforce, with a large majority also including registered mental health nurses, occupational therapists, and psychologists. Non-medical prescribers and healthcare assistants were also commonly employed staff groups.

Some staff groups were less frequently represented, but still present in services, including neurologists and neuropsychologists, dementia navigators, and other staff groups such as Admiral nurses and Alzheimer’s society outreach workers.

We asked English respondents about the gaps or challenges in their current commissioned workforce model, with 78% of respondents identifying gaps. These fell into three broad categories: general capacity; the need for specialist staff; and staff to support post-diagnostic support.

First, some respondents indicated that staffing issues were related to general capacity.

“Assistant psychologists are brilliant at doing neuropsychological assessments under supervision from a psychologist in another team - but are hard to retain- which means there are gaps when one goes and another is coming. Ideally we would benefit from a full time qualified psychologist but service is not commissioned or funded to include this.” “No Occupational Therapist/s. No Assistant Practitioners (1 Fixed Term post at present), No Health Care Assistants/Support Workers. We do not have enough dedicated medic time in to the service. There are not enough staff in general.”

Second, many respondents identified the need for staff and associated support pathways that can provide specialist or rarer dementia support, this included MCI, young onset dementia and less common forms of dementia.

“Pathway for people who have a suspected alcohol-related brain damage and are still actively drinking .”

Third, many respondents also identified needing more staff to enhance post-diagnostic support.

“We would benefit from additional nurses and dementia navigators for post diagnostic support as currently we cannot meet the need.”

Commissioned services in MAS

To obtain a comprehensive overview of the MAS represented in our survey we requested respondents indicate which services they were commissioned to offer and deliver and where services were delivered locally but outside of the MAS (Table  4 ). Most MAS were commissioned to offer assessment and diagnosis to those over 65, with the majority also offering a diagnostic service to those under 65. Neuropsychology assessment, occupational therapy and cognitive stimulation therapy were also offered by most services.

Where services referred to specialist components of assessment or diagnoses, such as imaging or biomedical assessment, these were less frequently commissioned as part of the service but could be accessed. Similarly, services that related to post diagnostic support (outside of CST) were less likely to be commissioned, but in most cases could be accessed, for examples information sessions or care co-ordinators. Specialist support, such as Admiral nurses, was not commonly offered or accessible elsewhere.

A follow-on question was asked (to respondents from England) about gaps in respondent’s current service commissioning. Of the 38 respondents to this question, 45% said they had gaps in the way the service is commissioned, 29% said there were no gaps and 26% were unsure. We asked respondents to provide further detail with regards to the gaps in service commissioning. Their responses fell broadly into two categories; support for MCI and less common forms of dementia and post diagnostic support and carer support.

“Inadequate under 65s services, especially for non-neurodegenerative dementias (i.e. vascular and alcohol related brain injury).” “Longer term follow-up is an issue. Currently , stable patients are discharged to the GP after 6 months , with referral back to the MAS when necessary. There are plans to increase support (e.g. Admiral Nurses) in the near future.”

Finally, we asked English respondents whether they had plans in place for quality improvement over the coming 12-months. Most respondents (78%) indicated that they did, with 22% saying no or maybe. For the respondents indicating yes, the descriptions of their quality improvement plans broadly fell under three themes; streamlining and workforce recruitment (e.g. “we have trained our support workers to do phlebotomy and ECG’s so that we can complete all outstanding investigations at the first appointment”), introducing new services (e.g. “new business case to support MCI services”) and remodelling existing pathways (e.g. “Developing of Pathway Lead structure, reviewing the current pathway and designing a virtual diagnostic clinic for the county to help streamline assessments”).

Multiple case study findings

A total of 44 staff and service users were interviewed across the 15 sites. Table  5 provides an overview of the case study sites including the key service features at each site. The interviews were conducted with eight Memory Service Mangers, five Consultants/Old Age Psychiatrists, seven carers and people with dementia, five Nurses, five Occupational Therapists, four Memory Support Workers, two Assistant Psychologists, four Clinical psychologists, three Assistant Practitioners and one GP Specialist. More granular details of the roles of staff interviewed have not been provided since this could lead to identification of participants where there is only one individual working in a particular role within a MAS. Examples of practice under each service feature from the case studies in the series are presented after the table.

• Post diagnostic support

Half of the case studies featured innovative approaches to post diagnostic support. In some cases, this referred to specific interventions such as cognitive stimulation therapy. For example, at site 6, due to COVID staff felt alternatives to face-to-face group CST were needed to prevent people newly diagnosed with dementia from becoming isolated and under-stimulated. They developed options for delivering CST to people in their own home by way of a cross-borough project set up by the MAS psychologists and working collaboratively with psychologists from another MAS service within the same Trust.

“[We were] very aware that , as the pandemic moved on and a lot of things had moved to online , that it was very much an issue around exclusion , digital exclusion , with older people predominantly. Maybe , many people within that group may not have… be able to access it. So , we are very mindful of that and the additional challenge of people with dementia as well. But we thought it would be worth giving it a go and seeing… and starting to develop a way of having conversations with people who were waiting for CST. About the idea and thinking about what support they would need to access the group online. And talking , also , to people who supported them , their families and carers , to see whether we could work together to enable them to access the group if they were interested.” (Site 6 - Staff member two).

In other cases, innovative post diagnostic support meant adopting an extended model of post diagnostic support such as at case study site two where post diagnostic support is offered until end of life. At site two the lifetime support includes a one-month post-diagnostic review, followed by six-monthly comprehensive reviews which can be increased in frequency where complexities exist/arise, until the person with dementia has stabilised. Reviews are undertaken by either an Assistant Practitioner or a nurse dependent on the complexity of needs. At least one review annually is conducted in the person’s own home. The team includes occupational therapy and psychology staff who support diagnosis and post-diagnostic support. A lead practitioner and non-medical prescriber provide more intensive support for those with the most complex needs.

“It was the beginning of a relationship and that for us was critical , that it’s not about being dumped with something and go away and sort out your affairs. … It’s about , yes , this is something we’re going to support you through and we will be following it up and you will be seeing [name] on a regular basis. So I think that’s … absolutely critical. You need continuity and you need somebody that you can begin to build trust with because it’s such an unknown territory at the beginning and you know it’s pretty terrifying because you think. Where do I begin?” (Wife of someone diagnosed with dementia by the service – site two)

As in the above example, many of the reported cases rely on MDT approaches. For example, in site 12 a post-diagnosis support service within primary care was commissioned and is led by two GPs with a special interest in dementia. Both the memory assessment and post-diagnostic services work in collaboration with the Alzheimer’s Society.

Personalised care pathways

In several sites, personalised care pathways meant operating a tailored approach to referral or triage systems (site one, five, six). For example, site six provides telephone triage for anyone referred into the service within 24-hours. This operates seven-days a week. The information gathered at triage alongside the referral is used to determine whether a person is assessed via the Tier One routine pathway, or Tier Two pathway for more complex cases. Tier Two includes neuropsychological assessment and MDT review. This triage is available 7-days a week as referrals dealt with by the nurses cover both memory assessment and functional mental health problems.

“If we find that we identify risks within that conversation , where people need support within 24 h , or even a couple of hours , depending on what it is , we are able to do that. And I think that’s really important.” (Site 6 - staff member 3)

Similarly, a site five, the service offers different pathways that are based upon patient needs and presentation at screening.

“ Clients we would sort of divide people up into different pathways depending on how they present. So from the most not for the most straightforward , the most kind of obvious. You know people that look like they’ve gotten established cognitive impairment or established dementia , but nobody has formally diagnosed them through to people that you may have comorbid major mental health difficulties may be considerably younger and may still be working. So we’ve we developed a number of different pathways.” (Site 5 - Staff member one) .

The idea of the pathways ensures that people are not over or under assessed whilst ensuring that diagnostic accuracy is maintained.

“So it’s making sure that we’re giving the right type of assessment to the to the right , to the right clients so that the with the exception of the formulation pathway , the other pathways people get the same. Assessment process. But how much of which bits they get will depend on how much they need.”(Site 5 - Staff member one) .

Support for MCI and rarer dementia

This was identified as a key theme present in two cases. Site four offers pre diagnostic support, diagnosis and post diagnostic support for younger people with dementia for as long as required.

“I work with the younger person’s memory service and if someone needs nursing input prior to diagnosis , that will be through the younger person’s memory service , which is one of the reasons why there’s not dementia name in the service because a lot of people referred to the service won’t have dementia… And then when someone receives a diagnosis with dementia , then will remain within the younger person’s memory service until they have no need for us or until they’re 65” (Site 4 - Staff member 3) .

This has also afforded the opportunity for re(de)diagnosis.

“there was a kind of natural point there to start looking at diagnoses again when you repeat cognitive tests. And then you look back and think , well , right over a period of years , this hasn’t declined. This isn’t really consistent with your diagnosis anymore…. I think that is quite unique to our service because we do follow people up long term even if there aren’t major issues.” (Site 4 – staff member 3) .

This was only possible because of the length of time people are followed up and has enabled staff to identify people who they may have expected to decline but have not. This approach may not be viable in services that do not offer an extensive follow up in this age group.

Site nine had developed an innovative service improvement project for people presenting to services unlikely to meet the threshold for dementia (e.g. MCI or similar). In this project a consultant intercepted and reviewed referrals to the regional MAS, redirecting those likely to present as MCI or functional impairment to a brain health clinic.

“It’s not a perfect system , people … who are MCI , stage , still get through to the other consultants and people who have dementia stage illnesses are still getting through to me… over the last three months (the clinic) taking about 20% of the referrals which works out , if you do it retrospectively , works out at about the rate at which MCI is diagnosed amongst all referrals.” (Site 9 – staff member 1) .

After a comprehensive assessment within the brain health clinic, clients are offered feedback and follow up care based upon their individual need. The idea of the clinic is to address the gap in support that people with subjective cognitive impairment might experience, and recognise that tailored support can be offered with beneficial outcomes for this heterogeneous group.

Site six operates a specific MCI post diagnostic pathway using funding provided by the Clinical Commissioning Group (CCG). This includes six group sessions that cover biopsychosocial advice to support the person to lead a healthy lifestyle and a workbook which provides advice and information related to the session content. People can receive the workbook even if they don’t want to attend the group sessions.

“[The workbook includes] links to local resources that they can tap into so local exercise classes , …different voluntary organisations etc. People have found that useful , and … reiterates healthy living , health promotion , exercise , and … we … if someone wanted to give up smoking we can sign post them to smoking cessation or alcohol reduction teams. So we feel like we’re giving them something useful” (Site six – staff member 1) .

The team have also been able to create a specific MCI register to ensure recall happens in a timely manner. This includes a six-monthly triage for those who are at high risk of conversion to dementia. If there has been a change the patient will come back in for assessment sooner.

Equity of access

Examples of services that promoted equity of access included those that had adopted culturally appropriate practices. Site 7 was located in a city region with a high South Asian population. They noticed that members of this community were not being referred into the service at the same rate as white British people. When they did attend assessment, members of the South Asian community reported feeling the process was not culturally sensitive and staff reported difficulties administering the Addenbrookes cognitive assessment tool due to issues with language and the euro-centric nature of some of the questions. The service has worked with local GPs to dispel myths about dementia and to highlight the potential benefits of referring for/seeking a diagnosis. They undertook a project to develop a culturally appropriate version of the Addenbrookes which included revised questions and translation into Urdu and Hindi, and employ staff who speak some of the languages spoken in the local community so assessments can be conducted in their preferred language.

“I’d experienced that challenge as a practitioner when I was delivering the original form of the Addenbrookes. Even interpreters were saying , well , that that’s not a fair tool. You’re not giving this this person a fair chance to , to demonstrate their cognitive abilities. That often resulted in fairly uncomfortable sessions where the interpreter was attempting to help out the individual who was being assessed and … trying to rephrase.” (Site 7 – staff member 1)

Innovative/examples working with external services

Site 13 had worked with external services to develop a rapid scanning pathway. Unlike other MAS’ who need to refer service users to local hospitals with long wait times for brain scans, the service had an innovative and bold scanning provision with very short waiting times. Both MRI and CT scans can be booked at the same time as the assessment appointment. The team also commissioned another more local scanning facility with longer wait times. This second service is more accessible by public transport and the more protracted wait times consider that not everyone will want a rapid service.

“Look at your scanning pathway and see if there’s a possibility of doing that better as a kind of quick fairly , I mean , I’d say quick , easy win. I don’t do the contracts [S1] knows about that stuff , but you know , it seems to me to be a common theme of and a source of frustration or you know , some services get around that by requesting that the GPs get the scans done before they come into the service”. (Site 13 – staff member 3)

A further example of novel approaches to external working was seen in Site 14 in which the team established a relationship with Digital Technologies Wales and was able to loan equipment, for example, iPads and Echo Dots, to trial with their service users.

“How technology can advance somebody’s independence , looking at different ways in which we can enable people to be independent rather than just looking at kind of not using technology…there’s a perception there with older people , they’ll be less likely to use technology , but our outcomes of that are very different.” (Site 14 – staff member 4)

The team based their interventions around technology that is affordable and is often already in people’s homes, or that can be easily purchased from websites such as Amazon.

Specialist staff

Site 14 provided an example of a service that utilises specialist staff for a large portion of their service provision. The MAS occupational therapy (OT) service is a new service that delivers evidence-based pre-diagnostic assessment and post-diagnostic intervention. Each case is discussed at weekly MDT meeting and service users are referred to the OT team on a needs-based basis. For service users in receipt of OT support, once the OT team have completed their intervention (on average 12 weeks but can be shorter or longer) the service user will be discharged but will remain on the wider MAS caseload. To assist other healthcare professionals (e.g. GP), the OT team conduct re-assessments to determine if there have been any changes to an individual’s clinical or functional profile.

Location of memory services

The location of services featured in some of the cases, often alongside innovative workforce practices or approaches, as a means to increase diagnosis rates and/or the efficacy of post diagnostic support. For example, in site 13 an innovative MAS nurse-led model was implemented. The service was reformed into a community service, operating out of primary care locations and delivering home visits.

In site 11 the service had identified some localities across the area it serves which have low referral and dementia diagnosis rates. They considered ways they could be targeted to increase referrals from these areas. Public brain health sessions were suggested as a possible solution, and these were commissioned for delivery by a local charity.

“And the idea of the brain health sessions was to get down to grassroots. So we want [sessions] in supermarkets. We want them in libraries , in leisure centres. We were sort of saying , right , how do we get right down to … a really basic level with people who are out shopping and , oh , let’s talk about brain health. This is why it is important.” (Site 11 – staff member 1)

The intention of the sessions is to increase availability and accessibility of support, raise awareness of dementia and its symptoms, reduce stigma by getting people talking and promoting the importance of getting a timely diagnosis.

This evaluation provides an overview of MAS in England and Wales demonstrating both common challenges and examples of innovative and unique service delivery. It showed that service variation exists which creates opportunities for services to tailor their provision to better meet local needs and improve patient outcomes. The case studies provide examples of practice for national commissioners as was as contributing to the evidence base for developing services, including those in LMIC. Examples of good and innovative practice often involved undertaking multiple service innovations, related to features of service provision (e.g. post diagnostic support, counselling), service structure (location of services, care pathways, accessibility), service workforce (use of GPs and specialists), and remit (supporting younger people, people with MCI or rarer dementia).

Services included in the case series strengthen the case for individual MAS to routinely (re)evaluate the design and delivery of their services. Many enforced changes to service provision due to COVID-19 generated opportunities to for services to streamline and refine MAS pathways, as identified by the services that took part in the survey. A key characteristic of the collective case studies was the importance of developing services that are responsive to local need and informed by evidence of such. Implementation science and practice change theory, such as the i-PARIHS model in the healthcare domain [ 37 ], draw heavily on the need for consultation in identifying service need and implementing local/inner context solutions. The importance of co design and consultation is also reflected in NHS commissioning guidance [ 38 ]. In our sites there was clear evidence of establishing local need and working collaboratively with staff or service users to inform solutions. For example, at site 6 solutions for the delivery of remote CST were driven by consultation with people with dementia and their families on the waiting list to receive CST. In our case studies, sites also spoke to the importance of commissioning support for the success of their approach – with top down organisational support representing key feature of practice change success.

That being said, our evaluation was also indicative of the challenges of local commissioning. Significant gaps and shortfalls identified by the survey (for example with regards to postdiagnostic support) indicate that local commissioning arrangements can also create uncertainty within dementia diagnostic and post-diagnostic support pathways. Whilst commissioning for local needs is undoubtedly important, it can lead to commissioning for the lowest cost resulting in disjointed service provision with gaps that may fall between the responsibilities of individual providers.

As an example, our survey findings indicate that despite existing evidence-based guidelines on dementia diagnosis and post-diagnostic support (e.g. NICE guidelines [ 8 ]), in some areas of the UK recommended services such as CST are reported to not be routinely available. There are a number of reasons why this might be the case including commissioners not providing funding for post diagnostic support at all, for specific CST services, or a lack of resources within commissioned services to deliver all aspects of a service they are commissioned to deliver. The latter could result from a need to prioritise resources elsewhere in the system to meet more pressing demands (e.g. to diagnosis post pandemic vs. post-diagnostic support), lack of staff/staff with the requisite skills to deliver particular interventions [ 21 ], or a perception that other services/interventions better meet local needs and so reflect a better investment of limited resources [ 38 ].

NHS commissioning guidance for dementia requires that commissioners take an approach aimed at reducing health inequalities [ 10 , 38 ]. This involves identifying and meeting local need, such as demonstrated in sites adopting culturally appropriate assessment practices, but balancing this against “reducing unwarranted local variation in process and outcomes” [ 38 ], Overall, the commissioners’ priority is one that prioritises personalisation over place based approaches such that “the commissioning landscape…is characterised as much by the ability to personalise and shape care and support in response to individual needs and preferences, as it is by place-based approaches and new models of care” [ 39 ]. A third of the case series reflected the service feature of personalisation, with all cases reflecting an element of personalisation or person-centred approaches, potentially indicating the success of this commissioning principle. Although, given the survey format and complexity of commissioning arrangements and decision-making within local healthcare systems, it was not possible for us to have a more in-depth understanding of this issue and it should be a topic for future research.

In a few sites, such as site 9 that presented a Brain Health Service, the innovation had not yet met the threshold for commissioning, but nonetheless demonstrated an innovative local solution. Innovation at this site relied on individual motivation and skills to demonstrate solution, and whilst not (yet) showcasing sustainable service change, made a key contribution to the evidence base for future memory services. The brain health site reflects contemporary thinking that Brain Health Clinics are the next step in dementia care provision [ 12 ] and provides a working example of this in practice. The European Task Force on brain health services suggested the deployment of a second generation of memory clinics designed to offer evidence – based prevention in at risk individuals [ 12 ]. These clinics – conceptualised as Brain Health Services - will offer risk assessment (biomarkers and brain pathology), risk communication and personalised prevention. These are likely to become more important as earlier minimally or non-invasive dementia screening and diagnostic tests become more widely available (e.g. blood tests) and new disease modifying drugs come onto the market. These may lead to earlier presentation at MAS and a need to combine prescriptions of drugs where warranted, with a range of health advice on personalised prevention and risk reduction and ongoing monitoring.

However, personalised prevention is likely to be based on multidomain interventions [ 40 ] – and will likely put further pressure on services already struggling to offer PDS for dementia. Therefore, understanding the prevalence and exploring the reasons for existing shortfalls in this provision is an increasing priority. Service pressures will also arise from new treatments that require etiology to be clearly established (e.g. monoclonal antibody treatments) [ 41 ] in order to offer personalised treatment plans.

Examples from our collective case studies that address shortfalls in postdiagnostic care will be useful for national commissioning as well as provide examples for international service development. For example, two case study sites focused on meeting the needs of ethnically diverse communities, contributing evidence that may have additional utility for service development in LMIC. In the UK we are facing a projected seven-fold increase in dementia over the next five years in people from Global Majority communities compared to a two-fold increase in White British counterparts [ 42 ]. In the UK older South Asian adults are less likely to access dementia diagnostic services in a timely way, compared to rates for older white British adults [ 43 ]. Our case studies explored ways in which the diagnostic process can be adopted to be more sensitive and accurate as well as ways to reach into communities who may be reluctant to engage with services. In line with previous studies that suggest that simply scaling up services that work well in HIC will not work in LMIC [ 15 ], our findings indicate the importance of adapting services according to population characterises in order to achieve successful service outcomes. Whilst our communities exist in a HIC, there may be elements of learning that can be applied to the development of services in LMIC in South Asia and Somalia.

Previous research in HIC with similar models of care have indicated that patient experience can be adversely affected by the articulation between the MAS and other services, as in our evaluation, a study in Australia patients report significant gaps in post diagnostic support available to them [ 13 ], which was attributed to the articulation of services where GP discharge occurs. Our case studies also reflected the importance of the physical location of services or the points of contacts within the service pathway. Services that improved relationship with GPs or ancillary services elicited better patient outcomes. The importance of improved articulation existed at both ends of the pathway, referral and discharge. For example, in one of our cases (site 11) – the service point of contact was early in the pathway (pre diagnosis) and located in the community. This service was attempting to address the issue of low local diagnostic rates by running brain health sessions within the local community.

Innovation relied upon the creative use of staff as well as location. In our sites a range of staff have been shown to be equipped to reliably obtain accurate diagnosis. This is in line with published finings such as previously evaluated service addressed workforce issues by implementing advanced nurse practitioner (ANP) roles across four localities of a large NHS Trust. The ANP were upskilled and able to meet competencies related to assessment and diagnosis of dementia, thus reducing reliance on medical staff within the MAS [ 44 ]. In another evaluation structured assessment by AHP’s was shown to be just as accurate as a formal MDT judgment [ 45 ]. The use of community nurses at the point of screening has also been shown to have potential to enhance the speed and accuracy of dementia pathways [ 46 ]. Taken together, these findings support the recommendations of the WHO which advocated the use of health care workers in the community to increase diagnosis rates in LMIC. However, simply scaling up interventions that have worked in HIC is unlikely to generate optimal outcomes [ 14 ].

Limitations

This evaluation was limited by the number of services that the responded to the survey in the first instance ( n  = 49) which served as the sample from which the practice cases were obtained. However, given our evaluation was designed to seek examples of good or innovative practice, our self-selecting sample was primed to be receptive to requests for information about their services and provide access to their services for the subsequent case study component of the evaluation. A further limitation was that in conducting the case studies it wasn’t possible to obtain service user experience in all cases, so in most cases the staff perspective dominated. Previous research has suffered the same limitation in demonstrating that the structural and process characteristics of MAS in England are unrelated to HRQOL [ 47 ]. However the service innovations and structural and process characteristics may positively or adversely affect patient experience, and this should be further investigated via through qualitative exploration.

Whilst we did not record details of MAS accretion with MSNAP in our survey or in the case studies, it may be considered a limitation of the study that not all MAS taking part in the cases were accredited. Some were accredited, some were waiting to be and others reported being limited applying for accreditation because of the way that they were commissioned. However, previous research shows that MAS who had been accredited by MNSAP did not stand out as different in regard to structural or process characteristics to those that had not been [ 21 ].

A further limitation of the study is that we did not consider access to service as part of the pathway. Previous research has shown that the experience of accessing the service is as important for patient experience and outcomes as their experience of the service itself [ 13 ]. Future research should consider the local pathway in its entirety.

Our findings, taken together with the available evidence, suggest a significant shortfall in postdiagnostic services. This is particularly important given new dementia disease modifying treatments in the pipeline and the proposed second generation of memory services that will extend assessment to individuals at risk of dementia.

Whilst incentivisation of diagnosis in the UK led to increased diagnosis this created the “gap” of postdiagnosis service provision that has not been claimed by a specified service. Our collective case studies series offered solutions to the PDS shortfall. For example, the offer of CST remotely, with the benefit that it is not subject to the limitation of rural or remote geography – ideal for implementation in many LMIC, that may rely on digitation and remote delivery of services [ 14 ].

Our findings indicate that services should reflect local need. Population characteristics may be a important drivers for successful service outcomes – and providing a variety of services as examples that work well with specific communities is useful. Furthermore,

MAS will need evolve to keep up with our conceptualisation of cognitive impairments and the treatments on offer, which are increasingly becoming both more personalised (based on etiology) and preventative. Services need to prepare to deliver a changed offer and to meet national clinical guidelines on expected service provision and standards of pre-, diagnostic and post-diagnostic care for people with dementia. This will entail working collaboratively with stakeholders and commissioners, working across the dementia pathway, and balancing non-standard models of working with equitability. Forums which showcase good practice, that often remain unseen, will be a useful resource for developing national and international memory assessment and support services.

Data availability

Data may be made available from the authors upon reasonable request by contact Dr Sarah J Smith at [email protected].

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Acknowledgements

We would like to acknowledge the input of out project steering group and lay advisory group members in the design and delivery of this evaluation, and Sally Brown and Leanne Greene for their contribution to the project.

This work was funded by NHS England NHS England and NHS Improvement and Improvement Cymru.

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CS and SS jointly conceived the project, conducted the data collection, analysis and preparation for publication. Both authors reviewed the manuscript.

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Correspondence to Sarah Jane Smith .

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Ethical approval for the service evaluation was obtained from the Research Ethics Committee at Leeds Beckett University on 21.9.21 (survey) and 29.11.21 (case studies), with the survey approved as an audit and the case studies as service evaluation under the Health Research Authority definitions [ 31 ]. The service evaluation included human participants and informed consent was obtain and all procedures carried out in accordance with the Declaration of Helskini and approved by the aforementioned research ethics committee.

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Smith, S.J., Surr, C. Exploring challenges and innovation in memory assessment services in England and Wales – a national survey and case study approach. BMC Health Serv Res 24 , 1143 (2024). https://doi.org/10.1186/s12913-024-11571-2

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DOI : https://doi.org/10.1186/s12913-024-11571-2

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Case study: barfoots uk, contacts & related research.

Developing world-leading growers and pioneering new crops and systems

Following the sun

Five generations of the Barfoot family have farmed the unique soils and microclimate of the Hampshire basin in the south of England. During the 1970s, Peter Barfoot and his father grew and marketed a single crop of vegetables directly to retailers. Fast-forward nearly 50 years and Barfoots operates out of four key global hubs; working across thousands of acres, employing thousands of people and supplying 135,000 tonnes of fresh produce to the UK market annually.

Barfoots UK 

In 1994, the business purchased Sefter Farm in West Sussex. This has since become the Barfoots main site for producing, processing and supplying pre-packed sweetcorn to the major supermarkets. As retailers began demanding a year-round supply of fresh produce, the business looked overseas to warmer climates. 

Local knowledge, insight and advice has been invaluable when setting up the overseas hubs and has reduced some of the complexities of running a global business Kim Barfoot-Brace, Barfoots Brand and Marketing Manager

Barfoots España

Over time, the business built connections with Spanish growers which led to sweetcorn being imported to the UK market outside of the traditional British growing season. The success in Spain prompted the launch of Barfoots España in 2002. Today, 6,500 acres of productive Spanish farmland grows many semi-exotic vegetables for British consumers. Barfoots España is managed by Peter’s eldest daughter, Jo-Anne, who continues to work with many of the original growers. As well as farms, Barfoots España incorporates packing facilities, a supply chain, and a logistics management hub. 

Barfoots Latin America 

Barfoots has been working with the finest growers in Latin America since 2003, when they first started importing asparagus from Peru. In 2006, following an extensive career working for Barfoots in the UK, a senior employee originating from Argentina returned to his home country and later launched Barfoots Latin America. Barfoots have gone on to develop growing partnerships in Argentina and Brazil, providing a number of crops to ensure its year-round supply schedule.

Barfoots Senegal 

In 2006, Barfoots embarked on a joint venture with the French Société de Cultures Légumiéres to purchase farmland in Senegal. Barfoots Senegal is a major grower of vegetables such as sweetcorn, baby corn, chillies and butternut squash. It has become one of the most important supply hubs for Barfoots, with its large-scale growing, packing and exporting capabilities due to the superb location on the Atlantic coast enabling efficient export of produce by boat. 

Sustainability at Barfoots 

Barfoots strives to be as sustainable and ethical as possible, particularly in the long-term approach to its relationships with growers, employees, and the farmed land. In selecting its overseas hubs, the businesses’ primary driver is finding locations that provide the best conditions for the produce to grow, but also where it can be easily transported by road and sea. This reduces transport carbon emissions without compromising quality. 

The business aims to improve woody biomass, soil health, biodiversity and input efficiency of the farmland managed by Barfoots and its growers. This supports its greenhouse gas roadmap, which aims to maximise on-farm carbon sinks and minimise emissions.

In 2010, an anaerobic digestor plant was installed at Sefter Farm to utilise green factory waste. This produces all the energy the site requires, plus a surplus, which is exported to the grid. This also reduces waste leaving Sefter Farm, produces organic fertiliser for Barfoots farms and reduces the number of vehicle movements associated with transporting waste off-site. In 2022, a wastewater treatment plant was also installed at the Farm to convert factory wastewater into irrigation water for crops. Solar photovoltaic panels have been introduced at Sefter Farm and the adjacent Leythorne packaging facility this year to ensure continued energy self-sufficiency as the business grows. 

Such is the integration of sustainability throughout Barfoot’s operating model, and the milestones achieved, that Peter Barfoot was awarded a CBE for Services to Sustainable Farming in 2020.

Barfoots global supply chain 

The business has scrutinised everything from the growing, processing, packaging, and transportation of the produce. This enables the business to supply fresh produce to the UK market all year round in the most cost-effective and environmentally sensitive way. Figure 3 illustrates Barfoots global supply chain. 

Investing in the global hubs has enabled the business to grow in locations that provide the best environment for its produce outside of the UK season, whether that be on its own land, or forming close collaborations with other growers. Barfoots Brand and Marketing Manager, Kim Barfoot-Brace explains: ‘As UK farmers, we stand by the belief that the right crop should be produced in the best location at the best time. Outside of the UK season, we follow the sun for the best conditions to ensure the highest quality crop, produced as sustainably as possible for the UK market all year round.’ 

Community projects  

Many environmental, economic and social overseas projects have been supported by the business. For example, in Senegal, the business supports community projects, invests in schools and medical facilities, employs doctors and supports projects to improve health education. In South America, the focus has been on restoring biodiversity. In the UK, Barfoots supports charities including food redistribution organisations UKHarvest and FareShare who redistribute surplus produce to those who need it, and Veg Power; a project to inspire children through to teenagers, to enjoy more vegetables. 

Solar and green energy generation at Sefter Farm, West Sussex

Wastewater treatment plant at Sefter Farm, West Sussex

Barfoots Senegal team

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Building Height Estimation from Open Optical Remote Sensing by Machine Learning Regression Technique: A Case Study of the Central of Bangkok

Article sidebar, main article content.

Building height is crucial for understanding the urban environment and human activity. In Bangkok, there is open building footprint polygon layer, but it still lacks building height data. Recently, a digital surface model (DSM) from an unmanned aerial vehicle (UAV) was obtained for referencing. Additionally, open medium-resolution optical satellite images are freely provided almost a decade. Both data sources were used in research to estimate building heights. The study demonstrated that optical remote sensing, combined with reference height data, can effectively estimate building heights in urban areas. In this research we deploy two approaches namely, support vector machine regression (SVR) and random forest regression (RFR). The result produced similar root mean square error (RMSE) values: approximately 6.6 meters for buildings under 50 meters and around 12 meters for buildings under 100 meters. However, when evaluated with the 50 -meter building height group in the second model testing, the SVR algorithm performed better than the RFR algorithm.

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