what is the primary limitation of case study research method

Case Study Research Method in Psychology

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Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

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Case studies are in-depth investigations of a person, group, event, or community. Typically, data is gathered from various sources using several methods (e.g., observations & interviews).

The case study research method originated in clinical medicine (the case history, i.e., the patient’s personal history). In psychology, case studies are often confined to the study of a particular individual.

The information is mainly biographical and relates to events in the individual’s past (i.e., retrospective), as well as to significant events that are currently occurring in his or her everyday life.

The case study is not a research method, but researchers select methods of data collection and analysis that will generate material suitable for case studies.

Freud (1909a, 1909b) conducted very detailed investigations into the private lives of his patients in an attempt to both understand and help them overcome their illnesses.

This makes it clear that the case study is a method that should only be used by a psychologist, therapist, or psychiatrist, i.e., someone with a professional qualification.

There is an ethical issue of competence. Only someone qualified to diagnose and treat a person can conduct a formal case study relating to atypical (i.e., abnormal) behavior or atypical development.

 Famous Case Studies

• Anna O – One of the most famous case studies, documenting psychoanalyst Josef Breuer’s treatment of “Anna O” (real name Bertha Pappenheim) for hysteria in the late 1800s using early psychoanalytic theory.
• Little Hans – A child psychoanalysis case study published by Sigmund Freud in 1909 analyzing his five-year-old patient Herbert Graf’s house phobia as related to the Oedipus complex.
• Bruce/Brenda – Gender identity case of the boy (Bruce) whose botched circumcision led psychologist John Money to advise gender reassignment and raise him as a girl (Brenda) in the 1960s.
• Genie Wiley – Linguistics/psychological development case of the victim of extreme isolation abuse who was studied in 1970s California for effects of early language deprivation on acquiring speech later in life.
• Phineas Gage – One of the most famous neuropsychology case studies analyzes personality changes in railroad worker Phineas Gage after an 1848 brain injury involving a tamping iron piercing his skull.

Clinical Case Studies

• Studying the effectiveness of psychotherapy approaches with an individual patient
• Assessing and treating mental illnesses like depression, anxiety disorders, PTSD
• Neuropsychological cases investigating brain injuries or disorders

Child Psychology Case Studies

• Studying psychological development from birth through adolescence
• Cases of learning disabilities, autism spectrum disorders, ADHD
• Effects of trauma, abuse, deprivation on development

Types of Case Studies

• Explanatory case studies : Used to explore causation in order to find underlying principles. Helpful for doing qualitative analysis to explain presumed causal links.
• Exploratory case studies : Used to explore situations where an intervention being evaluated has no clear set of outcomes. It helps define questions and hypotheses for future research.
• Descriptive case studies : Describe an intervention or phenomenon and the real-life context in which it occurred. It is helpful for illustrating certain topics within an evaluation.
• Multiple-case studies : Used to explore differences between cases and replicate findings across cases. Helpful for comparing and contrasting specific cases.
• Intrinsic : Used to gain a better understanding of a particular case. Helpful for capturing the complexity of a single case.
• Collective : Used to explore a general phenomenon using multiple case studies. Helpful for jointly studying a group of cases in order to inquire into the phenomenon.

Where Do You Find Data for a Case Study?

There are several places to find data for a case study. The key is to gather data from multiple sources to get a complete picture of the case and corroborate facts or findings through triangulation of evidence. Most of this information is likely qualitative (i.e., verbal description rather than measurement), but the psychologist might also collect numerical data.

1. Primary sources

• Interviews – Interviewing key people related to the case to get their perspectives and insights. The interview is an extremely effective procedure for obtaining information about an individual, and it may be used to collect comments from the person’s friends, parents, employer, workmates, and others who have a good knowledge of the person, as well as to obtain facts from the person him or herself.
• Observations – Observing behaviors, interactions, processes, etc., related to the case as they unfold in real-time.
• Documents & Records – Reviewing private documents, diaries, public records, correspondence, meeting minutes, etc., relevant to the case.

2. Secondary sources

• News/Media – News coverage of events related to the case study.
• Academic articles – Journal articles, dissertations etc. that discuss the case.
• Government reports – Official data and records related to the case context.
• Books/films – Books, documentaries or films discussing the case.

3. Archival records

Searching historical archives, museum collections and databases to find relevant documents, visual/audio records related to the case history and context.

Public archives like newspapers, organizational records, photographic collections could all include potentially relevant pieces of information to shed light on attitudes, cultural perspectives, common practices and historical contexts related to psychology.

4. Organizational records

Organizational records offer the advantage of often having large datasets collected over time that can reveal or confirm psychological insights.

Of course, privacy and ethical concerns regarding confidential data must be navigated carefully.

However, with proper protocols, organizational records can provide invaluable context and empirical depth to qualitative case studies exploring the intersection of psychology and organizations.

• Organizational/industrial psychology research : Organizational records like employee surveys, turnover/retention data, policies, incident reports etc. may provide insight into topics like job satisfaction, workplace culture and dynamics, leadership issues, employee behaviors etc.
• Clinical psychology : Therapists/hospitals may grant access to anonymized medical records to study aspects like assessments, diagnoses, treatment plans etc. This could shed light on clinical practices.
• School psychology : Studies could utilize anonymized student records like test scores, grades, disciplinary issues, and counseling referrals to study child development, learning barriers, effectiveness of support programs, and more.

How do I Write a Case Study in Psychology?

Follow specified case study guidelines provided by a journal or your psychology tutor. General components of clinical case studies include: background, symptoms, assessments, diagnosis, treatment, and outcomes. Interpreting the information means the researcher decides what to include or leave out. A good case study should always clarify which information is the factual description and which is an inference or the researcher’s opinion.

1. Introduction

• Provide background on the case context and why it is of interest, presenting background information like demographics, relevant history, and presenting problem.
• Compare briefly to similar published cases if applicable. Clearly state the focus/importance of the case.

2. Case Presentation

• Describe the presenting problem in detail, including symptoms, duration,and impact on daily life.
• Include client demographics like age and gender, information about social relationships, and mental health history.
• Describe all physical, emotional, and/or sensory symptoms reported by the client.
• Use patient quotes to describe the initial complaint verbatim. Follow with full-sentence summaries of relevant history details gathered, including key components that led to a working diagnosis.
• Summarize clinical exam results, namely orthopedic/neurological tests, imaging, lab tests, etc. Note actual results rather than subjective conclusions. Provide images if clearly reproducible/anonymized.
• Clearly state the working diagnosis or clinical impression before transitioning to management.

3. Management and Outcome

• Indicate the total duration of care and number of treatments given over what timeframe. Use specific names/descriptions for any therapies/interventions applied.
• Present the results of the intervention,including any quantitative or qualitative data collected.
• For outcomes, utilize visual analog scales for pain, medication usage logs, etc., if possible. Include patient self-reports of improvement/worsening of symptoms. Note the reason for discharge/end of care.

4. Discussion

• Analyze the case, exploring contributing factors, limitations of the study, and connections to existing research.
• Analyze the effectiveness of the intervention,considering factors like participant adherence, limitations of the study, and potential alternative explanations for the results.
• Identify any questions raised in the case analysis and relate insights to established theories and current research if applicable. Avoid definitive claims about physiological explanations.
• Offer clinical implications, and suggest future research directions.

5. Additional Items

• Thank specific assistants for writing support only. No patient acknowledgments.
• References should directly support any key claims or quotes included.
• Use tables/figures/images only if substantially informative. Include permissions and legends/explanatory notes.
• Provides detailed (rich qualitative) information.
• Provides insight for further research.
• Permitting investigation of otherwise impractical (or unethical) situations.

Case studies allow a researcher to investigate a topic in far more detail than might be possible if they were trying to deal with a large number of research participants (nomothetic approach) with the aim of ‘averaging’.

Because of their in-depth, multi-sided approach, case studies often shed light on aspects of human thinking and behavior that would be unethical or impractical to study in other ways.

Research that only looks into the measurable aspects of human behavior is not likely to give us insights into the subjective dimension of experience, which is important to psychoanalytic and humanistic psychologists.

Case studies are often used in exploratory research. They can help us generate new ideas (that might be tested by other methods). They are an important way of illustrating theories and can help show how different aspects of a person’s life are related to each other.

The method is, therefore, important for psychologists who adopt a holistic point of view (i.e., humanistic psychologists ).

Limitations

• Lacking scientific rigor and providing little basis for generalization of results to the wider population.
• Researchers’ own subjective feelings may influence the case study (researcher bias).
• Difficult to replicate.
• Time-consuming and expensive.
• The volume of data, together with the time restrictions in place, impacted the depth of analysis that was possible within the available resources.

Because a case study deals with only one person/event/group, we can never be sure if the case study investigated is representative of the wider body of “similar” instances. This means the conclusions drawn from a particular case may not be transferable to other settings.

Because case studies are based on the analysis of qualitative (i.e., descriptive) data , a lot depends on the psychologist’s interpretation of the information she has acquired.

This means that there is a lot of scope for Anna O , and it could be that the subjective opinions of the psychologist intrude in the assessment of what the data means.

For example, Freud has been criticized for producing case studies in which the information was sometimes distorted to fit particular behavioral theories (e.g., Little Hans ).

This is also true of Money’s interpretation of the Bruce/Brenda case study (Diamond, 1997) when he ignored evidence that went against his theory.

Breuer, J., & Freud, S. (1895).  Studies on hysteria . Standard Edition 2: London.

Curtiss, S. (1981). Genie: The case of a modern wild child .

Diamond, M., & Sigmundson, K. (1997). Sex Reassignment at Birth: Long-term Review and Clinical Implications. Archives of Pediatrics & Adolescent Medicine , 151(3), 298-304

Freud, S. (1909a). Analysis of a phobia of a five year old boy. In The Pelican Freud Library (1977), Vol 8, Case Histories 1, pages 169-306

Freud, S. (1909b). Bemerkungen über einen Fall von Zwangsneurose (Der “Rattenmann”). Jb. psychoanal. psychopathol. Forsch ., I, p. 357-421; GW, VII, p. 379-463; Notes upon a case of obsessional neurosis, SE , 10: 151-318.

Harlow J. M. (1848). Passage of an iron rod through the head.  Boston Medical and Surgical Journal, 39 , 389–393.

Harlow, J. M. (1868).  Recovery from the Passage of an Iron Bar through the Head .  Publications of the Massachusetts Medical Society. 2  (3), 327-347.

Money, J., & Ehrhardt, A. A. (1972).  Man & Woman, Boy & Girl : The Differentiation and Dimorphism of Gender Identity from Conception to Maturity. Baltimore, Maryland: Johns Hopkins University Press.

Money, J., & Tucker, P. (1975). Sexual signatures: On being a man or a woman.

Further Information

• Case Study Approach
• Case Study Method
• Enhancing the Quality of Case Studies in Health Services Research
• “We do things together” A case study of “couplehood” in dementia
• Using mixed methods for evaluating an integrative approach to cancer care: a case study

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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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• Open access
• Published: 27 June 2011

The case study approach

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

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

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

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Introduction

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

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

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

What is a case study?

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

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

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

What are case studies used for?

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

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

How are case studies conducted?

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

Defining the case

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

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

Selecting the case(s)

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

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

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

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

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

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

Collecting the data

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

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

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

Analysing, interpreting and reporting case studies

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

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

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

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

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

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

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

Conclusions

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

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Acknowledgements

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

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AS conceived this article. SC, KC and AR wrote this paper with GH, AA and AS all commenting on various drafts. SC and AS are guarantors.

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Crowe, S., Cresswell, K., Robertson, A. et al. The case study approach. BMC Med Res Methodol 11 , 100 (2011). https://doi.org/10.1186/1471-2288-11-100

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The limitations of the study are those characteristics of design or methodology that impacted or influenced the interpretation of the findings from your research. Study limitations are the constraints placed on the ability to generalize from the results, to further describe applications to practice, and/or related to the utility of findings that are the result of the ways in which you initially chose to design the study or the method used to establish internal and external validity or the result of unanticipated challenges that emerged during the study.

Price, James H. and Judy Murnan. “Research Limitations and the Necessity of Reporting Them.” American Journal of Health Education 35 (2004): 66-67; Theofanidis, Dimitrios and Antigoni Fountouki. "Limitations and Delimitations in the Research Process." Perioperative Nursing 7 (September-December 2018): 155-163. .

Importance of...

Always acknowledge a study's limitations. It is far better that you identify and acknowledge your study’s limitations than to have them pointed out by your professor and have your grade lowered because you appeared to have ignored them or didn't realize they existed.

Keep in mind that acknowledgment of a study's limitations is an opportunity to make suggestions for further research. If you do connect your study's limitations to suggestions for further research, be sure to explain the ways in which these unanswered questions may become more focused because of your study.

Acknowledgment of a study's limitations also provides you with opportunities to demonstrate that you have thought critically about the research problem, understood the relevant literature published about it, and correctly assessed the methods chosen for studying the problem. A key objective of the research process is not only discovering new knowledge but also to confront assumptions and explore what we don't know.

Claiming limitations is a subjective process because you must evaluate the impact of those limitations . Don't just list key weaknesses and the magnitude of a study's limitations. To do so diminishes the validity of your research because it leaves the reader wondering whether, or in what ways, limitation(s) in your study may have impacted the results and conclusions. Limitations require a critical, overall appraisal and interpretation of their impact. You should answer the question: do these problems with errors, methods, validity, etc. eventually matter and, if so, to what extent?

Price, James H. and Judy Murnan. “Research Limitations and the Necessity of Reporting Them.” American Journal of Health Education 35 (2004): 66-67; Structure: How to Structure the Research Limitations Section of Your Dissertation. Dissertations and Theses: An Online Textbook. Laerd.com.

Descriptions of Possible Limitations

All studies have limitations . However, it is important that you restrict your discussion to limitations related to the research problem under investigation. For example, if a meta-analysis of existing literature is not a stated purpose of your research, it should not be discussed as a limitation. Do not apologize for not addressing issues that you did not promise to investigate in the introduction of your paper.

Here are examples of limitations related to methodology and the research process you may need to describe and discuss how they possibly impacted your results. Note that descriptions of limitations should be stated in the past tense because they were discovered after you completed your research.

Possible Methodological Limitations

• Sample size -- the number of the units of analysis you use in your study is dictated by the type of research problem you are investigating. Note that, if your sample size is too small, it will be difficult to find significant relationships from the data, as statistical tests normally require a larger sample size to ensure a representative distribution of the population and to be considered representative of groups of people to whom results will be generalized or transferred. Note that sample size is generally less relevant in qualitative research if explained in the context of the research problem.
• Lack of available and/or reliable data -- a lack of data or of reliable data will likely require you to limit the scope of your analysis, the size of your sample, or it can be a significant obstacle in finding a trend and a meaningful relationship. You need to not only describe these limitations but provide cogent reasons why you believe data is missing or is unreliable. However, don’t just throw up your hands in frustration; use this as an opportunity to describe a need for future research based on designing a different method for gathering data.
• Lack of prior research studies on the topic -- citing prior research studies forms the basis of your literature review and helps lay a foundation for understanding the research problem you are investigating. Depending on the currency or scope of your research topic, there may be little, if any, prior research on your topic. Before assuming this to be true, though, consult with a librarian! In cases when a librarian has confirmed that there is little or no prior research, you may be required to develop an entirely new research typology [for example, using an exploratory rather than an explanatory research design ]. Note again that discovering a limitation can serve as an important opportunity to identify new gaps in the literature and to describe the need for further research.
• Measure used to collect the data -- sometimes it is the case that, after completing your interpretation of the findings, you discover that the way in which you gathered data inhibited your ability to conduct a thorough analysis of the results. For example, you regret not including a specific question in a survey that, in retrospect, could have helped address a particular issue that emerged later in the study. Acknowledge the deficiency by stating a need for future researchers to revise the specific method for gathering data.
• Self-reported data -- whether you are relying on pre-existing data or you are conducting a qualitative research study and gathering the data yourself, self-reported data is limited by the fact that it rarely can be independently verified. In other words, you have to the accuracy of what people say, whether in interviews, focus groups, or on questionnaires, at face value. However, self-reported data can contain several potential sources of bias that you should be alert to and note as limitations. These biases become apparent if they are incongruent with data from other sources. These are: (1) selective memory [remembering or not remembering experiences or events that occurred at some point in the past]; (2) telescoping [recalling events that occurred at one time as if they occurred at another time]; (3) attribution [the act of attributing positive events and outcomes to one's own agency, but attributing negative events and outcomes to external forces]; and, (4) exaggeration [the act of representing outcomes or embellishing events as more significant than is actually suggested from other data].

Possible Limitations of the Researcher

• Access -- if your study depends on having access to people, organizations, data, or documents and, for whatever reason, access is denied or limited in some way, the reasons for this needs to be described. Also, include an explanation why being denied or limited access did not prevent you from following through on your study.
• Longitudinal effects -- unlike your professor, who can literally devote years [even a lifetime] to studying a single topic, the time available to investigate a research problem and to measure change or stability over time is constrained by the due date of your assignment. Be sure to choose a research problem that does not require an excessive amount of time to complete the literature review, apply the methodology, and gather and interpret the results. If you're unsure whether you can complete your research within the confines of the assignment's due date, talk to your professor.
• Cultural and other type of bias -- we all have biases, whether we are conscience of them or not. Bias is when a person, place, event, or thing is viewed or shown in a consistently inaccurate way. Bias is usually negative, though one can have a positive bias as well, especially if that bias reflects your reliance on research that only support your hypothesis. When proof-reading your paper, be especially critical in reviewing how you have stated a problem, selected the data to be studied, what may have been omitted, the manner in which you have ordered events, people, or places, how you have chosen to represent a person, place, or thing, to name a phenomenon, or to use possible words with a positive or negative connotation. NOTE :   If you detect bias in prior research, it must be acknowledged and you should explain what measures were taken to avoid perpetuating that bias. For example, if a previous study only used boys to examine how music education supports effective math skills, describe how your research expands the study to include girls.
• Fluency in a language -- if your research focuses , for example, on measuring the perceived value of after-school tutoring among Mexican-American ESL [English as a Second Language] students and you are not fluent in Spanish, you are limited in being able to read and interpret Spanish language research studies on the topic or to speak with these students in their primary language. This deficiency should be acknowledged.

Aguinis, Hermam and Jeffrey R. Edwards. “Methodological Wishes for the Next Decade and How to Make Wishes Come True.” Journal of Management Studies 51 (January 2014): 143-174; Brutus, Stéphane et al. "Self-Reported Limitations and Future Directions in Scholarly Reports: Analysis and Recommendations." Journal of Management 39 (January 2013): 48-75; Senunyeme, Emmanuel K. Business Research Methods. Powerpoint Presentation. Regent University of Science and Technology; ter Riet, Gerben et al. “All That Glitters Isn't Gold: A Survey on Acknowledgment of Limitations in Biomedical Studies.” PLOS One 8 (November 2013): 1-6.

Structure and Writing Style

Information about the limitations of your study are generally placed either at the beginning of the discussion section of your paper so the reader knows and understands the limitations before reading the rest of your analysis of the findings, or, the limitations are outlined at the conclusion of the discussion section as an acknowledgement of the need for further study. Statements about a study's limitations should not be buried in the body [middle] of the discussion section unless a limitation is specific to something covered in that part of the paper. If this is the case, though, the limitation should be reiterated at the conclusion of the section.

If you determine that your study is seriously flawed due to important limitations , such as, an inability to acquire critical data, consider reframing it as an exploratory study intended to lay the groundwork for a more complete research study in the future. Be sure, though, to specifically explain the ways that these flaws can be successfully overcome in a new study.

But, do not use this as an excuse for not developing a thorough research paper! Review the tab in this guide for developing a research topic . If serious limitations exist, it generally indicates a likelihood that your research problem is too narrowly defined or that the issue or event under study is too recent and, thus, very little research has been written about it. If serious limitations do emerge, consult with your professor about possible ways to overcome them or how to revise your study.

When discussing the limitations of your research, be sure to:

• Describe each limitation in detailed but concise terms;
• Explain why each limitation exists;
• Provide the reasons why each limitation could not be overcome using the method(s) chosen to acquire or gather the data [cite to other studies that had similar problems when possible];
• Assess the impact of each limitation in relation to the overall findings and conclusions of your study; and,
• If appropriate, describe how these limitations could point to the need for further research.

Remember that the method you chose may be the source of a significant limitation that has emerged during your interpretation of the results [for example, you didn't interview a group of people that you later wish you had]. If this is the case, don't panic. Acknowledge it, and explain how applying a different or more robust methodology might address the research problem more effectively in a future study. A underlying goal of scholarly research is not only to show what works, but to demonstrate what doesn't work or what needs further clarification.

Aguinis, Hermam and Jeffrey R. Edwards. “Methodological Wishes for the Next Decade and How to Make Wishes Come True.” Journal of Management Studies 51 (January 2014): 143-174; Brutus, Stéphane et al. "Self-Reported Limitations and Future Directions in Scholarly Reports: Analysis and Recommendations." Journal of Management 39 (January 2013): 48-75; Ioannidis, John P.A. "Limitations are not Properly Acknowledged in the Scientific Literature." Journal of Clinical Epidemiology 60 (2007): 324-329; Pasek, Josh. Writing the Empirical Social Science Research Paper: A Guide for the Perplexed. January 24, 2012. Academia.edu; Structure: How to Structure the Research Limitations Section of Your Dissertation. Dissertations and Theses: An Online Textbook. Laerd.com; What Is an Academic Paper? Institute for Writing Rhetoric. Dartmouth College; Writing the Experimental Report: Methods, Results, and Discussion. The Writing Lab and The OWL. Purdue University.

Writing Tip

Don't Inflate the Importance of Your Findings!

After all the hard work and long hours devoted to writing your research paper, it is easy to get carried away with attributing unwarranted importance to what you’ve done. We all want our academic work to be viewed as excellent and worthy of a good grade, but it is important that you understand and openly acknowledge the limitations of your study. Inflating the importance of your study's findings could be perceived by your readers as an attempt hide its flaws or encourage a biased interpretation of the results. A small measure of humility goes a long way!

Another Writing Tip

Negative Results are Not a Limitation!

Negative evidence refers to findings that unexpectedly challenge rather than support your hypothesis. If you didn't get the results you anticipated, it may mean your hypothesis was incorrect and needs to be reformulated. Or, perhaps you have stumbled onto something unexpected that warrants further study. Moreover, the absence of an effect may be very telling in many situations, particularly in experimental research designs. In any case, your results may very well be of importance to others even though they did not support your hypothesis. Do not fall into the trap of thinking that results contrary to what you expected is a limitation to your study. If you carried out the research well, they are simply your results and only require additional interpretation.

Lewis, George H. and Jonathan F. Lewis. “The Dog in the Night-Time: Negative Evidence in Social Research.” The British Journal of Sociology 31 (December 1980): 544-558.

Yet Another Writing Tip

Sample Size Limitations in Qualitative Research

Sample sizes are typically smaller in qualitative research because, as the study goes on, acquiring more data does not necessarily lead to more information. This is because one occurrence of a piece of data, or a code, is all that is necessary to ensure that it becomes part of the analysis framework. However, it remains true that sample sizes that are too small cannot adequately support claims of having achieved valid conclusions and sample sizes that are too large do not permit the deep, naturalistic, and inductive analysis that defines qualitative inquiry. Determining adequate sample size in qualitative research is ultimately a matter of judgment and experience in evaluating the quality of the information collected against the uses to which it will be applied and the particular research method and purposeful sampling strategy employed. If the sample size is found to be a limitation, it may reflect your judgment about the methodological technique chosen [e.g., single life history study versus focus group interviews] rather than the number of respondents used.

Boddy, Clive Roland. "Sample Size for Qualitative Research." Qualitative Market Research: An International Journal 19 (2016): 426-432; Huberman, A. Michael and Matthew B. Miles. "Data Management and Analysis Methods." In Handbook of Qualitative Research . Norman K. Denzin and Yvonna S. Lincoln, eds. (Thousand Oaks, CA: Sage, 1994), pp. 428-444; Blaikie, Norman. "Confounding Issues Related to Determining Sample Size in Qualitative Research." International Journal of Social Research Methodology 21 (2018): 635-641; Oppong, Steward Harrison. "The Problem of Sampling in qualitative Research." Asian Journal of Management Sciences and Education 2 (2013): 202-210.

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10 Case Study Advantages and Disadvantages

A case study in academic research is a detailed and in-depth examination of a specific instance or event, generally conducted through a qualitative approach to data.

The most common case study definition that I come across is is Robert K. Yin’s (2003, p. 13) quote provided below:

“An empirical inquiry that investigates a contemporary phenomenon within its real-life context, especially when the boundaries between phenomenon and context are not clearly evident.”

Researchers conduct case studies for a number of reasons, such as to explore complex phenomena within their real-life context, to look at a particularly interesting instance of a situation, or to dig deeper into something of interest identified in a wider-scale project.

While case studies render extremely interesting data, they have many limitations and are not suitable for all studies. One key limitation is that a case study’s findings are not usually generalizable to broader populations because one instance cannot be used to infer trends across populations.

Case Study Advantages and Disadvantages

1. in-depth analysis of complex phenomena.

Case study design allows researchers to delve deeply into intricate issues and situations.

By focusing on a specific instance or event, researchers can uncover nuanced details and layers of understanding that might be missed with other research methods, especially large-scale survey studies.

As Lee and Saunders (2017) argue,

“It allows that particular event to be studies in detail so that its unique qualities may be identified.”

This depth of analysis can provide rich insights into the underlying factors and dynamics of the studied phenomenon.

2. Holistic Understanding

Building on the above point, case studies can help us to understand a topic holistically and from multiple angles.

This means the researcher isn’t restricted to just examining a topic by using a pre-determined set of questions, as with questionnaires. Instead, researchers can use qualitative methods to delve into the many different angles, perspectives, and contextual factors related to the case study.

We can turn to Lee and Saunders (2017) again, who notes that case study researchers “develop a deep, holistic understanding of a particular phenomenon” with the intent of deeply understanding the phenomenon.

3. Examination of rare and Unusual Phenomena

We need to use case study methods when we stumble upon “rare and unusual” (Lee & Saunders, 2017) phenomena that would tend to be seen as mere outliers in population studies.

Take, for example, a child genius. A population study of all children of that child’s age would merely see this child as an outlier in the dataset, and this child may even be removed in order to predict overall trends.

So, to truly come to an understanding of this child and get insights into the environmental conditions that led to this child’s remarkable cognitive development, we need to do an in-depth study of this child specifically – so, we’d use a case study.

4. Helps Reveal the Experiences of Marginalzied Groups

Just as rare and unsual cases can be overlooked in population studies, so too can the experiences, beliefs, and perspectives of marginalized groups.

As Lee and Saunders (2017) argue, “case studies are also extremely useful in helping the expression of the voices of people whose interests are often ignored.”

Take, for example, the experiences of minority populations as they navigate healthcare systems. This was for many years a “hidden” phenomenon, not examined by researchers. It took case study designs to truly reveal this phenomenon, which helped to raise practitioners’ awareness of the importance of cultural sensitivity in medicine.

5. Ideal in Situations where Researchers cannot Control the Variables

Experimental designs – where a study takes place in a lab or controlled environment – are excellent for determining cause and effect . But not all studies can take place in controlled environments (Tetnowski, 2015).

When we’re out in the field doing observational studies or similar fieldwork, we don’t have the freedom to isolate dependent and independent variables. We need to use alternate methods.

Case studies are ideal in such situations.

A case study design will allow researchers to deeply immerse themselves in a setting (potentially combining it with methods such as ethnography or researcher observation) in order to see how phenomena take place in real-life settings.

6. Supports the generation of new theories or hypotheses

While large-scale quantitative studies such as cross-sectional designs and population surveys are excellent at testing theories and hypotheses on a large scale, they need a hypothesis to start off with!

This is where case studies – in the form of grounded research – come in. Often, a case study doesn’t start with a hypothesis. Instead, it ends with a hypothesis based upon the findings within a singular setting.

The deep analysis allows for hypotheses to emerge, which can then be taken to larger-scale studies in order to conduct further, more generalizable, testing of the hypothesis or theory.

7. Reveals the Unexpected

When a largescale quantitative research project has a clear hypothesis that it will test, it often becomes very rigid and has tunnel-vision on just exploring the hypothesis.

Of course, a structured scientific examination of the effects of specific interventions targeted at specific variables is extermely valuable.

But narrowly-focused studies often fail to shine a spotlight on unexpected and emergent data. Here, case studies come in very useful. Oftentimes, researchers set their eyes on a phenomenon and, when examining it closely with case studies, identify data and come to conclusions that are unprecedented, unforeseen, and outright surprising.

As Lars Meier (2009, p. 975) marvels, “where else can we become a part of foreign social worlds and have the chance to become aware of the unexpected?”

Disadvantages

1. not usually generalizable.

Case studies are not generalizable because they tend not to look at a broad enough corpus of data to be able to infer that there is a trend across a population.

As Yang (2022) argues, “by definition, case studies can make no claims to be typical.”

Case studies focus on one specific instance of a phenomenon. They explore the context, nuances, and situational factors that have come to bear on the case study. This is really useful for bringing to light important, new, and surprising information, as I’ve already covered.

But , it’s not often useful for generating data that has validity beyond the specific case study being examined.

2. Subjectivity in interpretation

Case studies usually (but not always) use qualitative data which helps to get deep into a topic and explain it in human terms, finding insights unattainable by quantitative data.

But qualitative data in case studies relies heavily on researcher interpretation. While researchers can be trained and work hard to focus on minimizing subjectivity (through methods like triangulation), it often emerges – some might argue it’s innevitable in qualitative studies.

So, a criticism of case studies could be that they’re more prone to subjectivity – and researchers need to take strides to address this in their studies.

3. Difficulty in replicating results

Case study research is often non-replicable because the study takes place in complex real-world settings where variables are not controlled.

So, when returning to a setting to re-do or attempt to replicate a study, we often find that the variables have changed to such an extent that replication is difficult. Furthermore, new researchers (with new subjective eyes) may catch things that the other readers overlooked.

Replication is even harder when researchers attempt to replicate a case study design in a new setting or with different participants.

Comprehension Quiz for Students

Question 1: What benefit do case studies offer when exploring the experiences of marginalized groups?

a) They provide generalizable data. b) They help express the voices of often-ignored individuals. c) They control all variables for the study. d) They always start with a clear hypothesis.

Question 2: Why might case studies be considered ideal for situations where researchers cannot control all variables?

a) They provide a structured scientific examination. b) They allow for generalizability across populations. c) They focus on one specific instance of a phenomenon. d) They allow for deep immersion in real-life settings.

Question 3: What is a primary disadvantage of case studies in terms of data applicability?

a) They always focus on the unexpected. b) They are not usually generalizable. c) They support the generation of new theories. d) They provide a holistic understanding.

Question 4: Why might case studies be considered more prone to subjectivity?

a) They always use quantitative data. b) They heavily rely on researcher interpretation, especially with qualitative data. c) They are always replicable. d) They look at a broad corpus of data.

Question 5: In what situations are experimental designs, such as those conducted in labs, most valuable?

a) When there’s a need to study rare and unusual phenomena. b) When a holistic understanding is required. c) When determining cause-and-effect relationships. d) When the study focuses on marginalized groups.

Question 6: Why is replication challenging in case study research?

a) Because they always use qualitative data. b) Because they tend to focus on a broad corpus of data. c) Due to the changing variables in complex real-world settings. d) Because they always start with a hypothesis.

Lee, B., & Saunders, M. N. K. (2017). Conducting Case Study Research for Business and Management Students. SAGE Publications.

Meir, L. (2009). Feasting on the Benefits of Case Study Research. In Mills, A. J., Wiebe, E., & Durepos, G. (Eds.). Encyclopedia of Case Study Research (Vol. 2). London: SAGE Publications.

Tetnowski, J. (2015). Qualitative case study research design.  Perspectives on fluency and fluency disorders ,  25 (1), 39-45. ( Source )

Yang, S. L. (2022). The War on Corruption in China: Local Reform and Innovation . Taylor & Francis.

Yin, R. (2003). Case Study research. Thousand Oaks, CA: Sage.

Chris Drew (PhD)

Dr. Chris Drew is the founder of the Helpful Professor. He holds a PhD in education and has published over 20 articles in scholarly journals. He is the former editor of the Journal of Learning Development in Higher Education. [Image Descriptor: Photo of Chris]

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The Advantages and Limitations of Single Case Study Analysis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Limitations

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

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

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

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

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

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

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

References 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Further Reading on E-International Relations

• Identity in International Conflicts: A Case Study of the Cuban Missile Crisis
• Imperialism’s Legacy in the Study of Contemporary Politics: The Case of Hegemonic Stability Theory
• Recreating a Nation’s Identity Through Symbolism: A Chinese Case Study
• Ontological Insecurity: A Case Study on Israeli-Palestinian Conflict in Jerusalem
• Terrorists or Freedom Fighters: A Case Study of ETA
• A Critical Assessment of Eco-Marxism: A Ghanaian Case Study

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The Strengths and Limitations of Case Study Research

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• 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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How to Write Limitations of the Study (with examples)

This blog emphasizes the importance of recognizing and effectively writing about limitations in research. It discusses the types of limitations, their significance, and provides guidelines for writing about them, highlighting their role in advancing scholarly research.

Updated on August 24, 2023

No matter how well thought out, every research endeavor encounters challenges. There is simply no way to predict all possible variances throughout the process.

These uncharted boundaries and abrupt constraints are known as limitations in research . Identifying and acknowledging limitations is crucial for conducting rigorous studies. Limitations provide context and shed light on gaps in the prevailing inquiry and literature.

This article explores the importance of recognizing limitations and discusses how to write them effectively. By interpreting limitations in research and considering prevalent examples, we aim to reframe the perception from shameful mistakes to respectable revelations.

What are limitations in research?

In the clearest terms, research limitations are the practical or theoretical shortcomings of a study that are often outside of the researcher’s control . While these weaknesses limit the generalizability of a study’s conclusions, they also present a foundation for future research.

Sometimes limitations arise from tangible circumstances like time and funding constraints, or equipment and participant availability. Other times the rationale is more obscure and buried within the research design. Common types of limitations and their ramifications include:

• Theoretical: limits the scope, depth, or applicability of a study.
• Methodological: limits the quality, quantity, or diversity of the data.
• Empirical: limits the representativeness, validity, or reliability of the data.
• Analytical: limits the accuracy, completeness, or significance of the findings.
• Ethical: limits the access, consent, or confidentiality of the data.

Regardless of how, when, or why they arise, limitations are a natural part of the research process and should never be ignored . Like all other aspects, they are vital in their own purpose.

Why is identifying limitations important?

Whether to seek acceptance or avoid struggle, humans often instinctively hide flaws and mistakes. Merging this thought process into research by attempting to hide limitations, however, is a bad idea. It has the potential to negate the validity of outcomes and damage the reputation of scholars.

By identifying and addressing limitations throughout a project, researchers strengthen their arguments and curtail the chance of peer censure based on overlooked mistakes. Pointing out these flaws shows an understanding of variable limits and a scrupulous research process.

Showing awareness of and taking responsibility for a project’s boundaries and challenges validates the integrity and transparency of a researcher. It further demonstrates the researchers understand the applicable literature and have thoroughly evaluated their chosen research methods.

Presenting limitations also benefits the readers by providing context for research findings. It guides them to interpret the project’s conclusions only within the scope of very specific conditions. By allowing for an appropriate generalization of the findings that is accurately confined by research boundaries and is not too broad, limitations boost a study’s credibility .

Limitations are true assets to the research process. They highlight opportunities for future research. When researchers identify the limitations of their particular approach to a study question, they enable precise transferability and improve chances for reproducibility. 

Simply stating a project’s limitations is not adequate for spurring further research, though. To spark the interest of other researchers, these acknowledgements must come with thorough explanations regarding how the limitations affected the current study and how they can potentially be overcome with amended methods.

How to write limitations

Typically, the information about a study’s limitations is situated either at the beginning of the discussion section to provide context for readers or at the conclusion of the discussion section to acknowledge the need for further research. However, it varies depending upon the target journal or publication guidelines. 

Don’t hide your limitations

It is also important to not bury a limitation in the body of the paper unless it has a unique connection to a topic in that section. If so, it needs to be reiterated with the other limitations or at the conclusion of the discussion section. Wherever it is included in the manuscript, ensure that the limitations section is prominently positioned and clearly introduced.

While maintaining transparency by disclosing limitations means taking a comprehensive approach, it is not necessary to discuss everything that could have potentially gone wrong during the research study. If there is no commitment to investigation in the introduction, it is unnecessary to consider the issue a limitation to the research. Wholly consider the term ‘limitations’ and ask, “Did it significantly change or limit the possible outcomes?” Then, qualify the occurrence as either a limitation to include in the current manuscript or as an idea to note for other projects. 

Writing limitations

Once the limitations are concretely identified and it is decided where they will be included in the paper, researchers are ready for the writing task. Including only what is pertinent, keeping explanations detailed but concise, and employing the following guidelines is key for crafting valuable limitations:

1) Identify and describe the limitations : Clearly introduce the limitation by classifying its form and specifying its origin. For example:

• An unintentional bias encountered during data collection
• An intentional use of unplanned post-hoc data analysis

2) Explain the implications : Describe how the limitation potentially influences the study’s findings and how the validity and generalizability are subsequently impacted. Provide examples and evidence to support claims of the limitations’ effects without making excuses or exaggerating their impact. Overall, be transparent and objective in presenting the limitations, without undermining the significance of the research. 

3) Provide alternative approaches for future studies : Offer specific suggestions for potential improvements or avenues for further investigation. Demonstrate a proactive approach by encouraging future research that addresses the identified gaps and, therefore, expands the knowledge base.

Whether presenting limitations as an individual section within the manuscript or as a subtopic in the discussion area, authors should use clear headings and straightforward language to facilitate readability. There is no need to complicate limitations with jargon, computations, or complex datasets.

Examples of common limitations

Limitations are generally grouped into two categories , methodology and research process .

Methodology limitations

Methodology may include limitations due to:

• Sample size
• Lack of available or reliable data
• Lack of prior research studies on the topic
• Measure used to collect the data
• Self-reported data

The researcher is addressing how the large sample size requires a reassessment of the measures used to collect and analyze the data.

Research process limitations

Limitations during the research process may arise from:

• Access to information
• Longitudinal effects
• Cultural and other biases
• Language fluency
• Time constraints

The author is pointing out that the model’s estimates are based on potentially biased observational studies.

Final thoughts

Successfully proving theories and touting great achievements are only two very narrow goals of scholarly research. The true passion and greatest efforts of researchers comes more in the form of confronting assumptions and exploring the obscure.

In many ways, recognizing and sharing the limitations of a research study both allows for and encourages this type of discovery that continuously pushes research forward. By using limitations to provide a transparent account of the project's boundaries and to contextualize the findings, researchers pave the way for even more robust and impactful research in the future.

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What are the limitations of case studies?

Case studies are in-depth analyses of a particular person, group, circumstance, or civilization. Data is frequently obtained from several sources and in various methods (e.g. observations & interviews). The patient’s medical history or personal case study is where the case study research methodology started, and case studies frequently look into one person in their investigations.

The content is mostly biographical and pertains to noteworthy events in the person’s past (i.e., retrospective) and current events in their day-to-day lives. The case study is not a research method in and of itself; rather, researchers select methods for data collection and analysis that will result in case study-worthy data.

Limitations of Case Studies

• There is insufficient scientific rigour and no basis for extending findings to a broader population.
• The researchers could inject their personal opinions into the case study (researcher bias).
• It is challenging to repeat.
• It’s expensive and time-consuming.
• The amount of analysis done with the instruments was constrained by the data and the time limits imposed.

It is hard to determine whether a case study represents a larger body of “similar” events because it only examines one individual, event, or group. As a result, the findings drawn in one instance might not apply in another. Since case studies are based on qualitative (descriptive) data, the psychologist’s interpretation is essential.

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Home » Limitations in Research – Types, Examples and Writing Guide

Limitations in Research – Types, Examples and Writing Guide

Table of Contents

Limitations in Research

Limitations in research refer to the factors that may affect the results, conclusions , and generalizability of a study. These limitations can arise from various sources, such as the design of the study, the sampling methods used, the measurement tools employed, and the limitations of the data analysis techniques.

Types of Limitations in Research

Types of Limitations in Research are as follows:

Sample Size Limitations

This refers to the size of the group of people or subjects that are being studied. If the sample size is too small, then the results may not be representative of the population being studied. This can lead to a lack of generalizability of the results.

Time Limitations

Time limitations can be a constraint on the research process . This could mean that the study is unable to be conducted for a long enough period of time to observe the long-term effects of an intervention, or to collect enough data to draw accurate conclusions.

Selection Bias

This refers to a type of bias that can occur when the selection of participants in a study is not random. This can lead to a biased sample that is not representative of the population being studied.

Confounding Variables

Confounding variables are factors that can influence the outcome of a study, but are not being measured or controlled for. These can lead to inaccurate conclusions or a lack of clarity in the results.

Measurement Error

This refers to inaccuracies in the measurement of variables, such as using a faulty instrument or scale. This can lead to inaccurate results or a lack of validity in the study.

Ethical Limitations

Ethical limitations refer to the ethical constraints placed on research studies. For example, certain studies may not be allowed to be conducted due to ethical concerns, such as studies that involve harm to participants.

Examples of Limitations in Research

Some Examples of Limitations in Research are as follows:

Research Title: “The Effectiveness of Machine Learning Algorithms in Predicting Customer Behavior”

Limitations:

• The study only considered a limited number of machine learning algorithms and did not explore the effectiveness of other algorithms.
• The study used a specific dataset, which may not be representative of all customer behaviors or demographics.
• The study did not consider the potential ethical implications of using machine learning algorithms in predicting customer behavior.

Research Title: “The Impact of Online Learning on Student Performance in Computer Science Courses”

• The study was conducted during the COVID-19 pandemic, which may have affected the results due to the unique circumstances of remote learning.
• The study only included students from a single university, which may limit the generalizability of the findings to other institutions.
• The study did not consider the impact of individual differences, such as prior knowledge or motivation, on student performance in online learning environments.

Research Title: “The Effect of Gamification on User Engagement in Mobile Health Applications”

• The study only tested a specific gamification strategy and did not explore the effectiveness of other gamification techniques.
• The study relied on self-reported measures of user engagement, which may be subject to social desirability bias or measurement errors.
• The study only included a specific demographic group (e.g., young adults) and may not be generalizable to other populations with different preferences or needs.

How to Write Limitations in Research

When writing about the limitations of a research study, it is important to be honest and clear about the potential weaknesses of your work. Here are some tips for writing about limitations in research:

• Identify the limitations: Start by identifying the potential limitations of your research. These may include sample size, selection bias, measurement error, or other issues that could affect the validity and reliability of your findings.
• Be honest and objective: When describing the limitations of your research, be honest and objective. Do not try to minimize or downplay the limitations, but also do not exaggerate them. Be clear and concise in your description of the limitations.
• Provide context: It is important to provide context for the limitations of your research. For example, if your sample size was small, explain why this was the case and how it may have affected your results. Providing context can help readers understand the limitations in a broader context.
• Discuss implications : Discuss the implications of the limitations for your research findings. For example, if there was a selection bias in your sample, explain how this may have affected the generalizability of your findings. This can help readers understand the limitations in terms of their impact on the overall validity of your research.
• Provide suggestions for future research : Finally, provide suggestions for future research that can address the limitations of your study. This can help readers understand how your research fits into the broader field and can provide a roadmap for future studies.

Purpose of Limitations in Research

There are several purposes of limitations in research. Here are some of the most important ones:

• To acknowledge the boundaries of the study : Limitations help to define the scope of the research project and set realistic expectations for the findings. They can help to clarify what the study is not intended to address.
• To identify potential sources of bias: Limitations can help researchers identify potential sources of bias in their research design, data collection, or analysis. This can help to improve the validity and reliability of the findings.
• To provide opportunities for future research: Limitations can highlight areas for future research and suggest avenues for further exploration. This can help to advance knowledge in a particular field.
• To demonstrate transparency and accountability: By acknowledging the limitations of their research, researchers can demonstrate transparency and accountability to their readers, peers, and funders. This can help to build trust and credibility in the research community.
• To encourage critical thinking: Limitations can encourage readers to critically evaluate the study’s findings and consider alternative explanations or interpretations. This can help to promote a more nuanced and sophisticated understanding of the topic under investigation.

When to Write Limitations in Research

Limitations should be included in research when they help to provide a more complete understanding of the study’s results and implications. A limitation is any factor that could potentially impact the accuracy, reliability, or generalizability of the study’s findings.

It is important to identify and discuss limitations in research because doing so helps to ensure that the results are interpreted appropriately and that any conclusions drawn are supported by the available evidence. Limitations can also suggest areas for future research, highlight potential biases or confounding factors that may have affected the results, and provide context for the study’s findings.

Generally, limitations should be discussed in the conclusion section of a research paper or thesis, although they may also be mentioned in other sections, such as the introduction or methods. The specific limitations that are discussed will depend on the nature of the study, the research question being investigated, and the data that was collected.

Examples of limitations that might be discussed in research include sample size limitations, data collection methods, the validity and reliability of measures used, and potential biases or confounding factors that could have affected the results. It is important to note that limitations should not be used as a justification for poor research design or methodology, but rather as a way to enhance the understanding and interpretation of the study’s findings.

Importance of Limitations in Research

Here are some reasons why limitations are important in research:

• Enhances the credibility of research: Limitations highlight the potential weaknesses and threats to validity, which helps readers to understand the scope and boundaries of the study. This improves the credibility of research by acknowledging its limitations and providing a clear picture of what can and cannot be concluded from the study.
• Facilitates replication: By highlighting the limitations, researchers can provide detailed information about the study’s methodology, data collection, and analysis. This information helps other researchers to replicate the study and test the validity of the findings, which enhances the reliability of research.
• Guides future research : Limitations provide insights into areas for future research by identifying gaps or areas that require further investigation. This can help researchers to design more comprehensive and effective studies that build on existing knowledge.
• Provides a balanced view: Limitations help to provide a balanced view of the research by highlighting both strengths and weaknesses. This ensures that readers have a clear understanding of the study’s limitations and can make informed decisions about the generalizability and applicability of the findings.

Advantages of Limitations in Research

Here are some potential advantages of limitations in research:

• Focus : Limitations can help researchers focus their study on a specific area or population, which can make the research more relevant and useful.
• Realism : Limitations can make a study more realistic by reflecting the practical constraints and challenges of conducting research in the real world.
• Innovation : Limitations can spur researchers to be more innovative and creative in their research design and methodology, as they search for ways to work around the limitations.
• Rigor : Limitations can actually increase the rigor and credibility of a study, as researchers are forced to carefully consider the potential sources of bias and error, and address them to the best of their abilities.
• Generalizability : Limitations can actually improve the generalizability of a study by ensuring that it is not overly focused on a specific sample or situation, and that the results can be applied more broadly.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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• Open access
• Published: 13 May 2024

What are the strengths and limitations to utilising creative methods in public and patient involvement in health and social care research? A qualitative systematic review

• Olivia R. Phillips 1 , 2   na1 ,
• Cerian Harries 2 , 3   na1 ,
• Jo Leonardi-Bee 1 , 2 , 4   na1 ,
• Holly Knight 1 , 2 ,
• Lauren B. Sherar 2 , 3 ,
• Veronica Varela-Mato 2 , 3 &
• Joanne R. Morling 1 , 2 , 5  

Research Involvement and Engagement volume  10 , Article number:  48 ( 2024 ) Cite this article

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There is increasing interest in using patient and public involvement (PPI) in research to improve the quality of healthcare. Ordinarily, traditional methods have been used such as interviews or focus groups. However, these methods tend to engage a similar demographic of people. Thus, creative methods are being developed to involve patients for whom traditional methods are inaccessible or non-engaging.

To determine the strengths and limitations to using creative PPI methods in health and social care research.

Electronic searches were conducted over five databases on 14th April 2023 (Web of Science, PubMed, ASSIA, CINAHL, Cochrane Library). Studies that involved traditional, non-creative PPI methods were excluded. Creative PPI methods were used to engage with people as research advisors, rather than study participants. Only primary data published in English from 2009 were accepted. Title, abstract and full text screening was undertaken by two independent reviewers before inductive thematic analysis was used to generate themes.

Twelve papers met the inclusion criteria. The creative methods used included songs, poems, drawings, photograph elicitation, drama performance, visualisations, social media, photography, prototype development, cultural animation, card sorting and persona development. Analysis identified four limitations and five strengths to the creative approaches. Limitations included the time and resource intensive nature of creative PPI, the lack of generalisation to wider populations and ethical issues. External factors, such as the lack of infrastructure to support creative PPI, also affected their implementation. Strengths included the disruption of power hierarchies and the creation of a safe space for people to express mundane or “taboo” topics. Creative methods are also engaging, inclusive of people who struggle to participate in traditional PPI and can also be cost and time efficient.

‘Creative PPI’ is an umbrella term encapsulating many different methods of engagement and there are strengths and limitations to each. The choice of which should be determined by the aims and requirements of the research, as well as the characteristics of the PPI group and practical limitations. Creative PPI can be advantageous over more traditional methods, however a hybrid approach could be considered to reap the benefits of both. Creative PPI methods are not widely used; however, this could change over time as PPI becomes embedded even more into research.

Plain English Summary

It is important that patients and public are included in the research process from initial brainstorming, through design to delivery. This is known as public and patient involvement (PPI). Their input means that research closely aligns with their wants and needs. Traditionally to get this input, interviews and group discussions are held, but this can exclude people who find these activities non-engaging or inaccessible, for example those with language challenges, learning disabilities or memory issues. Creative methods of PPI can overcome this. This is a broad term describing different (non-traditional) ways of engaging patients and public in research, such as through the use or art, animation or performance. This review investigated the reasons why creative approaches to PPI could be difficult (limitations) or helpful (strengths) in health and social care research. After searching 5 online databases, 12 studies were included in the review. PPI groups included adults, children and people with language and memory impairments. Creative methods included songs, poems, drawings, the use of photos and drama, visualisations, Facebook, creating prototypes, personas and card sorting. Limitations included the time, cost and effort associated with creative methods, the lack of application to other populations, ethical issues and buy-in from the wider research community. Strengths included the feeling of equality between academics and the public, creation of a safe space for people to express themselves, inclusivity, and that creative PPI can be cost and time efficient. Overall, this review suggests that creative PPI is worthwhile, however each method has its own strengths and limitations and the choice of which will depend on the research project, PPI group characteristics and other practical limitations, such as time and financial constraints.

Peer Review reports

Introduction

Patient and public involvement (PPI) is the term used to describe the partnership between patients (including caregivers, potential patients, healthcare users etc.) or the public (a community member with no known interest in the topic) with researchers. It describes research that is done “‘with’ or ‘by’ the public, rather than ‘to,’ ‘about’ or ‘for’ them” [ 1 ]. In 2009, it became a legislative requirement for certain health and social care organisations to include patients, families, carers and communities in not only the planning of health and social care services, but the commissioning, delivery and evaluation of them too [ 2 ]. For example, funding applications for the National Institute of Health and Care Research (NIHR), a UK funding body, mandates a demonstration of how researchers plan to include patients/service users, the public and carers at each stage of the project [ 3 ]. However, this should not simply be a tokenistic, tick-box exercise. PPI should help formulate initial ideas and should be an instrumental, continuous part of the research process. Input from PPI can provide unique insights not yet considered and can ensure that research and health services are closely aligned to the needs and requirements of service users PPI also generally makes research more relevant with clearer outcomes and impacts [ 4 ]. Although this review refers to both patients and the public using the umbrella term ‘PPI’, it is important to acknowledge that these are two different groups with different motivations, needs and interests when it comes to health research and service delivery [ 5 ].

Despite continuing recognition of the need of PPI to improve quality of healthcare, researchers have also recognised that there is no ‘one size fits all’ method for involving patients [ 4 ]. Traditionally, PPI methods invite people to take part in interviews or focus groups to facilitate discussion, or surveys and questionnaires. However, these can sometimes be inaccessible or non-engaging for certain populations. For example, someone with communication difficulties may find it difficult to engage in focus groups or interviews. If individuals lack the appropriate skills to interact in these types of scenarios, they cannot take advantage of the participation opportunities it can provide [ 6 ]. Creative methods, however, aim to resolve these issues. These are a relatively new concept whereby researchers use creative methods (e.g., artwork, animations, Lego), to make PPI more accessible and engaging for those whose voices would otherwise go unheard. They ensure that all populations can engage in research, regardless of their background or skills. Seminal work has previously been conducted in this area, which brought to light the use of creative methodologies in research. Leavy (2008) [ 7 ] discussed how traditional interviews had limits on what could be expressed due to their sterile, jargon-filled and formulaic structure, read by only a few specialised academics. It was this that called for more creative approaches, which included narrative enquiry, fiction-based research, poetry, music, dance, art, theatre, film and visual art. These practices, which can be used in any stage of the research cycle, supported greater empathy, self-reflection and longer-lasting learning experiences compared to interviews [ 7 ]. They also pushed traditional academic boundaries, which made the research accessible not only to researchers, but the public too. Leavy explains that there are similarities between arts-based approaches and scientific approaches: both attempts to investigate what it means to be human through exploration, and used together, these complimentary approaches can progress our understanding of the human experience [ 7 ]. Further, it is important to acknowledge the parallels and nuances between creative and inclusive methods of PPI. Although creative methods aim to be inclusive (this should underlie any PPI activity, whether creative or not), they do not incorporate all types of accessible, inclusive methodologies e.g., using sign language for people with hearing impairments or audio recordings for people who cannot read. Given that there was not enough scope to include an evaluation of all possible inclusive methodologies, this review will focus on creative methods of PPI only.

We aimed to conduct a qualitative systematic review to highlight the strengths of creative PPI in health and social care research, as well as the limitations, which might act as a barrier to their implementation. A qualitative systematic review “brings together research on a topic, systematically searching for research evidence from primary qualitative studies and drawing the findings together” [ 8 ]. This review can then advise researchers of the best practices when designing PPI.

Public involvement

The PHIRST-LIGHT Public Advisory Group (PAG) consists of a team of experienced public contributors with a diverse range of characteristics from across the UK. The PAG was involved in the initial question setting and study design for this review.

Search strategy

For the purpose of this review, the JBI approach for conducting qualitative systematic reviews was followed [ 9 ]. The search terms were (“creativ*” OR “innovat*” OR “authentic” OR “original” OR “inclu*”) AND (“public and patient involvement” OR “patient and public involvement” OR “public and patient involvement and engagement” OR “patient and public involvement and engagement” OR “PPI” OR “PPIE” OR “co-produc*” OR “co-creat*” OR “co-design*” OR “cooperat*” OR “co-operat*”). This search string was modified according to the requirements of each database. Papers were filtered by title, abstract and keywords (see Additional file 1 for search strings). The databases searched included Web of Science (WoS), PubMed, ASSIA and CINAHL. The Cochrane Library was also searched to identify relevant reviews which could lead to the identification of primary research. The search was conducted on 14/04/23. As our aim was to report on the use of creative PPI in research, rather than more generic public engagement, we used electronic databases of scholarly peer-reviewed literature, which represent a wide range of recognised databases. These identified studies published in general international journals (WoS, PubMed), those in social sciences journals (ASSIA), those in nursing and allied health journals (CINAHL), and trials of interventions (Cochrane Library).

Inclusion criteria

Only full-text, English language, primary research papers from 2009 to 2023 were included. This was the chosen timeframe as in 2009 the Health and Social Reform Act made it mandatory for certain Health and Social Care organisations to involve the public and patients in planning, delivering, and evaluating services [ 2 ]. Only creative methods of PPI were accepted, rather than traditional methods, such as interviews or focus groups. For the purposes of this paper, creative PPI included creative art or arts-based approaches (e.g., e.g. stories, songs, drama, drawing, painting, poetry, photography) to enhance engagement. Titles were related to health and social care and the creative PPI was used to engage with people as research advisors, not as study participants. Meta-analyses, conference abstracts, book chapters, commentaries and reviews were excluded. There were no limits concerning study location or the demographic characteristics of the PPI groups. Only qualitative data were accepted.

Quality appraisal

Quality appraisal using the Critical Appraisal Skills Programme (CASP) checklist [ 10 ] was conducted by the primary authors (ORP and CH). This was done independently, and discrepancies were discussed and resolved. If a consensus could not be reached, a third independent reviewer was consulted (JRM). The full list of quality appraisal questions can be found in Additional file 2 .

Data extraction

ORP extracted the study characteristics and a subset of these were checked by CH. Discrepancies were discussed and amendments made. Extracted data included author, title, location, year of publication, year study was carried out, research question/aim, creative methods used, number of participants, mean age, gender, ethnicity of participants, setting, limitations and strengths of creative PPI and main findings.

Data analysis

The included studies were analysed using inductive thematic analysis [ 11 ], where themes were determined by the data. The familiarisation stage took place during full-text reading of the included articles. Anything identified as a strength or limitation to creative PPI methods was extracted verbatim as an initial code and inputted into the data extraction Excel sheet. Similar codes were sorted into broader themes, either under ‘strengths’ or ‘limitations’ and reviewed. Themes were then assigned a name according to the codes.

The search yielded 9978 titles across the 5 databases: Web of Science (1480 results), PubMed (94 results), ASSIA (2454 results), CINAHL (5948 results) and Cochrane Library (2 results), resulting in 8553 different studies after deduplication. ORP and CH independently screened their titles and abstracts, excluding those that did not meet the criteria. After assessment, 12 studies were included (see Fig.  1 ).

PRISMA flowchart of the study selection process

Study characteristics

The included studies were published between 2018 and 2022. Seven were conducted in the UK [ 12 , 14 , 15 , 17 , 18 , 19 , 23 ], two in Canada [ 21 , 22 ], one in Australia [ 13 ], one in Norway [ 16 ] and one in Ireland [ 20 ]. The PPI activities occurred across various settings, including a school [ 12 ], social club [ 12 ], hospital [ 17 ], university [ 22 ], theatre [ 19 ], hotel [ 20 ], or online [ 15 , 21 ], however this information was omitted in 5 studies [ 13 , 14 , 16 , 18 , 23 ]. The number of people attending the PPI sessions varied, ranging from 6 to 289, however the majority (ten studies) had less than 70 participants [ 13 , 14 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Seven studies did not provide information on the age or gender of the PPI groups. Of those that did, ages ranged from 8 to 76 and were mostly female. The ethnicities of the PPI group members were also rarely recorded (see Additional file 3 for data extraction table).

Types of creative methods

The type of creative methods used to engage the PPI groups were varied. These included songs, poems, drawings, photograph elicitation, drama performance, visualisations, Facebook, photography, prototype development, cultural animation, card sorting and creating personas (see Table  1 ). These were sometimes accompanied by traditional methods of PPI such as interviews and focus group discussions.

The 12 included studies were all deemed to be of good methodological quality, with scores ranging from 6/10 to 10/10 with the CASP critical appraisal tool [ 10 ] (Table  2 ).

Thematic analysis

Analysis identified four limitations and five strengths to creative PPI (see Fig.  2 ). Limitations included the time and resource intensity of creative PPI methods, its lack of generalisation, ethical issues and external factors. Strengths included the disruption of power hierarchies, the engaging and inclusive nature of the methods and their long-term cost and time efficiency. Creative PPI methods also allowed mundane and “taboo” topics to be discussed within a safe space.

Theme map of strengths and limitations

Limitations of creative PPI

Creative ppi methods are time and resource intensive.

The time and resource intensive nature of creative PPI methods is a limitation, most notably for the persona-scenario methodology. Valaitis et al. [ 22 ] used 14 persona-scenario workshops with 70 participants to co-design a healthcare intervention, which aimed to promote optimal aging in Canada. Using the persona method, pairs composed of patients, healthcare providers, community service providers and volunteers developed a fictional character which they believed represented an ‘end-user’ of the healthcare intervention. Due to the depth and richness of the data produced the authors reported that it was time consuming to analyse. Further, they commented that the amount of information was difficult to disseminate to scientific leads and present at team meetings. Additionally, to ensure the production of high-quality data, to probe for details and lead group discussion there was a need for highly skilled facilitators. The resource intensive nature of the creative co-production was also noted in a study using the persona scenario and creative worksheets to develop a prototype decision support tool for individuals with malignant pleural effusion [ 17 ]. With approximately 50 people, this was also likely to yield a high volume of data to consider.

To prepare materials for populations who cannot engage in traditional methods of PPI was also timely. Kearns et al. [ 18 ] developed a feedback questionnaire for people with aphasia to evaluate ICT-delivered rehabilitation. To ensure people could participate effectively, the resources used during the workshops, such as PowerPoints, online images and photographs, had to be aphasia-accessible, which was labour and time intensive. The author warned that this time commitment should not be underestimated.

There are further practical limitations to implementing creative PPI, such as the costs of materials for activities as well as hiring a space for workshops. For example, the included studies in this review utilised pens, paper, worksheets, laptops, arts and craft supplies and magazines and took place in venues such as universities, a social club, and a hotel. Further, although not limited to creative PPI methods exclusively but rather most studies involving the public, a financial incentive was often offered for participation, as well as food, parking, transport and accommodation [ 21 , 22 ].

Creative PPI lacks generalisation

Another barrier to the use of creative PPI methods in health and social care research was the individual nature of its output. Those who participate, usually small in number, produce unique creative outputs specific to their own experiences, opinions and location. Craven et al. [ 13 ], used arts-based visualisations to develop a toolbox for adults with mental health difficulties. They commented, “such an approach might still not be worthwhile”, as the visualisations were individualised and highly personal. This indicates that the output may fail to meet the needs of its end-users. Further, these creative PPI groups were based in certain geographical regions such as Stoke-on-Trent [ 19 ] Sheffield [ 23 ], South Wales [ 12 ] or Ireland [ 20 ], which limits the extent the findings can be applied to wider populations, even within the same area due to individual nuances. Further, the study by Galler et al. [ 16 ], is specific to the Norwegian context and even then, maybe only a sub-group of the Norwegian population as the sample used was of higher socioeconomic status.

However, Grindell et al. [ 17 ], who used persona scenarios, creative worksheets and prototype development, pointed out that the purpose of this type of research is to improve a certain place, rather than apply findings across other populations and locations. Individualised output may, therefore, only be a limitation to research wanting to conduct PPI on a large scale.

If, however, greater generalisation within PPI is deemed necessary, then social media may offer a resolution. Fedorowicz et al. [ 15 ], used Facebook to gain feedback from the public on the use of video-recording methodology for an upcoming project. This had the benefit of including a more diverse range of people (289 people joined the closed group), who were spread geographically around the UK, as well as seven people from overseas.

Creative PPI has ethical issues

As with other research, ethical issues must be taken into consideration. Due to the nature of creative approaches, as well as the personal effort put into them, people often want to be recognised for their work. However, this compromises principles so heavily instilled in research such as anonymity and confidentiality. With the aim of exploring issues related to health and well-being in a town in South Wales, Byrne et al. [ 12 ], asked year 4/5 and year 10 pupils to create poems, songs, drawings and photographs. Community members also created a performance, mainly of monologues, to explore how poverty and inequalities are dealt with. Byrne noted the risks of these arts-based approaches, that being the possibility of over-disclosure and consequent emotional distress, as well as people’s desire to be named for their work. On one hand, the anonymity reduces the sense of ownership of the output as it does not portray a particular individual’s lived experience anymore. On the other hand, however, it could promote a more honest account of lived experience. Supporting this, Webber et al. [ 23 ], who used the persona method to co-design a back pain educational resource prototype, claimed that the anonymity provided by this creative technique allowed individuals to externalise and anonymise their own personal experience, thus creating a more authentic and genuine resource for future users. This implies that anonymity can be both a limitation and strength here.

The use of creative PPI methods is impeded by external factors

Despite the above limitations influencing the implementation of creative PPI techniques, perhaps the most influential is that creative methodologies are simply not mainstream [ 19 ]. This could be linked to the issues above, like time and resource intensity, generalisation and ethical issues but it is also likely to involve more systemic factors within the research community. Micsinszki et al. [ 21 ], who co-designed a hub for the health and well-being of vulnerable populations, commented that there is insufficient infrastructure to conduct meaningful co-design as well as a dominant medical model. Through a more holistic lens, there are “sociopolitical environments that privilege individualism over collectivism, self-sufficiency over collaboration, and scientific expertise over other ways of knowing based on lived experience” [ 21 ]. This, it could be suggested, renders creative co-design methodologies, which are based on the foundations of collectivism, collaboration and imagination an invalid technique in the research field, which is heavily dominated by more scientific methods offering reproducibility, objectivity and reliability.

Although we acknowledge that creative PPI techniques are not always appropriate, it may be that their main limitation is the lack of awareness of these methods or lack of willingness to use them. Further, there is always the risk that PPI, despite being a mandatory part of research, is used in a tokenistic or tick-box fashion [ 20 ], without considering the contribution that meaningful PPI could make to enhancing the research. It may be that PPI, let alone creative PPI, is not at the forefront of researchers’ minds when planning research.

Strengths of creative PPI

Creative ppi disrupts power hierarchies.

One of the main strengths of creative PPI techniques, cited most frequently in the included literature, was that they disrupt traditional power hierarchies [ 12 , 13 , 17 , 19 , 23 ]. For example, the use of theatre performance blurred the lines between professional and lay roles between the community and policy makers [ 12 ]. Individuals created a monologue to portray how poverty and inequality impact daily life and presented this to representatives of the National Assembly of Wales, Welsh Government, the Local Authority, Arts Council and Westminster. Byrne et al. [ 12 ], states how this medium allowed the community to engage with the people who make decisions about their lives in an environment of respect and understanding, where the hierarchies are not as visible as in other settings, e.g., political surgeries. Creative PPI methods have also removed traditional power hierarchies between researchers and adolescents. Cook et al. [ 13 ], used arts-based approaches to explore adolescents’ ideas about the “perfect” condom. They utilised the “Life Happens” resource, where adolescents drew and then decorated a person with their thoughts about sexual relationships, not too dissimilar from the persona-scenario method. This was then combined with hypothetical scenarios about sexuality. A condom-mapping exercise was then implemented, where groups shared the characteristics that make a condom “perfect” on large pieces of paper. Cook et al. [ 13 ], noted that usually power imbalances make it difficult to elicit information from adolescents, however these power imbalances were reduced due to the use of creative co-design techniques.

The same reduction in power hierarchies was noted by Grindell et al. [ 17 ], who used the person-scenario method and creative worksheets with individuals with malignant pleural effusion. This was with the aim of developing a prototype of a decision support tool for patients to help with treatment options. Although this process involved a variety of stakeholders, such as patients, carers and healthcare professionals, creative co-design was cited as a mechanism that worked to reduce power imbalances – a limitation of more traditional methods of research. Creative co-design blurred boundaries between end-users and clinical staff and enabled the sharing of ideas from multiple, valuable perspectives, meaning the prototype was able to suit user needs whilst addressing clinical problems.

Similarly, a specific creative method named cultural animation was also cited to dissolve hierarchies and encourage equal contributions from participants. Within this arts-based approach, Keleman et al. [ 19 ], explored the concept of “good health” with individuals from Stoke-on Trent. Members of the group created art installations using ribbons, buttons, cardboard and straws to depict their idea of a “healthy community”, which was accompanied by a poem. They also created a 3D Facebook page and produced another poem or song addressing the government to communicate their version of a “picture of health”. Public participants said that they found the process empowering, honest, democratic, valuable and practical.

This dissolving of hierarchies and levelling of power is beneficial as it increases the sense of ownership experienced by the creators/producers of the output [ 12 , 17 , 23 ]. This is advantageous as it has been suggested to improve its quality [ 23 ].

Creative PPI allows the unsayable to be said

Creative PPI fosters a safe space for mundane or taboo topics to be shared, which may be difficult to communicate using traditional methods of PPI. For example, the hypothetical nature of condom mapping and persona-scenarios meant that adolescents could discuss a personal topic without fear of discrimination, judgement or personal disclosure [ 13 ]. The safe space allowed a greater volume of ideas to be generated amongst peers where they might not have otherwise. Similarly, Webber et al. [ 23 ], , who used the persona method to co-design the prototype back pain educational resource, also noted how this method creates anonymity whilst allowing people the opportunity to externalise personal experiences, thoughts and feelings. Other creative methods were also used, such as drawing, collaging, role play and creating mood boards. A cardboard cube (labelled a “magic box”) was used to symbolise a physical representation of their final prototype. These creative methods levelled the playing field and made personal experiences accessible in a safe, open environment that fostered trust, as well as understanding from the researchers.

It is not only sensitive subjects that were made easier to articulate through creative PPI. The communication of mundane everyday experiences were also facilitated, which were deemed typically ‘unsayable’. This was specifically given in the context of describing intangible aspects of everyday health and wellbeing [ 11 ]. Graphic designers can also be used to visually represent the outputs of creative PPI. These captured the movement and fluidity of people and well as the relationships between them - things that cannot be spoken but can be depicted [ 21 ].

Creative PPI methods are inclusive

Another strength of creative PPI was that it is inclusive and accessible [ 17 , 19 , 21 ]. The safe space it fosters, as well as the dismantling of hierarchies, welcomed people from a diverse range of backgrounds and provided equal opportunities [ 21 ], especially for those with communication and memory difficulties who might be otherwise excluded from PPI. Kelemen et al. [ 19 ], who used creative methods to explore health and well-being in Stoke-on-Trent, discussed how people from different backgrounds came together and connected, discussed and reached a consensus over a topic which evoked strong emotions, that they all have in common. Individuals said that the techniques used “sets people to open up as they are not overwhelmed by words”. Similarly, creative activities, such as the persona method, have been stated to allow people to express themselves in an inclusive environment using a common language. Kearns et al. [ 18 ], who used aphasia-accessible material to develop a questionnaire with aphasic individuals, described how they felt comfortable in contributing to workshops (although this material was time-consuming to make, see ‘Limitations of creative PPI’ ).

Despite the general inclusivity of creative PPI, it can also be exclusive, particularly if online mediums are used. Fedorowicz et al. [ 15 ], used Facebook to create a PPI group, and although this may rectify previous drawbacks about lack of generalisation of creative methods (as Facebook can reach a greater number of people, globally), it excluded those who are not digitally active or have limited internet access or knowledge of technology. Online methods have other issues too. Maintaining the online group was cited as challenging and the volume of responses required researchers to interact outside of their working hours. Despite this, online methods like Facebook are very accessible for people who are physically disabled.

Creative PPI methods are engaging

The process of creative PPI is typically more engaging and produces more colourful data than traditional methods [ 13 ]. Individuals are permitted and encouraged to explore a creative self [ 19 ], which can lead to the exploration of new ideas and an overall increased enjoyment of the process. This increased engagement is particularly beneficial for younger PPI groups. For example, to involve children in the development of health food products, Galler et al. [ 16 ] asked 9-12-year-olds to take photos of their food and present it to other children in a “show and tell” fashion. They then created a newspaper article describing a new healthy snack. In this creative focus group, children were given lab coats to further their identity as inventors. Galler et al. [ 16 ], notes that the methods were highly engaging and facilitated teamwork and group learning. This collaborative nature of problem-solving was also observed in adults who used personas and creative worksheets to develop the resource for lower back pain [ 23 ]. Dementia patients too have been reported to enjoy the creative and informal approach to idea generation [ 20 ].

The use of cultural animation allowed people to connect with each other in a way that traditional methods do not [ 19 , 21 ]. These connections were held in place by boundary objects, such as ribbons, buttons, fabric and picture frames, which symbolised a shared meaning between people and an exchange of knowledge and emotion. Asking groups to create an art installation using these objects further fostered teamwork and collaboration, both at an individual and collective level. The exploration of a creative self increased energy levels and encouraged productive discussions and problem-solving [ 19 ]. Objects also encouraged a solution-focused approach and permitted people to think beyond their usual everyday scope [ 17 ]. They also allowed facilitators to probe deeper about the greater meanings carried by the object, which acted as a metaphor [ 21 ].

From the researcher’s point of view, co-creative methods gave rise to ideas they might not have initially considered. Valaitis et al. [ 22 ], found that over 40% of the creative outputs were novel ideas brought to light by patients, healthcare providers/community care providers, community service providers and volunteers. One researcher commented, “It [the creative methods] took me on a journey, in a way that when we do other pieces of research it can feel disconnected” [ 23 ]. Another researcher also stated they could not return to the way they used to do research, as they have learnt so much about their own health and community and how they are perceived [ 19 ]. This demonstrates that creative processes not only benefit the project outcomes and the PPI group, but also facilitators and researchers. However, although engaging, creative methods have been criticised for not demonstrating academic rigour [ 17 ]. Moreover, creative PPI may also be exclusive to people who do not like or enjoy creative activities.

Creative PPI methods are cost and time efficient

Creative PPI workshops can often produce output that is visible and tangible. This can save time and money in the long run as the output is either ready to be implemented in a healthcare setting or a first iteration has already been developed. This may also offset the time and costs it takes to implement creative PPI. For example, the prototype of the decision support tool for people with malignant pleural effusion was developed using personas and creative worksheets. The end result was two tangible prototypes to drive the initial idea forward as something to be used in practice [ 17 ]. The use of creative co-design in this case saved clinician time as well as the time it would take to develop this product without the help of its end-users. In the development of this particular prototype, analysis was iterative and informed the next stage of development, which again saved time. The same applies for the feedback questionnaire for the assessment of ICT delivered aphasia rehabilitation. The co-created questionnaire, designed with people with aphasia, was ready to be used in practice [ 18 ]. This suggests that to overcome time and resource barriers to creative PPI, researchers should aim for it to be engaging whilst also producing output.

That useable products are generated during creative workshops signals to participating patients and public members that they have been listened to and their thoughts and opinions acted upon [ 23 ]. For example, the development of the back pain resource based on patient experiences implies that their suggestions were valid and valuable. Further, those who participated in the cultural animation workshop reported that the process visualises change, and that it already feels as though the process of change has started [ 19 ].

The most cost and time efficient method of creative PPI in this review is most likely the use of Facebook to gather feedback on project methodology [ 15 ]. Although there were drawbacks to this, researchers could involve more people from a range of geographical areas at little to no cost. Feedback was instantaneous and no training was required. From the perspective of the PPI group, they could interact however much or little they wish with no time commitment.

This systematic review identified four limitations and five strengths to the use of creative PPI in health and social care research. Creative PPI is time and resource intensive, can raise ethical issues and lacks generalisability. It is also not accepted by the mainstream. These factors may act as barriers to the implementation of creative PPI. However, creative PPI disrupts traditional power hierarchies and creates a safe space for taboo or mundane topics. It is also engaging, inclusive and can be time and cost efficient in the long term.

Something that became apparent during data analysis was that these are not blanket strengths and limitations of creative PPI as a whole. The umbrella term ‘creative PPI’ is broad and encapsulates a wide range of activities, ranging from music and poems to prototype development and persona-scenarios, to more simplistic things like the use of sticky notes and ordering cards. Many different activities can be deemed ‘creative’ and the strengths and limitations of one does not necessarily apply to another. For example, cultural animation takes greater effort to prepare than the use of sticky notes and sorting cards, and the use of Facebook is cheaper and wider reaching than persona development. Researchers should use their discretion and weigh up the benefits and drawbacks of each method to decide on a technique which suits the project. What might be a limitation to creative PPI in one project may not be in another. In some cases, creative PPI may not be suitable at all.

Furthermore, the choice of creative PPI method also depends on the needs and characteristics of the PPI group. Children, adults and people living with dementia or language difficulties all have different engagement needs and capabilities. This indicates that creative PPI is not one size fits all and that the most appropriate method will change depending on the composition of the group. The choice of method will also be determined by the constraints of the research project, namely time, money and the research aim. For example, if there are time constraints, then a method which yields a lot of data and requires a lot of preparation may not be appropriate. If generalisation is important, then an online method is more suitable. Together this indicates that the choice of creative PPI method is highly individualised and dependent on multiple factors.

Although the limitations discussed in this review apply to creative PPI, they are not exclusive to creative PPI. Ethical issues are a consideration within general PPI research, especially when working with more vulnerable populations, such as children or adults living with a disability. It can also be the case that traditional PPI methods lack generalisability, as people who volunteer to be part of such a group are more likely be older, middle class and retired [ 24 ]. Most research is vulnerable to this type of bias, however, it is worth noting that generalisation is not always a goal and research remains valid and meaningful in its absence. Although online methods may somewhat combat issues related to generalisability, these methods still exclude people who do not have access to the internet/technology or who choose not to use it, implying that online PPI methods may not be wholly representative of the general population. Saying this, however, the accessibility of creative PPI techniques differs from person to person, and for some, online mediums may be more accessible (for example for those with a physical disability), and for others, this might be face-to-face. To combat this, a range of methods should be implemented. Planning multiple focus group and interviews for traditional PPI is also time and resource intensive, however the extra resources required to make this creative may be even greater. Although, the rich data provided may be worth the preparation and analysis time, which is also likely to depend on the number of participants and workshop sessions required. PPI, not just creative PPI, often requires the provision of a financial incentive, refreshments, parking and accommodation, which increase costs. These, however, are imperative and non-negotiable, as they increase the accessibility of research, especially to minority and lower-income groups less likely to participate. Adequate funding is also important for co-design studies where repeated engagement is required. One barrier to implementation, which appears to be exclusive to creative methods, however, is that creative methods are not mainstream. This cannot be said for traditional PPI as this is often a mandatory part of research applications.

Regarding the strengths of creative PPI, it could be argued that most appear to be exclusive to creative methodologies. These are inclusive by nature as multiple approaches can be taken to evoke ideas from different populations - approaches that do not necessarily rely on verbal or written communication like interviews and focus groups do. Given the anonymity provided by some creative methods, such as personas, people may be more likely to discuss their personal experiences under the guise of a general end-user, which might be more difficult to maintain when an interviewer is asking an individual questions directly. Additionally, creative methods are by nature more engaging and interactive than traditional methods, although this is a blanket statement and there may be people who find the question-and-answer/group discussion format more engaging. Creative methods have also been cited to eliminate power imbalances which exist in traditional research [ 12 , 13 , 17 , 19 , 23 ]. These imbalances exist between researchers and policy makers and adolescents, adults and the community. Lastly, although this may occur to a greater extent in creative methods like prototype development, it could be suggested that PPI in general – regardless of whether it is creative - is more time and cost efficient in the long-term than not using any PPI to guide or refine the research process. It must be noted that these are observations based on the literature. To be certain these differences exist between creative and traditional methods of PPI, direct empirical evaluation of both should be conducted.

To the best of our knowledge, this is the first review to identify the strengths and limitations to creative PPI, however, similar literature has identified barriers and facilitators to PPI in general. In the context of clinical trials, recruitment difficulties were cited as a barrier, as well as finding public contributors who were free during work/school hours. Trial managers reported finding group dynamics difficult to manage and the academic environment also made some public contributors feel nervous and lacking confidence to speak. Facilitators, however, included the shared ownership of the research – something that has been identified in the current review too. In addition, planning and the provision of knowledge, information and communication were also identified as facilitators [ 25 ]. Other research on the barriers to meaningful PPI in trial oversight committees included trialist confusion or scepticism over the PPI role and the difficulties in finding PPI members who had a basic understanding of research [ 26 ]. However, it could be argued that this is not representative of the average patient or public member. The formality of oversight meetings and the technical language used also acted as a barrier, which may imply that the informal nature of creative methods and its lack of dependency on literacy skills could overcome this. Further, a review of 42 reviews on PPI in health and social care identified financial compensation, resources, training and general support as necessary to conduct PPI, much like in the current review where the resource intensiveness of creative PPI was identified as a limitation. However, others were identified too, such as recruitment and representativeness of public contributors [ 27 ]. Like in the current review, power imbalances were also noted, however this was included as both a barrier and facilitator. Collaboration seemed to diminish hierarchies but not always, as sometimes these imbalances remained between public contributors and healthcare staff, described as a ‘them and us’ culture [ 27 ]. Although these studies compliment the findings of the current review, a direct comparison cannot be made as they do not concern creative methods. However, it does suggest that some strengths and weaknesses are shared between creative and traditional methods of PPI.

Strengths and limitations of this review

Although a general definition of creative PPI exists, it was up to our discretion to decide exactly which activities were deemed as such for this review. For example, we included sorting cards, the use of interactive whiteboards and sticky notes. Other researchers may have a more or less stringent criteria. However, two reviewers were involved in this decision which aids the reliability of the included articles. Further, it may be that some of the strengths and limitations cannot fully be attributed to the creative nature of the PPI process, but rather their co-created nature, however this is hard to disentangle as the included papers involved both these aspects.

During screening, it was difficult to decide whether the article was utilising creative qualitative methodology or creative PPI , as it was often not explicitly labelled as such. Regardless, both approaches involved the public/patients refining a healthcare product/service. This implies that if this review were to be replicated, others may do it differently. This may call for greater standardisation in the reporting of the public’s involvement in research. For example, the NIHR outlines different approaches to PPI, namely “consultation”, “collaboration”, “co-production” and “user-controlled”, which each signify an increased level of public power and influence [ 28 ]. Papers with elements of PPI could use these labels to clarify the extent of public involvement, or even explicitly state that there was no PPI. Further, given our decision to include only scholarly peer-reviewed literature, it is possible that data were missed within the grey literature. Similarly, the literature search will not have identified all papers relating to different types of accessible inclusion. However, the intent of the review was to focus solely on those within the definition of creative.

This review fills a gap in the literature and helps circulate and promote the concept of creative PPI. Each stage of this review, namely screening and quality appraisal, was conducted by two independent reviewers. However, four full texts could not be accessed during the full text reading stage, meaning there are missing data that could have altered or contributed to the findings of this review.

Research recommendations

Given that creative PPI can require effort to prepare, perform and analyse, sufficient time and funding should be allocated in the research protocol to enable meaningful and continuous PPI. This is worthwhile as PPI can significantly change the research output so that it aligns closely with the needs of the group it is to benefit. Researchers should also consider prototype development as a creative PPI activity as this might reduce future time/resource constraints. Shifting from a top-down approach within research to a bottom-up can be advantageous to all stakeholders and can help move creative PPI towards the mainstream. This, however, is the collective responsibility of funding bodies, universities and researchers, as well as committees who approve research bids.

A few of the included studies used creative techniques alongside traditional methods, such as interviews, which could also be used as a hybrid method of PPI, perhaps by researchers who are unfamiliar with creative techniques or to those who wish to reap the benefits of both. Often the characteristics of the PPI group were not included, including age, gender and ethnicity. It would be useful to include such information to assess how representative the PPI group is of the population of interest.

Creative PPI is a relatively novel approach of engaging the public and patients in research and it has both advantages and disadvantages compared to more traditional methods. There are many approaches to implementing creative PPI and the choice of technique will be unique to each piece of research and is reliant on several factors. These include the age and ability of the PPI group as well as the resource limitations of the project. Each method has benefits and drawbacks, which should be considered at the protocol-writing stage. However, given adequate funding, time and planning, creative PPI is a worthwhile and engaging method of generating ideas with end-users of research – ideas which may not be otherwise generated using traditional methods.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

Critical Appraisal Skills Programme

The Joanna Briggs Institute

National Institute of Health and Care Research

Public Advisory Group

Public and Patient Involvement

Web of Science

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Acknowledgements

With thanks to the PHIRST-LIGHT public advisory group and consortium for their thoughts and contributions to the design of this work.

The research team is supported by a National Institute for Health and Care Research grant (PHIRST-LIGHT Reference NIHR 135190).

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Olivia R. Phillips and Cerian Harries share joint first authorship.

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Nottingham Centre for Public Health and Epidemiology, Lifespan and Population Health, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK

Olivia R. Phillips, Jo Leonardi-Bee, Holly Knight & Joanne R. Morling

National Institute for Health and Care Research (NIHR) PHIRST-LIGHT, Nottingham, UK

Olivia R. Phillips, Cerian Harries, Jo Leonardi-Bee, Holly Knight, Lauren B. Sherar, Veronica Varela-Mato & Joanne R. Morling

School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, Leicestershire, LE11 3TU, UK

Cerian Harries, Lauren B. Sherar & Veronica Varela-Mato

Nottingham Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK

Jo Leonardi-Bee

NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, NG7 2UH, UK

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Author contributions: study design: ORP, CH, JRM, JLB, HK, LBS, VVM, literature searching and screening: ORP, CH, JRM, data curation: ORP, CH, analysis: ORP, CH, JRM, manuscript draft: ORP, CH, JRM, Plain English Summary: ORP, manuscript critical review and editing: ORP, CH, JRM, JLB, HK, LBS, VVM.

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Phillips, O.R., Harries, C., Leonardi-Bee, J. et al. What are the strengths and limitations to utilising creative methods in public and patient involvement in health and social care research? A qualitative systematic review. Res Involv Engagem 10 , 48 (2024). https://doi.org/10.1186/s40900-024-00580-4

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Exploring the significant problems confronting secondary schools history education: a baseline study

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• Volume 3 , article number  52 , ( 2024 )

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• Fekede Sileshi Fufa   ORCID: orcid.org/0000-0001-6035-8205 1 ,
• Abera Husen Tulu   ORCID: orcid.org/0000-0002-0408-9028 2 &
• Ketebo Abdiyo Ensene   ORCID: orcid.org/0000-0001-8492-9340 1  

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The purpose of this baseline study is to determine the significant problems confronting history education in secondary school. The researchers employed qualitative research methods and case study design. The techniques that were employed to acquire credible data were document analysis, interviews, and classroom observation. Six experienced history education teachers and eight top-ten students from Sebeta town public secondary school were interviewed, and academic achievement statistics of 174 students in history education were analyzed. In addition eight lesson observations were carried out to validate the information gleaned from the interviews and document analysis. The study's findings show that the primary challenges influencing history education in Sebeta town public secondary schools were teaching strategy, a lack of awareness about implementing participatory teaching methods, a lack of comprehensiveness of the contents of history education teaching materials, and the issue of the bulkiness and scope of history education texts being covered on time. The findings also indicate the significance of training history education teachers to use participatory teaching tactics, as well as the need for curriculum experts to better coordinate the range of history education content and teaching strategies. The findings of this study will help teachers, practitioners, scholars, policymakers, and educational professionals find solutions to significant problems in secondary school history education, as well as develop effective techniques for teaching history education in secondary schools that involve twenty-first century skills and abilities.

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1 Introduction

History education as an academic discipline has a long history in the world. In the nineteenth century a German historian Leopold von Ranke an indispensable contribution to modernizing history writing [ 1 , p. 2, 2 , p. 171]. Ranke (1795–1886) not only established history as a major discipline, but he also established the idea that all accurate history must be based on primary sources and rigorous methodology [ 1 , p.13, 3 ]. As a result, he is regarded as the father of modern historiography [ 1 , p. 2]. Since the nineteenth century, history education has developed as an independent discipline across the world.

In terms of teaching strategies, evidence shows that teaching approaches play an important role in any subject of study in enhancing students' academic achievements [ 4 , p. 601, 5 ]. Many research findings demonstrate that the approach employed to develop any operation significantly determines the end product [ 6 , p. 7]. Several factors influence students' academic achievement; evidence suggests that teachers are the most essential ones in terms of students’ education and achievements [ 7 , pp. 2633–34]. According to the research findings conducted on student learning, the way teachers engage their pupils is crucial in the teaching and learning process [ 8 , p. 39]. The approaches used by the teacher should be matched to the demands of the students [ 6 , p.7]. Students’ motivation and achievement are mostly dependent on the teachers’ activities [ 9 , p. 15). Several researches have indicated that among the subjects offered in schools, students do have not much interest in history education [ 10 , p. 45]. According to a study conducted on secondary schools, history education has been taught through lectures rather than participatory and student- centred strategies [ 11 , p. 1). According to Kiio [ 11 , pp. 1–2], effective implementation of participatory teaching and learning methodologies can increase students' interest in history education. Issar [ 10 , p. 49] also emphasized the significance of learning history education, stating that learning history education should help students understand the complexities of human lives, the diversity and relationships between different groups, the changes and continuities and connect the past, present, and future events.

Scholars confirm that constructive learning approaches allow students to participate actively in the lessons [ 12 , p. 35]. Since 1980, the theory of social constructivism has been advocated as an effective way of learning and teaching [ 12 , pp. 35–36]. It is a theory developed by Russian psychologist Lev Vygotsky (1896–1934), which holds that individuals are active participants in the creation of their knowledge [ 13 , p.783]. Vygotsky’s social constructivism focuses on pedagogies that encourage active learning, effective and meaningful learning, constructive learning, and learning by doing [ 13 , p.783]. Current research in the field of history education supports the notion that participatory approaches to teaching the subject at the secondary school level are the preferred method for developing the skills required to handle the world's future historiographical needs [ 14 , p. 81]. In several works of literature, interactive teaching approaches are vital in increasing student academic achievement. The purpose of this baseline study is to investigate the significant problems confronting history education in Sebeta government secondary schools.

2 Statement of the problem

History education is frequently a source of public debate, a source of unrest, and a site of struggle over what and how should be taught in schools in Ethiopia [ 15 , p. 2]. National history is taught as a compulsory subject in different countries. Several countries believe that knowing the country’s history is a requirement for all citizens [ 16 , pp. 1–2]. In the case of history education teaching in Ethiopia, for the first time, a history syllabus was included in the education curriculum after 1943 [ 17 , p.87]. However, no specific research on significant problems confronting history education in Ethiopian secondary schools has been conducted. Researchers who have studied the problem of education in Ethiopia have directly and indirectly addressed the issue of history education [ 18 , pp.18–19].

According to research conducted by Resource and Guide [ 19 , p. 8], teaching is important by incorporating 21st-century skills such as critical thinking skills, problem-solving, language proficiency, communication and collaborative skills, cognitive skills, adaptability skills and the ability to make decisions. Furthermore, student-centred teaching method fosters students' comprehension, deep learning, problem-solving, critical thinking, and communication [ 20 , p. 4]. Research conducted on history education has discovered a link between teaching approaches and students' attitudes towards history education [ 21 , p. 3]. A scant study has been conducted on significant problems confronting history education in Ethiopian secondary schools and on approaches more appropriate for teaching history.

This motivated the researchers to conduct research on major problems confronting history education in Ethiopian secondary schools in Sebeta town. To fill this gap, the researchers used a variety of tools to analyze significant problems confront history education in Ethiopian secondary schools in general, and Sebeta town public Secondary School in particular.

Thus, this study attempts to answer the following questions:

What are the most significant problems facing history education at Sebeta town public secondary school?

What are the most common teaching strategies employed at Sebeta town government secondary school?

How is the student’s academic achievement in history at Sebeta public secondary school?

3 Objectives of the study

To find out the most significant problems facing history education at Sebeta Town Government Secondary School.

To identify the most common teaching strategies employed at Sebeta town government secondary school.

To determine a student’s academic achievement in history at Sebeta government secondary school.

4 Literature review

Any research project needs theory to provide direction and help on how things are implemented. Theoretical foundation aids in deciphering the way phenomena happen and the basis of specific actions [ 22 , p. 75]. This research is founded on Vygotsky’s social constructivist learning theory, which supports historical thinking. According to a social learning theory developed by Russian psychologist Lev Vygotsky (1896–1934), individuals are active participants in the development of their knowledge [ 23 , p. 395]. This social constructivism approach places a strong emphasis on pairs and small groups [ 24 , pp.13–15]. According to this theory, students learn primarily through interactions with their classmates, instructors, and parents, whereas teachers are expected to facilitate dialogue in the classroom [ 25 , p. 243]. According to Richard [ 26 , p. 380], good teaching and learning are strongly reliant on interpersonal interaction and conversation, with the primary focus on the student’s understanding of the topic.

Scholarly works reveal that there is very little study on the significant problems confronting history education. The existing scholarly works on teaching approach and students’ learning, on the other hand, demonstrate that there are strong relationships between the effects of teaching strategies and students’ achievement. Sugano and Mamolo [ 27 , p. 827] conducted a study on the “Effects of Teaching Methodologies on Students’ Attitude and Motivation,’’ found that teaching methods had an enormous positive impact (Cohen’s d = 0.379) on student attitude. The study also found that cooperative learning had a greater power than traditional teaching methods in improving students’ positive attitudes, motivation and interest.

History teaching should not only be mastery of the basic content (substantive knowledge) but also enhance the acquisition of subject skills and competencies that will make students learn on their own and manage their own lives and carry it through the adversities of life in society [ 26 , 28 ]. Luka [ 14 , p. VII] discovered in his study, “The Impact of Teaching Methods on Attitudes of Secondary School Students Towards Learning of History in Malawi,” that students in secondary schools have negative attitudes towards learning history. One of the reasons he highlighted is that student-centred techniques of teaching are not regularly used in the subject of history education ( Ibid , [ 29 ]).

Moreover, Mazibuko [ 30 , p. 142] revealed that teaching methods in history education greatly contributed to students' negative perceptions of the subject. He discovered that traditional methods of teaching history utilized by teachers contributed to students decreasing interest in the subject ( Ibid ). Besides, Zhu and Kaiser [ 31 , p. 191] discovered that teaching methods influence students’ motivation, attitudes towards school, willingness to do homework, and confidence in their learning.

In his study on effective teaching in history, Boadu [ 8 , p. 39] discovered that effective teaching of history should bring the subject closer to students’ lives, hearts, and minds. He argued that effective teaching cannot emerge from traditional history teaching, because the teacher lectures on the subject intensely, and students are forced to take and memorize notes.

Silver and Perini [ 32 , p. 16) argued that teachers who use a variety of teaching techniques have well-behaved and motivated students, resulting in high student academic achievement.

Adding to this, according to [ 33 , p. 74], the quality of teaching strategies influences student learning and contributes to a 15 to 20 times improvement in student achievement. These researches highlighted that effective teaching strategies played a crucial influence on student motivation, developing students’ positive attitudes, and improving students’ academic achievement more than traditional teacher-centred approaches. There has been no research undertaken in Ethiopian secondary schools to determine which methodologies could be better appropriate for teaching history. Using the designed study instruments, the researchers examine and determine the significant problems confronting history education in Sebeta government secondary schools.

5 Research methodology

The study was conducted using the constructivist paradigm view with the qualitative research approach. In this study, the researchers utilized a qualitative research approach. The qualitative research approach allows the researchers to conduct an in-depth investigation of the problem under study [ 34 , pp. 177–179, 35 , p. 12]. The qualitative research approach has different specific designs. These are Phenomenology, Ethnography, Narrative inquiry, Case study, Grounded theory and Historical research [ 36 , p. 49]. In this study, the qualitative case study design was used. Case studies are ways to explain, describe, or explore phenomena. According to Hatch [ 37 , p. 37], case studies are the type of qualitative work that investigates a contextualized contemporary phenomenon within specific boundaries. This study was carried out using document analysis, interviews, and classroom observation techniques.

The researchers received the accreditation letter from their institution and submitted it to the relevant authorities to confirm the legality of the research. The letter was then submitted to the Sebeta town’s education office and Sebeta secondary schools to acquire authorization to collect primary data from sampled respondents. The data collection process was started after getting all relevant permits from the authorities. Before interviews with respondents, the researchers described the goal of the study to the participants to acquire their permission. The researchers told participants that the study's primary aim was to collect data for the research titled "The significant problems confronting history education in history education in Sebeta town public secondary schools, Ethiopia." After extensive verbal discussions with the respondents, interviews were conducted with those who expressed full interest in participating in the study.

5.1 Sampling procedure

This study employed a purposive sampling technique. In the first stage, the study site was chosen purposively, which is Sebeta town. In the following step, this baseline study was confined to two out of four government secondary schools in Sebeta town with similar standards, a higher number of students and staff than the others. The schools that were purposely selected for the study are those that have been in existence for a long time, have more experienced staff than others, and are expected to provide firsthand information. Purposive sampling was used to select knowledgeable research participants [ 38 , pp. 512–513]. Because it allows the researcher to select the research participants who were believed informed sources of information, thoughtful, informative, articulate, and experienced with the problem under the study [ 35 , p.142, 39 , pp. 100–114]. The researchers selected individuals who have a good source of information about the issue under study (history education teachers and students [ 39 , p. 100]. In the selected two secondary schools, there are six history education teachers, five males and one female. These teachers were purposefully included in the study. The researchers believed that the experienced teachers who were chosen were useful as a primary source of data because they were familiar with the subject's contents, as well as its problems. Eight top-ten grade ten students from the two schools also took part in the study directly. The researchers believed the top-ten students were able to explain the area of study more accurately than the others. Grade ten students were purposefully chosen for the study. The following are the grounds for choosing grade ten students: First history education in Ethiopia begins in grade nine. Students began studying history education grade nine onwards. Because it is assumed that grade ten students know more about history education contents than grade nine students. Second, it is assumed that grade ten comprises all types of students (higher achievers, moderate, and slow learners), as well as grade 10 students who will choose a major (social sciences and natural sciences) in their future grade eleven. As a result, the researchers opted to gather the finest information from grade ten students to establish their perspectives toward history.

6 Results and discussions

6.1 what are the significant problems facing history education in sebeta town government secondary school, 6.1.1 interviews analysis.

For explanation, the abbreviation SSST stands for “Sebeta Secondary School Teacher”, similarly, BSSST stands for “Burka Sebeta Secondary School Teacher” and the numbers denote the order. As shown in Table  1 , six history education teachers were interviewed for this study. Of the six teachers interviewed, five had more than 15 years of teaching experience. Five of these teachers hold a bachelor's degree and one has an MA in history. Five of the teachers interviewed were male and one was female. During the interviews, the teachers revealed to the researchers that three of the six teachers had an MA in another academic discipline (Table 2 ).

For clarification, the abbreviation SSSS stands for, “Sebeta Secondary School Student”, BSSS, “Burka Sebeta Secondary School Student” and the numbers represent the order. Eight students’ four males and four females from both schools were chosen for the interview of this study.

An interview is one of the data collection instruments that were used to explore the significant problems confronting history education in government secondary schools. An interview allows the researchers to gather information that is directly related to the research objectives [ 40 , p. 411]. It is typically conducted one-on-one with informants who have firsthand experience with the research topic [ 25 , p. 144]. An interview was conducted with six experienced history education teachers, and eight secondary school students to gather adequate data about the topic under investigation.

The researchers began their interview with teachers by asking, “What are the significant problems facing history education in Sebeta town government secondary school?” The researchers interviewed teachers concerning the organization of the history education curriculum. Teacher SSST1’s response to this question is as follows: “I have been teaching history education for 18 years but I have never seen or read the curriculum of history education until today.’’ Furthermore, BSSST1 shared the same point of view saying: “So far, I have not read any history education syllabus or seen what it contains except students’ textbook. There is no available history education syllabus in secondary school for teachers. ” Teacher SSST2 also made a similar note: “We do not have a history syllabus, and the teaching materials that we use to teach students are only students’ textbooks.”

All of the teachers interviewed stated that they did not have a history curriculum and had never utilized it. The researchers found that teachers do not see contents, structures, recommended teaching aids, and methodologies in the history education syllabus and teachers’ guide.

Teachers explained that the history education textbook is divided into three parts: world history, African history, and Ethiopian history. According to the teachers interviewed, the history of the Ethiopian peoples are not written inclusively in students’ textbooks, and Ethiopian history education does not adequately addressed the political, social, and economic history of the Ethiopian people (BSSST1, BSSST2, SSST1, SSSS2, SSST3). However, research work suggests that in multi-ethnic countries, all students should be able to learn about themselves and their culture from the books they learn from Hodkinson et al. [ 41 , p. 3] stated that “all learners must be able to find themselves and their world represented in the books from which they learn.”.

In addition, teachers were asked as history education teaching materials in the same way as other Subjects. To this question, all of the teachers interviewed consistently said no. Teachers claim that “since our country’s political changes, textbooks for all disciplines have been updated three to four times, but history education has not been updated in the same way” (BSSST1, BSSST2, SSST1, SSSS2, SSST3, SSSST4). They demonstrated this to the researchers by referring to the textbook they were using. In this instance, a history grade 10 students’ textbook was published in 2002 GC/1994, reprinted in 2005/1997 and renewed in 2023 after 18 years. According to the teachers interviewed, there has been no detailed reform of history education in terms of adding or removing content, implementing new teaching strategies, or keeping up with the 21st-century world. One interviewed teacher said, ‘’I have been teaching history for 18 years and have not observed any changes in history education contents since I started teaching history education.’’ (SSST1).

The researchers continued their interview with teachers by asking, is the content of the history education curriculum appropriate for the student's abilities? This question is to gather evidence to understand that the content of the history curriculum is appropriate for the student's abilities. Teachers and students were asked this question. When asked about the content of history education in grade ten, teachers made two comments:

Students who did not study history as a subject in elementary school (1st grade to grade eight) may find it more difficult when they begin studying history education as a subject in grade nine (SSST1 and SSST2).

They have been studying in their mother tongue in primary school (grades 1 to 8) and studying in English from grade 9 onwards will make it difficult for students to understand the contents (SSST1 and SSST2). The students interviewed strongly agree with the latter. According to the students, “the content of history is very difficult to understand, history is not like other subjects, it requires proper knowledge of English” SSSS1, SSSS2, BSSSS1 and BSSS2).

Follow-up questions were also raised for teachers, to determine the teaching methods included in the history education curriculum. However, teachers were unable to respond to this question because they were not implementing the teaching practices outlined in the history education curriculum due to a lack of a history syllabus. A well-designed teaching strategy has a crucial role in improving students' academic achievement [ 42 , p. 51–64]. Therefore, teachers teach history using their own teaching and learning methods. When asked what teaching method they used, the teachers stated that they used the lecture teaching method (SSSS1, SSSS2, BSSSS1 and BSSS2). The reason they use lecture methods more than other teaching and learning methods is that the content of history lessons is extensive and the time allocated for history lessons is 80 min per week (SSSS1, SSSS2, BSSSS1 and BSSS2).

6.1.2 Classroom observation analysis

The researchers used lesson observations to obtain firsthand and ‘real' facts and data about the significant problems confronting history education in Sebeta government secondary schools. This is because many people do not want to discuss all topics during an interview [ 43 , p. 117]. The researchers employed the lesson observation checklist, which included activities such as the teacher's teaching strategies, teacher and student activities throughout the session, teacher-student interaction during the lesson, student seating arrangements, and teaching aids used. Using this checklist, the researchers observed the teacher’s teaching practice during the lesson. The researchers observed four different classrooms. The primary aim of this observation was to strengthen the data obtained from teachers and students during an interview. The teachers in all of the classrooms first ask students what they learned in their last class. Aside from that, they only used to give notes and lectures to the students in every class.

Another point that the researchers visited in the classroom was the teachers’ and students’ activities during the lesson. The teachers gave notes, and lectures and many students were busy writing notes. When the teachers lecture the content some students do not pay attention and instead take notes. Some students do not take notes, do not listen and look elsewhere. As observed by the researchers, teacher-student interaction during the lesson is very weak. Based on the observation students' seating arrangements were traditional in that three students' seats occur on a wave which is not convenient for group discussion, group work and collaborative learning.

During classroom observation, there are no teaching aids used in all classrooms visited by the teachers to make the lessons practical.

Finally, based on the findings of the study through classroom observation, traditional methods of teaching and learning in history classrooms are still the dominant teaching strategies in the twenty-first century. Researchers who research teaching strategies confirm that participatory teaching is an effective way to improve students’ academic achievement. Madar and Baban [ 42 , pp. 51–64] also discovered that participatory teaching is a good strategy to develop students’ skills and increase their academic achievements. They added that participatory teaching strategies put students at the centre of the teaching and learning process (p. 51). However, through interviews with teachers, students, and lesson observation, the researchers discovered that teachers are not employing student-centred approaches that are fitting for students' learning and achievement.

The responses of teachers and students are consistent with the literature on strategies for teaching. Researchers who conducted studies on teaching strategies found that the teacher- centred method is a traditional strategy that is not very effective in enhancing student achievement. The findings of this study also agree with Mohammed [ 44 , p. 11] who conducted a study on, “strategies in the teaching of geography …” , and stated that the lecture method of teaching has a negative effect on students’ creativity, critical thinking, ability to produce new ideas, and academic achievement of students. Similarly, this study’s findings also concur with Ezurike [ 45 , pp. 1120–124] conducted a study on, “The Influence of Teacher-Centered and Student-Centered Teaching Methods on Academic Achievement of Students,” which discovered that poor methods, mostly teacher-centred and conventional teaching methods used by teachers, are one of the major factors contributing to students’ poor achievement.

Finally, it is better to conclude that teaching strategies can positively and negatively influence students' academic achievement. If teachers only employ the lecture approach without involving students in the lesson, it may result in low student academic achievement in contrast if teachers employ student-centred strategies students can understand the main point of the lesson and enhance the academic achievement of students.

6.2 How do teaching strategies influence students' academic achievement in Sebeta secondary schools?

To answer this question, the researchers conducted interviews with teachers and students, as well as document reviews and classroom observations. This issue was addressed by both teachers and students. Methods of teaching have a wide range of effects on the academic success of learners. When asked this question, they all had similar answers. According to teachers, good teaching strategies play a significant role in improving students’ academic achievement. They state this as follows:

Using collaborative teaching practices can significantly improve students' academic achievement. Because collaborative instruction is a teaching technique in which students learn together by assisting one another. Higher achiever students support the low achiever learner in this instructional learning process. However, if teachers utilize traditional teaching methods without involving students in the teaching-learning process, students' academic achievement may suffer (BSSST1, SSST2, and SSST3).

However, for a variety of reasons, teachers do not use collaborative teaching strategies to improve the academic achievement of their students. Rather than focusing on improving the academic achievements of students’ teachers are only concerned with completing their content. Furthermore, the student stated that teaching strategy can positively and negatively influence students' academic achievement. According to students:

…if teachers employ interactive teaching strategies during teaching lessons, students can understand the main point of the lesson and profit much from it. In contrast, if teachers exclusively employ the lecture approach without involving students in the lesson, it may result in low student achievement in the subject. Furthermore, students responded with two statements: excellent teaching strategies encourage students’ interest in the subject and are also, critical for improving students' academic achievement (BSSSS1, BSSSS2, SSSS1, SSSS3, and SSSS6).

The teachers were interviewed about teaching methods they implement when teaching a history education lesson. The teachers were asked to mention teaching methods that they always use in teaching history. The majority of the teachers claimed to use lecture approaches when teaching history education lessons. Teachers noted: “huge class sizes and low time allotted to history subjects, making it difficult to apply participator/student-centred methods (BSSST3, SSST, and SSST2). Furthermore, when asked about their teachers’ teaching methods in history class, students stated that “teachers only use teacher-centred strategies (lecture, dictation, note-giving and reading notes on the blackboard)” (BSSSS3, SSSS1, SSSS2).

During the interview all interviewed teachers acknowledged the use of the lecture method in their teaching. The justifications provided for the use of the lecture method include saving time, the convenience of covering content on time and the nature of students. Teachers said, “A lecture method helps the teacher to cover a lot of content in a short period” (SSST1, SSST2, SSST3, SSST4, BSST1, and BSST2). The findings of this study are consistent with the findings of a study conducted by Luka [ 14 , p. 30] on the topic of “the impact of teaching methods on attitudes of secondary school students towards learning of history in Malawi,” which discovered that teachers use boring lecture methods to complete their courses rather than focusing on students' results.

History teachers' perceptions of the use of the participatory approach were very low. Based on the interview conducted with history education teachers they were not interested in using student-center teaching strategies (BSSST1, BSSST2, SSST1, SSST2, SSST3, and SSSST4). Teachers claimed that participatory teaching strategies were time-consuming and unsuitable for large-class settings ( Ibid ). Instead of using participatory teaching strategies teachers choose teacher-centred methods to cover a large portion within a given time.

The researchers interviewed history teachers at Sebeta secondary schools about the challenges that they confront when implementing the participatory approach. The interviewed teachers stated that the time allotted for history education did not correspond to the content (BSSST1, BSSST2, SSST1, SSST2, SSST3, and SSST4). They were unwilling to utilize student-centred teaching methodologies because they believed it would be time-consuming and difficult to cover the contents of the student’s textbooks within the academic year. According to the teachers, the time allotted to history education every week was only two periods (80 min), although history education included more than 246 pages ( Ibid ). Students also stated that teachers frequently employ lecture methods when teaching history lessons. Both teachers and students agree that collaborative learning methods are more beneficial than traditional teaching methods in improving students’ academic achievement (SSST1, SSST2, SSST3, SSST4, BSST1, and BSST2). Teachers claim that "due to the wide range of topics covered in history education, we use lecture methods of teaching rather than participatory approaches" (SSST1, SSST3, BSST1, and BSST2).

6.3 How is the student's academic achievement in history at Sebeta government secondary school? To answer this question, the researchers used document review

6.3.1 document analysis.

Document analysis is part of the qualitative data collection strategy that every researcher engages in throughout the research period. In this research researchers reviewed, history education students’ textbooks, published articles and roasters of students (students’ mark list). The history education achievement of 174 Sebeta government secondary school students scored in grade 9 in 2020/2021 was compared to look at their achievement in grade 10 in 2021/2022. As a result, one student achieved less than 50% out of 100%, 39 students’ scores ranged from 50 to 60 out of 100%, 98 students scored from 61 to 70 out of 100%, 27 students scored between 71 and 80 out of 100%, 8 students scored between 81 and 90 out of 100%, and 1 student scored between 91 and 100, in grade nine. In grade 10, 11 students scored below 50, 103 students scored between 50 and 60, 45 students scored between 61 and 70, 9 students scored between 71 and 80, 4 students scored between 81 and 90, and 2 students scored between 91 and 100 out of 100%.

Based on this analysis, we can witness students’ achievement in two ways. The first is that in grade 9, 138 out of 174 students scored less than 70% out of 100% and the results of students scoring from 70 to 100% declined significantly. The second point to mention is that student achievement in history education has been highly declining at the subsequent grade level. In Grade 10, the number of students scoring less than 50% grew, and 159 out of 174 students scored less than 70% in history education. This indicates students' achievement in history in grade 9 decreased in grade 10. This suggests that students' achievement in history education was inadequate. Following the analysis of student achievement, interviews were conducted with students and teachers to identify why students' achievement in history education was so low.

7 Conclusion and recommendations

Research shows that teaching strategies are a crucial aspect in successful learning because they enable learners to learn, create, and take a proactive attitude towards learning. The significant issues confronting history education have been identified were teaching strategy, a lack of awareness about implementing participatory teaching methods, a lack of comprehensiveness of the contents of history education teaching materials, and the issue of the bulkiness and scope of history education texts being covered on time and Lack of teachers’ understanding of employing creative teaching strategies to improve students’ academic progress. Despite this, the study found that teachers in Sebeta government secondary schools use the teacher-centered lecture approach rather than interactive or student-centered strategies, which are recommended for students' learning. Teachers were cognizant of student-center teaching and learning improved student achievement. Conversely, teachers are hesitant to adopt participatory teaching methodologies due to the vastness of history textbooks and the lack of time provided to history education to cover bulky texts. As a result, they employ teaching approaches that they believe will allow them to complete the history education contents in the allocated time rather than focusing on enhancing students' academic achievement.

Furthermore, the study also found out that teachers are reluctant to use participatory student-centred learning methods because the two periods per week allocated (80 min) to teaching history education are not enough to cover a wide range of history education content. They believe participatory student-center teaching is ineffective in large classrooms and takes more time than the lecture method. Such thinking stems from a lack of understanding (imparting knowledge) on the use of innovative teaching strategies. The researchers examined the lecture teaching approach that students had learned as well as their results. Several students' achievement in history education shows below 70% out of 100% at Sebeta government secondary schools. The main reason for this low achievement is the teachers’ teaching strategies (the use of teacher-centred approach) to teaching history education to complete a wide content within the allotted time. Teachers do not consider which strategies could improve students’ achievement rather than focus on completing their content. This has also resulted in students’ negative attitudes towards the subject.

The outcomes of this study can serve as the foundation for future research in academic and professional studies. This discovery is notable for the fact that teaching and learning approaches influence students' academic achievement in both directions. Accordingly, if teachers only employ the lecture approach without involving students in the lesson, it may result in low student academic achievement in contrast if teachers employ student-centred strategies students can understand the main point of the lesson and enhance the academic achievement of students.

Thus, for future studies intervention exprimental research in history education is required to measure the extent to which participatory methods of instruction increase the academic achievement of students over teacher-centred strategies. More research, according to the researchers, should be conducted using participatory teaching methods in one classroom and lecture methods in others to determine to what extent participatory teaching methods improve the academic achievement of students when compared to teacher-centred strategies. Following the findings, researchers provided the following recommendations: national and regional education experts should collaborate closely in making history education content inclusive, as well as training history education teachers in the use of participatory teaching approaches. Curriculum experts should effectively organize the breadth of history education contents. To ensure that students learn successfully, the relevant authorities should rigorously monitor the state of the teaching and learning processes in general and history education in particular.

Data availability

The data of this study is the primary source, which is the roster of students' results and education policies. The student results/ marks analyzed for this study are from two Sebeta town public secondary schools: Sebeta secondary school and Burka Sebeta secondary school and Ethiopian education policies. So, the data are available from the corresponding author upon reasonable request from anyone.

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Corresponding Author of the article: Fekede Sileshi Fufa. Abera Husen (PhD, Assistant Professor). Ketebo Abdiyo (PhD, Associate Professor). Authors’ contribution statements 1. Initially, Fekede Sileshi convinced Abera Husen and Ketebo Abdiyo as the study should be conducted. 2. Then, Abera Husen devised the study's theory. 3. Fekede Sileshi and Ketebo Abdiyo verified the analytical methods of the study. 4. Abera Husen encouraged Fekede Sileshi to investigate the study. 5. Ketebo Abdiyo supervised the overall findings of this work.

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Fufa, F.S., Tulu, A.H. & Ensene, K.A. Exploring the significant problems confronting secondary schools history education: a baseline study. Discov Educ 3 , 52 (2024). https://doi.org/10.1007/s44217-024-00132-8

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Original research article, local perspectives on marine ecotourism development in a water-insecure island region: the case of bocas del toro, panama.

• 1 Ocean Nexus, Dalhousie University, Marine Affairs Program, Halifax, NS, Canada
• 2 Center for Tropical Island Biodiversity Studies, The School for Field Studies, Bocas del Toro, Panama

As a dimension of a blue economy, marine ecotourism should, in theory, not only increase economic viability and environmental sustainability but, most importantly, pursue socially equitable outcomes. In tropical and sub-tropical island regions, where substantial tourism development is often coupled with widespread strains on public infrastructure and services, including water access, there exists a need to better understand the expansion of this industry is felt at the community level; more importantly by individuals who are reliant on these infrastructures and services. Through a case study of the Bocas del Toro Archipelago, where water insecurity is becoming acute, we draw on and mobilize stories from local community members, alongside non-participant observations and document collection, to 1) document the experience of some community members with water insecurity and shortages, including how they perceive the roles played by the central government and marine ecotourism sector, and 2) examine how community members feel about how communities feel about policies and investment priorities of the central government regarding water insecurity, including the extent to which they view marine ecotourism development as undermining or promoting local needs. Our results underline the complex nature of marine ecotourism governance and infrastructure development outcomes in a resource-insecure island region, demonstrating that current issues are greatly impacted by historical and social underpinnings of neo-colonialism and systemic racism, misalignments of community vs. government development priorities, and eroded political trust, that shape local experiences with sustainable development and local residents’ perceptions of the ability of marine ecotourism to address issues of water insecurity. Moreover, while our focus is on the marine ecotourism industry, the significance of these findings contributes to a growing body of literature that places local experiences at the forefront of research into the implications of sustainable development in island regions.

Introduction

The marine ecotourism industry is considered to be a dimension of a ‘blue economy’; an ocean-wide sustainable development strategy proposed by Small Island Developing States (SIDS) in 2012 to “promote economic growth, social inclusion, and preservation or improvement of livelihoods, while at the same time ensuring environmental sustainability” ( World Bank and UN DESA, 2017 , p.1). In theory, marine ecotourism should not only increase economic viability and environmental sustainability but, most importantly, pursue social equity—a “distinctive system of individualized justice” ( Minow, 2021 , p.173). In island regions, where substantial tourism appeal is often coupled with widespread issues of water insecurity ( Cole, 2012 ; Gössling et al., 2012 ; Gossling, 2015 ), this study explores questions regarding the ability of a blue economy strategy, rooted in marine ecotourism, to equitably address both development and well-being in the eyes of those local to island regions. In this paper, we refer exclusively to tropical and sub-tropical islands when discussing ‘islands’ or ‘island regions.’

In island regions, local blue economies are often heavily reliant on the marine tourism industry ( UNWTO, 2023 ). However, as per Leposa (2020) , large volumes of tourists, and the services required to support them (e.g., transportation, accommodation, food and beverage, recreation, etc.), can exacerbate existing issues of local public utility access, often due to infrastructural deficiencies or inherent vulnerabilities to climate change. Important to this study, in particular, is the relationship between the marine ecotourism industry and the availability and management of water resources.

To our knowledge there exist few studies that sit at the intersection of marine ecotourism and water insecurity in island regions specifically; less so those that are guided by, and draw conclusions from, the experiences of those individuals that most closely feel their impacts. As the push for blue economic development continues to grow ( Cisneros-Montemayor et al., 2021 ; Pace et al., 2023 ), and water insecurity becomes increasingly prevalent in climate-vulnerable regions ( Winters et al., 2022 ; Crisman and Winters, 2023 ), failing to capture how the two intersect and are felt at the community level could pose risks of conducting research with communities as the ‘subject’ rather than active participants and beneficiaries of the research process ( Israel et al., 2019 ), and/or informing policies that do not capture the nuances of community interests and needs ( Freudenberg and Tsui, 2014 ; Cisneros-Montemayor et al., 2019 ).

Marine ecotourism can be described as a “nature-based; environmentally educated; and sustainably managed” ocean tourism industry involving activities such as recreational fishing, snorkelling, whale watching, and SCUBA diving, for example ( Blamey, 2001 , p.6). Modern definitions also include dimensions of local benefits ( Sakellariadou, 2014 ; Das and Chatterjee, 2015 ; Ramos-García et al., 2017 ; Tuwo et al., 2021 ). This can entail increasing market demand for locally produced goods, the use of, and investment in, local facilities and infrastructure, opportunities for local entrepreneurship, and the generation of new revenue streams that remain within a community, for example ( Sakellariadou, 2014 ).

Unlike traditional mass tourism models, marine ecotourism adopts aspects of environmental conservation and promotes community involvement. However, when these tenets are not upheld, due to a variety of reasons (e.g., poor management, lack of community involvement, limited enforcement regimes, etc.), the industry can promote unsustainable practices on all fronts—economic, social, and environmental ( Hoyman and McCall, 2013 ; Rahman et al., 2022 ; Zeng et al., 2022 ). As such, recent scholarship has called for a re-prioritization of social sustainability within blue economic development ( Pascual et al., 2014 ; Bennett et al., 2019 ; Leposa, 2020 ; Nugraheni et al., 2020 ; Osterblum et al., 2020 ; Campbell et al., 2021 ; Cisneros-Montemayor et al., 2021 ), with concerns raised regarding the implication of developing marine industries in areas where there is significant need to consume and manage resources sustainably.

The United Nations (UN) refers to water security as the ability of a population to safeguard sustainable access to adequate quantities and quality of water for the support of livelihoods, human well-being and socio-economic development ( UN Water, 2013 ). In this sense, water in security is the condition in which at least one of the above variables (i.e., quantity, quality, or accessibility) is not met, threatening human well-being. While many island regions have some degree of established water infrastructure, the coincidence of ‘dry season’ and peak tourist landings can perpetuate regional instabilities in water security, where local residents compete for this essential yet scarce resource; both with tourists and between communities ( Gheuens et al., 2019 ).

In this study, we draw on and mobilize stories of local residents in a heavily touristed island to better understand how the relationship between marine ecotourism and water insecurity manifests at the community level. We explore the case of Panama’s Bocas del Toro Archipelago (henceforth referred to as ‘Bocas del Toro’ or ‘the archipelago’), where substantial tourism appeal and infrastructural issues coexist, as a microcosm of the paradox of pursuing a marine ecotourism-based blue economy in a water insecure island region. Through integrating non-participant observations and collected documents with a series of semi-structured interview responses we aim to 1) document the experience of some community members with water insecurity and shortages, including how they perceive the roles played by the central government and marine ecotourism sector, and 2) examine whether community members feel as though water insecurity and shortages have influenced policies and economic investment and the extent to which marine ecotourism development may undermine or promote changes.

Our results underline the dynamic and complex nature of marine ecotourism governance and infrastructure development outcomes in a resource-insecure island region, highlighting the historical, political, and social underpinnings that shape perceptions of, and poor experiences with, blue economic. While our focus is on the marine ecotourism industry, the significance of these findings contributes to a growing body of literature that places local experiences at the forefront of research into the implications of sustainable development in island regions.

Island development and marine ecotourism

Although often associated with ‘paradise’ ( Baldacchino, 2012 ), island nations are considered, by the UN, to be some of the world’s ‘least developed’ nations (UN, n.d.), with island regions often referred to as ‘vulnerable,’ given their narrow resource bases, remoteness, and susceptibility to natural hazards and external economic shocks ( Baldacchino, 2012 ; Belmar et al., 2016 ; Lucas et al., 2017 ; Nunn and Kumar, 2017 ). That said, it is important to note that this explicitly reflects the barriers that may limit attempts to garner increased economic prosperity and/or development capacity rather than island societies as a whole.

As described by ( Grydehøj et al., 2021 , p.4), in reflecting upon Hau’ofa (1994) , the modern development and governance of island resources is also often heavily steeped in colonialism, where Western standards for ‘successful’ development are far too narrow in their economic, geographic, and cultural views. Dating back to the 15th century, island states have faced oppression from the United States, France, Spain, England, and the Netherlands ( Keegan and Diamond, 1987 ; Leposa, 2020 ). While there remain proponents of some aspects of the colonial legacy ( Feyrer and Sacerdote, 2009 ), Kay (2010) maintains that colonialism, in Latin America specifically, has led to harmful endo -colonial relations that sit at the root of present-day developmental inequities. In the Caribbean, Sealy (2018) notes that colonization has not only impacted the regional ethnic makeup, but that the perpetuation of globalization as a neo-colonial structure has created a larger dependence on investments from the Global North. Overall, there exists a small body of literature that discusses the role of the blue economy in perpetuating or combating neo-colonialism. However, scholarship surrounding the colonization of islands maintains that neo-colonialism can propagate harmful outcomes of sustainable development projects such as marine ecotourism ( Heim, 2017 ; Durokifa and Ijeoma, 2018 ; Grydehøj et al., 2021 ).

Typically, ‘tourism intensive’ island regions derive a substantial proportion of their economic development from the marine ecotourism industry ( Adamiak and Szyda, 2022 ). McElroy (2006) refers to tourist-driven island economies as SITES (‘Small Island Tourist Economies’), describing the expansion of tourism as a prominent development strategy for small economies, where there exist large dependencies on the industry. While, marine ecotourism can lead to a host of benefits, research in the island context specifically, more often notes the potential consequences of such development in destinations considered to be on the ‘global periphery’ ( Dodds and Graci, 2012 ). For example, while ecotourism may produce local job opportunities, Das and Chatterjee (2015) posit that community members are more often placed in low-skill and/or low-pay roles. Moreover, Harrison and Prasad (2011) found that in Fiji, for example, there exist high levels of benefit leakages to foreign investors. In Bocas del Toro, specifically ( Scott et al., 2024 , p.2), explain that tourism-related development can lead to inequitable impacts through the promotion of real estate ventures in culturally significant areas, like mangroves, where investors may view the local environment as “obstacles to achieving ‘paradise.’”

Bocas del Toro, Panama

Located off the Caribbean coast of Panama, Bocas del Toro is one of the country’s top ecotourism destinations. It consists of approximately nine islands and 200 islets and is home to a population of approximately 22,500 across the larger Bocas del Toro district ( INEC, 2021 ). Attributable to a history of colonialism, the construction of the Panama Canal, and the cultivation of a plantation economy, among other reasons, the region is also home to a variety of distinct racial and cultural groups including Ngäbe peoples (those indigenous to present-day Panama and Costa Rica), Panamanians, Afro-Antilleans, and Chinese individuals, for example ( Guerrón-Montero, 2006 ; Carse, 2014 ; Suman and Spalding, 2018 ). Moreover, Bocas del Toro’s most developed islands have become increasingly inhabited by lifestyle migrants—relatively affluent individuals with the capacity to move to destinations, typically in the Global South, with warmer climates, a lower cost of living, and a seemingly higher quality of life—from the United States ( Benson, 2013 ; Spalding, 2013 ).

Although not formally considered an autonomous state, Bocas del Toro displays many of the hallmark characteristics of a SIDS as per the UN Office of the High Representative for the Least Developed Countries, Landlocked Developing Countries and Small Island Developing States ( UN-OHRLLS, 2022 ). It is home to both a distinct societal makeup and unique marine ecosystems ( Seemann et al., 2014 ; Pleasant and Spalding, 2021 ), and faces documented issues of infrastructural development and geographic isolation from larger global markets ( Tilmans et al., 2014 ; Pleasant and Spalding, 2021 ).

Bocas del Toro’s economy is predominantly supported by the tourism industry; across the larger Bocas del Toro province, tourism makes up 95% of all economic activity, greatly exceeding the national average ( Klytchnikova and Dorosh, 2013 ). The most lucrative form of tourism is referred to by the Autoridad de Turismo de Panama (Tourism Authority of Panama; ATP) as ‘island ecotourism’ ( ATP, 2020 ), with the most popular destinations being Starfish Beach, Red Frog Beach, and Isla Bastimentos National Marine Park ( Camarca de Turismo de Bocas del Toro, 2022 ). While the ATP does not explicitly refer to ‘marine ecotourism’ in their reporting, for the purposes of this study, ‘island ecotourism’ and ‘marine ecotourism’ will be considered synonymous, as their accepted definitions align greatly.

Common marine ecotourism-based businesses in the region include boat tours and taxis, restaurants, hostels, and gift shops, with much of the region’s tourism development concentrated in Bocas Town, Isla Colón, where an average of 150,000 tourists visited annually pre-COVID-19 pandemic ( Gray et al., 2015 ). Strikingly, although Bocas del Toro now sees approximately 225,000 tourists per year, the Bocas del Toro province remains one of the poorest in the nation ( CECOMRO, 2018 ; ATP, 2020 ).

Moreover, to appreciate the nuances of Bocas del Toro’s current socioeconomic landscape, one must also understand its economic history, which is closely tied to colonial resource extraction. In the early 20 th century, the construction of the Panama Canal and the establishment of the U.S. Canal Zone cemented the United States as a major player in the Panamanian economy. In Bocas del Toro, specifically, this presence was predominantly felt through the establishment of the United Fruit Company (UFC), an American-owned corporation trading in Latin American-grown fruit, namely bananas ( Pleasant and Spalding, 2021 ). Typically supporting the UFC’s operations were Afro-Caribbean and Ngäbe workers, as well as labour migrants from China and Italy ( Spalding, 2011 ). This created harmful shifts in power, as Black and Indigenous individuals were often exploited and marginalized through the imposition of a globally capitalistic system ( Amin, 1978 ). While small-scale operations remain (now Chiquita Brands International), the UFC’s presence in the archipelago declined greatly by 1990 due to war, crop diseases, and labour losses (as a result of poor pay and working conditions) ( Guerrón-Montero, 2006 ), making way for a burgeoning tourism industry by the 2000s, as many large-scale housing developments were left vacant and global interest in the region increased following the 1991 earthquake.

Today, the archipelago’s socioeconomic and environmental systems are inextricably linked to the marine ecotourism industry, attracting individuals looking to experience its vibrant culture, beautiful beaches, and ocean life ( Klytchnikova and Dorosh, 2013 ; Spalding et al., 2015 ; Lucas, 2019 ; ATP, 2020 ; Mach and Vahradian, 2021 ; Pleasant and Spalding, 2021 ; Bocas del Toro Tourism, 2023 ). That said, tourism infrastructure across Bocas del Toro has been deemed ‘suboptimal’ by the ATP, specifically as it pertains to the limitation of physical space and the overload of basic services, such as water provisioning ( ATP, 2020 ). Critical to this study, Bocas del Toro is also home to widespread issues of water insecurity; the majority of households across archipelago do not have access to running water supplied by the Instituto de Acueductos y Alcantarillados Nacionales (Institute of Aquaducts and Sewers; IDAAN), with 23% of the population instead turning to bottled water or drinking unfiltered rainwater respectively ( CNA, 2016 ) ( Figure 1 ). In fact, just 1.9% of the total residences connected to IDAAN’s services reside in the Bocas del Toro province ( IDAAN, 2022 ). As such, water insecurity is among the region’s most precarious issues.

Figure 1 Regional water insecurity across the Bocas del Toro Archipelago represented by the percentage of households in each census region without access to running water. The population density of each region in relation to the archipelago’s total population is also represented. Uncoloured areas represent regions outside of the archipelago or those not captured by the Panamanian Census. Created using the 2010 Panamanian Census Data, accessed from the STRI GIS Data Portal (2019) .

In this study we employ a multi-method approach—the combining of two or more methods to expand one’s research base when investigating a research question or phenomenon ( Roller and Lavrakas, 2015 )—that is firmly rooted in local experiences and perceptions. This includes the use of semi-structured interviews, non-participant observation, and document collection. While our approach pulls from that of political ecology, we do not attempt to formally mobilize methods typically used in such studies (e.g., Cole, 2012 ), but rather utilize participant responses to deduce the governance processes, historical events, etc., that frame their experiences with marine ecotourism and water insecurity. It should be noted that the data collection period in Bocas del Toro (May 25 th , 2023 to June 27 th , 2023) also coincided with a water shortage; declared an environmental emergency on June 9 th , 2023.

Semi-structured interviews

A member of our research team travelled to Bocas del Toro from May 25 th , 2023 to June 9 th , 2023 to conduct semi-structured interviews; asking participants open-ended questions to elicit information regarding one’s research topic ( Adeoye-Olatunde and Olenik, 2021 ). During this time, a total of 16 individuals, including members of the Bocas del Toro Chamber of Tourism, property owners, business owners, tour guides, labourers, and concerned citizens, were interviewed. Participants in this process—those older than 18 years of age and who have lived in the region for over 5 years—were identified through a purposive snowball method ( Weiss, 1994 ), beginning with contacts provided by a local informant.

Topics discussed (i.e., water shortages, infrastructure, economic and tourism development, and overall welfare) were drawn from a pre-determined interview guide developed through preliminary document collection and with guidance from researchers in the region (see Supplementary Table 3 ). While the guide was used to facilitate conversation, it adapted as more information was provided and new events occurred (i.e., the onset of an environmental emergency during the interview period). Interviews lasted an average of one hour and, depending on the participant’s level of comfort, were conducted in both English and Spanish (with an interpreter translating responses). Due to participant location and the accessibility of each island, interviews took place across three of Bocas del Toro’s nine main islands—Isla Colón, Isla Carenero, and Isla San Cristóbal ( Table 1 ).

Table 1 Socioeconomic and geographic description of interview locations/study sites.

Non-participant observation

To support responses collected during interviews, non-participant observation—observing and documenting an event without actively participating in activities ( Becker and Geer, 1957 )—was used to explore how ecotourist attractions function across the archipelago and further understand how communities respond to, and navigate, water shortages. Observed events were identified through community contacts established during the interview period as well as local WhatsApp groups; typically used to share important information across the region. They included waiting in line at public wells, visiting an ecotourist attraction, observing protests regarding water access, and attending a public meeting with IDAAN (further event details available in Supplementary Table 4 ). The average observation process lasted approximately one hour and involved taking notes regarding what did and did not occur, what demographic of individuals were present, and the overall tone of those present.

Document collection

Given that this is the first study to investigate topics of marine ecotourism and water insecurity in Bocas del Toro, supplementary grey literature was sought out to provide wider context and breadth to the study. Documents were found by searching for qualitative phrases related to drought, water, and tourism in Bocas del Toro in Google and the Bocas Breeze Newspaper database. Documents collected include government policies, local news articles, and regional reports.

The analysis of the data was guided by an inductive, constant comparative approach, as per Hodkinson (2008) and Glaser (1965) , whereby we sought to increase our understanding of potential underlying theories and identify emergent themes through a constant back-and-forth engagement with the data. In practice, this first involved transcribing and digitizing interview responses and observation notes. The data was then coded categorically (e.g., the codes ‘GOV-TOURISM’ and ‘GOV-WATER’ were utilized whenever a participant described how they felt about and experienced tourism and water governance respectively), and supplemental documents were reviewed to compare and contrast with interview and observational data.

In an effort to mirror the anecdotal nature of the data collected, here we weave together interview responses, observational notes, and document insights to describe how the economic development of Bocas del Toro, governance processes, experiences with water shortages, and future development in the region, shape local experiences with, and perceptions of, marine ecotourism and water insecurity. Figure 2 demonstrates a timeline of events and governance developments described by participants, as well as relevant events to contextualize the case.

Figure 2 Timeline of events and developments regarding ecotourism and water security in Bocas del Toro, Panama. The timeline presented is not exhaustive of all related moments in history, but rather those relevant to this particular study. Entries on the left of the timeline represent historical events, while those on the left represent policies and plans. ATP refers to the Tourism Authority of Panama; IDAAN refers to the Institute of Aquaducts and Sewers.

Beaches as the new bananas–shifting to a tourism-based economy

With increased neoliberal capital interest, government incentives to purchase land for tourism, and an abundance of global interest, tourism in Bocas del Toro effectively ‘exploded’ by the year 2000, signifying, as put by Pleasant and Spalding (2021) , a shift from a banana-based export economy created by the UFC to a tourism-centric economy based on the region’s beaches and biodiversity. Despite this shift, the UFC’s presence in Bocas del Toro remains prominent, as it had become integrated into the region’s social and infrastructural fabric (e.g., the creation of communication networks, railway systems, power plants, medical facilities, and housing developments) (United Fruit Historical Society, n.d.). Furthermore, when asked about the UFC in Bocas del Toro, participants described how a dependency on a singular industry and foreign entity resulted in harmful losses of traditional livelihoods, such as fishing and agriculture—”we used to be farmers who could feed ourselves, now we’ve lost this completely,” said one property owner.

Among those participants directly employed by the tourism industry, all spoke positively about the renewed economic benefit it brings. As one tour operator put it, “the money is in tourism, the experiences.” Of those participants situated outside of the industry, a majority also acknowledged that marine ecotourism does play a major role in supporting the local economy— “tourism is good,” noted a construction worker we spoke with, “yeah it’s good because it makes work and brings in money to us when it’s done right.”

That said, there remains great skepticism across all participants surrounding the industry’s future in Bocas del Toro:

“I used to fully believe that tourism was the key to successful cities with no opportunities.

But then we have fragile societies like we have in Latin America, and there’s not a strong

government that actually tries to implement human development. It is not taking us to the

right place,” said a member of the Bocas del Toro Chamber of Tourism.

When asked what she believes to be the largest development project in the community, one business owner responded:

“Tourists. But it grew alone. It grows alone … It’s incredible. Bocas [del Toro] has been developed in many ways, but not in basic things. It keeps growing, growing, growing, and I don’t see [public utilities] growing with it.”

Navigating an era of sustainable development – tourism and water governance

In contextualizing participant responses, we offer a brief exploration of relevant actors, plans, and policies as they pertain to marine ecotourism and water governance in Bocas del Toro. The overarching development of Panama’s marine sector is directed by the Ministerio de Relaciones Exteriores (Ministry of Foreign Affairs), Ministerio de Ambiente (Ministry of the Environment; MiAMBIENTE), and the UN Development Programme via the Política Nacional de Océanos de Panamá ( National Ocean Policy of Panama; NOP). Ratified in 2022, the goal of the NOP is to pursue a ‘Blue Panama,’ where “marine and coastal resources are protected, conserved, valued, and used sustainably, positively impacting the quality of life of citizens in an inclusive and participatory manner” ( MiAMBIENTE, 2022 , p.13). To do so, blue economic development, internally defined as the “sustainable use of marine and coastal resources…, approaching marine-coastal activities under the prism of balance between the three social, economic and environmental dimensions,” is prioritized as one of 4 strategic axes ( MiAMBIENTE, 2022 , p.21). Central to this, under Goal M. 27, is the “promotion of sustainable tourism development linked to the oceans” ( MiAMBIENTE, 2022 , p.21), where the NOP yields much of the responsibility around this directive to the ATP.

Since 2008, the ATP has been responsible for “the development, promotion, and regulation of tourism as an activity”; maintaining tourist resources, protecting the ecological balance of the land, and respecting the customs of its inhabitants ( Decreto Ley No.4, 2008 , p.1). When asked about their feelings towards the ATP, virtually all participants expressed concern regarding tourism governance in Bocas del Toro, and its ability to “make things happen.” According to one individual, tourism in Bocas del Toro is “governed by people who don’t have morals, they are just selfish. If it doesn’t make them money, they don’t do it.” At the community level, tourism in Bocas del Toro is monitored by the Cámara Turismo Bocas del Toro (Bocas del Toro Chamber of Tourism), a non-profit community organization that works to organize the local tourism sector and protect its longevity ( CTB, 2023 ). Nonetheless, the Chamber of Tourism is not afforded government funds or jurisdiction to carry out and/or enforce such endeavours and does not play a large role in high-level decision-making regarding tourism in the archipelago ( ATP, 2020 ). According to a member of the Chamber of Tourism, this creates issues surrounding community input, whereby the community is neither adequately consulted nor are their ideas accurately integrated into development plans:

“We are a private sector, but we have no say or worth in the final decision. [The ATP] says: ‘We met with the Chamber of Tourism and the chamber is approving [the development]’. But later, when we come and tell you all the things wrong with the plan, they say ‘Oh no, you came up with this idea, the Chamber approved it’…We don’t want that; we don’t need that. We need real things.”

At large, plans for tourism development in Bocas del Toro are organized under the Plan Maestro de Desarrollo Turístico Sostenible 2020-2050 (Master Plan for Sustainable Tourism Development 2020-2050; MPSTD), with goals to promote Panamanian tourism, improve global competitiveness, decentralize tourism operations, and develop state tourism policies ( ATP, 2020 ). In Bocas del Toro, the MPSTD’s Action Plan includes a total of 19 actions and 75 projects. Of this, 6 projects fall under Action 2.4.4. Improvement of Basic Infrastructures, including a project to, in tandem with IDAAN, “improve the drinking water supply system on Isla Colón” by 2022 ( ATP, 2020 , p.316). Despite this, participants were wary as to whether these plans would ever “hit the ground,” as put by one individual. “The [MPSTD] is a plan,” said a member of the Chamber of Tourism, “but if you do nothing to implement it, it’s not going to change. I haven’t seen any real action.” “You don’t need the government. The government is not going to do it. Because the government has no brain to think,” expressed another member of the community.

The implementation of these projects is largely overseen by IDAAN, with more specific water infrastructure improvement plans for Bocas del Toro listed in Panama’s Plan Nacional de Seguridad Hídrica 2015-2050 (National Plan for Water Security 2015-2050; NPWS). The NPWS serves as a roadmap for ensuring that “every person in [Panama] has sustained access to quality water and basic sanitation,” with a focus on “eliminating inequalities of access in an inclusive and equitable manner” ( CNA, 2016 , p.65). In pursuit of this, the NPSW budgets 3.3 billion USD to address issues of drinking water in Isla Colón exclusively, including improvements to catchments and sewage systems ( CNA, 2016 ). However, while the NPSW projects that all individuals in the Bocas del Toro province will have access to drinking water by 2025, as will be described in subsequent sections, participants note that, as of 2023, they are skeptical as to whether this goal will ever be reached. As one business owner put it, “it’s only plans plans. But when you go to practice? No, nothing happens.”

Accessing water in Bocas del Toro – a myriad of methods

Very limited formal documentation on water infrastructure and distribution processes in Bocas del Toro is publicly available; as put by one participant, “nobody really knows exactly how the water works [in Bocas del Toro].” Despite this, with insights from community members, we attempt here to establish a clearer picture of water distribution across the study sites ( Figure 3 ), highlighting the intensity of water insecurity in Bocas del Toro and inform how marine ecotourism might impact water access.

Figure 3 Maps of approximate locations of examples of water infrastructure across Isla Colón/Isla Carenero (A) , and Isla San Cristóbal (B) as described by participants. Image 1—a newly constructed water reserve tank. Image 2—a typical public well in Isla Colón. Image 3—Big Creek Reservoir. Image 4—IDAAN water processing station. Image 5—a typical rain catchment system in Isla Colón. Image 6—a water tanker deployed during water shortages. Image 7—water line that connects Isla Colón and Isla Carenero. Image 8—a typical rain catchment system in Isla Carenero. Image 9—water catchment station in Isla San Cristóbal. Image 10—underground pipe system in Isla San Cristóbal. Images 1-3 and 5-10 were taken by Abigael Kim. Image 4 is reprinted from the IDAAN Water Treatment Plant Database ( https://sig-idaan.hub.arcgis.com/apps/0a722564d72f421798b33b902ebef781/explore ).

Residents of Isla Colón typically access water through IDAAN’s public distribution system, and/or via public or private wells. IDAAN services over 9,000 individuals across the southern region of Isla Colón through an underground pipe system powered by gravity and a select number of pumps. While it is widely understood this water, supplied by a local reservoir (‘Big Creek’) ( Figure 3 , Point 3), is filtered at a nearby plant ( Figure 3 , Point 4), the efficacy of this process remains highly debated ( Corea, 2016 ; Telemetro, 2022 ; Albaez, 2023 ; Godoy, 2023 ; Ortiz, 2023 ). When asked whether she would drink water from her tap, one shop owner responded, “I’m not gonna do that,” while her partner added that the water is often “yellow or brown” in colour. This system is also subject to the impacts of ‘dry season’ in the Caribbean (October to April), when services are often limited by IDAAN to two hours in the morning and evening. Regions of the island not serviced by IDAAN rely on rainwater collection ( Figure 3 , Point 5) or the use of public or private wells ( Figure 3 , Point 2). As of today, there exist eight IDAAN wells in Isla Colón, with only four in constant operation, while private wells on the island are typically located in regions populated by lifestyle migrants and affluent families. That said, virtually all wells across the archipelago require electricity, of which the local supply is highly unpredictable.

In Isla Carenero, those residing along the island’s perimeter typically rely on underwater pipes that distribute water sourced from IDAAN’s system in Isla Colón ( Figure 3 , Point 7). That said, participants noted that this process is unreliable, as there is often not enough water pressure from Big Creek to reach the shores of Isla Carenero. According to a local restaurant owner, “[Isla] Carenero has huge water problems. When there is no water there, [they] struggle the most.” Participants from Isla Carenero also noted that it is common to utilize rain collection systems ( Figure 3 , Point 8) or to travel to Isla Colón to purchase jugs of water. Furthermore, many restaurants and tourist operations on the island utilize private wells to service their patrons, while lifestyle migrants are also known to have access to private wells.

Isla Colón and Isla Carenero are the only islands (out of nine that are inhabited) to have direct access to IDAAN’s services. Other islands, like Isla San Cristóbal, rely on community-led initiatives or the purchasing of water jugs from Isla Colón. As described by a local tour guide, approximately 600 individuals on Isla San Cristóbal access water via a natural catchment system and man-made storage and distribution point developed through a fundraising project by local and international organizations ( Figure 3 , Point 9). The storage point collects water from the island’s northern mountain region, filters it for solids, and distributes it to the community via gravity and underground pipes ( Figure 3 , Point 10). According to a local tour guide, this process is quite reliable; during times of drought, residents of other islands have looked to him for water.

Frustrations run high – a history of water shortages

Bocas del Toro has faced (documented) water shortages in 2016, 2017, 2019, 2022, and 2023. One restaurant owner noted that, while “water has always been an issue in [Bocas del Toro],” the problem “has never been this bad.” Following a prolonged period of drought and water restrictions, as well as pressure from MiAMBIENTE, a State of Environmental Emergency was declared by the Cabinet of Panama in both 2022 (November 8 th ) and 2023 (May 30 th ) ( Resolución de Gabinete No. 127, 2022 ; Resolución de Gabinete No. 48, 2023 ). Doing so authorizes IDAAN to enact the region’s ‘Contingency Plan’, involving the assignment of water trucks to distribute potable water to affected businesses and residences on Isla Colón and Isla Carenero, the increase of water conduction line diameters, the activation of additional wells, and the increase of regional technical support ( IDAAN, n.d. ).

During this type of Environmental Emergency, those without private well access typically purchase water jugs from local shops, fill their household tanks at public wells, or fill up smaller jugs from IDAAN trucks ( Figure 3 , Point 6). However, participants mentioned that such alternative methods are not sufficient, leaving many without water for days on end. One souvenir vendor, for example, mentioned that she had not been able to shower in “over 8 days.” Moreover, as lines for local wells grow, business owners mentioned that these trucks are extremely challenging to access, having to “choose between running [their] shops and getting water.”

Overall, aside from climate change as a catalyst, there is no largely agreed-upon answer or government consensus as to why water management and infrastructure are so precarious or why Bocas del Toro feels droughts so intensely. However, participants speculated that they have something to do with the coinciding of ‘dry season’ and tourist season in the fall. As mentioned in the Bocas Breeze Newspaper in response to the 2016 shortage:

“In recent years, sometimes it doesn’t rain for a while or excited tourists flood the island in

record numbers and when you turn the faucet, you are met with the depressing sound of a

‘drip, drip, (silence)…’ Maybe you left your toilet running and your tank has gone empty, or

perhaps the town reservoir has gone dry” (2016).

Undoubtedly at the center of these frustrations is IDAAN, more specifically as it pertains to the uneven distribution of water and lack of government accountability. According to IDAAN, water trucks are to deliver water to both city centres and residential areas. However, almost all participants mentioned that this system is not well executed, citing disparities in where water was being delivered during the 2023 shortage. “Unfortunately, there is a bad distribution of the water and trucks,” one tour operator said, “they don’t have a good plan for giving out the water, so they pass me by.” More specifically, many participants mentioned that hotels are often prioritized, and speculated that truck drivers were being paid a premium by these establishments to visit them first. “A government truck should be for the community,” said one community member, “but it doesn’t happen in Panama.”

Participants also expressed frustration with IDAAN’s accountability during these shortages. “I don’t look to the government for water,” said one individual, “I pray to God.” During the 2023 shortage, in particular, many community members were left with unanswered questions, as the regional IDAAN phone line for Bocas del Toro was disconnected, and public meetings with IDAAN were continuously cancelled. As was seen on multiple occasions during the 2023 shortage, such feelings often led to public displays of frustration, in the form of road blockades and protests; “we don’t just wait for water, we have to block the streets for water,” said one shop owner.

In June 2023, after over a month without reliable access to running water, IDAAN announced the connection of two additional wells to supplement Big Creek while precipitation levels remained low ( Ortiz, 2023 ). Despite these developments, residents of both Isla Colón and Isla Carenero still face water insecurity at large, with water remaining a contentious issue across the archipelago.

A potential paradox? – Future plans for water infrastructure and marine ecotourism

Looking towards 2050, Bocas del Toro is the topic of numerous development projects in both marine ecotourism and water infrastructure. However, participants expressed disappointment about the priorities of the central government’s plans and were skeptical of their potential outcomes.

In 2022, under the NPSW, IDAAN announced a 10 million USD investment in the “study, design, construction, operation, and maintenance of improvements to the components of the aqueduct in Isla Colón” ( Ortiz, 2023 , p.1). According to Albaez (2023) , this includes a 3-Phase Plan to develop a more reliable 24-hour public, potable water supply system:

● Phase 1—Well drilling/maintenance and construction of a water storage tank with a 700,000-gallon capacity.

● Phase 2—Construction of well-housing units and pumping equipment.

● Phase 3—Construction of supplementary desalinization plant and improvements to water treatment plant and dispensers.

Despite reports that 60% of the project has been completed as of May 2023 ( Ortiz, 2023 ), including the totality of Phase 1 and the maintenance of public well systems from Phase 2, none of the participants indicated that they had seen improvements in their water supply, but instead questioned the efficacy of IDAAN’s projects. For example, one participant referred to the early release of 5 million USD of the 3-Phase Plan investment during the 2022 shortage to rapidly increase water infrastructure quality and capacity ( Resolución de Gabinete No. 127, 2022 ), of which they had yet to see the effects of:

“They would come around and promise us that they would solve the problem, and it never

happened … They released 5 million dollars. Where does it go? It’s like ice in the sun, nobody knows where it goes … A week after they got the money the water came like lemonade, and we got it once a day”.

All participants were critical of where the Government of Panama’s plans for the development of water infrastructure sit on the list of priorities, as compared to tourism. Those directly employed by the tourism industry made note of the Urban Development of Cities with a Tourist Vocation Plan; a 6-year 100 million USD loan (2019-2023) for the development of tourism infrastructure, management, and governance, including that of public utilities in Isla Colón ( Inter-American Development Bank , n.d.). However, when asked whether they had seen any benefits from this investment, all pointed to the development of more hotels, attractions, and restaurants rather than improvements to existing infrastructure. “When I see that [investment] here, it’s in building hotels,” mentioned one property owner, “but they’re not building up the community with it, you know? ‘Why is that?’ I ask all the time”. Another participant mentioned that “[Bocas del Toro] is so marketed as a tourism place that there is nothing else [the government] does. We have culture and needs but they don’t see.”

While not explicitly discussed with participants, an important development in this case came in July of 2023, when Panama signed on to the UN’s Water Capacity Development Initiative (CDI) for SDG 6; the first country in the world to do so. The CDI serves as a vehicle for inter-agency cooperation on capacity development related to freshwater, sanitation, and hygiene ( UN Water, 2021 , p.1). Its goal is to enable the UN system, and its partners, to coordinate support for participating countries based on their unique needs. While it is too early to predict the efficacy of this initiative, it does indeed promote “national-level ownership” and capacity building, rather than a “simple transfer of mechanisms” ( UN Water, 2021 , p.1). As Panama continues to pursue a blue economy rooted in marine ecotourism as well as improved water security, questions remain as to whether there is indeed a balance to be struck between the two; one that aligns government aspirations for development with the realities and needs of those living in Bocas del Toro.

Contextualized around the potential paradox of developing a blue economy in a resource-insecure island region, this study examines how the relationship between marine ecotourism and water insecurity, in particular, manifests at the community level through a case study of Bocas del Toro, Panama. Guided by local experiences and perceptions, our findings highlight the role that socio-historical shifts, central plans and policies, and ongoing crises play in shaping the realities of local residents and their attitudes toward sustainable development and the government as a whole. In this section, we situate key findings within the literature, teasing out applicable lessons learned, making inquiries into the reasoning behind our results, and contemplating areas for future research.

The role of colonialism and race in marine ecotourism and water governance

Our results further perpetuate the widely accepted notion that issues of island development and resource governance must be considered within the context of colonization and systemic racism. In particular, studies in the ‘island tourism’ field (e.g., Cywiński (2015) ; Guerrón-Montero (2006) ; Grydehøj et al. (2021) ) would describe the lasting impacts of losses in traditional livelihoods at the hands of the UFC, and its role in directing Bocas del Toro’s economic development, as a function of neo -colonialism. Along this vein, Grimwood et al ( Grimwood et al., 2019 , p.1) posit that the production and consumption of tourism have the propensity to “(re)inscribe colonizing structures, systems, and narratives across time and space,” while ( Eyisi et al., 2024 , p.154) note that the pace and manner of tourism development is often an artifact of “tourists from colonizers becoming the source market for the colonized”. For example, a study of wildlife tourism by ( Mach et al., 2023 , p.1474) found that wildlife tourism boat guides learned what tourists (many being from Europe and North America) “wanted to see and seemed to enjoy most (e.g. pretty beaches and charismatic wildlife) and itineraries evolved accordingly,” often changing the actual names of destination, commonly used between locals to simple English, in order attract more tourists (e.g., ‘Sloth Island’).

A discussion of colonialism in this context, that being inherently racially formed, also brings us to the role of systemic racism. While the Panamanian government has enacted laws surrounding racial discrimination, in an effort to reconcile past and present harms [e.g., the dispossession of Afro-Caribbean farming communities ( Chapman, 2014 ), infringements upon Ngäbe land rights ( Finley-Brook and Thomas, 2010 ), and the attempted assimilation of Afro-Caribbean identity into mestizo society ( Corinealdi, 2022 )], Afro-Panamanians and Ngäbe individuals still make up some of the poorest groups in the nation, often residing in some of the least invested-in regions, with limited access to social services, water included ( INEC, 2021 ). While drawing a causal relationship between race and water insecurity is not within the scope of this research, the 2020 UN World Water Report does explicitly relate water insecurity and intersectionality, especially regarding race and class ( UN Water, 2020 ). Peer-reviewed studies on this issue, however, overwhelmingly exist in the North American context (e.g., Deitz and Meehan, 2019 ; Dickin and Gabrielsson, 2023 ; Harrington et al., 2023 ; Méndez-Barrientos et al., 2023 ; Workman and Shah, 2023 ). For example, a spatial analysis of water insecurity across the United States by Deitz and Meehan (2019) found that deficiencies in household water infrastructure are concentrated in regions typically inhabited by racialized groups. Specific to Bocas del Toro, our research highlights disparities in access to water between social and racial groups, as determined by foreign and ethno-racial status. For example, participants note that, during water shortages, wealthier lifestyle migrants and hotel operators have the financial capital to purchase water and/or pay truck drivers to deliver it.

The government-community disconnect

Central to this case is an evident disconnect between the Government of Panama’s aspirations for marine ecotourism development in Bocas del Toro and the needs of those living in the region, with many participants believing the government to be prioritizing marine ecotourism development over plans to improve water infrastructure. While a more intensive study, one which highlights the interconnectedness of climate change impacts and water management within larger government policies, is required to support this notion, our findings suggest that local realities may perpetuate the narrative that the government is ‘leaving behind’ social sustainability in pursuit of a viable marine ecotourism industry. In the Caribbean context, Peterson ( Peterson, 2020 , p.20) argues that “growth, rather than development, remains the overriding focus,” whereby “the quality of life for residents and, in turn, the quality of experience for visitors have not always met the various principles of sustainable tourism.” Furthermore, Srivastava and Mehta (2023) and Scott et al. (2024) propose that this outcome can indeed be “further exacerbated by neoliberal development policies and the notion of [Bocas del Toro] as a ‘resource frontier.’

As found by Wortman et al. (2016) ’s examination of local opinions on foreign tourism investment in Mauritius, our results suggest that the sheer profitability of the marine ecotourism sector may incentivize governments to continue to pursue its growth in terms of investment and future planning. They describe the tourism industry as “a variant of outward-oriented development strategies,” where the services required to host a successful industry may eclipse the services required by the local population. This is of extreme relevance in island regions, where tourism is a major contributor to national economies, motivating governments to continue to pursue ‘tourism-led growth,’ as put by Lee and Chien (2008) , and attracting increasing amounts of foreign direct investment ( Tecel et al., 2020 ; Broner et al., 2023 ).

If Bocas del Toro’s marine ecotourism sector continues to grow without the development of essential infrastructure alongside it, the region may indeed hit the point of ‘over-tourism’, where the arrival of excessive numbers of tourists at a destination imposes negative impacts on local communities ( Dioko, 2017 ). Peterson (2023) notes that over-tourism, in the Caribbean specifically, is often an artifact of “neo-liberal outward-oriented tourism policy., largely based on private and political interests to the exclusion of societal values and community interests.” Notably, reaching this point may, in fact, incentivize governing bodies to prioritize the development of public utility infrastructure to ensure that marine ecotourism remains an economically viable industry.

The importance of trust

The prevalence of mistrust in the Government of Panama expressed by participants can be described as a lack of ‘political trust’; trust in institutions and governance actors stemming from group membership, government policies, and/or general political support or satisfaction ( Bauer and Freitag, 2016 ). Our results demonstrate that local perceptions of corruption can mold residents’ opinions of marine ecotourism development, and its ability to act on issues of water insecurity. While we are not aware of any studies that explore the role of government corruption in affecting local perceptions of sustainable development, more broadly, Karst and Nepal (2022) note that a lack of established trust between communities and actors that oversee ecotourism development can lead to an array of management challenges and stakeholder conflicts.

Political trust is also often tied to the ability of actors to deliver quality public services and respond to citizen demands ( Murtin et al., 2018 ). In this study, participant responses indicate skepticism regarding the effectiveness and accountability of government actors and policies. As described by Fragkou and McEvoy (2016) , in an investigation of community attitudes surrounding water scarcity in Latin America, traumatic and frequent experiences with water scarcity can foster concerns regarding political accountability, further erode trust in utility providers, and perpetuate poor opinions of future developments that could potentially improve water access, like desalinization plants. Enqvist and Ziervogel (2019) also found that when compounded with historically tense relationships between communities and policymakers, the mishandling of water shortages can signal to local residents that government action is ineffective and subsequently untrustworthy. Eyisi et al. (2024) review of tourism in Nigeria also found that negative opinions of tourism development can be tied to a history of unfulfilled government promises. In the case of Bocas del Toro, participants often pointed out a lack of follow-through on the MPSTD. Nilsen et al. (2023) describe what it means to be a ‘periphery’ region on an intra -national scale, where the development of rural or isolated regions may fall victim to an ‘urban bias’ ( Lipton, 1977 ). We witness this in Bocas del Toro as participants note that management schemes from the national level often overlook their interests as compared to more urbanized provinces closer to the core of Panama City.

Study limitations and future research avenues

While we believe the stories and perceptions shared with us to be of the utmost value to understanding our research questions, we acknowledge that our results represent the experiences of 16 individuals across the archipelago. Although a smaller sample size can enhance the validity of an in-depth inquiry ( Crouch and McKenzie, 2006 ), a larger sample size can better account for diversity within and between stakeholder groups ( Boddy, 2016 ). As the pool of research in this field begins to expand, we recommend that not only do future studies adequately account for community experiences and perceptions, but that they aim to include a variety of stake- and rights-holders, determining sample size as a “matter of judgment and experience … evaluating the quality of the information collected against the uses to which it will be put,” as per Sandelowski ( Sandelowski, 1995 , p.179).

This research begins to fill knowledge gaps in the literature surrounding marine ecotourism development and access to water in island regions. To ensure that community realities and interests do not effectively ‘fall through the cracks,’ there exists a need to pursue community-centric research on the impact of a blue economic agenda on a variety of essential public utilities and human needs (e.g., electricity, food, housing). Furthermore, valuable insights can be drawn from studies that compare and contrast, in-depth, cases across island regions to better understand the norms of the community impacts of blue economic development in resource-scarce societies. Concerning Bocas del Toro specifically, there is a great need for continued research into all areas of marine ecotourism development and the equitable distribution of resources (both in relation to one another and independently), as ours is one of a handful of studies within the region (e.g., Spalding, 2013 ; Spalding et al., 2015 ; Spalding, 2017 ; Mach and Vahradian, 2021 ; Pleasant and Spalding, 2021 ; Mach et al., 2023 ; Sandelowski, 1995 ; Pigram, 2000 ; McElroy, 2006 ; Pascual et al., 2014 ; Sakellariadou, 2014 ; Roller and Lavrakas, 2015 ; Pierskalla, 2016 ; Nunn and Kumar, 2017 ; Ramos-García et al., 2017 ; Murtin et al., 2018 ; Nugraheni et al., 2020 ; Osterblum et al., 2020 ; Peterson, 2020 ; Phelan et al., 2020 ; Mach and Vahradian, 2021 ; Minow, 2021 ; Pleasant and Spalding, 2021 ; Ministerio de Ambiente de Panamá, 2022 ; Rahman et al., 2022 ; Resolución de Gabinete No. 127, 2022 ; Méndez-Barrientos et al., 2023 ; Nilsen et al., 2023 ; Ortiz, 2023 ; Pace et al., 2023 ; Resolución de Gabinete No. 48, 2023 ; Scott et al., 2024 ).

In this study, we mobilize local experiences with marine ecotourism and water insecurity to better understand how the relationship between the two manifests at the community level. Our results highlight issues, of colonialism and systemic racism, misalignments of development priorities, and eroded trust, that shape local experiences with sustainable development, and residents’ perceptions of the ability of marine ecotourism to address issues of water insecurity.

Moving forward, as the Government of Panama pursues a ‘Blue Panama,’ and the global community continues to adopt the blue economy as a framework for sustainable ocean development, there exists a need to re-center and internalize social sustainability, primarily issues of equity, as the leading goal of blue economic development. More specifically, in order to adhere to the original intent of a blue economy, this must not only include the prioritization of social equity throughout marine ecotourism and water governance, but also address the issues that underpin such misalignments, as found in this study. This can include an approach that focuses on the power disparities between groups through a socio-historical lens. Singh et al. (2023) refer to this as an ‘anti-inequity’ approach, whereby it is critical to investigate and understand the processes that perpetuate inequities in, in this case, water security.

Overall, this research has demonstrated that the ‘balance’ between community well-being and development in the pursuit of a blue economy in island regions is a matter far greater than ‘growth,’ ‘infrastructure,’ or ‘development’. There exist important historical and social underpinnings that define the relationship between decision-makers and the communities in which they make decisions for, who proves to benefit from a blue economy, and perceptions of sustainable development as a whole. Ultimately, marine ecotourism cannot be considered part of a blue economy strategy if it does not prioritize social equity. As such it is pivotal that future research within this field understand how relevant plans and policies may manifest at the community level, directly from those communities that may face existing barriers to social well-being and sustainability.

Data availability statement

The original contributions presented in the study are included in the article/ Supplementary Material . Further inquiries can be directed to the corresponding author.

Ethics statement

The studies involving humans were approved by Marine Affairs Program Ethics Review Standing Committee, Dalhousie University. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

Author contributions

AK: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Visualization, Writing – original draft, Writing – review & editing. CS: Conceptualization, Funding acquisition, Investigation, Project administration, Resources, Supervision, Writing – review & editing. WS: Conceptualization, Funding acquisition, Investigation, Project administration, Resources, Supervision, Writing – review & editing.

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was funded by the Nippon Foundation, Ocean Nexus.

Acknowledgments

We sincerely thank the communities and participants of Bocas del Toro for allowing, actively participating in, and supporting the data collection for this study. We also thank the staff of The School for Field Studies, Panama, for hosting us during our time in the field, as well as Laura Bruce and Sydney Rubinstein for their support as interpreters. Commentary and edits on the original manuscript were also provided by Ricardo de Ycaza (Oregon State University). We are grateful for the time and input from the reviewers of this paper, which have greatly improved the manuscript.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fmars.2024.1377053/full#supplementary-material

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Keywords: marine ecotourism, water security, blue economy, island systems, Bocas del Toro, sustainable development

Citation: Kim A, Scott CP and Swartz W (2024) Local perspectives on marine ecotourism development in a water-insecure island region: the case of Bocas del Toro, Panama. Front. Mar. Sci. 11:1377053. doi: 10.3389/fmars.2024.1377053

Received: 26 January 2024; Accepted: 02 May 2024; Published: 17 May 2024.

Reviewed by:

Copyright © 2024 Kim, Scott and Swartz. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Abigael Kim, [email protected]

† These authors have contributed equally to this work

This article is part of the Research Topic

The Potentials and Pitfalls from National Blue Economy Plans Towards Sustainable Development

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Please note you do not have access to teaching notes, strategy and challenges of value-based intermediation implementation: the case of bimb.

Qualitative Research in Financial Markets

ISSN : 1755-4179

Article publication date: 16 May 2024

The present study aims to evaluate the VBI strategies that have been implemented and to analyze the implementation challenges that BIMB has encountered.

Design/methodology/approach

A case study method was used to generate an in-depth and multi-faceted understanding of VBI strategy implementation in Bank Islam Malaysia Berhad (BIMB). A semi-structured in-depth interview was conducted with BIMB which is among of the earliest members of the VBI Community of Practitioners (CoPs). The data were transcribed and analyzed based on the content and thematic analyses.

This paper provides insights into how Islamic bank, i.e. BIMB, implement initiatives and strategies for adopting VBI based on the four underpinning principles. VBI is seen as a continuous strategy implementation of what has been practiced in BIMB, for instance, the Sadaqah House initiative introduced in 2018.

Research limitations/implications

The primary limitation of the study is that it only focused on BIMB and does not represent the larger members of VBI CoPs among Islamic banks in Malaysia. A larger sample would have given more trustworthy results and could give better insights on the VBI implementation.

Practical implications

A good strategy implementation can be realized by generating a positive and sustainable economic, societal and environmental impact consistent with sustainable shareholder returns and long-term interests. The regulator should consider the policy implications of this study by strengthening the VBI and encouraging more Islamic and conventional banks to adopt it based on the findings.

Originality/value

The originality of this study is that it focuses on strategy implementation and the challenges facing Islamic bank toward VBI. It provides information on the implementation strategy of VBI in Islamic banks in Malaysia and facilitates other Islamic banking institutions, specifically future members of CoPs in creating a strong ethical foundation.

• Islamic bank
• Value-based banking

Acknowledgements

The authors’ immense gratitude to informants – the Islamic banking practitioners - who provided insights and expertise that greatly assisted the research, although they may not agree with all of the interpretations/conclusions of this paper.

Shafruddin, A.S. and Shahimi, S. (2024), "Strategy and challenges of value-based intermediation implementation: the case of BIMB", Qualitative Research in Financial Markets , Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/QRFM-04-2023-0101

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The case study approach

Sarah crowe.

1 Division of Primary Care, The University of Nottingham, Nottingham, UK

Kathrin Cresswell

2 Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK

Ann Robertson

3 School of Health in Social Science, The University of Edinburgh, Edinburgh, UK

Anthony Avery

Aziz sheikh.

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

Introduction

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

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

This paper is structured around the following main questions: What is a case study? What are case studies used for? How are case studies conducted? What are the potential pitfalls and how can these be avoided? We draw in particular on four of our own recently published examples of case studies (see Tables ​ Tables1, 1 , ​ ,2, 2 , ​ ,3 3 and ​ and4) 4 ) and those of others to illustrate our discussion[ 3 - 7 ].

Example of a case study investigating the reasons for differences in recruitment rates of minority ethnic people in asthma research[ 3 ]

Example of a case study investigating the process of planning and implementing a service in Primary Care Organisations[ 4 ]

Example of a case study investigating the introduction of the electronic health records[ 5 ]

Example of a case study investigating the formal and informal ways students learn about patient safety[ 6 ]

What is a case study?

A case study is a research approach that is used to generate an in-depth, multi-faceted understanding of a complex issue in its real-life context. It is an established research design that is used extensively in a wide variety of disciplines, particularly in the social sciences. A case study can be defined in a variety of ways (Table ​ (Table5), 5 ), the central tenet being the need to explore an event or phenomenon in depth and in its natural context. It is for this reason sometimes referred to as a "naturalistic" design; this is in contrast to an "experimental" design (such as a randomised controlled trial) in which the investigator seeks to exert control over and manipulate the variable(s) of interest.

Definitions of a case study

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

These are however not necessarily mutually exclusive categories. In the first of our examples (Table ​ (Table1), 1 ), we undertook an intrinsic case study to investigate the issue of recruitment of minority ethnic people into the specific context of asthma research studies, but it developed into a instrumental case study through seeking to understand the issue of recruitment of these marginalised populations more generally, generating a number of the findings that are potentially transferable to other disease contexts[ 3 ]. In contrast, the other three examples (see Tables ​ Tables2, 2 , ​ ,3 3 and ​ and4) 4 ) employed collective case study designs to study the introduction of workforce reconfiguration in primary care, the implementation of electronic health records into hospitals, and to understand the ways in which healthcare students learn about patient safety considerations[ 4 - 6 ]. Although our study focusing on the introduction of General Practitioners with Specialist Interests (Table ​ (Table2) 2 ) was explicitly collective in design (four contrasting primary care organisations were studied), is was also instrumental in that this particular professional group was studied as an exemplar of the more general phenomenon of workforce redesign[ 4 ].

What are case studies used for?

According to Yin, case studies can be used to explain, describe or explore events or phenomena in the everyday contexts in which they occur[ 1 ]. These can, for example, help to understand and explain causal links and pathways resulting from a new policy initiative or service development (see Tables ​ Tables2 2 and ​ and3, 3 , for example)[ 1 ]. In contrast to experimental designs, which seek to test a specific hypothesis through deliberately manipulating the environment (like, for example, in a randomised controlled trial giving a new drug to randomly selected individuals and then comparing outcomes with controls),[ 9 ] the case study approach lends itself well to capturing information on more explanatory ' how ', 'what' and ' why ' questions, such as ' how is the intervention being implemented and received on the ground?'. The case study approach can offer additional insights into what gaps exist in its delivery or why one implementation strategy might be chosen over another. This in turn can help develop or refine theory, as shown in our study of the teaching of patient safety in undergraduate curricula (Table ​ (Table4 4 )[ 6 , 10 ]. Key questions to consider when selecting the most appropriate study design are whether it is desirable or indeed possible to undertake a formal experimental investigation in which individuals and/or organisations are allocated to an intervention or control arm? Or whether the wish is to obtain a more naturalistic understanding of an issue? The former is ideally studied using a controlled experimental design, whereas the latter is more appropriately studied using a case study design.

Case studies may be approached in different ways depending on the epistemological standpoint of the researcher, that is, whether they take a critical (questioning one's own and others' assumptions), interpretivist (trying to understand individual and shared social meanings) or positivist approach (orientating towards the criteria of natural sciences, such as focusing on generalisability considerations) (Table ​ (Table6). 6 ). Whilst such a schema can be conceptually helpful, it may be appropriate to draw on more than one approach in any case study, particularly in the context of conducting health services research. Doolin has, for example, noted that in the context of undertaking interpretative case studies, researchers can usefully draw on a critical, reflective perspective which seeks to take into account the wider social and political environment that has shaped the case[ 11 ].

Example of epistemological approaches that may be used in case study research

How are case studies conducted?

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

Defining the case

Carefully formulated research question(s), informed by the existing literature and a prior appreciation of the theoretical issues and setting(s), are all important in appropriately and succinctly defining the case[ 8 , 12 ]. Crucially, each case should have a pre-defined boundary which clarifies the nature and time period covered by the case study (i.e. its scope, beginning and end), the relevant social group, organisation or geographical area of interest to the investigator, the types of evidence to be collected, and the priorities for data collection and analysis (see Table ​ Table7 7 )[ 1 ]. A theory driven approach to defining the case may help generate knowledge that is potentially transferable to a range of clinical contexts and behaviours; using theory is also likely to result in a more informed appreciation of, for example, how and why interventions have succeeded or failed[ 13 ].

Example of a checklist for rating a case study proposal[ 8 ]

For example, in our evaluation of the introduction of electronic health records in English hospitals (Table ​ (Table3), 3 ), we defined our cases as the NHS Trusts that were receiving the new technology[ 5 ]. Our focus was on how the technology was being implemented. However, if the primary research interest had been on the social and organisational dimensions of implementation, we might have defined our case differently as a grouping of healthcare professionals (e.g. doctors and/or nurses). The precise beginning and end of the case may however prove difficult to define. Pursuing this same example, when does the process of implementation and adoption of an electronic health record system really begin or end? Such judgements will inevitably be influenced by a range of factors, including the research question, theory of interest, the scope and richness of the gathered data and the resources available to the research team.

Selecting the case(s)

The decision on how to select the case(s) to study is a very important one that merits some reflection. In an intrinsic case study, the case is selected on its own merits[ 8 ]. The case is selected not because it is representative of other cases, but because of its uniqueness, which is of genuine interest to the researchers. This was, for example, the case in our study of the recruitment of minority ethnic participants into asthma research (Table ​ (Table1) 1 ) as our earlier work had demonstrated the marginalisation of minority ethnic people with asthma, despite evidence of disproportionate asthma morbidity[ 14 , 15 ]. In another example of an intrinsic case study, Hellstrom et al.[ 16 ] studied an elderly married couple living with dementia to explore how dementia had impacted on their understanding of home, their everyday life and their relationships.

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

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

The selected case study site(s) should allow the research team access to the group of individuals, the organisation, the processes or whatever else constitutes the chosen unit of analysis for the study. Access is therefore a central consideration; the researcher needs to come to know the case study site(s) well and to work cooperatively with them. Selected cases need to be not only interesting but also hospitable to the inquiry [ 8 ] if they are to be informative and answer the research question(s). Case study sites may also be pre-selected for the researcher, with decisions being influenced by key stakeholders. For example, our selection of case study sites in the evaluation of the implementation and adoption of electronic health record systems (see Table ​ Table3) 3 ) was heavily influenced by NHS Connecting for Health, the government agency that was responsible for overseeing the National Programme for Information Technology (NPfIT)[ 5 ]. This prominent stakeholder had already selected the NHS sites (through a competitive bidding process) to be early adopters of the electronic health record systems and had negotiated contracts that detailed the deployment timelines.

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

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

Collecting the data

In order to develop a thorough understanding of the case, the case study approach usually involves the collection of multiple sources of evidence, using a range of quantitative (e.g. questionnaires, audits and analysis of routinely collected healthcare data) and more commonly qualitative techniques (e.g. interviews, focus groups and observations). The use of multiple sources of data (data triangulation) has been advocated as a way of increasing the internal validity of a study (i.e. the extent to which the method is appropriate to answer the research question)[ 8 , 18 - 21 ]. An underlying assumption is that data collected in different ways should lead to similar conclusions, and approaching the same issue from different angles can help develop a holistic picture of the phenomenon (Table ​ (Table2 2 )[ 4 ].

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

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

Analysing, interpreting and reporting case studies

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

The Framework approach is a practical approach, comprising of five stages (familiarisation; identifying a thematic framework; indexing; charting; mapping and interpretation) , to managing and analysing large datasets particularly if time is limited, as was the case in our study of recruitment of South Asians into asthma research (Table ​ (Table1 1 )[ 3 , 24 ]. Theoretical frameworks may also play an important role in integrating different sources of data and examining emerging themes. For example, we drew on a socio-technical framework to help explain the connections between different elements - technology; people; and the organisational settings within which they worked - in our study of the introduction of electronic health record systems (Table ​ (Table3 3 )[ 5 ]. Our study of patient safety in undergraduate curricula drew on an evaluation-based approach to design and analysis, which emphasised the importance of the academic, organisational and practice contexts through which students learn (Table ​ (Table4 4 )[ 6 ].

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

When reporting findings, it is important to provide the reader with enough contextual information to understand the processes that were followed and how the conclusions were reached. In a collective case study, researchers may choose to present the findings from individual cases separately before amalgamating across cases. Care must be taken to ensure the anonymity of both case sites and individual participants (if agreed in advance) by allocating appropriate codes or withholding descriptors. In the example given in Table ​ Table3, 3 , we decided against providing detailed information on the NHS sites and individual participants in order to avoid the risk of inadvertent disclosure of identities[ 5 , 25 ].

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

The case study approach is, as with all research, not without its limitations. When investigating the formal and informal ways undergraduate students learn about patient safety (Table ​ (Table4), 4 ), for example, we rapidly accumulated a large quantity of data. The volume of data, together with the time restrictions in place, impacted on the depth of analysis that was possible within the available resources. This highlights a more general point of the importance of avoiding the temptation to collect as much data as possible; adequate time also needs to be set aside for data analysis and interpretation of what are often highly complex datasets.

Case study research has sometimes been criticised for lacking scientific rigour and providing little basis for generalisation (i.e. producing findings that may be transferable to other settings)[ 1 ]. There are several ways to address these concerns, including: the use of theoretical sampling (i.e. drawing on a particular conceptual framework); respondent validation (i.e. participants checking emerging findings and the researcher's interpretation, and providing an opinion as to whether they feel these are accurate); and transparency throughout the research process (see Table ​ Table8 8 )[ 8 , 18 - 21 , 23 , 26 ]. Transparency can be achieved by describing in detail the steps involved in case selection, data collection, the reasons for the particular methods chosen, and the researcher's background and level of involvement (i.e. being explicit about how the researcher has influenced data collection and interpretation). Seeking potential, alternative explanations, and being explicit about how interpretations and conclusions were reached, help readers to judge the trustworthiness of the case study report. Stake provides a critique checklist for a case study report (Table ​ (Table9 9 )[ 8 ].

Potential pitfalls and mitigating actions when undertaking case study research

Stake's checklist for assessing the quality of a case study report[ 8 ]

Conclusions

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

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

AS conceived this article. SC, KC and AR wrote this paper with GH, AA and AS all commenting on various drafts. SC and AS are guarantors.

Pre-publication history

The pre-publication history for this paper can be accessed here:

http://www.biomedcentral.com/1471-2288/11/100/prepub

Acknowledgements

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

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Application of observational research methods to real-world studies for rare disease drugs: a scoping review protocol

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Objective The primary objective is to identify which observational research methods have been used in the last 5 years in rare disease drug evaluation and how they are applied to generate adequate evidence regarding the real-world effectiveness or safety of rare disease drugs. Background Rare disease is an umbrella term for a condition which affects <200,000 people each year and despite the rarity of these conditions, collectively they encompass approximately 7000 different conditions. With the striking number of rare conditions, many pharmaceutical manufacturers are introducing an increased number of drugs to treat them. However, due to small patient populations, heterogeneity and other factors related to rare diseases, there are feasibility concerns regarding the generation of adequate efficacy and safety evidence using conventional randomized controlled trials (RCTs). Recently, real-world evidence generated through observational (or real-world) studies has been proposed to address some of the feasibility concerns with RCTs by measuring drug effectiveness or safety in the real-world setting. However, there remain methodological concerns due to a lack of randomization/masking. This proposed scoping review aims to identify which observational research methods in the last 5 years are used in rare disease drug evaluation to address methodological concerns and how they’re applied to generate evidence on drug effectiveness or safety. Inclusion criteria Articles must be primary observational or real-world studies reporting rare disease drug effectiveness or safety published between 2018-2023. Literature reviews, meta-analyses, randomized control trials, case series, case reports, opinion pieces, conference abstracts, and studies with unavailable full-text articles will be excluded. Methods The search strategy will combine the following key search concepts: rare disease, drugs for rare disease and observational/real-world studies. The search will be conducted in MEDLINE and EMBASE. Review registration number Open Science Framework, https://osf.io/f3wpv

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

The author(s) received no specific funding for this work.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

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