difference between interview and case study

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Methodology

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

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

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

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

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

Table of contents

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Research bias

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

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• Knowledge Base
• Methodology
• Case Study | Definition, Examples & Methods

Case Study | Definition, Examples & Methods

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

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

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

Table of contents

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the ‘Cite this Scribbr article’ button to automatically add the citation to our free Reference Generator.

McCombes, S. (2023, January 30). Case Study | Definition, Examples & Methods. Scribbr. Retrieved 24 June 2024, from https://www.scribbr.co.uk/research-methods/case-studies/

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What Is a Case Study?

What is a case study interview, how to prep for a case study interview, case study interview example questions, during the case study interview.

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Table of Contents

A case study interview isn’t your average interview. While most interviews ask you to give examples of how you use your skills on the job, in a case study interview, you’ll use those skills in front of the interviewer to solve a real-life problem.

It’s like auditioning for the school play. But instead of showing you can sing and dance, you’re using a case interview to show how you provide innovative solutions to pressing business problems. Not sure how to get ready for this kind of interview? We’ve got you covered. This guide explains how to prep for a case study interview.

Case studies are used across a variety of industries — everything from business to medicine. They are an in-depth examination, analysis, and critique of a real-world scenario the company experienced. People discuss the situation and explore what they learned while forming new solutions to try when they face a similar situation in the future and hope to improve their performance.

For example, doctors and nurses use case studies to improve how they diagnose and treat patients. Using real patient information, the medical team analyzes the case to see what the team may have missed and why they missed it. Learning from these errors helps the team better prepare for similar cases in the future to improve patient care.

While many industries use case studies to iterate and improve their performance, not every company uses case study interviews. This type of interview is very common at consulting companies (no matter what kind of consulting it is). But it’s not unusual for companies outside of consulting to use case interviews for marketing or operations roles.

In a case study interview, you’re given a real-world situation the company has faced and are tasked with analyzing it and suggesting a course of action.

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Businesses use case study interviews to assess your abilities in real-time. While you’ll probably draw on a variety of skills, most case study interviews assess:

• Strategic thinking
• Analytical skills
• Common sense

The advantage of a case study interview is that the interviewer can evaluate your ability in each of these areas and see how you’ll actually use them on the job.

What Is a Fit Interview?

Some people use “case study interview” and “fit interview” interchangeably. While a fit interview and a case study interview both ask behavioral interview questions , they are not the same thing.

A case study interview assesses your ability to do the job. It primarily evaluates how you approach business problems and use your skills to solve them. A fit interview is about company culture fit. The interviewer asks questions that assess how well you’ll fit into the company, like asking you questions about what motivates you or how you lead .

Fit and case interviews are important parts of the evaluation process. Getting the job done is just as critical as getting along with coworkers and supporting the company’s mission. Depending on where you interview, you may have one fit interview and one case study interview, or the fit interview may be a smaller part of the case study interview.

What You’ll Learn in a Case Study Interview

A case study interview allows the hiring manager to see your skills in action and how you approach business challenges. But it also teaches you a lot about the company (even if you’re doing most of the talking).

In a sense, you’re behaving as an employee during a case study interview. This gives you a peek behind the curtain, allowing you to see the company’s inner workings, like how they approach business problems and what they expect from you and your performance.

For example, you may offer a novel approach to solving a problem during a case interview. How does the interviewer react to it? Are they impressed? Surprised? Is there a scowl or frown on their face? Their reaction gives you insights into how the company will likely receive your solutions.

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Depending on the specific company, you may have the case study interview questions in advance, but you may not. Whether you do or don’t, here’s how to prepare for a case study interview.

Conduct Deep Research

Good interview prep for any interview means researching the company. That includes things like learning more about the company’s mission and the challenges the industry faces. But when you’re preparing for a case study interview, your research needs to go deeper. 

When you answer a case study question, your answer has to be specific to the company’s clients or business objectives. For example, if you’re interviewing for a role in strategy consulting , your answer shouldn’t focus on aspects of human resources consulting (unless it’s particularly relevant).

Your research needs to include the kinds of clients the company works with and what types of problems the company solves. For example, the company may only consult for Fortune 100 companies that need accounting advice. Keep these facts in mind as you prepare for the interview.

Case Study Interview Formats

There are four types of case study interview formats:

• Candidate-led: The interviewer asks you a specific question (or gives you a prompt), and you walk the interviewer through a detailed answer.
• Employer-led: The interviewer leads you through a series of specific (and predetermined) prompts and questions, no matter your answers.
• Presentation: You’re given a problem in advance to create and present a detailed case study.
• Video: Similar to a presentation case study interview, you’ll create a video presentation of the case study.

Most companies will tell you in advance which style of case study interview you should prepare for. But if they don’t, reach out to your recruiter or check the company’s website. Many include the essential details you need to prepare for the case study interview.

Seek Out Company-Specific Tips

Speaking of companies and their websites, not only do many companies that use case study interviews tell you the format, they often include helpful tips and tricks to help candidates prepare. This includes what to expect, what the company is looking for skill-wise, and what kinds of responses they want. They may even have a few practice questions and videos you can use to help you prep.

Unlike other common interview questions , it’s not as easy to prepare an answer to case study interview questions. Even though you know it’s a case study interview, you don’t necessarily know the specifics of the case or what problems you’ll be asked to solve.

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That said, it’s likely your case study interview questions will cover one or several of these concepts:

• Entering new markets
• Increasing profits
• Cutting costs
• Turnarounds
• Mergers and acquisitions
• Pricing strategy
• Developing new products
• Industry analysis
• Competitive response

While there are many ways to answer case study interview questions, a few basic prep tips can help you get ready for every question.

In addition to what you usually bring to a job interview , make sure you bring a notepad and pen or pencil to a case study interview. Taking notes will help you better understand the questions and formulate your answers. It also gives you a place to calculate numbers and figures if you need to. Not every case study interview allows calculators, so you’ll need to be ready to do your calculations manually.

Ask Specific Questions

As you’re working through the case study, you can and should ask any clarifying questions you need. The interviewer wants to hear specific, detailed answers that solve the problem. So, whenever you’re unclear, ask a follow-up question to not only get what you need but to give the interviewer what they need. 

That said, your question(s) should be very specific. You need to verify exactly what the interview is asking so you can create an appropriate answer. Say the interviewer gives you a broad question: The client’s revenue is falling. How do you help them increase it? You can follow up with a very specific question or two to make sure you understand what the interviewer is asking:

You’re asking how I would help the client raise revenue, correct? Are you also asking how I would help them increase their profit and cut costs?

>>Related: 5 Top Questions to Ask in an Interview (and Why You Should Ask Them)

Talk Them Through It

A big part of the case study interview is seeing you in action. However, in this case, “see” really means “how you think.” Since the interviewer can’t hear your inner monologue, you’ll need to practice thinking out loud.

While the interviewer wants to hear your solution, they also want to hear how you got there. That means talking through your entire thought process. Instead of saying, “I’d do X,” you have to explain how you arrived at your decision while you’re getting there.

Because not everyone thinks out loud, it may feel unnatural to you, and you likely won’t be expected to do it on the job. But it’s crucial to practice this skill — and it is a skill — because the interviewer is expecting you to do it in a case study interview.

Want to give a case study a shot? Try out a Forage consulting virtual simulation program and gain the skills you’ll need to ace a case study interview.

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Case Study vs. Survey

What's the difference.

Case studies and surveys are both research methods used in various fields to gather information and insights. However, they differ in their approach and purpose. A case study involves an in-depth analysis of a specific individual, group, or situation, aiming to understand the complexities and unique aspects of the subject. It often involves collecting qualitative data through interviews, observations, and document analysis. On the other hand, a survey is a structured data collection method that involves gathering information from a larger sample size through standardized questionnaires. Surveys are typically used to collect quantitative data and provide a broader perspective on a particular topic or population. While case studies provide rich and detailed information, surveys offer a more generalizable and statistical overview.

Further Detail

Introduction.

When conducting research, there are various methods available to gather data and analyze it. Two commonly used methods are case study and survey. Both approaches have their own unique attributes and can be valuable in different research contexts. In this article, we will explore the characteristics of case study and survey, highlighting their strengths and limitations.

A case study is an in-depth investigation of a particular individual, group, or phenomenon. It involves collecting detailed information about the subject of study through various sources such as interviews, observations, and document analysis. Case studies are often used in social sciences, psychology, and business research to gain a deep understanding of complex issues.

One of the key attributes of a case study is its ability to provide rich and detailed data. Researchers can gather extensive information about the subject, including their background, experiences, and perspectives. This depth of data allows for a comprehensive analysis and interpretation of the case, providing valuable insights into the phenomenon under investigation.

Furthermore, case studies are particularly useful when studying rare or unique cases. Since case studies focus on specific individuals or groups, they can shed light on situations that are not easily replicated or observed in larger populations. This makes case studies valuable in exploring complex and nuanced phenomena that may not be easily captured through other research methods.

However, it is important to note that case studies have certain limitations. Due to their in-depth nature, case studies are often time-consuming and resource-intensive. Researchers need to invest significant effort in data collection, analysis, and interpretation. Additionally, the findings of a case study may not be easily generalized to larger populations, as the focus is on a specific case rather than a representative sample.

Despite these limitations, case studies offer a unique opportunity to explore complex issues in real-life contexts. They provide a detailed understanding of individual experiences and can generate hypotheses for further research.

A survey is a research method that involves collecting data from a sample of individuals through a structured questionnaire or interview. Surveys are widely used in social sciences, market research, and public opinion studies to gather information about a larger population. They aim to provide a snapshot of people's opinions, attitudes, behaviors, or characteristics.

One of the main advantages of surveys is their ability to collect data from a large number of respondents. By reaching out to a representative sample, researchers can generalize the findings to a larger population. Surveys also allow for efficient data collection, as questionnaires can be distributed electronically or in person, making it easier to gather a wide range of responses in a relatively short period.

Moreover, surveys offer a structured approach to data collection, ensuring consistency in the questions asked and the response options provided. This allows for easy comparison and analysis of the data, making surveys suitable for quantitative research. Surveys can also be conducted anonymously, which can encourage respondents to provide honest and unbiased answers, particularly when sensitive topics are being explored.

However, surveys also have their limitations. One of the challenges is the potential for response bias. Respondents may provide inaccurate or socially desirable answers, leading to biased results. Additionally, surveys often rely on self-reported data, which may be subject to memory recall errors or misinterpretation of questions. Researchers need to carefully design the survey instrument and consider potential biases to ensure the validity and reliability of the data collected.

Furthermore, surveys may not capture the complexity and depth of individual experiences. They provide a snapshot of people's opinions or behaviors at a specific point in time, but may not uncover the underlying reasons or motivations behind those responses. Surveys also rely on predetermined response options, limiting the range of possible answers and potentially overlooking important nuances.

Case studies and surveys are both valuable research methods, each with its own strengths and limitations. Case studies offer in-depth insights into specific cases, providing rich and detailed data. They are particularly useful for exploring complex and unique phenomena. On the other hand, surveys allow for efficient data collection from a large number of respondents, enabling generalization to larger populations. They provide structured and quantifiable data, making them suitable for statistical analysis.

Ultimately, the choice between case study and survey depends on the research objectives, the nature of the research question, and the available resources. Researchers need to carefully consider the attributes of each method and select the most appropriate approach to gather and analyze data effectively.

Comparisons may contain inaccurate information about people, places, or facts. Please report any issues.

• Research Methods
• Post last modified: 26 August 2021
• Reading time: 36 mins read
• Post category: Research Methodology

4 Research Methods

4 Major Research Methods are:

Observations

Schedule and questionnaire, case study method.

Table of Content

• 1.1.1 Types of Interview
• 1.1.2 Features of Interviews
• 1.1.3 Essentials for an Effective Interview
• 1.1.4 Advantages of Interviews
• 1.1.5 Disadvantages of Interviews
• 1.1.6 Interview Process
• 1.1.7 Problems Faced in an Interview
• 1.2.1 Characteristics of Observation Method
• 1.2.2 Types of Observation
• 1.2.3 Prerequisites of Observation
• 1.2.4 Advantages of observations
• 1.2.5 Disadvantages of observations
• 1.2.6 Use of observation in business research
• 1.3.1 Importance of questionnaires
• 1.3.2 Types of Questionnaire
• 1.3.3 Advantages of Questionnaires
• 1.3.4 Disadvantages of Questionnaires
• 1.3.5 Preparation of an Effective Questionnaire
• 1.3.6 Difference between schedule and questionnaire
• 1.4.1 Assumptions of case study method
• 1.4.2 Advantages of Case Study Method
• 1.4.3 Disadvantages of Case Study Method
• 1.4.4 Case study as a method of business research

Interviewing is a very effective method of data collection. It is a systematic and objective conversation between an investigator and respondent for collecting relevant data for a specific research study. Along with conversation, learning about the gestures, facial expressions and environmental conditions of a respondent are also very important.

Generally, interview collects a wide range of data from factual demographic data to highly personal and intimate information relating to a person’s opinions, attitudes, values and beliefs, past experience and future intentions.

The interview method is very important in the collection of data from the respondent who is less educated or illiterate. Personal interview is more feasible when the area covered for survey is compact. Probing is a very important part of an interview.

Types of Interview

The following are the various types of interviews:

Structured or directive interview

In this type of interview, the investigator goes to the respondent with a detailed schedule. Some questions in same sequence are asked from all respondents.

Unstructured or non-directive interview

In this type of interview, the respondent is encouraged to give his honest opinion on a given topic without or with minimum help from others.

Focused interview

This is a semi-structured interview where the respondent shares the effect of the experience to the given conditions with the researcher or investigator. It is conducted with those respondents only who have prior experience of conditions given by the investigator.

Analysis of the attitude, emotional feelings for the situations under study is main purpose behind conducting these interviews. A set of fix questions may not be required in this interview but a relevant topic is required which is known to the respondent.

Clinical interview

While a focussed interview is concerned with effects of specific experience, clinical interviews are concerned with broad underlying feelings or motivations or the course of the individual’s life experiences with reference to the research study. It encourages the interviewee to share his experience freely.

Depth interview

To analyse or study the respondent’s emotions, opinions, etc., depth interviews are conducted. This kind of interview aims to collect intensive data about individuals, especially their opinions.

It is a lengthy process to get unbiased data from the respondent. Interviewers should avoid advising or showing this agreement. Instead, the investigator has to motivate the respondent to answer the questions.

Features of Interviews

The following are some of the features of interviews

• The interviewer and the respondent are the participants in any interview. They both are unknown to each other and so it is important for an interviewer to introduce himself first to the respondent.
• An interview has a beginning and a termination point in the relationship between the participants.
• Interview is not a mere casual conversational exchange. It has a specific purpose of collecting data which is relevant to the study.
• Interview is a mode of obtaining a verbal response to questions to put verbally. It is not always face to face.
• Success of interview depends on the interviewer and respondent and how they perceive each other.
• It is not a standardized process.

Essentials for an Effective Interview

The following are the requirements for a successful interview:

• Data availability : The respondent should have complete knowledge of the information required for specific study.
• Role perception : The interviewer and the respondent should be aware of their roles in the interview process. The respondent should be clear about the topic or questions which have to be answered by him. Similarly, it is the responsibility of the interviewer to make the respondent comfortable by introducing himself first. The investigator should not affect the interview situation through subjective attitude and argumentation.
• Respondent’s motivation : The respondent can hesitate to answer the questions. In this case, the approach and skills of the interviewer are very important as he has to motivate the respondent to answer or express himself.

Advantages of Interviews

The following are the advantages of the interview method:

• In-depth and detailed information is collected.
• The interviewer tries to improve the responses and quality of data received.
• He can control the conditions in favour of the research study.
• Interviews help in gathering supplementary information which can be helpful to the study.
• Interviews use special scoring devices, visuals and materials to improve the quality of data or information collected.
• Interviews use observation and probing by the interviewer to see the accuracy and dependability of given data by the respondent.
• Interviews are flexible in nature.

Disadvantages of Interviews

The following are the disadvantages of interviews:

• Interviews consume more time and cost.
• The respondent’s responses can be affected by the way the interviewer asks the questions.
• The respondent may refuse to answer some personal questions which are relevant to the study.
• Recording and coding of data during the interview process may sometimes be difficult for the interviewer.
• The interviewer may not have good communication or interactive skills.

Interview Process

The following are the stages in an interview process:

Preparation

The interviewer needs to make certain preparations to make an interview successful. The interviewer should keep all the copies of the schedule or guide ready. They need to prepare the lists of respondents with their addresses, contact number and meeting time.

They should prepare themselves with all the approaches and skills required to conduct an interview. They should prepare themselves to face all adverse situations during the interview. If the interviewer is not doing such planning, they can fail to collect the right information from respondent.

Introduction

The interviewer is not known to the respondent. Therefore, the interviewer must introduce himself first to every respondent. In the introduction, the interviewer should tell about himself, his organization details and the purpose of his visit.

If the interviewer knows someone who the respondent is familiar with, then he can use that person’s reference to make the respondent more comfortable. The following are some steps which help in motivating the respondent:

• The interviewer should introduce himself with a smiling face and always greet the respondent.
• He should identify and call the respondent by name.
• He must describe how the respondent is selected.
• He should explain the purpose and usefulness of the study.
• He should focus on the value of the respondent’s cooperation.

Developing report

It is important for an interviewer to develop a rapport with the respondent before starting the interview. By doing this, a cordial relationship is established between them. It helps the interviewer understand the inherent nature of the respondent which helps in building a rapport and the discussion can be started with some general topic or with the help of a person who is commonly known to both of them.

Carrying the interview forward

After establishing a rapport, the skills of the interviewer are required to carry the interview forward. The following are some guidelines that should be followed:

• Start the interview in an informal and natural manner.
• Ask all the questions in the same sequence as in the schedule.
• Do not take an answer for granted. It is not necessary that an interviewee will know all answers or will give all answers. The interviewer has to create interest for answering questions.
• The objective of the question should be known to the interviewer to ensure that the correct information is collected for research study.
• Explain the question if it has not been understood properly by the respondent.
• Listen to the respondent carefully with patience.
• Never argue with the respondent.
• Show your concern and interest in the information given by the respondent.
• Do not express your own opinion for answers of any question in the schedule.
• Continue to motivate the respondent.
• If the respondent is unable to frame the right answer, the interviewer should help him by providing alternate questions.
• Ensure that the conversation does not go off track.
• If the respondent is unable to answer a particular question due to some reasons, drop the question at that moment. This question can be asked indirectly later on.

Recording the interview

Responses should be recorded in the same sequence as they are given by the respondent. The response should be recorded at the same time as it is generated. It may be very difficult to remember all the responses later for recording them.

Recording can be done in writing but there may be some problems if the writing skills of an interviewer are not good. Hence, the use of electronic devices like tape recorders can help in this purpose. The interviewer should also record all his probes and other comments on the schedule, but they should be in brackets to ensure that they are set off from response.

Closing the interview

After the interview is over, the interviewer must thank the respondent for his cooperation. He must collect all the papers before leaving the respondent. If the respondent wants to know the result of the survey, the interviewer must ensure that the results are mailed to him when they are ready.

At the end, the interviewer must edit the schedule to check that all the questions have been asked and recorded. Also, abbreviations in recording should be replaced by full words.

Problems Faced in an Interview

The following are some of the main problems faced in an interview:

Inadequate response

Kahn and Cannel laid down five principal symptoms of inadequate response. They are given as follows:

• Partial response in which the respondent gives a relevant but incomplete answer.
• Non-response in which the respondent remains silent or refuses to answer the questions.
• Irrelevant response in which the respondent’s answer is not relevant to the question asked.
• Inaccurate response in which the reply is biased.
• Verbalized response problem which arises because of the respondent’s failure to understand the question.

Interviewer’s biasness, refusal, incapability to understand questions

An interviewer can affect the performance of an interview with his own responses and suggestions. Such biasing factors can never be overcome fully, but their effect can be reduced by training and development techniques.

Non response

Some respondents out of the total respondents fail to respond to the schedule. The reasons for this non response can be non availability, refusal, incapability to understand questions, etc.

Non availability

Some respondents are not available at their places at the time of call. This could be because of odd timings or working hours.

Some respondents refuse to answer the questions. There can be many reasons for this, such as language, odd hours, sickness, no interest in such studies, etc.

Inaccessibility

Some respondents can be inaccessible because of various reasons such as migration, touring job, etc.

Observation can be defined as viewing or seeing. Observation means specific viewing with the purpose of gathering the data for a specific research study. Observation is a classical method of scientific study. It is very important in any research study as it is an effective method for data collection.

Characteristics of Observation Method

The following are the characteristics of the observation method of data collection:

• Physical and mental activity : Eyes observe so many things in our surroundings but our focus or attention is only on data which is relevant to research study.
• Observation is selective : It is very difficult for a researcher to observe everything in his surroundings. He only observes the data which is purposive for his research study and meets with the scope of his study. The researcher ignores all the data which is not relevant to the study.
• Observation is purposive and not casual : Observation is purposive as it is relevant to a particular study. The purpose of observation is to collect data for the research study. It focusses on human behaviour which occurs in a social phenomenon. It analyses the relationship of different variables in a specific context.
• Accuracy and standardization : Observation of pertinent data should be accurate and standardized for its applications.

Types of Observation

Different concepts define the classification of observations.

With respect to an investigator’s role, observation may be:

Participant observation

Non-participant observation

With respect to the method of observation, it can be classified into the following:

Direct observation

Indirect observation

With reference to the control on the system to be observed, observation can be classified into the following:

Controlled observation

Uncontrolled observation

In participant type of observation, the observer is an active participant of the group or process. He participates as well as observes as a part of a phenomenon;

For example, to study the behaviour of management students towards studying and understanding marketing management, the observer or researcher has to participate in the discussion with students without telling them about the observation or purpose. When respondents are unaware of observations, then only their natural interest can be studied.

In non-participant observation, the observer does not participate in the group process. He acknowledges the behaviour of the group without telling the respondents. It requires a lot of skills to record observations in an unnoticeable manner.

In direct observation, the observer and researcher personally observe all the happenings of a process or an event when the event is happening. In this method, the observer records all the relevant aspects of an event which are necessary for study.

He is free to change the locations and focus of the observation. One major limitation of the method is that the observer may not be able to cover all relevant events when they are happening.

Physical presence of an observer is not required and recording is done with the help of mechanical, photographic or electronic devices;

For example, close circuit TV (CCTV) cameras are used in many showrooms to observe the behaviour of customers. It provides a permanent record for an analysis of different aspects of the event.

All observations are done under pre-specified conditions over extrinsic and intrinsic variables by adopting experimental design and systematically recording observations. Controlled observations are carried out either in the laboratory or the field.

There is no control over extrinsic and intrinsic variables. It is mainly used for descriptive research. Participant observation is a typical uncontrolled one.

Prerequisites of Observation

The following are the prerequisites of observation:

• The conditions of observation must provide accurate results. An observer should be in a position to observe the object clearly.
• The right number of respondents should be selected as the sample size for the observation to produce the desired results.
• Accurate and complete recording of an event.
• If it is possible, two separate observers and sets of instruments can be used in all or some observations. Then the result can be compared to measure accuracy and completeness.

Advantages of observations

The following are the advantages of observations:

• It ensures the study of behaviour in accordance with the occurrence of events. The observer does not ask anything from the representatives, he just watches the doing and saying of the sample.
• The data collected by observation defines the observed phenomenon as they occur in their natural settings.
• When an object is not able to define the meaning of its behaviour, observation is best method for analysis; for example, animals, birds and children.
• Observation covers the entire happenings of an event.
• Observation is less biased as compared to questioning.
• It is easier to conduct disguised observation studies as opposed to disguised questioning.
• The use of mechanical devices can generate accurate results.

Disadvantages of observations

The following are the limitations of observation:

• Past studies and events are of no use to observation. For these events and study, one has to go through narrations, people and documents.
• It is difficult to understand attitudes with the help of observation.
• Observations cannot be performed by the choice of the observer. He has to wait for an event to occur.
• It is difficult to predict when and where the event will occur. Thus, it may not be possible for an observer to reach in every event.
• Observation requires more time and money.

Use of observation in business research

Observation is very useful in the following business research purposes:

• Buying behaviour of customer, lifestyles, customs, interpersonal relations, group dynamics, leadership styles, managerial style and actions.
• Physical characteristics of inanimate things like houses, factories, stores, etc.
• Movements in a production plant.
• Flow of traffic, crowd and parking on road.

Primary data can be collected with the help of emails and surveys. The respondents receive the questionnaires from the researcher and are asked to fill them completely and return them to the researcher. It can be performed only when the respondents are educated.

The mail questionnaire should be simple and easy to understand so that the respondents can answer all questions easily. In mail questionnaires, all the answers have to be given and recorded by the respondents and not by the researcher or investigator, as in the case of the personal interview method. There is no face-to-face interaction between the investigator and respondent and so the respondent is free to give answers of his own choice.

Importance of questionnaires

A questionnaire is a very effective method as well as research tool in any research study. It ensures the collection of a diversified and wide range of scientific data to complete the research objectives. The questionnaire provides all the inputs in the form of relevant data to all statistical methods used in a research study.

Types of Questionnaire

The following are the various categories of questionnaires:

• Structured or standard questionnaire Structured or standard questionnaires contain predefined questions in order to collect the required data for research study. These questions are the same for all the respondents. Questions are in the same language and in the same order for all the respondents.
• Unstructured questionnaire In unstructured questionnaires, the respondent has the freedom

Process of Data Collection

The researcher prepares the mailing list by collecting the addresses of all the respondents with the help of primary and secondary sources of data. A covering letter must accompany every questionnaire, indicating the purpose and importance of the research and importance of cooperation of the respondent for the success of the research study.

Advantages of Questionnaires

The following are the advantages of questionnaires:

• Wide reach and extensive coverage
• Easy to contact the person who is busy
• Respondent’s convenience in completion of questionnaire
• More impersonal, provides more anonymity
• No interviewer’s biasness

Disadvantages of Questionnaires

The following are the disadvantages of questionnaires:

• Low response by respondent
• Low scope in many societies where literary level is low
• More time requirement

Preparation of an Effective Questionnaire

While preparing a questionnaire, the researcher must focus on some key parameters to prepare it. These key parameters are as follows:

• Proper use of open and close probe
• Proper sequence of questions
• Use of simple language
• Asking no personal question in which the respondent is hesitating to answer
• Should not be time consuming
• Use of control questions indicating reliability of the respondent

Collecting Data through Schedule

This method is very similar to the collection of data through questionnaires. The only difference is that in schedule, enumerators are appointed. These enumerators go to the respondents, ask the stated questions in the same sequence as the schedule and record the reply of respondents.

Schedules may be given to the respondents and the enumerators should help them solve the problems faced while answering the question in the given schedule. Thus, enumerator selection is very important in data collection through schedules.

Difference between schedule and questionnaire

Both questionnaire and schedule are popular methods of data collection. The following are the main differences between questionnaire and schedule:

• A questionnaire is generally sent to the respondents through mail, but in case of schedule, it is sent through enumerators.
• Questionnaires are relatively cheaper mediums of data collection as compared to schedules. In the case of questionnaires, the cost is incurred in preparing it and mailing it to respondent, while in schedule, more money is required for hiring enumerators, training them and incurring their field expenses.
• The response rate in questionnaires is low as many people return it without filling. On the other hand, the response rate in schedules is high because they are filled by enumerators.
• In collecting data through questionnaires, the identity of the respondent may not be known, but this is not the case when it comes to schedules.
• Data collection through questionnaires requires a lot of time, which is comparatively very less in case of schedules.
• Generally, there is no personal contact in case of questionnaires, but in schedules, personal contact is always there.
• The literacy level of the respondent is very important while filling questionnaires, but in schedules, the literacy level of the respondent is not a major concern as the responses have to be recorded by enumerators.
• Wider distribution of questionnaires is possible but this is difficult with schedules.
• There is less accuracy and completeness of responses in questionnaires as compared to schedules.
• The success of questionnaires depends on the quality of questions but success of a schedule depends on the enumerators.
• The physical appearance of questionnaire matters a lot, which is less important in case of schedules.
• Observation method cannot be used along with questionnaires but it can be used along with schedule.

We explore and analyse the life of a social chapter or entity, whether it be a family, a person, an institution or a community, with the help of a case study. The purpose of case study method is to identify the factors and reasons that account for particular behaviour patterns of a sample chapter and its association with other social or environmental factors.

Generally social researchers use case study method to understand the complex social phenomenon and to identify the factors related to this phenomenon.

Case study provides the clues and ideas to a researcher for further research study. By adopting case study method, a researcher gets to know about happenings in the past, which could be related to the research studies and analyse the problem with better perspectives.

Assumptions of case study method

The assumptions made in a case study method are as follows:

• Case study depends on the imagination of the investigator who is analysing the case study. The investigator makes up his procedure as he goes along.
• History related to the case is complete and as coherent as it could be.
• It is advisable to supplement the case data by observational, statistical and historical data, since these provide standards for assessing the reliability and consistency of the case material.
• Efforts should be made to ascertain the reliability of life history data by examining the internal consistency of the material.
• A judicious combination of techniques of data collection is a prerequisite for securing data that is culturally meaningful and scientifically significant.

Advantages of Case Study Method

Key advantages of the case study method are as follows:

• Provides the basis for understanding complex social phenomenon and all related factors affecting the social phenomenon.
• Provides clues and ideas for exploratory research. When the researcher is not able to get a fair idea about the research, past happenings mentioned in a case study help the researcher get clues and ideas.
• Case study helps in generating objectives for exploratory research.
• It suggests the new courses of inquiry.
• Case study helps in formulating research hypothesis.

Disadvantages of Case Study Method

Some important disadvantages of case study method are as follows:

• Reliability : Data collected through case study may not be reliable or it can be difficult to verify the reliability of data in the current scenario.
• Adequacy : Data collected through case studies may not be adequate for research work as data is not pertinent to the research conditions.
• Representative : Data presented by case studies represents the happenings with unknown circumstances to a researcher. Hence, it cannot be the true representation of events to a researcher.

Case study as a method of business research

A detailed case study helps the researcher identify the reasons behind business related problems. As it can be possible that that particular incident has happened in past, so the current issues can be sorted out, by referring to the same case.

In depth analysis of selected cases is of particular value to business research when a complex set of variables may be at work in generating observed results and intensive study is needed to unravel the complexities.

The exploratory investigator should have an active curiosity and willingness to deviate from the initial plan, when the finding suggests a new course of enquiry, which might prove more productive. With the help of case study method, the risk can be minimized in any decision-making process.

Business Ethics

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• What is Ethics?
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• What is Corporate Governance?
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• What is Risk Register?
• Risk Management Committee

Corporate social responsibility (CSR)

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• What is Corporate Ethics?

Lean Six Sigma

• What is Six Sigma?
• What is Lean Six Sigma?
• Value and Waste in Lean Six Sigma
• Six Sigma Team
• MAIC Six Sigma
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• What is Binomial, Poisson, Normal Distribution?
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• Gage Repeatability and Reproducibility
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• Failure Modes and Effects Analysis (FMEA)
• What is Process Audits?
• Six Sigma Implementation at Ford
• IBM Uses Six Sigma to Drive Behaviour Change
• Research Methodology
• What is Research?

What is Hypothesis?

• Sampling Method
• Data Collection in Research
• Methods of Collecting Data
• Application of Business Research
• Levels of Measurement
• What is Sampling?

Hypothesis Testing

• Research Report
• What is Management?
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• Centralization vs Decentralization
• Organizing in Management
• Schools of Management Thought
• Classical Management Approach
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• Who is a Manager?

Operations Research

• What is Operations Research?
• Operation Research Models
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• Linear Programming Simplex Method
• Linear Programming Artificial Variable Technique
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Operation Management

• What is Strategy?
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• What is Supply Chain Mapping?
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• Re-engineering Improvement in SCM
• What is Supply Chain Drivers?
• Supply Chain Operations Reference (SCOR) Model
• Customer Service and Cost Trade Off
• Internal and External Performance Measures
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• Netflix’s Niche Focused Strategy
• Disney and Pixar Merger
• Process Planning at Mcdonald’s

Service Operations Management

• What is Service?
• What is Service Operations Management?
• What is Service Design?
• Service Design Process
• Service Delivery
• What is Service Quality?
• Gap Model of Service Quality
• Juran Trilogy
• Service Performance Measurement
• Service Decoupling
• IT Service Operation
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Procurement Management

• What is Procurement Management?
• Procurement Negotiation
• Types of Requisition
• RFX in Procurement
• What is Purchasing Cycle?
• Vendor Managed Inventory
• Internal Conflict During Purchasing Operation
• Spend Analysis in Procurement
• Sourcing in Procurement
• Supplier Evaluation and Selection in Procurement
• Blacklisting of Suppliers in Procurement
• Total Cost of Ownership in Procurement
• Incoterms in Procurement
• Documents Used in International Procurement
• Transportation and Logistics Strategy
• What is Capital Equipment?
• Procurement Process of Capital Equipment
• Acquisition of Technology in Procurement
• What is E-Procurement?
• E-marketplace and Online Catalogues
• Fixed Price and Cost Reimbursement Contracts
• Contract Cancellation in Procurement
• Ethics in Procurement
• Legal Aspects of Procurement
• Global Sourcing in Procurement
• Intermediaries and Countertrade in Procurement

Strategic Management

• What is Strategic Management?
• What is Value Chain Analysis?
• Mission Statement
• Business Level Strategy
• What is SWOT Analysis?
• What is Competitive Advantage?
• What is Vision?
• What is Ansoff Matrix?
• Prahalad and Gary Hammel
• Strategic Management In Global Environment
• Competitor Analysis Framework
• Competitive Rivalry Analysis
• Competitive Dynamics
• What is Competitive Rivalry?
• Five Competitive Forces That Shape Strategy
• What is PESTLE Analysis?
• Fragmentation and Consolidation Of Industries
• What is Technology Life Cycle?
• What is Diversification Strategy?
• What is Corporate Restructuring Strategy?
• Resources and Capabilities of Organization
• Role of Leaders In Functional-Level Strategic Management
• Functional Structure In Functional Level Strategy Formulation
• Information And Control System
• What is Strategy Gap Analysis?
• Issues In Strategy Implementation
• Matrix Organizational Structure
• What is Strategic Management Process?

Supply Chain

• What is Supply Chain Management?
• Supply Chain Planning and Measuring Strategy Performance
• What is Warehousing?
• What is Packaging?
• What is Inventory Management?
• What is Material Handling?
• What is Order Picking?
• Receiving and Dispatch, Processes
• What is Warehouse Design?
• What is Warehousing Costs?

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Qualitative research method-interviewing and observation

Shazia jamshed.

Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan Campus, Pahang, Malaysia

Buckley and Chiang define research methodology as “a strategy or architectural design by which the researcher maps out an approach to problem-finding or problem-solving.”[ 1 ] According to Crotty, research methodology is a comprehensive strategy ‘that silhouettes our choice and use of specific methods relating them to the anticipated outcomes,[ 2 ] but the choice of research methodology is based upon the type and features of the research problem.[ 3 ] According to Johnson et al . mixed method research is “a class of research where the researcher mixes or combines quantitative and qualitative research techniques, methods, approaches, theories and or language into a single study.[ 4 ] In order to have diverse opinions and views, qualitative findings need to be supplemented with quantitative results.[ 5 ] Therefore, these research methodologies are considered to be complementary to each other rather than incompatible to each other.[ 6 ]

Qualitative research methodology is considered to be suitable when the researcher or the investigator either investigates new field of study or intends to ascertain and theorize prominent issues.[ 6 , 7 ] There are many qualitative methods which are developed to have an in depth and extensive understanding of the issues by means of their textual interpretation and the most common types are interviewing and observation.[ 7 ]

Interviewing

This is the most common format of data collection in qualitative research. According to Oakley, qualitative interview is a type of framework in which the practices and standards be not only recorded, but also achieved, challenged and as well as reinforced.[ 8 ] As no research interview lacks structure[ 9 ] most of the qualitative research interviews are either semi-structured, lightly structured or in-depth.[ 9 ] Unstructured interviews are generally suggested in conducting long-term field work and allow respondents to let them express in their own ways and pace, with minimal hold on respondents’ responses.[ 10 ]

Pioneers of ethnography developed the use of unstructured interviews with local key informants that is., by collecting the data through observation and record field notes as well as to involve themselves with study participants. To be precise, unstructured interview resembles a conversation more than an interview and is always thought to be a “controlled conversation,” which is skewed towards the interests of the interviewer.[ 11 ] Non-directive interviews, form of unstructured interviews are aimed to gather in-depth information and usually do not have pre-planned set of questions.[ 11 ] Another type of the unstructured interview is the focused interview in which the interviewer is well aware of the respondent and in times of deviating away from the main issue the interviewer generally refocuses the respondent towards key subject.[ 11 ] Another type of the unstructured interview is an informal, conversational interview, based on unplanned set of questions that are generated instantaneously during the interview.[ 11 ]

In contrast, semi-structured interviews are those in-depth interviews where the respondents have to answer preset open-ended questions and thus are widely employed by different healthcare professionals in their research. Semi-structured, in-depth interviews are utilized extensively as interviewing format possibly with an individual or sometimes even with a group.[ 6 ] These types of interviews are conducted once only, with an individual or with a group and generally cover the duration of 30 min to more than an hour.[ 12 ] Semi-structured interviews are based on semi-structured interview guide, which is a schematic presentation of questions or topics and need to be explored by the interviewer.[ 12 ] To achieve optimum use of interview time, interview guides serve the useful purpose of exploring many respondents more systematically and comprehensively as well as to keep the interview focused on the desired line of action.[ 12 ] The questions in the interview guide comprise of the core question and many associated questions related to the central question, which in turn, improve further through pilot testing of the interview guide.[ 7 ] In order to have the interview data captured more effectively, recording of the interviews is considered an appropriate choice but sometimes a matter of controversy among the researcher and the respondent. Hand written notes during the interview are relatively unreliable, and the researcher might miss some key points. The recording of the interview makes it easier for the researcher to focus on the interview content and the verbal prompts and thus enables the transcriptionist to generate “verbatim transcript” of the interview.

Similarly, in focus groups, invited groups of people are interviewed in a discussion setting in the presence of the session moderator and generally these discussions last for 90 min.[ 7 ] Like every research technique having its own merits and demerits, group discussions have some intrinsic worth of expressing the opinions openly by the participants. On the contrary in these types of discussion settings, limited issues can be focused, and this may lead to the generation of fewer initiatives and suggestions about research topic.

Observation

Observation is a type of qualitative research method which not only included participant's observation, but also covered ethnography and research work in the field. In the observational research design, multiple study sites are involved. Observational data can be integrated as auxiliary or confirmatory research.[ 11 ]

Research can be visualized and perceived as painstaking methodical efforts to examine, investigate as well as restructure the realities, theories and applications. Research methods reflect the approach to tackling the research problem. Depending upon the need, research method could be either an amalgam of both qualitative and quantitative or qualitative or quantitative independently. By adopting qualitative methodology, a prospective researcher is going to fine-tune the pre-conceived notions as well as extrapolate the thought process, analyzing and estimating the issues from an in-depth perspective. This could be carried out by one-to-one interviews or as issue-directed discussions. Observational methods are, sometimes, supplemental means for corroborating research findings.

Case Study vs. Survey: What's the Difference?

Key Differences

Comparison chart, methodology, generalizability, case study and survey definitions, what is the purpose of a case study, what is a case study, can case studies be generalized, can case studies be biased, are case studies credible, how is data collected in a case study, how long does a case study take, what is a survey, are case studies qualitative or quantitative, what fields use case studies, are surveys qualitative or quantitative, how are survey results analyzed, what challenges are associated with surveys, can surveys predict behavior, what makes a good case study, what types of surveys exist, what is a good response rate for a survey, what is the purpose of a survey, can surveys be biased, how are surveys conducted.

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• Published: 05 October 2018

Interviews and focus groups in qualitative research: an update for the digital age

• P. Gill 1 &
• J. Baillie 2  

British Dental Journal volume  225 ,  pages 668–672 ( 2018 ) Cite this article

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Highlights that qualitative research is used increasingly in dentistry. Interviews and focus groups remain the most common qualitative methods of data collection.

Suggests the advent of digital technologies has transformed how qualitative research can now be undertaken.

Suggests interviews and focus groups can offer significant, meaningful insight into participants' experiences, beliefs and perspectives, which can help to inform developments in dental practice.

Qualitative research is used increasingly in dentistry, due to its potential to provide meaningful, in-depth insights into participants' experiences, perspectives, beliefs and behaviours. These insights can subsequently help to inform developments in dental practice and further related research. The most common methods of data collection used in qualitative research are interviews and focus groups. While these are primarily conducted face-to-face, the ongoing evolution of digital technologies, such as video chat and online forums, has further transformed these methods of data collection. This paper therefore discusses interviews and focus groups in detail, outlines how they can be used in practice, how digital technologies can further inform the data collection process, and what these methods can offer dentistry.

You have full access to this article via your institution.

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Interviews in the social sciences

Professionalism in dentistry: deconstructing common terminology

A review of technical and quality assessment considerations of audio-visual and web-conferencing focus groups in qualitative health research, introduction.

Traditionally, research in dentistry has primarily been quantitative in nature. 1 However, in recent years, there has been a growing interest in qualitative research within the profession, due to its potential to further inform developments in practice, policy, education and training. Consequently, in 2008, the British Dental Journal (BDJ) published a four paper qualitative research series, 2 , 3 , 4 , 5 to help increase awareness and understanding of this particular methodological approach.

Since the papers were originally published, two scoping reviews have demonstrated the ongoing proliferation in the use of qualitative research within the field of oral healthcare. 1 , 6 To date, the original four paper series continue to be well cited and two of the main papers remain widely accessed among the BDJ readership. 2 , 3 The potential value of well-conducted qualitative research to evidence-based practice is now also widely recognised by service providers, policy makers, funding bodies and those who commission, support and use healthcare research.

Besides increasing standalone use, qualitative methods are now also routinely incorporated into larger mixed method study designs, such as clinical trials, as they can offer additional, meaningful insights into complex problems that simply could not be provided by quantitative methods alone. Qualitative methods can also be used to further facilitate in-depth understanding of important aspects of clinical trial processes, such as recruitment. For example, Ellis et al . investigated why edentulous older patients, dissatisfied with conventional dentures, decline implant treatment, despite its established efficacy, and frequently refuse to participate in related randomised clinical trials, even when financial constraints are removed. 7 Through the use of focus groups in Canada and the UK, the authors found that fears of pain and potential complications, along with perceived embarrassment, exacerbated by age, are common reasons why older patients typically refuse dental implants. 7

The last decade has also seen further developments in qualitative research, due to the ongoing evolution of digital technologies. These developments have transformed how researchers can access and share information, communicate and collaborate, recruit and engage participants, collect and analyse data and disseminate and translate research findings. 8 Where appropriate, such technologies are therefore capable of extending and enhancing how qualitative research is undertaken. 9 For example, it is now possible to collect qualitative data via instant messaging, email or online/video chat, using appropriate online platforms.

These innovative approaches to research are therefore cost-effective, convenient, reduce geographical constraints and are often useful for accessing 'hard to reach' participants (for example, those who are immobile or socially isolated). 8 , 9 However, digital technologies are still relatively new and constantly evolving and therefore present a variety of pragmatic and methodological challenges. Furthermore, given their very nature, their use in many qualitative studies and/or with certain participant groups may be inappropriate and should therefore always be carefully considered. While it is beyond the scope of this paper to provide a detailed explication regarding the use of digital technologies in qualitative research, insight is provided into how such technologies can be used to facilitate the data collection process in interviews and focus groups.

In light of such developments, it is perhaps therefore timely to update the main paper 3 of the original BDJ series. As with the previous publications, this paper has been purposely written in an accessible style, to enhance readability, particularly for those who are new to qualitative research. While the focus remains on the most common qualitative methods of data collection – interviews and focus groups – appropriate revisions have been made to provide a novel perspective, and should therefore be helpful to those who would like to know more about qualitative research. This paper specifically focuses on undertaking qualitative research with adult participants only.

Overview of qualitative research

Qualitative research is an approach that focuses on people and their experiences, behaviours and opinions. 10 , 11 The qualitative researcher seeks to answer questions of 'how' and 'why', providing detailed insight and understanding, 11 which quantitative methods cannot reach. 12 Within qualitative research, there are distinct methodologies influencing how the researcher approaches the research question, data collection and data analysis. 13 For example, phenomenological studies focus on the lived experience of individuals, explored through their description of the phenomenon. Ethnographic studies explore the culture of a group and typically involve the use of multiple methods to uncover the issues. 14

While methodology is the 'thinking tool', the methods are the 'doing tools'; 13 the ways in which data are collected and analysed. There are multiple qualitative data collection methods, including interviews, focus groups, observations, documentary analysis, participant diaries, photography and videography. Two of the most commonly used qualitative methods are interviews and focus groups, which are explored in this article. The data generated through these methods can be analysed in one of many ways, according to the methodological approach chosen. A common approach is thematic data analysis, involving the identification of themes and subthemes across the data set. Further information on approaches to qualitative data analysis has been discussed elsewhere. 1

Qualitative research is an evolving and adaptable approach, used by different disciplines for different purposes. Traditionally, qualitative data, specifically interviews, focus groups and observations, have been collected face-to-face with participants. In more recent years, digital technologies have contributed to the ongoing evolution of qualitative research. Digital technologies offer researchers different ways of recruiting participants and collecting data, and offer participants opportunities to be involved in research that is not necessarily face-to-face.

Research interviews are a fundamental qualitative research method 15 and are utilised across methodological approaches. Interviews enable the researcher to learn in depth about the perspectives, experiences, beliefs and motivations of the participant. 3 , 16 Examples include, exploring patients' perspectives of fear/anxiety triggers in dental treatment, 17 patients' experiences of oral health and diabetes, 18 and dental students' motivations for their choice of career. 19

Interviews may be structured, semi-structured or unstructured, 3 according to the purpose of the study, with less structured interviews facilitating a more in depth and flexible interviewing approach. 20 Structured interviews are similar to verbal questionnaires and are used if the researcher requires clarification on a topic; however they produce less in-depth data about a participant's experience. 3 Unstructured interviews may be used when little is known about a topic and involves the researcher asking an opening question; 3 the participant then leads the discussion. 20 Semi-structured interviews are commonly used in healthcare research, enabling the researcher to ask predetermined questions, 20 while ensuring the participant discusses issues they feel are important.

Interviews can be undertaken face-to-face or using digital methods when the researcher and participant are in different locations. Audio-recording the interview, with the consent of the participant, is essential for all interviews regardless of the medium as it enables accurate transcription; the process of turning the audio file into a word-for-word transcript. This transcript is the data, which the researcher then analyses according to the chosen approach.

Types of interview

Qualitative studies often utilise one-to-one, face-to-face interviews with research participants. This involves arranging a mutually convenient time and place to meet the participant, signing a consent form and audio-recording the interview. However, digital technologies have expanded the potential for interviews in research, enabling individuals to participate in qualitative research regardless of location.

Telephone interviews can be a useful alternative to face-to-face interviews and are commonly used in qualitative research. They enable participants from different geographical areas to participate and may be less onerous for participants than meeting a researcher in person. 15 A qualitative study explored patients' perspectives of dental implants and utilised telephone interviews due to the quality of the data that could be yielded. 21 The researcher needs to consider how they will audio record the interview, which can be facilitated by purchasing a recorder that connects directly to the telephone. One potential disadvantage of telephone interviews is the inability of the interviewer and researcher to see each other. This is resolved using software for audio and video calls online – such as Skype – to conduct interviews with participants in qualitative studies. Advantages of this approach include being able to see the participant if video calls are used, enabling observation of non-verbal communication, and the software can be free to use. However, participants are required to have a device and internet connection, as well as being computer literate, potentially limiting who can participate in the study. One qualitative study explored the role of dental hygienists in reducing oral health disparities in Canada. 22 The researcher conducted interviews using Skype, which enabled dental hygienists from across Canada to be interviewed within the research budget, accommodating the participants' schedules. 22

A less commonly used approach to qualitative interviews is the use of social virtual worlds. A qualitative study accessed a social virtual world – Second Life – to explore the health literacy skills of individuals who use social virtual worlds to access health information. 23 The researcher created an avatar and interview room, and undertook interviews with participants using voice and text methods. 23 This approach to recruitment and data collection enables individuals from diverse geographical locations to participate, while remaining anonymous if they wish. Furthermore, for interviews conducted using text methods, transcription of the interview is not required as the researcher can save the written conversation with the participant, with the participant's consent. However, the researcher and participant need to be familiar with how the social virtual world works to engage in an interview this way.

Conducting an interview

Ensuring informed consent before any interview is a fundamental aspect of the research process. Participants in research must be afforded autonomy and respect; consent should be informed and voluntary. 24 Individuals should have the opportunity to read an information sheet about the study, ask questions, understand how their data will be stored and used, and know that they are free to withdraw at any point without reprisal. The qualitative researcher should take written consent before undertaking the interview. In a face-to-face interview, this is straightforward: the researcher and participant both sign copies of the consent form, keeping one each. However, this approach is less straightforward when the researcher and participant do not meet in person. A recent protocol paper outlined an approach for taking consent for telephone interviews, which involved: audio recording the participant agreeing to each point on the consent form; the researcher signing the consent form and keeping a copy; and posting a copy to the participant. 25 This process could be replicated in other interview studies using digital methods.

There are advantages and disadvantages of using face-to-face and digital methods for research interviews. Ultimately, for both approaches, the quality of the interview is determined by the researcher. 16 Appropriate training and preparation are thus required. Healthcare professionals can use their interpersonal communication skills when undertaking a research interview, particularly questioning, listening and conversing. 3 However, the purpose of an interview is to gain information about the study topic, 26 rather than offering help and advice. 3 The researcher therefore needs to listen attentively to participants, enabling them to describe their experience without interruption. 3 The use of active listening skills also help to facilitate the interview. 14 Spradley outlined elements and strategies for research interviews, 27 which are a useful guide for qualitative researchers:

Greeting and explaining the project/interview

Asking descriptive (broad), structural (explore response to descriptive) and contrast (difference between) questions

Asymmetry between the researcher and participant talking

Expressing interest and cultural ignorance

Repeating, restating and incorporating the participant's words when asking questions

Creating hypothetical situations

Asking friendly questions

Knowing when to leave.

For semi-structured interviews, a topic guide (also called an interview schedule) is used to guide the content of the interview – an example of a topic guide is outlined in Box 1 . The topic guide, usually based on the research questions, existing literature and, for healthcare professionals, their clinical experience, is developed by the research team. The topic guide should include open ended questions that elicit in-depth information, and offer participants the opportunity to talk about issues important to them. This is vital in qualitative research where the researcher is interested in exploring the experiences and perspectives of participants. It can be useful for qualitative researchers to pilot the topic guide with the first participants, 10 to ensure the questions are relevant and understandable, and amending the questions if required.

Regardless of the medium of interview, the researcher must consider the setting of the interview. For face-to-face interviews, this could be in the participant's home, in an office or another mutually convenient location. A quiet location is preferable to promote confidentiality, enable the researcher and participant to concentrate on the conversation, and to facilitate accurate audio-recording of the interview. For interviews using digital methods the same principles apply: a quiet, private space where the researcher and participant feel comfortable and confident to participate in an interview.

Box 1: Example of a topic guide

Study focus: Parents' experiences of brushing their child's (aged 0–5) teeth

1. Can you tell me about your experience of cleaning your child's teeth?

How old was your child when you started cleaning their teeth?

Why did you start cleaning their teeth at that point?

How often do you brush their teeth?

What do you use to brush their teeth and why?

2. Could you explain how you find cleaning your child's teeth?

Do you find anything difficult?

What makes cleaning their teeth easier for you?

3. How has your experience of cleaning your child's teeth changed over time?

Has it become easier or harder?

Have you changed how often and how you clean their teeth? If so, why?

4. Could you describe how your child finds having their teeth cleaned?

What do they enjoy about having their teeth cleaned?

Is there anything they find upsetting about having their teeth cleaned?

5. Where do you look for information/advice about cleaning your child's teeth?

What did your health visitor tell you about cleaning your child's teeth? (If anything)

What has the dentist told you about caring for your child's teeth? (If visited)

Have any family members given you advice about how to clean your child's teeth? If so, what did they tell you? Did you follow their advice?

6. Is there anything else you would like to discuss about this?

Focus groups

A focus group is a moderated group discussion on a pre-defined topic, for research purposes. 28 , 29 While not aligned to a particular qualitative methodology (for example, grounded theory or phenomenology) as such, focus groups are used increasingly in healthcare research, as they are useful for exploring collective perspectives, attitudes, behaviours and experiences. Consequently, they can yield rich, in-depth data and illuminate agreement and inconsistencies 28 within and, where appropriate, between groups. Examples include public perceptions of dental implants and subsequent impact on help-seeking and decision making, 30 and general dental practitioners' views on patient safety in dentistry. 31

Focus groups can be used alone or in conjunction with other methods, such as interviews or observations, and can therefore help to confirm, extend or enrich understanding and provide alternative insights. 28 The social interaction between participants often results in lively discussion and can therefore facilitate the collection of rich, meaningful data. However, they are complex to organise and manage, due to the number of participants, and may also be inappropriate for exploring particularly sensitive issues that many participants may feel uncomfortable about discussing in a group environment.

Focus groups are primarily undertaken face-to-face but can now also be undertaken online, using appropriate technologies such as email, bulletin boards, online research communities, chat rooms, discussion forums, social media and video conferencing. 32 Using such technologies, data collection can also be synchronous (for example, online discussions in 'real time') or, unlike traditional face-to-face focus groups, asynchronous (for example, online/email discussions in 'non-real time'). While many of the fundamental principles of focus group research are the same, regardless of how they are conducted, a number of subtle nuances are associated with the online medium. 32 Some of which are discussed further in the following sections.

Focus group considerations

Some key considerations associated with face-to-face focus groups are: how many participants are required; should participants within each group know each other (or not) and how many focus groups are needed within a single study? These issues are much debated and there is no definitive answer. However, the number of focus groups required will largely depend on the topic area, the depth and breadth of data needed, the desired level of participation required 29 and the necessity (or not) for data saturation.

The optimum group size is around six to eight participants (excluding researchers) but can work effectively with between three and 14 participants. 3 If the group is too small, it may limit discussion, but if it is too large, it may become disorganised and difficult to manage. It is, however, prudent to over-recruit for a focus group by approximately two to three participants, to allow for potential non-attenders. For many researchers, particularly novice researchers, group size may also be informed by pragmatic considerations, such as the type of study, resources available and moderator experience. 28 Similar size and mix considerations exist for online focus groups. Typically, synchronous online focus groups will have around three to eight participants but, as the discussion does not happen simultaneously, asynchronous groups may have as many as 10–30 participants. 33

The topic area and potential group interaction should guide group composition considerations. Pre-existing groups, where participants know each other (for example, work colleagues) may be easier to recruit, have shared experiences and may enjoy a familiarity, which facilitates discussion and/or the ability to challenge each other courteously. 3 However, if there is a potential power imbalance within the group or if existing group norms and hierarchies may adversely affect the ability of participants to speak freely, then 'stranger groups' (that is, where participants do not already know each other) may be more appropriate. 34 , 35

Focus group management

Face-to-face focus groups should normally be conducted by two researchers; a moderator and an observer. 28 The moderator facilitates group discussion, while the observer typically monitors group dynamics, behaviours, non-verbal cues, seating arrangements and speaking order, which is essential for transcription and analysis. The same principles of informed consent, as discussed in the interview section, also apply to focus groups, regardless of medium. However, the consent process for online discussions will probably be managed somewhat differently. For example, while an appropriate participant information leaflet (and consent form) would still be required, the process is likely to be managed electronically (for example, via email) and would need to specifically address issues relating to technology (for example, anonymity and use, storage and access to online data). 32

The venue in which a face to face focus group is conducted should be of a suitable size, private, quiet, free from distractions and in a collectively convenient location. It should also be conducted at a time appropriate for participants, 28 as this is likely to promote attendance. As with interviews, the same ethical considerations apply (as discussed earlier). However, online focus groups may present additional ethical challenges associated with issues such as informed consent, appropriate access and secure data storage. Further guidance can be found elsewhere. 8 , 32

Before the focus group commences, the researchers should establish rapport with participants, as this will help to put them at ease and result in a more meaningful discussion. Consequently, researchers should introduce themselves, provide further clarity about the study and how the process will work in practice and outline the 'ground rules'. Ground rules are designed to assist, not hinder, group discussion and typically include: 3 , 28 , 29

Discussions within the group are confidential to the group

Only one person can speak at a time

All participants should have sufficient opportunity to contribute

There should be no unnecessary interruptions while someone is speaking

Everyone can be expected to be listened to and their views respected

Challenging contrary opinions is appropriate, but ridiculing is not.

Moderating a focus group requires considered management and good interpersonal skills to help guide the discussion and, where appropriate, keep it sufficiently focused. Avoid, therefore, participating, leading, expressing personal opinions or correcting participants' knowledge 3 , 28 as this may bias the process. A relaxed, interested demeanour will also help participants to feel comfortable and promote candid discourse. Moderators should also prevent the discussion being dominated by any one person, ensure differences of opinions are discussed fairly and, if required, encourage reticent participants to contribute. 3 Asking open questions, reflecting on significant issues, inviting further debate, probing responses accordingly, and seeking further clarification, as and where appropriate, will help to obtain sufficient depth and insight into the topic area.

Moderating online focus groups requires comparable skills, particularly if the discussion is synchronous, as the discussion may be dominated by those who can type proficiently. 36 It is therefore important that sufficient time and respect is accorded to those who may not be able to type as quickly. Asynchronous discussions are usually less problematic in this respect, as interactions are less instant. However, moderating an asynchronous discussion presents additional challenges, particularly if participants are geographically dispersed, as they may be online at different times. Consequently, the moderator will not always be present and the discussion may therefore need to occur over several days, which can be difficult to manage and facilitate and invariably requires considerable flexibility. 32 It is also worth recognising that establishing rapport with participants via online medium is often more challenging than via face-to-face and may therefore require additional time, skills, effort and consideration.

As with research interviews, focus groups should be guided by an appropriate interview schedule, as discussed earlier in the paper. For example, the schedule will usually be informed by the review of the literature and study aims, and will merely provide a topic guide to help inform subsequent discussions. To provide a verbatim account of the discussion, focus groups must be recorded, using an audio-recorder with a good quality multi-directional microphone. While videotaping is possible, some participants may find it obtrusive, 3 which may adversely affect group dynamics. The use (or not) of a video recorder, should therefore be carefully considered.

At the end of the focus group, a few minutes should be spent rounding up and reflecting on the discussion. 28 Depending on the topic area, it is possible that some participants may have revealed deeply personal issues and may therefore require further help and support, such as a constructive debrief or possibly even referral on to a relevant third party. It is also possible that some participants may feel that the discussion did not adequately reflect their views and, consequently, may no longer wish to be associated with the study. 28 Such occurrences are likely to be uncommon, but should they arise, it is important to further discuss any concerns and, if appropriate, offer them the opportunity to withdraw (including any data relating to them) from the study. Immediately after the discussion, researchers should compile notes regarding thoughts and ideas about the focus group, which can assist with data analysis and, if appropriate, any further data collection.

Qualitative research is increasingly being utilised within dental research to explore the experiences, perspectives, motivations and beliefs of participants. The contributions of qualitative research to evidence-based practice are increasingly being recognised, both as standalone research and as part of larger mixed-method studies, including clinical trials. Interviews and focus groups remain commonly used data collection methods in qualitative research, and with the advent of digital technologies, their utilisation continues to evolve. However, digital methods of qualitative data collection present additional methodological, ethical and practical considerations, but also potentially offer considerable flexibility to participants and researchers. Consequently, regardless of format, qualitative methods have significant potential to inform important areas of dental practice, policy and further related research.

Gussy M, Dickson-Swift V, Adams J . A scoping review of qualitative research in peer-reviewed dental publications. Int J Dent Hygiene 2013; 11 : 174–179.

Article   Google Scholar  

Burnard P, Gill P, Stewart K, Treasure E, Chadwick B . Analysing and presenting qualitative data. Br Dent J 2008; 204 : 429–432.

Gill P, Stewart K, Treasure E, Chadwick B . Methods of data collection in qualitative research: interviews and focus groups. Br Dent J 2008; 204 : 291–295.

Gill P, Stewart K, Treasure E, Chadwick B . Conducting qualitative interviews with school children in dental research. Br Dent J 2008; 204 : 371–374.

Stewart K, Gill P, Chadwick B, Treasure E . Qualitative research in dentistry. Br Dent J 2008; 204 : 235–239.

Masood M, Thaliath E, Bower E, Newton J . An appraisal of the quality of published qualitative dental research. Community Dent Oral Epidemiol 2011; 39 : 193–203.

Ellis J, Levine A, Bedos C et al. Refusal of implant supported mandibular overdentures by elderly patients. Gerodontology 2011; 28 : 62–68.

Macfarlane S, Bucknall T . Digital Technologies in Research. In Gerrish K, Lathlean J (editors) The Research Process in Nursing . 7th edition. pp. 71–86. Oxford: Wiley Blackwell; 2015.

Google Scholar  

Lee R, Fielding N, Blank G . Online Research Methods in the Social Sciences: An Editorial Introduction. In Fielding N, Lee R, Blank G (editors) The Sage Handbook of Online Research Methods . pp. 3–16. London: Sage Publications; 2016.

Creswell J . Qualitative inquiry and research design: Choosing among five designs . Thousand Oaks, CA: Sage, 1998.

Guest G, Namey E, Mitchell M . Qualitative research: Defining and designing In Guest G, Namey E, Mitchell M (editors) Collecting Qualitative Data: A Field Manual For Applied Research . pp. 1–40. London: Sage Publications, 2013.

Chapter   Google Scholar  

Pope C, Mays N . Qualitative research: Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. BMJ 1995; 311 : 42–45.

Giddings L, Grant B . A Trojan Horse for positivism? A critique of mixed methods research. Adv Nurs Sci 2007; 30 : 52–60.

Hammersley M, Atkinson P . Ethnography: Principles in Practice . London: Routledge, 1995.

Oltmann S . Qualitative interviews: A methodological discussion of the interviewer and respondent contexts Forum Qualitative Sozialforschung/Forum: Qualitative Social Research. 2016; 17 : Art. 15.

Patton M . Qualitative Research and Evaluation Methods . Thousand Oaks, CA: Sage, 2002.

Wang M, Vinall-Collier K, Csikar J, Douglas G . A qualitative study of patients' views of techniques to reduce dental anxiety. J Dent 2017; 66 : 45–51.

Lindenmeyer A, Bowyer V, Roscoe J, Dale J, Sutcliffe P . Oral health awareness and care preferences in patients with diabetes: a qualitative study. Fam Pract 2013; 30 : 113–118.

Gallagher J, Clarke W, Wilson N . Understanding the motivation: a qualitative study of dental students' choice of professional career. Eur J Dent Educ 2008; 12 : 89–98.

Tod A . Interviewing. In Gerrish K, Lacey A (editors) The Research Process in Nursing . Oxford: Blackwell Publishing, 2006.

Grey E, Harcourt D, O'Sullivan D, Buchanan H, Kipatrick N . A qualitative study of patients' motivations and expectations for dental implants. Br Dent J 2013; 214 : 10.1038/sj.bdj.2012.1178.

Farmer J, Peressini S, Lawrence H . Exploring the role of the dental hygienist in reducing oral health disparities in Canada: A qualitative study. Int J Dent Hygiene 2017; 10.1111/idh.12276.

McElhinney E, Cheater F, Kidd L . Undertaking qualitative health research in social virtual worlds. J Adv Nurs 2013; 70 : 1267–1275.

Health Research Authority. UK Policy Framework for Health and Social Care Research. Available at https://www.hra.nhs.uk/planning-and-improving-research/policies-standards-legislation/uk-policy-framework-health-social-care-research/ (accessed September 2017).

Baillie J, Gill P, Courtenay P . Knowledge, understanding and experiences of peritonitis among patients, and their families, undertaking peritoneal dialysis: A mixed methods study protocol. J Adv Nurs 2017; 10.1111/jan.13400.

Kvale S . Interviews . Thousand Oaks (CA): Sage, 1996.

Spradley J . The Ethnographic Interview . New York: Holt, Rinehart and Winston, 1979.

Goodman C, Evans C . Focus Groups. In Gerrish K, Lathlean J (editors) The Research Process in Nursing . pp. 401–412. Oxford: Wiley Blackwell, 2015.

Shaha M, Wenzell J, Hill E . Planning and conducting focus group research with nurses. Nurse Res 2011; 18 : 77–87.

Wang G, Gao X, Edward C . Public perception of dental implants: a qualitative study. J Dent 2015; 43 : 798–805.

Bailey E . Contemporary views of dental practitioners' on patient safety. Br Dent J 2015; 219 : 535–540.

Abrams K, Gaiser T . Online Focus Groups. In Field N, Lee R, Blank G (editors) The Sage Handbook of Online Research Methods . pp. 435–450. London: Sage Publications, 2016.

Poynter R . The Handbook of Online and Social Media Research . West Sussex: John Wiley & Sons, 2010.

Kevern J, Webb C . Focus groups as a tool for critical social research in nurse education. Nurse Educ Today 2001; 21 : 323–333.

Kitzinger J, Barbour R . Introduction: The Challenge and Promise of Focus Groups. In Barbour R S K J (editor) Developing Focus Group Research . pp. 1–20. London: Sage Publications, 1999.

Krueger R, Casey M . Focus Groups: A Practical Guide for Applied Research. 4th ed. Thousand Oaks, California: SAGE; 2009.

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Gill, P., Baillie, J. Interviews and focus groups in qualitative research: an update for the digital age. Br Dent J 225 , 668–672 (2018). https://doi.org/10.1038/sj.bdj.2018.815

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Published : 05 October 2018

Issue Date : 12 October 2018

DOI : https://doi.org/10.1038/sj.bdj.2018.815

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Generalized anxiety disorder (GAD) is a devastating mental health condition characterized by constant, uncontrolled worrying. Recent hypotheses indicate that pro-inflammatory cytokines and chemokines are potential contributors to the pathogenesis of GAD. Here, we aimed to assess the role of interleukin-2 (IL-2) and interleukin-10 (IL-10) in the pathophysiology and development of GAD.

This study recruited 50 GAD patients diagnosed according to the DSM-5 criteria and 38 age-sex-matched healthy controls (HCs). A qualified psychiatrist evaluated all study subjects. The socio-demographic and clinical characteristics of the study population were determined using pre-structured questionnaires or interviews, and cytokine serum levels were estimated using commercially available ELISA kits.

We observed reduced serum IL-10 levels in GAD patients compared to HCs (33.69 ± 1.37 pg/ml vs. 44.12 ± 3.16 pg/ml). Also, we observed a significant negative correlation between altered IL-10 levels and GAD-7 scores ( r =-0.315, p  = 0.039). Moreover, IL-10 serum measurement exhibited good predictive value in receiver operating characteristics (ROC) analysis with an area under the curve (AUC) value of 0.793 ( p  < 0.001) with 80.65% sensitivity and 62.79% specificity at a cutoff value of 33.93 pg/ml. Conversely, we noticed elevated serum IL-2 levels in GAD patients than in HCs (14.81 ± 2.88 pg/ml vs. 8.08 ± 1.1 pg/ml); however, it failed to maintain any significant association with GAD-7 scores, implying that IL-2 might not be involved in GAD pathogenesis. The lower AUC value (0.640; p  > 0.05) exhibited by IL-2 serum measurement in ROC analysis further supported that IL-2 might not be associated with GAD.

This study provides new insights into the complex interplay between anti-inflammatory cytokines and GAD pathogenesis. Based on the present findings, we can assume that IL-10 but not IL-2 may be associated with the pathophysiology and development of GAD. However, further research with a larger population size and longitudinal design is required to confirm the potential diagnostic efficacy of IL-10.

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Generalized anxiety disorder (GAD) is a chronic neuropsychiatric disorder characterized by persistent and excessive uncontrollable fear or worry (occurs for at least 6 months) about various aspects/activities of daily life, affecting the educational, occupational, or social lives of the affected people [ 1 ]. If a person is excessively worried about anything for most days over at least 6 months, he/she is considered to have GAD. Though currently the prevalence rate of GAD is 3–6% worldwide [ 1 , 2 , 3 ], the prevalence is increasing day by day due to the complexity of modern lifestyles and thus warrants attention from national and international authorities to take interventions for mitigating and managing this disorder properly. If it remains undiagnosed or untreated, the uncontrollable and persistently intense anxiety can lead to a marked reduction in cognitive functions or a reduced capacity to work properly in all spheres of life, including educational, family, social, and individual routine work. As such, chronic GAD leads to a reduced quality of life and thereby poses a significant mental health concern globally.

Despite its high prevalence, significant morbidity, and socioeconomic burden, GAD remains poorly characterized in terms of its pathophysiology or effective treatment options. Though the precise cause and mechanism of pathogenesis are still unknown, evidence suggests that multiple factors, including disrupted serotonergic, dopaminergic, and GABAergic neurotransmission and excessive glutamatergic neurotransmission in the brain, genetic factors, family or environmental stress, chronic diseases, hyperthyroidism, childhood trauma, and special personality traits, are linked to GAD. Alterations in monoaminergic neurotransmissions in limbic systems (cingulate gyrus, hippocampus, amygdala, thalamus, and hypothalamus) due to the lower synaptic availability of serotonin, norepinephrine, and dopamine are thought to be associated with anxiety symptoms. Besides, decreased GABA-mediated inhibitory neurotransmission in the amygdala or excessive activation of excitatory glutamatergic neurotransmission are also suggested to be involved in GAD pathology.

Currently, available pharmacotherapies for GAD include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), pregabalin, and benzodiazepines, which act by reversing these altered monoaminergic neurotransmitter systems. Alongside these drug treatments, non-pharmacological therapies such as several psychological interventions, including cognitive-behavioral therapy, and the acquisition and application of stress management skills, including relaxation and mindfulness skills are also widely used for the management of GAD. However, currently, available pharmacotherapies (SSRIs, SNRIs, pregabalin, and benzodiazepines) have failed to demonstrate the required efficacy in treating anxiety disorders, as 50% of patients failed to respond to these drugs, and at least in 30% of cases, there is a recurrence of the disease following the pharmacological treatment [ 1 , 4 , 5 ]. Moreover, studies reported a higher rate of discontinuity from these pharmacotherapies with low patient adherence or compliance due to the adverse effects, including sexual dysfunction for SSRIs and SNRIs, nausea and dizziness for pregabalin, demonstrating an urgent need for searching for novel anxiolytics [ 3 ]. These findings raised questions about the validity of the currently available mechanism of pathogenesis and suggested that the altered monoaminergic neurotransmitter system might not fully explain the molecular mechanism of GAD development, suggesting other pathophysiological factors might be involved in GAD. Recently, dysregulated immune systems have attracted great interest as an important pathophysiological factor for the development of GAD [ 4 , 6 , 7 , 8 ]. Several clinical and preclinical studies suggest a link between the altered immune system and GAD pathology. Preclinical studies in mice also demonstrated that administration of pro-inflammatory cytokines (including IL-1β, TNF-α, and IL-6) in mice resulted in anxiety-like behaviors that were attenuated or normalized after injecting either anti-inflammatory cytokines or antagonists for the concerned cytokines [ 9 , 10 , 11 , 12 , 13 ]. A recent prospective cohort study conducted by Hou et al., (2019) demonstrated that administration of selective serotonin reuptake inhibitors (escitalopram or sertraline) resulted in a significant reduction in peripheral pro-inflammatory cytokines, and the authors suggested that the anxiolytic effects of these SSRIs might partly be based on their acute anti-inflammatory activities [ 14 ], implicating a significant association between dysregulated peripheral immune systems and GAD development. The development of anxiety-like symptoms in IL-4 gene knock-out mice, reduced levels of IL-4 in anxious mice, and the significant attenuation of anxiety-like behaviors following IL-4 injection demonstrated a positive association between anti-inflammatory cytokines, IL-4 levels, and anxiety pathology [ 15 , 16 , 17 , 18 ]. This immune hypothesis of GAD development is further potentiated by findings from several clinical studies that reported that GAD patients showed significantly higher levels of pro-inflammatory cytokines ( IL-1Ra, IL-1, IL-6, TNF-α, etc.) compared to healthy controls (HCs) [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ] along with decreased levels of anti-inflammatory cytokines, including IL-4 and IL-10 [ 25 ]. Besides, pro-inflammatory cytokines such as TNF-α, and IL-6 were significantly associated with anxiety scores [ 29 ]. Consistent with this, a randomized clinical trial in humans demonstrated that LPS administration resulted in enhanced anxiety scores, and the authors suggested a significant correlation between pro-inflammatory cytokine levels and anxiety severity [ 30 ]. LPS-mediated microglia activation causes enhanced release of excessive pro-inflammatory cytokines in the basolateral amygdala, which ultimately leads to neuroinflammation in mice, resulting in the development of anxiety and depression-like behaviors by modulating neuronal plasticity. The authors found that anxiety pathogenesis was due to the excessive release of excitatory neurotransmitter glutamate from presynaptic axonal terminals of the prefrontal cortex, leading to neuroplasticity [ 31 ]. However, some studies reported either no significant variation in pro-inflammatory or anti-inflammatory cytokine serum levels between GAD patients and HCs [ 32 ] or that pro-inflammatory cytokines including IL-1, IL-2, and IL-6 were significantly reduced in GAD patients than HCs [ 33 , 34 ]. This discrepancy in altered levels of inflammatory cytokines across clinical studies necessitates a further examination of the role of these cytokines in GAD pathophysiology.

Interleukin-2 (IL-2) is one of the major pro-inflammatory cytokines implicated in T cell activation, proliferation, and differentiation and is thus linked to excessive neuro-inflammatory processes [ 35 ]. IL-2 has been shown to impair synaptic plasticity and cause neuroinflammation, which ultimately leads to neuronal damage in neurocircuits associated with fear and anxiety signal transduction. IL-2 was also reported to act as a potent modulator of NMDA and kainite-mediated excitability in mesolimbic or mesostriatal systems [ 36 , 37 , 38 ] and thus affect neuroplasticity. As IL-2 was found to be positively associated with major depressive disorder [ 38 , 39 ], probably, IL-2 might also be correlated with anxiety disorders like GAD, as MDD and GAD are highly co-morbid themselves and thus might share common pathophysiological factors. Recently, a preclinical study conducted by Gilio et al., (2022) observed that IL-2 administration in experimentally healthy mice triggered marked anxiety and depression-like behaviors, and the authors suggested that inhibition of GABA-mediated synaptic inhibitory neurotransmission was involved in the pathology of anxiety [ 40 ].

Interleukin-10 (IL-10) is one of the major anti-inflammatory cytokines that is secreted from Treg cells, Th2 cells, CD4 + T cells, CD8 + T cells, monocytes, macrophages, dendritic cells, B cells, neutrophils in the peripheral nervous system, and from microglia, astrocytes in the central nervous system (CNS) [ 41 ]. IL-10 signaling triggers anti-inflammatory, immunosuppressive, and immunoregulatory activities, including downregulating the production and secretion of pro-inflammatory cytokines and chemokines from activated macrophages, neutrophils, mast cells, Th1 cells, and DCS, decreasing the expression of MHC class II and co-stimulatory molecules on macrophages, and thereby suppressing the antigen presentation capacity of APCS [ 42 , 43 , 44 , 45 , 46 ]. In the CNS, it inhibits the production of such cytokines and chemokines by activated microglia and thereby counteracts cellular and tissue damage in response to excessive neuroinflammation [ 47 , 48 ]. IL-10 has also been shown to stimulate axonal regeneration and activate wound healing through tissue repair [ 48 ]. Research also indicates its role as an inhibitor for microglial hyperactivation in response to LPS-induced inflammatory stimulus [ 49 ]. Based on its anti-inflammatory and immunoregulatory functions, researchers suggested an intricate role for IL-10 in several auto-immune and neuropsychiatric disorders. For example, Mesquita et al., (2008) observed that IL-10 KO mice developed markedly enhanced depressive-like behavior, which was attenuated after IL-10 administration, and that overexpression of IL-10 resulted in reduced depressive behaviors in mice [ 50 ]. Moreover, administration of IL-10 into rats attenuated the pro-inflammatory cytokine IL-1β-induced anxiety-like symptoms in male rats [ 10 ], demonstrating that IL-10 possesses anxiolytic activities. Preclinical research using an experimental animal model also suggests that the observed anxiolytic effect of several anti-anxiety drugs, including 3’-deoxyadenosine (3’-dA), imipramine, fluoxetine, and chlordiazepoxide, stems from their ability to upregulate anti-inflammatory cytokine (IL-4, IL-10) expression in the prefrontal cortex and locus coeruleus and simultaneous down-regulation of proinflammatory cytokine gene expression, leading to a correction of the imbalance between proinflammatory and anti-inflammatory states [ 51 , 52 ]. Though several preclinical studies suggest a potential link between IL-10 levels and anxiety disorder, there is a scarcity of clinical studies aimed at evaluating such an association between IL-10 and GAD development [ 10 ].

Currently, there is no objective and cost-effective diagnostic or prognostic biomarker for GAD, which poses challenges in early diagnosis or risk prediction and leads to misdiagnosis or underdiagnosis, hampering the proper management of the disease. Currently available diagnostic tools, including self-reported symptoms and scoring severity based on the patient’s response to the 7-item questionnaire (GAD-7 scores), are subjective. Though neuroimaging techniques such as positron emission tomography (PET) and functional MRI can be used for the proper and objective diagnosis of GAD, due to their high cost and sophistication or complexities, these diagnostic tools are not suitable for either mass-level screening or are not easy to conduct multiple times to monitor the disease progression or therapeutic drug response. As such, the investigation of cost-effective objective biomarkers for GAD is one of the major focuses of current research on GAD. Finding a suitable biomarker is essential for early diagnosis and initiating psychotherapy and pharmacotherapy as early as possible [ 3 ]. Several studies were performed investigating the potential association between altered pro-inflammatory cytokines or anti-inflammatory cytokines and the pathogenesis of GAD. However, the actual role of inflammatory cytokines in GAD patients is not well explained. Therefore, the present study aims to explore the role of pro-inflammatory cytokines (IL-2) and anti-inflammatory cytokines (IL-10) in the pathophysiology and development of GAD. Also, we aim to find the potential associations of IL-2 and IL-10 with the severity of GAD patients. We believe the present study results would help to understand the pathophysiology and development of GAD.

Study population

We recruited 88 participants for this case-control study (50 GAD patients and 38 HCs matched by age and sex). Patients were collected from the Department of Psychiatry, Bangabandhu Sheikh Mujib Medical University Hospital, Dhaka, Bangladesh, and HCs from nearby areas of Dhaka city. A professional psychiatrist diagnosed patients and evaluated HCs based on DSM-5 criteria. We applied a 7-item GAD scale to assess the severity of anxiety symptoms [ 53 ]. The total scores range from 0 to 21, and it classifies the anxiety severity into four categories: minimal anxiety (0–4 scores), mild anxiety (5–9 scores), moderate anxiety (10–14 scores), and severe anxiety (15–21 scores). We excluded subjects with a co-morbidity of other psychiatric disorders, such as MDD, panic disorder, post-traumatic stress disorder, and social phobia, from the study. Additional exclusion criteria for participants were chronic liver and kidney diseases, infectious diseases, and alcohol or substance abuse. We also excluded patients who were exposed to anxiolytics or antidepressant medications within at least two weeks prior to the study that might have an impact on cytokine levels. We recorded the sociodemographic profile of the study population using a pre-designed questionnaire. The objectives of the study were explained to each participant, and informed written consent was obtained from them before their participation in this study. The study was conducted in accordance with the Declaration of Helsinki.

Blood sample collection and serum isolation

A 5 ml blood sample was collected from the cephalic vein of each participant. The blood samples were kept at room temperature for 1 hour to ensure coagulation and were then subjected to centrifugation at 3000 rpm for 15 minutes at room temperature to collect serum samples. The collected serum was then placed in the Eppendorf tube and stored at -80 °C until further analysis.

Estimation of serum cytokine levels

We estimated the serum levels of IL-2 and IL-10 by ELISA methods (Boster Bio, USA). We followed the manufacturer’s protocol for the ELISA assays. At first, we added 100 µl of standard cytokine solution, samples, and controls to each well of a pre-coated 96-well microplate. The microplates were covered with a plate sealer and incubated for 90 min at 37⁰C. After that, the cover was removed, and the liquid in each well was discarded. Subsequently, 100 µl of biotinylated anti-IL-2 antibody or anti-IL-10 antibody was incorporated into each well and incubated for 60 min at 37⁰C. After discarding the liquid from each well and washing it three times with 300 µl of wash buffer, 100 µl of avidin-biotin-peroxidase complex was added to each well, and the microplate was then again incubated for 30 min at 37⁰C. After the incubation period, the liquid was again discarded, and the plate was washed again with 300 µl of wash buffer five times. Following the addition of 90 µl color-developing reagent (TMB) into each well, the plate was incubated in a dark place for 30 min at RT, followed by the addition of 90 µl of stop solution to each well to stop the reaction process. We measured the absorbance with a microplate reader at 450 nm. We calculated the cytokine levels using standard curves and expressed them as pg/ml.

Data presentation and statistical analysis

GraphPad Prism (version 8.0.1) and Statistical Package for the Social Sciences (version 24.0) were used for data analysis. We used descriptive statistics to find the variations in sociodemographic profiles and clinical characteristics between the groups. A T-test and a Chi-square test were employed to determine the statistical level of significance between the mean differences for variables across patients versus HC groups in the case of continuous variables and categorical variables, respectively. We used boxplot graphs for comparisons of analyzed cytokines between patients and HCs. We also generated scatter plot graphs for several clinical variables in GAD patients to show the correlations among the clinical parameters. A correlation analysis was performed to assess the potential association between several demographic and clinical variables in GAD patients. Receiver operating characteristics (ROC) analysis was conducted to determine the diagnostic efficacy of serum IL-2 or IL-10 levels in discriminating GAD patients from HCs. In all cases, statistical significance was considered at p  < 0.05.

Sociodemographic characteristics of the study population

The sociodemographic characteristics of the study population are presented in Table  1 . The GAD patients and HCs were similar in terms of their age, sex, and BMI. Among the participants, about 60% were male and from urban areas. The majority of patients (60.00%) and HCs (68.42%) were unmarried. There was no significant variation between patients and HCs for their education level, occupation, economic status, or smoking status. In contrast, there was a difference between patients and HCs for their family history and previous history of the disease. In GAD patients, 20.00% had a family history, and 40.00% had a previous history of the disease.

Clinical characteristics and laboratory findings

Clinical characteristics and laboratory analysis results are presented in Table  2 . GAD patients displayed markedly higher serum levels of IL-2 (14.81 ± 2.88 pg/ml) compared to HCs (8.08 ± 1.10 pg/ml), and the difference reached the statistically significant level ( p  = 0.037, two-tailed unpaired t-test) (Table  2 ; Fig.  1 ). Though male GAD patients exhibited markedly higher levels of IL-2 compared to male HCs ( p  = 0.048), there was no significant variation in IL-2 levels between female patients and female HCs ( p  > 0.05) (Fig.  1 ). Though some 1.8-fold higher IL-2 serum levels were observed in male GAD patients compared to female GAD patients, the difference did not reach the statistical significance level ( p  = 0.198, two-tailed unpaired t-test). In contrast to the results obtained for IL-2, IL-10 showed a statistically significant ( p  < 0.001) reduction in GAD patients (33.69 ± 1.37 pg/ml) compared to HCs (44.12 ± 3.16 pg/ml) (Fig.  1 ). Similar to the results obtained for IL-2, IL-10 levels showed a statistically significant difference between patients versus HCs when male people were considered (Fig.  1 ). In contrast, there was no significant variation in IL-10 levels between female GAD patients and female HCs ( p  > 0.05).

Distribution of serum IL-2 ( a i ) and IL-10 ( b i ) levels in GAD patients and healthy controls. Comparison of IL-2 and IL-10 levels between GAD patients and their counterparts in control subjects are showed in a i and b i . Comparison of IL-2 and IL-10 levels between male or female GAD patients and their counterparts in control subjects are presented in a ii and b ii

Correlation analysis among different study parameters

We then performed a series of correlation analyses to investigate the association of altered cytokine serum levels with several demographic and clinical variables, such as age, BMI, DSM-5, and GAD-7 scores (Table  3 ). Serum IL-2 levels did not show any positive or negative association with either DSM-5 or GAD-7 scores ( p  > 0.05), suggesting that despite its significant enhancement in GAD patients compared to HCs, IL-2 may not associate with GAD pathophysiology. We also observed no significant association between the ages of the patients and IL-2 serum levels. In contrast, the IL-2 levels of GAD patients maintained a significant and positive correlation with BMI levels of patients ( r  = 0.390, p  < 0.05) which is consistent with the intricate relationship between body mass and enhanced pro-inflammatory responses. Contrary to the results obtained for IL-2, reduced serum IL-10 levels maintained a significant but negative association with both DSM-5 scores ( r =-0.300, p  = 0.045) and GAD-7 scores ( r =-0.315, p  = 0.039), implicating that altered IL-10 levels are linked to GAD development or pathogenesis. However, the age and BMI levels of GAD patients failed to show any positive or negative association with IL-10 serum levels. Analysis also showed a significant and strong positive association between IL-2 and IL-10 serum levels ( r  = 0.471, p  = 0.011) in GAD patients, which might be due to the compensatory enhancement of anti-inflammatory cytokine, IL-10 in response to elevated pro-inflammatory cytokine, IL-2 levels. Also, we displayed these correlations among several clinical variables of GAD patients by scatter plot graphs (Fig.  2 ).

Scatter plot graphs for several clinical variables of GAD patients showing existence or absence of correlation between the clinical parameters. Scatter plot for serum IL-2 levels versus GAD-7 scores ( a ) or DSM-5 scores ( b ) expressing no significant association between IL-2 and both clinical parameters. Scatter plot graphs showing significant association between IL-2 levels and BMI ( c ), IL-10 levels and GAD-7 scores ( d ), IL-10 levels and DSM-5 scores and IL-10 and IL-2 levels ( f )

Receiver operating characteristic curve analysis

Serum IL-10 measurement showed a good performance in differentiating GAD patients from HCs, which was evidenced by its significantly higher area under the curve (AUC) value of 0.793 ( p  < 0.001) with 80.65% sensitivity and 62.79% specificity at a cut-off value of 33.93 pg/ml, in which the cytokine levels below this point indicate disease states (Table  4 ; Fig.  3 ). ROC analysis of serum IL-2 levels failed to discriminate GAD patients from HCs as the AUC value was below the acceptable range (AUC: 0.640; p  = 0.108) with 54.17% sensitivity and 68.18% specificity at a cut-off value of 8.83 pg/ml) (Fig.  3 ; Table  4 ).

Receiver operating characteristic curve (ROC) for serum IL-2 ( a ) and IL-10 levels ( b )

To the best of our knowledge, this is the first case-control study to investigate the potential association between the pathophysiology of GAD and the pro-inflammatory cytokine, IL-2, and the anti-inflammatory cytokine, IL-10, among the Bangladeshi population. We observed that IL-10 serum levels were significantly lower in GAD patients than in HCs, and this reduction was found to be significantly but negatively associated with both DSM-5 scores and GAD-7 scores, demonstrating potential involvement of this anti-inflammatory cytokine in disease severity and symptoms. Our results of a significant reduction in IL-10 levels in GAD patients are in good agreement with those observed in other studies [ 23 , 25 ]. In contrast, our results diverge from those reported by others [ 33 , 54 ] who either reported no significant variation in IL-10 levels between GAD patients and HCs or that IL-10 levels were enhanced in GAD patients compared to HCs. ROC analysis also demonstrated the good predictive value of IL-10 serum measurement in discriminating diseased patients from HCs, suggesting that IL-10 serum level might be a potential biomarker for diagnosis, anti-anxiety drug response monitoring, or disease progression monitoring. Recently, Hou et al. (2019) demonstrated that peripheral serum levels of the pro-inflammatory cytokine IL-6 could be used to monitor the treatment response of SSRIs in GAD [ 14 ]. Similarly, IL-10 might be used as a marker for therapeutic drug monitoring in GAD. However, further longitudinal studies are required to find any causal relationship between IL-10 and disease severity or pathogenesis. On the other hand, serum IL-2 levels were significantly elevated in GAD patients compared to HCs, but they failed to demonstrate any significant association with either DSM-5 scores or GAD-7 scores in Pearson correlation analysis, implying that IL-2 levels might not be associated with the pathophysiology and development of GAD. Consistent with this, ROC analysis showed that IL-2 levels have no significant diagnostic efficacy in differentiating GAD patients from HCs. Further analysis with a larger population size is required to explore the role of IL-2 in the context of GAD severity. Our results are consistent with those reported by Tang et al. (2018), who also observed that GAD patients exhibited significantly higher serum levels of IL-2 compared to HCs [ 19 ]. However, our results are not in agreement with those reported by others who observed either no significant variation in IL-2 levels [ 54 ] or a significant reduction in GAD patients compared to HCs [ 25 , 33 , 34 , 55 ]. We also observed a significant positive correlation between IL-2 and IL-10 levels in GAD patients, which indicates a compensatory mechanism [ 56 ].

Our study provides some valuable insights into the complex and intricate relationship between the dysregulated immune system and GAD. The observed reduction in IL-10 levels in GAD patients in our study suggests a potential immunoregulatory imbalance in GAD, with IL-10 playing a role in modulating anxiety severity. The lack of a significant association between IL-2 serum levels and anxiety severity highlights the nuanced nature of immune dysregulation in GAD, warranting further exploration into the specific mechanisms involved. Elevated levels of pro-inflammatory cytokine, IL-2, and decreased levels of anti-inflammatory cytokine, IL-10, in GAD patients compared to HCs indicate that GAD individuals of the Bangladeshi cohort are characterized by heightened inflammatory responses derived from the imbalance between pro-inflammatory and anti-inflammatory states. Our study finding provides further support for the cytokine hypothesis of anxiety disorder, which proposes that pro-inflammatory cytokine-mediated neuroinflammatory processes can lead to anxiety symptoms or behaviors by downregulating serotonin biosynthesis or enhancing the reuptake of serotonin, resulting in an altered serotonergic neurotransmitter system in the CNS [ 15 ]. The observed significant negative correlation between IL-10 and DSM-5 scores or GAD-7 scores suggests that lowering IL-10 levels might be involved in the pathogenesis of GAD. One of the major implications of our study findings is that IL-10 signaling might be targeted to explore potential novel immunological/immunomodulatory therapies against GAD. The diminished IL-10 levels and their negative correlation with GAD severity suggest a potential avenue for therapeutic intervention. IL-10 might also be used as an anti-inflammatory adjunctive therapy with other pharmacotherapies including SSRIs/SNRIs. However, at this moment, we don’t know the exact mechanism by which lowered levels of IL-10 are linked to higher anxiety severity in GAD patients.

As IL-10 has anti-inflammatory and immunoregulatory activities such as suppression of production of pro-inflammatory cytokines (IL-1β, IL-6, and TNF-α) from microglia and astrocytes, reduction in IL-10 levels in GAD patients in our study led to an imbalance between pro-inflammatory and anti-inflammatory states and resulted in enhanced pro-inflammatory responses, which might be the cause of enhanced anxiety symptoms as inflammatory cytokine-mediated neuroinflammation was reported to be linked with disrupted monoaminergic neurotransmission in the brain. Besides, elevated levels of IL-10 were shown to attenuate anxiety-like behaviors by modulating GABAergic neurotransmission in the amygdala (Patel et al., 2021). IL-10 was also reported to display some neuroprotective activities and has been shown to inhibit neuronal apoptosis and promote neurite outgrowth, axonal outgrowth, and synapse formation in the brain by the JAK1-STAT3 signaling pathway [ 57 ]. In a preclinical study, IL-4 has been shown to cause the shifting of microglia and macrophages from pro-inflammatory to anti-inflammatory neuroprotective phenotypes characterized by excessive production of arginase-1 and PPARγ receptor expression in microglia and macrophage and thereby attenuating brain-injury-mediated anxiety by inhibiting neuronal loss and nerve tracts in the limbic system [ 58 ]. A similar mechanism might be involved in IL-10-mediated anxiety symptom improvement in GAD patients. Further research is required to unravel the exact mechanisms of IL-10-mediated anxiety symptom attenuation in GAD patients.

In terms of diagnostic marker development, as IL-10 serum level measurement demonstrated good performance in discriminating GAD patients from HCs and as IL-10 levels maintained a significant and negative correlation with disease severity, IL-10 serum level raised the possibility of being an objective biomarker for GAD. However, the diagnostic efficacy of this cytokine should be investigated thoroughly using a range of longitudinal studies. Despite this, at this time we can conclude that IL-10 might be used as a risk indicator for assessment of susceptibility to anxiety disorder, resulting in early detection of the disease and prompting the initiation of intervention strategies. This early detection will reduce treatment costs and decrease the prevalence and morbidity associated with this chronic disorder.

The strength of our study is that we designed a set of inclusion and exclusion criteria for the recruitment of participants and followed those criteria in such a way that homogenous population data could be obtained. The strict study design helped us enormously to minimize the potential impact of several confounding variables, including age, sex, BMI, co-morbid diseases, and immunomodulatory drugs, on cytokine levels. However, our study also has some limitations that should be acknowledged. The major limitation of this study is the smaller sample size. We recruited 50 patients and 38 HCs, which does not represent the whole Bangladeshi demographic. It would be better if we could enroll an equal number of cases and controls. For example, we observed that cytokine levels maintained a statistically significant difference between male GAD patients and male HCs. In contrast, no significant variation in cytokine levels was observed when female data were considered. As we have included more male participants (60%) than female participants (40%), the lower sample size of female participants might generate a higher background noise, resulting in lower statistical power, warranting further studies recruiting a larger population size to investigate sex-specific differences in cytokine levels in GAD patients. Our case-control study design is inherently correlational and thus not able to evaluate the causal relationship between altered cytokine levels and GAD. So, at this moment, we cannot conclude whether the altered levels of serum cytokines are the causes of anxiety development or just the outcome of pathophysiological changes.

Longitudinal studies are required to investigate whether altered cytokine levels precede GAD or if it’s just a mere reflection of GAD pathology. Though we have restricted the impacts of several co-variates, other confounding variables, including genetic polymorphism in cytokine genes, the effect of lifestyle or xenobiotics, and dietary habits, were not considered, which might have modulatory effects on serum cytokine levels.

The study provides valuable insights for understanding the pathogenesis of GAD. Despite having elevated IL-2 levels in GAD patients compared to HCs, it failed to demonstrate a significant association with anxiety severity as assessed by GAD-7 scores. In contrast, serum IL-10 levels were significantly reduced in GAD patients compared to HCs and showed a significant negative correlation with anxiety severity, implicating a potential link with the GAD pathophysiology. Our results support the immune hypothesis of GAD development. Our study findings also suggest that IL-10 serum level measurement might offer an objective blood-based biomarker or risk assessment indicator for GAD. We recommend further research employing a larger population size and homogenous data from different areas of Bangladesh to confirm our study findings.

Data availability

All the relevant data and information will be available from the corresponding author upon reasonable request.

Abbreviations

Body mass index

Chronic energy deficiency

Confidence interval

Central nervous system

Diagnostic and statistical manual for mental disorders, 5th edition

Enzyme-linked immunosorbent assay

• Generalized anxiety disorder

Generalized anxiety disorder 7-item scores

Healthy control

• Interleukin-2
• Interleukin-10

Receiver operating characteristic

Standard error mean

Statistical package for social science

Fagan HA, Baldwin DS. Pharmacological treatment of generalised anxiety disorder: current practice and future directions. Expert Rev Neurother. 2023;23(6):535–48. https://doi.org/10.1080/14737175.2023.2211767 .

Article   CAS   PubMed   Google Scholar  

Strawn JR, Geracioti L, Rajdev N, Clemenza K, Levine A. Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert Opin Pharmacother. 2018;19(10):1057–70. https://doi.org/10.1080/14656566.2018.1491966 .

Article   CAS   PubMed   PubMed Central   Google Scholar  

Maron E, Nutt D. Biological markers of generalized anxiety disorder. Dialogues Clin Neurosci. 2017;19(2):147–58. https://doi.org/10.31887/DCNS.2017.19.2/dnutt .

Article   PubMed   PubMed Central   Google Scholar  

Costello H, Gould RL, Abrol E, Howard R. Systematic review and meta-analysis of the association between peripheral inflammatory cytokines and generalised anxiety disorder. BMJ Open. 2019;9:e027925. https://doi.org/10.1136/bmjopen-2018-027925 .

Ansara ED. Management of treatment-resistant generalized anxiety disorder. Ment Health Clin. 2020;5(6):326–34. https://doi.org/10.9740/mhc.2020.11.326 .

Article   Google Scholar  

Michopoulos V, Powers A, Gillespie CF, Ressler KJ, Jovanovic T. Inflammation in fear- and anxiety-based disorders: PTSD, GAD, and beyond. Neuropsychopharmacology. 2017;42:254–70. https://doi.org/10.1038/npp.2016.146 .

Renna ME, O’Toole MS, Spaeth PE, Lekander M, Mennin DS. The association between anxiety,traumatic stress, and obsessive-compulsive disorders and chronic inflammation: A systematic review and meta-analysis. Depress Anxiety. 2018;;35(11):1081–1094. doi: 10.1002/da.22790.

Hou R, Baldwin DS. A neuroimmunological perspective on anxiety disorders. Hum Psychopharmacol. 2012;27(1):6–14.

Zhu CB, Lindler KM, Owens AW, Daws LC, Blakely RD, Hewlett WA. Interleukin-1 receptor activation by systemic lipopolysaccharide induces behavioral despair linked to MAPK regulation of CNS serotonin transporters. Neuropsychopharmacology. 2010;35:2510–20.

Munshi S, Parrilli V, Rosenkranz JA. Peripheral anti-inflammatory cytokine Interleukin-10 treatment mitigates interleukin-1β - induced anxiety and sickness behaviors in adult male rats. Behav Brain Res. 2019;17:372:112024. https://doi.org/10.1016/j.bbr.2019.112024 .

Article   CAS   Google Scholar  

Bercik P, Verdu EF, Foster JA, Macri J, Potter M, Huang X, et al. Chronic gastrointestinal inflammation induces anxiety-like behavior and alters central nervous system biochemistry in mice. Gastroenterology. 2010;139(6):2102–e21121. https://doi.org/10.1053/j.gastro.2010.06.063 .

Gentile A, Fresegna D, Musella A, Sepman H, Bullitta S, De Vito F et al. Interaction between interleukin-1β and type-1 cannabinoid receptor is involved in anxiety-like behavior in experimental autoimmune encephalomyelitis. J Neuroinflammation. 2016;13(1):231. Published 2016 Sep 2. https://doi.org/10.1186/s12974-016-0682-8 .

Haji N, Mandolesi G, Gentile A, Sacchetti L, Fresegna D, Rossi S, et al. TNF-α-mediated anxiety in a mouse model of multiple sclerosis. Exp Neurol. 2012;237(2):296–303. https://doi.org/10.1016/j.expneurol.2012.07.010 .

Hou R, Ye G, Liu Y, Chen X, Pan M, Zhu F, et al. Effects of SSRIs on peripheral inflammatory cytokines in patients with generalized anxiety disorder. Brain Behav Immun. 2019;81:105–10. https://doi.org/10.1016/j.bbi.2019.06.001 .

Quagliato LA, Nardi AE. Cytokine profile in drug-naïve panic disorder patients. Transl Psychiatry. 2022;12(1):75. https://doi.org/10.1038/s41398-022-01835-y . Published 2022 Feb 22.

Lee HJ, Park HJ, Starkweather A, An K, Shim I. Decreased Interleukin-4 release from the neurons of the Locus Coeruleus in response to immobilization stress. Mediators Inflamm. 2016;2016:3501905. https://doi.org/10.1155/2016/3501905 .

Gao T, Li B, Hou Y, Luo S, Feng L, Nie J, et al. Interleukin-4 signalling pathway underlies the anxiolytic effect induced by 3-deoxyadenosine. Psychopharmacology. 2019;236(10):2959–73. https://doi.org/10.1007/s00213-019-5186-7 .

Moon ML, Joesting JJ, Blevins NA, Lawson MA, Gainey SJ, Towers AE, et al. IL-4 knock out mice display anxiety-like Behavior. Behav Genet. 2015;45(4):451–60. https://doi.org/10.1007/s10519-015-9714-x .

Tang Z, Ye G, Chen X, Pan M, Fu J, Fu T, et al. Peripheral proinflammatory cytokines in Chinese patients with generalised anxiety disorder. J Affect Disord. 2018;225:593–8. https://doi.org/10.1016/j.jad.2017.08.082 .

Yang CJ, Liu D, Xu ZS, Shi SX, Du YJ. The pro-inflammatory cytokines, salivary cortisol and alpha-amylase are associated with generalized anxiety disorder (GAD) in patients with asthma. Neurosci Lett. 2017;656:15–21. https://doi.org/10.1016/j.neulet.2017.07.021 .

Vogelzangs N, Beekman AT, de Jonge P, Penninx BW. Anxiety disorders and inflammation in a large adult cohort. Transl Psychiatry. 2013;3(4):e249. https://doi.org/10.1038/tp.2013.27 .

Vieira MM, Ferreira TB, Pacheco PA, Barros PO, Almeida CR, Araújo-Lima CF, et al. Enhanced Th17 phenotype in individuals with generalized anxiety disorder. J Neuroimmunol. 2010;229(1–2):212–8. https://doi.org/10.1016/j.jneuroim.2010.07.018 .

Hou R, Garner M, Holmes C, Osmond C, Teeling J, Lau L, et al. Peripheral inflammatory cytokines and immune balance in generalised anxiety disorder: case-controlled study. Brain Behav Immun. 2017;62:212–8. https://doi.org/10.1016/j.bbi.2017.01.021 .

Copeland WE, Shanahan L, Worthman C, Angold A, Costello EJ. Generalized anxiety and C-reactive protein levels: a prospective, longitudinal analysis. Psychol Med. 2012;42(12):2641–50. https://doi.org/10.1017/S0033291712000554 .

Ferreira TB, Kasahara TM, Barros PO, Vieira MM, Bittencourt VC, Hygino J, et al. Dopamine up-regulates Th17 phenotype from individuals with generalized anxiety disorder. J Neuroimmunol. 2011;238(1–2):58–66. https://doi.org/10.1016/j.jneuroim.2011.06.009 .

Bankier B, Barajas J, Martinez-Rumayor A, Januzzi JL. Association between C-reactive protein and generalized anxiety disorder in stable coronary heart disease patients. Eur Heart J. 2008;29(18):2212–7. https://doi.org/10.1093/eurheartj/ehn326 .

Maes M, Song C, Lin A, De Jongh R, Van Gastel A, Kenis G, et al. The effects of psychological stress on humans: increased production of pro-inflammatory cytokines and a Th1-like response in stress-induced anxiety. Cytokine. 1998;10(4):313–8. https://doi.org/10.1006/cyto.1997.0290 .

Lu H, Yang Q, Zhang Y. The relation of common inflammatory cytokines with anxiety and depression and their values in estimating cardiovascular outcomes in coronary heart disease patients. J Clin Lab Anal. 2022;36(6):e24404. https://doi.org/10.1002/jcla.24404 .

Pitsavos C, Panagiotakos DB, Papageorgiou C, Tsetsekou E, Soldatos C, Stefanadis C. Anxiety in relation to inflammation and coagulation markers, among healthy adults: the ATTICA study. Atherosclerosis. 2006;185(2):320–6. https://doi.org/10.1016/j.atherosclerosis.2005.06.001 .

Lasselin J, Elsenbruch S, Lekander M, Axelsson J, Karshikoff B, Grigoleit JS, et al. Mood disturbance during experimental endotoxemia: predictors of state anxiety as a psychological component of sickness behavior. Brain Behav Immun. 2016;57:30–7. https://doi.org/10.1016/j.bbi.2016.01.003 .

Article   PubMed   Google Scholar  

Zheng ZH, Tu JL, Li XH, Hua Q, Liu WZ, Liu Y, et al. Neuroinflammation induces anxiety- and depressive-like behavior by modulating neuronal plasticity in the basolateral amygdala. Brain Behav Immun. 2021;91:505–18. https://doi.org/10.1016/j.bbi.2020.11.007 .

Mongan D, Raj SS, Föcking M, Byrne JF, Zammit S, Cannon M, et al. Associations between plasma inflammatory markers and psychotic disorder, depressive disorder and generalised anxiety disorder in early adulthood: a nested case-control study. Brain Behav Immun. 2023;111:90–100. https://doi.org/10.1016/j.bbi.2023.03.025 .

Shen Z, Cui L, Mou S, Ren L, Yuan Y, Shen X, et al. Combining S100B and cytokines as neuro-inflammatory biomarkers for diagnosing generalized anxiety disorder: a proof-of-Concept Study based on machine learning. Front Psychiatry. 2022;13:881241. https://doi.org/10.3389/fpsyt.2022.881241 . Published 2022 Jun 22.

Wagner EN, Strippoli MF, Ajdacic-Gross V, Gholam-Rezaee M, Glaus J, Vandeleur C, et al. Generalized anxiety disorder is prospectively Associated with decreased levels of Interleukin-6 and Adiponectin among individuals from the community. J Affect Disord. 2020;270:114–7. https://doi.org/10.1016/j.jad.2020.03.123 .

Ross SH, Cantrell DA. Signaling and function of Interleukin-2 in T lymphocytes. Annu Rev Immunol. 2018;36:411–33. https://doi.org/10.1146/annurev-immunol-042617-053352 .

Ye JH, Tao L, Zalcman SS. Interleukin-2 modulates N-methyl-D-aspartate receptors of native mesolimbic neurons. Brain Res. 2001;894(2):241–8. https://doi.org/10.1016/s0006-8993(01)02056-x .

Ye JH, Zalcman SS, Tao L. Kainate-activated currents in the ventral tegmental area of neonatal rats are modulated by interleukin-2. Brain Res. 2005;1049(2):227–33. https://doi.org/10.1016/j.brainres.2005.05.016 .

Suhee FI, Shahriar M, Islam SMA, Bhuiyan MA, Islam MR. Elevated serum IL-2 levels are Associated with Major Depressive disorder: a case-control study. Clin Pathol. 2023;16:2632010X231180797. https://doi.org/10.1177/2632010X231180797 .

Köhler CA, Freitas TH, Maes M, de Andrade NQ, Liu CS, Fernandes BS, et al. Peripheral cytokine and chemokine alterations in depression: a meta-analysis of 82 studies. Acta Psychiatr Scand. 2017;135(5):373–87. https://doi.org/10.1111/acps.12698 .

Gilio L, Fresegna D, Gentile A, Guadalupi L, Sanna K, De Vito F, et al. Preventive exercise attenuates IL-2-driven mood disorders in multiple sclerosis. Neurobiol Dis. 2022;172:105817. https://doi.org/10.1016/j.nbd.2022.105817 .

Carlini V, Noonan DM, Abdalalem E, Goletti D, Sansone C, Calabrone L, et al. The multifaceted nature of IL-10: regulation, role in immunological homeostasis and its relevance to cancer, COVID-19 and post-COVID conditions. Front Immunol. 2023;14:1161067. https://doi.org/10.3389/fimmu.2023.1161067 . Published 2023 Jun 8.

Fiorentino DF, Bond MW, Mosmann TR. Two types of mouse T helper cell. IV. Th2 clones secrete a factor that inhibits cytokine production by Th1 clones. J Exp Med. 1989;170(6):2081–95. https://doi.org/10.1084/jem.170.6.2081 .

Fiorentino DF, Zlotnik A, Mosmann TR, Howard M, O’Garra A. IL-10 inhibits cytokine production by activated macrophages. J Immunol. 1991;147(11):3815–22.

Fiorentino DF, Zlotnik A, Vieira P, Mosmann TR, Howard M, Moore KW, et al. IL-10 acts on the antigen-presenting cell to inhibit cytokine production by Th1 cells. J Immunol. 1991;146(10):3444–51.

Bogdan C, Vodovotz Y, Nathan C. Macrophage deactivation by interleukin 10. J Exp Med. 1991;174(6):1549–55. https://doi.org/10.1084/jem.174.6.1549 .

Murray PJ. The primary mechanism of the IL-10-regulated antiinflammatory response is to selectively inhibit transcription. Proc Natl Acad Sci U S A. 2005;102(24):8686–91. https://doi.org/10.1073/pnas.0500419102 .

Lobo-Silva D, Carriche GM, Castro AG, Roque S, Saraiva M. Balancing the immune response in the brain: IL-10 and its regulation. J Neuroinflammation. 2016;13(1):297. https://doi.org/10.1186/s12974-016-0763-8 .

Saraiva M, Vieira P, O’Garra A. Biology and therapeutic potential of interleukin-10. J Exp Med. 2020;217(1):e20190418. https://doi.org/10.1084/jem.20190418 .

Shemer A, Scheyltjens I, Frumer GR, Kim JS, Grozovski J, Ayanaw S, et al. Interleukin-10 prevents pathological Microglia Hyperactivation following Peripheral Endotoxin Challenge. Immunity. 2020;53(5):1033–e10497. https://doi.org/10.1016/j.immuni.2020.09.018 .

Mesquita AR, Correia-Neves M, Roque S, Castro AG, Vieira P, Pedrosa J, et al. IL-10 modulates depressive-like behavior. J Psychiatr Res. 2008;43(2):89–97. https://doi.org/10.1016/j.jpsychires.2008.02.004 .

Obuchowicz E, Bielecka AM, Paul-Samojedny M, Pudełko A, Kowalski J. Imipramine and fluoxetine inhibit LPS-induced activation and affect morphology of microglial cells in the rat glial culture. Pharmacol Rep. 2014;66(1):34–43. https://doi.org/10.1016/j.pharep.2013.08.002 .

Blatteau JE, de Maistre S, Lambrechts K, Abraini J, Risso JJ, Vallée N. Fluoxetine stimulates anti-inflammatory IL-10 cytokine production and attenuates sensory deficits in a rat model of decompression sickness. J Appl Physiol (1985). 2015;119(12):1393–9. https://doi.org/10.1152/japplphysiol.00602.2015 .

Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7. https://doi.org/10.1001/archinte.166.10.1092 .

Tofani T, Mannelli LD, Zanardelli M, et al. An immunologic profile study in drug-naive generalized anxiety non depressed patients: a pilot study. Eur Neuropsychopharmacol. 2015;25(suppl 2):S226.

Koh KB, Lee BK. Reduced lymphocyte proliferation and interleukin-2 production in anxiety disorders. Psychosom Med. 1998;60(4):479–83.

Inaba A, Tuong ZK, Zhao TX, et al. Low-dose IL-2 enhances the generation of IL-10-producing immunoregulatory B cells. Nat Commun. 2023;14(1):2071. https://doi.org/10.1038/s41467-023-37424-w . Published 2023 Apr 12.

Chen H, Lin W, Zhang Y, Lin L, Chen J, Zeng Y, et al. IL-10 promotes neurite outgrowth and synapse formation in cultured cortical neurons after the oxygen-glucose deprivation via JAK1/STAT3 pathway. Sci Rep. 2016;6:30459. https://doi.org/10.1038/srep30459 . Published 2016 Jul 26.

Pu H, Wang Y, Yang T, Leak RK, Stetler RA, Yu F, et al. Interleukin-4 mitigates anxiety-like behavior and loss of neurons and fiber tracts in limbic structures in a microglial PPARγ-dependent manner after traumatic brain injury. Neurobiol Dis. 2023;180:106078. https://doi.org/10.1016/j.nbd.2023.106078 .

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Acknowledgements

The authors are thankful to all the participants of this study. They are also thankful to the staff and physicians at the Department of Psychiatry, BSMMU, for their technical and administrative support. The authors are also thankful for the laboratory support provided by the Department of Pharmacy, University of Asia Pacific, Dhaka Bangladesh.

This research received no specific grant from any funding agency. However, we received partial funding from University of Dhaka, Bangladesh (Centennial Research grant (2nd Phase) for the year of 2020–2021, project title: “Investigation of peripheral pro-inflammatory and anti-inflammatory cytokines and immune balance in Bangladeshi patients with Generalized Anxiety Disorder”).

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Nisat Sarmin, A. S. M. Roknuzzaman and Rapty Sarker contributed equally to this work.

Authors and Affiliations

Department of Clinical Pharmacy and Pharmacology, Faculty of Pharmacy, University of Dhaka, Dhaka, 1000, Bangladesh

Nisat Sarmin, Rapty Sarker, Mamun -or-Rashid & Zobaer Al Mahmud

Department of Pharmacy, University of Asia Pacific, Dhaka, 1205, Bangladesh

A. S. M. Roknuzzaman

Department of Psychiatry, Bangabandhu Sheikh Mujib Medical University, Shahabagh, Dhaka, 1000, Bangladesh

MMA Shalahuddin Qusar

Department of Pharmacy, Faculty of Pharmacy, University of Dhaka, Dhaka, 1000, Bangladesh

Sitesh Chandra Bachar

School of Pharmacy, BRAC University, Kha 224 Bir Uttam Rafiqul Islam Avenue, Merul Badda, Dhaka, 1212, Bangladesh

Eva Rahman Kabir & Md. Rabiul Islam

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NS, ASMR, RS, MRI, and ZAM: Conceptualization, Data curation, Investigation, Writing – original draft. MR, MMASQ, SCB, and ZAM: Funding acquisition, Project administration, Validation. ERK, MRI, and ZAM: Conceptualization, Formal analysis, Methodology, Supervision, Writing – review & editing.

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Correspondence to Md. Rabiul Islam or Zobaer Al Mahmud .

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The research protocol was approved by the Research Ethics Committee (REC) of the University of Asia Pacific, Dhaka, Bangladesh (Ref: UAP/REC/2023/202-S). We briefed the objectives of the study to the participants, and informed consent was obtained from each of them. We conducted this investigation following the Helsinki Declaration’s guiding principles.

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Sarmin, N., Roknuzzaman, A.S.M., Sarker, R. et al. Association of interleukin-2 and interleukin-10 with the pathophysiology and development of generalized anxiety disorder: a case-control study. BMC Psychiatry 24 , 462 (2024). https://doi.org/10.1186/s12888-024-05911-z

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Correlation between the incidence of inguinal hernia and risk factors after radical prostatic cancer surgery: a case control study

• An-Ping Xiang 1 , 2 ,
• Yue-Fan Shen 1 ,
• Xu-Feng Shen 1 &
• Si-Hai Shao 1  

BMC Urology volume  24 , Article number:  131 ( 2024 ) Cite this article

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The incidence of recurrent hernia after radical resection of prostate cancer is high, so this article discusses the incidence and risk factors of inguinal hernia after radical resection of prostate cancer.

This case control study was conducted in The First People’s Hospital of Huzhou clinical data of 251 cases underwent radical resection of prostate cancer in this hospital from March 2019 to May 2021 were retrospectively analyzed. According to the occurrence of inguinal hernia, the subjects were divided into study group and control group, and the clinical data of each group were statistically analyzed, Multivariate Logistic analysis was performed to find independent influencing factors for predicting the occurrence of inguinal hernia. The Kaplan-Meier survival curve was drawn according to the occurrence and time of inguinal hernia.

The overall incidence of inguinal hernia after prostate cancer surgery was 14.7% (37/251), and the mean time was 8.58 ± 4.12 months. The average time of inguinal hernia in patients who received lymph node dissection was 7.61 ± 4.05 (month), and that in patients who did not receive lymph node dissection was 9.16 ± 4.15 (month), and there was no significant difference between them ( P  > 0.05). There were no statistically significant differences in the incidence of inguinal hernia with age, BMI, hypertension, diabetes, PSA, previous abdominal operations and operative approach ( P  > 0.05), but there were statistically significant differences with surgical method and pelvic lymph node dissection ( P  < 0.05). The incidence of pelvic lymph node dissection in the inguinal hernia group was 24.3% (14/57), which was significantly higher than that in the control group 11.8% (23/194). Logistic regression analysis showed that pelvic lymph node dissection was a risk factor for inguinal hernia after prostate cancer surgery (OR = 0.413, 95%Cl: 0.196–0.869, P  = 0.02). Kaplan-Meier survival curve showed that the rate of inguinal hernia in the group receiving pelvic lymph node dissection was significantly higher than that in the control group ( P  < 0.05).

Pelvic lymph node dissection is a risk factor for inguinal hernia after radical resection of prostate cancer.

Peer Review reports

Prostate cancer is a common malignant tumor in urology, which occurs in the prostate epithelial tissue, There are an average of 190,000 new cases of prostate cancer each year and about 80,000 deaths worldwide each year [ 1 , 2 ]. In recent years, the incidence of prostate cancer has increased year by year, seriously affecting the health and quality of life of patients [ 3 ]. Worldwide, the incidence of prostate cancer is second only to lung cancer, and its death rate ranks 7th among male cancer causes [ 4 ]. Radical resection of prostate cancer (RP) is the main means for the treatment of prostate cancer, and the surgical methods are generally divided into open radical resection of prostate cancer (RRP) and minimally invasive radical resection of prostate cancer, the latter including laparoscopic radical resection of prostate cancer (LRP) and robot-assisted laparoscopic radical resection of prostate cancer (RALP) [ 5 , 6 , 7 ].

Inguinal hernia (IH) is a relatively common disease in clinic, which is caused by increased abdominal pressure, thinning of abdominal wall, and bulging of abdominal organs. Inguinal hernias include direct hernias, oblique hernias and femoral hernias [ 8 ]. At the onset, lumps protruding outward from the inguinal region can be seen. If the intestines cannot return to the abdominal cavity in time, it is easy to cause intestinal necrosis, intestinal obstruction, intestinal perforation and other complications, which may endanger the life safety of patients in severe cases [ 9 , 10 ].

With the extensive development of radical resection of prostate cancer in various hospitals, the problem of postoperative inguinal hernia has gradually attracted the attention of urologists. The previously reported incidence of IH after radical prostate cancer surgery was approximately 13.7% [ 11 ]. A study by Nagatani S et al. showed that the incidence of inguinal hernia after radical prostate cancer surgery was 7-21%, most of which occurred within 2 years after surgery [ 12 ]. A study by Stranne J et al. showed that the cumulative risk of IH occurrence within 48 months in open radical resection for prostate cancer group and non-surgical group was 12.2% and 5.8%, respectively [ 13 ]. Most cases of IH require surgery due to pain, discomfort, and incarceration and are considered an advanced complication of radical resection of prostate cancer. The adhesion after radical resection of prostate cancer also increases the difficulty of hernia repair. Therefore, urologists need to be concerned not only about the risk of urinary incontinence and erectile dysfunction after radical resection of prostate cancer, but also about the occurrence of IH.

In recent 10 years, many scholars around the world have studied the risk factors of inguinal hernia after radical prostate cancer surgery. Currently, most of the studies believe that anastomotic stenosis, previous history of inguinal hernia, and patent processus vaginalis are risk factors, However there is no consensus on the risk of lymph node dissection. For example, Niitsu H et al. believed that pelvic lymph node dissection during radical prostate cancer operation might damage the pectineal foramina, thereby increasing the risk of inguinal hernia [ 14 ]. Contrary to the results of Johan Stranne’s study, the author suggested that previous incidence of inguinal hernia and advanced age increased the risk of inguinal hernia after radical prostate cancer surgery, and pelvic lymph node dissection was not a significant risk factor [ 15 ]. There is also no consistent conclusion on the influence of BMI, age and surgical method.

Therefore, in order to further investigate the risk factors of inguinal hernia after radical prostate cancer surgery, especially the correlation between pelvic lymph node dissection and inguinal hernia, this study was conducted. This study retrospectively analyzed the clinical data of 251 patients who underwent radical resection of prostate cancer in our hospital from March 2019 to May 2021, and investigated the risk factors of postoperative inguinal hernia. It is reported as follows:

Research objectives

The objective of this study was to explore the incidence and risk factors of inguinal hernia after radical resection of prostate cancer, which provides reference for further research and guide the clinician to choose the appropriate surgical method according to the patient’s condition.

Research methods

The patient was also examined by B-ultrasound every 3 months at the outpatient PSA review to verify the occurrence of inguinal hernia. The subjects were divided into the inguinal hernia group (study group) and the non-inguinal hernia group (control group), If the diagnosis of inguinal hernia occurred, the follow-up was completed, and the type and time of inguinal hernia were recorded; otherwise, the follow-up was 2 years, and the relevant clinical parameters of each group were statistically analyzed (age, BMI, hypertension, diabetes mellitus, PSA value, previous abdominal operations, operation methods, operative approach, pelvic lymph node dissection)and the correlation between these parameters and the occurrence of inguinal hernia was analyzed, and the risk factors of inguinal hernia were found by Logistic regression analysis. According to the occurrence and time of inguinal hernia, Kaplan-Meier survival curve was drawn to compare the differences between the two groups.

The content of this study has been approved by the Ethics Committee of our hospital(approval number, 2,018,137). All patients signed informed consent forms. This is the protocol was registered on the Chinese Clinical Trial Registry. The study is planned to begin in mid-March 2019 and is planned to end by May 2021.

Inclusion criteria

Patients who received radical surgery for prostate cancer in Huzhou First People’s Hospital from March 2019 to May 2021; PSA was reviewed every 3 months after surgery, and check the inguinal area for protruding masses. Complete the 2-year follow-up plan.

Exclusion criteria

Patients with inguinal hernia before operation; patients with prior inguinal hernia surgery.

Statistical methods

SPSS 21.0 statistical software was used for statistical processing, the research data followed normal distribution, and the measured data were represented by X ± S. P  < 0.05 was considered statistically significant.

From March 2019 to May 2021, 318 cases of radical prostatectomy were performed in our hospital, during the follow-up period, a total of 28 cases died of other diseases, a total of 39 cases were lost to follow-up or clinical data were incomplete, and a total of 251 cases were finally followed up. There were no significant differences in age, BMI, hypertension, diabetes, PSA, previous abdominal operations and operative approach between the two groups ( P  > 0.05), while there were significant differences in surgical method and pelvic lymph node dissection ( P  < 0.05). The incidence of pelvic lymph node dissection in the inguinal hernia group 24.3% (14/57) was significantly higher than that in the control group 11.8% (23/194). See Table  1 for details.

Multivariate Logistic regression analysis of risk factors showed that pelvic lymph node dissection was a risk factor for inguinal hernia after prostate cancer surgery (OR =0.413, 95%Cl: 0.196-0.869, P  = 0.02). There was no statistical significance in age, BMI, hypertension, diabetes, PSA value, previous abdominal operations, operation method, operative approach were not risk factors for inguinal hernia ( P  > 0.05). See Table  2 for details.

The cases of inguinal hernia were grouped according to whether or not they had received pelvic lymph node dissection. The incidence and time of inguinal hernia in the two groups were recorded, and the Kaplan-Meier survival curve was drawn. The overall incidence of inguinal hernia after radical resection of prostate cancer was 14.7% (37/251), There were 26 cases with indirect hernia, accounting for 70.2% (26/37), 21.6% (8/37) with direct hernia, 8.2% (3/37) with oblique hernia and direct hernia, and the mean time of occurrence was 8.58 ± 4.12 months. The average time of inguinal hernia was 7.61 ± 4.05 (month) for those who received lymph node dissection and 9.16 ± 4.15 (month) for those who did not receive lymph node dissection, and there was no significant difference between them ( P  > 0.05). The incidence of inguinal hernia in the group receiving pelvic lymph node dissection was significantly higher than that in the control group ( P  < 0.05). See Fig.  1 for details.

Survival curve of pelvic lymph node dissection and inguinal hernia (month)

In recent years, the incidence of prostate cancer has increased year by year, seriously affecting the health and quality of life of patients, the complications after radical prostate cancer surgery mainly include urinary incontinence and sexual dysfunction, but inguinal hernia is also one of the common complications [ 16 ]. Liu L et al. found that open radical resection for prostate cancer technique and advanced patient age, especially those over 80 years old, are associated with a higher incidence of IH. Appropriate prophylaxis during surgery should be evaluated in high-risk patients [ 17 ].In some regional studies, low BMI has been identified as a risk factor for IH, and the risk threshold for BMI has not been determined, which is about BMI < 25 kg/m2 [ 18 ]. However, a number of studies have found that low BMI does not increase the risk of postoperative IH [ 19 , 20 ]. At present, there is no uniform conclusion on the risk of IH between open radical resection for prostate cancer and laparoscopic radical prostatectomy. The study of Alder R scholars believed that the incidence of IH after laparoscopic radical prostatectomy was relatively low [ 21 ], while Otaki T’s study shows that the incidence of IH after laparoscopic radical prostatectomy is 7.3% and that of open radical resection for prostate cancer is 8.4%, showing no statistical difference between them [ 20 ]. There is no consensus on whether pelvic lymph node dissection is a risk factor for inguinal hernia [ 14 , 15 ]. In short, the specific mechanism of inguinal hernia after radical prostate cancer surgery is unclear.

This study retrospectively analyzed the clinical data of 251 cases treated in our hospital, and found that the overall incidence of inguinal hernia was 14.7% (37/251), which was consistent with most of the current research results. We also found that the average time of occurrence of inguinal hernia after surgery was 8.58 ± 4.12 months, which provided certain guidance for our postoperative follow-up time.

In this study, through Logistic multivariate analysis, it was found that pelvic lymph node dissection was a risk factor for inguinal hernia after prostate cancer surgery (OR = 0.413, 95%Cl: 0.196–0.869, P  = 0.02). There was no statistical significance in age, BMI, hypertension, diabetes, PSA value, previous abdominal operations, operation method, operative approach and the occurrence of inguinal hernia after prostate cancer surgery ( P  > 0.05),but there were statistically significant differences with surgical method and pelvic lymph node dissection ( P  < 0.05). Therefore, the advantages and disadvantages of pelvic lymph node dissection should be reasonably evaluated for low-medium-risk prostate cancer patients, so as to avoid the occurrence of inguinal hernia. By drawing Kaplan-Meier survival curve, it was found that the rate of inguinal hernia in the group receiving pelvic lymph node dissection was significantly higher than that in the control group. Some studies believe that pelvic lymph node dissection during radical resection of prostate cancer operation will cause postoperative scar contraction in the inguinal region, resulting in an increase in abdominal pressure outward and downward, resulting in an increase in the incidence of inguinal hernia. Lodding P designed a comparative study between the group of radical resection of prostate cancer plus pelvic lymph node dissection, the group of pelvic lymph node dissection and the group without operation. They found that the incidence of inguinal hernia in the three observation groups was 13.6%, 7.6% and 3.1%, respectively, and the difference between the prostatectomy group and the group without operation was statistically significant. There was no significant difference between the group and pelvic lymph node dissection group. This result implies that pelvic lymph node dissection is an important factor in the development of inguinal hernia [ 22 ]. Another Sun M study compared the incidence of inguinal hernias after radical prostate cancer surgery and pelvic lymph node dissection alone, and showed that the risk of inguinal hernias increased by 6.8% and 7.8% at 5 and 10 years, respectively, in the radical prostate cancer resection group compared with the pelvic lymph node dissection group [ 23 ]. Niitsu H et al. believed that pelvic lymph node dissection during radical resection of prostate cancer might damage the pectineal foramina, while inguinal hernia originated from the defective pectineal foramina [ 14 ].

Shimbo M et al. found that due to prostatectomy and vesicourethral anastomosis, preoperative and postoperative sagittal MRI images showed that the rectovesical excavation (RE) was moved downward by about 2 to 3 cm [ 24 ]. Accordingly, they speculated that due to the displacement of RE, the peritoneum and vas deferens after urethrovesical anastomosis were pulled, which further pulled the opening of the inner ring and caused it to shift medially, which led to the occurrence of postoperative IH. Based on this theory, many scholars have prevented the occurrence of hernia after operation by reducing the tension of peritoneum and vas deferens at the inner ring and ligation and rupture of sheathing process. Several other articles have reported the role of preserving the retropubic space (RS) in preventing IH after radical resection of prostate cancer. Chang KD et al. found that robot-assisted laparoscopic radical prostatectomywith retained Retzius space significantly reduced the incidence of postoperative IH compared with standard robot-assisted laparoscopic radical prostatectomy [ 25 ]. In addition, the study of Matsubara et al. also showed that compared with standard open radical resection for prostate cancer, the incidence of IH after transperineal radical resection of prostate cancer with retained anatomical structures such as the Retzius space was lower [ 26 ]. Therefore, urological surgeons can take some effective measures in the operation to prevent the recurrence of inguinal hernia.

In this study, we identified risk factors for inguinal hernia after pelvic lymphadenectomy for prostate cancer. Other risk factors such as age, BMI, hypertension, diabetes mellitus, PSA value, history of abdominal surgery, operative method, operative approach were not significant in multivariate analysis, which was inconsistent with the results of Iwamoto H et al [ 27 ]. They found that dilatation of the right internal inguinal ring and different manipulation of the medial peritoneal incision of the ventral femoral ring were independent risk factors for IH after laparoscopic radical prostatectomy. The reason why postoperative IH occurs more often on the right side is not known. Alder R et al. found that the incidence of IH after open radical prostate cancer treatment was significantly higher than laparoscopic radical prostate cancer treatment [ 21 ], but our study did not show a difference between the two groups, possibly due to the small number of cases included in open radical prostate surgery.

In summary, the incidence of inguinal hernia after radical prostate cancer surgery is relatively high, and the specific cause is still unclear. Our study shows that pelvic lymph node dissection is a risk factor for inguinal hernia.

Limitations

The sample size of this study is small, and it belongs to a single-center study, so the representativeness of the research conclusions may not be strong. This time, we followed up the samples for 2 years, which was not long enough and may have overlooked the real incidence of inguinal hernia. In addition, this study is a retrospective study, and the clinical parameters observed are not very comprehensive, which may ignore the influence of other factors on the IH. Because our data is derived from clinical data, some data cannot be detected. These problems need further study by more scholars.

Data availability

We cannot provide and share our datasets in publicly available repositories because of informed consent for participants as confidential patient data. Data may be obtained from the corresponding author upon reasonable request.

Sekhoacha M, Riet K, Motloung P et al. Prostate Cancer Review: Genetics, diagnosis, Treatment options, and alternative approaches. Molecules 2022; 27.

Rawla P. Epidemiology of prostate Cancer. World J Oncol. 2019;10(2):63–89.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Vietri MT, D’Elia G, Caliendo G et al. Hereditary prostate Cancer: genes related, Target Therapy and Prevention. Int J Mol Sci 2021; 22.

Williams IS, McVey A, Perera S, et al. Modern paradigms for prostate cancer detection and management. Med J Aust. 2022;217:424–33.

Article   PubMed   PubMed Central   Google Scholar  

Achard V, Panje CM, Engeler D, et al. Localized Local Adv Prostate Cancer: Treat Options Oncol. 2021;99:413–21.

CAS   Google Scholar  

Davis M, Egan J, Marhamati S, et al. Retzius-Sparing Robot-assisted robotic prostatectomy: past, Present, and Future. Urol Clin North Am. 2021;48:11–23.

Article   PubMed   Google Scholar  

Heidenreich A, Pfister D. Radical cytoreductive prostatectomy in men with prostate cancer and oligometastatic disease. Curr Opin Urol. 2020;30:90–7.

Miller HJ. Inguinal hernia: mastering the anatomy. Surg Clin North Am. 2018;98:607–21.

Gamborg S, Marcussen ML, Öberg S, Rosenberg J. Inguinal hernia repair but no Hernia Present: a Nationwide Cohort Study. Surg Technol Int. 2022;40:171–4.

PubMed   Google Scholar  

Chien S, Cunningham D, Khan KS. Inguinal hernia repair: a systematic analysis of online patient information using the modified ensuring Quality Information for patients tool. Ann R Coll Surg Engl. 2022;104:242–8.

CAS   PubMed   PubMed Central   Google Scholar  

Perez AJ, Campbell S. Inguinal hernia repair in older persons. J Am Med Dir Assoc. 2022;23(4):563–7.

Nagatani S, Tsumura H, Kanehiro T, et al. Inguinal hernia associated with radical prostatectomy. Surg Today. 2021;51:792–7.

Stranne J, Johansson E, Nilsson A, et al. Inguinal hernia after radical prostatectomy for prostate cancer: results from a randomized setting and a nonrandomized setting. Eur Urol. 2010;58:719–26.

Niitsu H, Taomoto J, Mita K, et al. Inguinal hernia repair with the mesh plug method is safe after radical retropubic prostatectomy. Surg Today. 2014;44:897–901.

Stranne J, Hugosson J, Lodding P. Post-radical retropubic prostatectomy inguinal hernia: an analysis of risk factors with special reference to preoperative inguinal hernia morbidity and pelvic lymph node dissection. J Urol. 2006;176:2072–6.

Tolle J, Knipper S, Pose R, et al. Evaluation of risk factors for adverse functional outcomes after Radical Prostatectomy in patients with previous transurethral surgery of the prostate. Urol Int. 2021;105:408–13.

Liu L, Xu H, Qi F, et al. Incidence and risk factors of inguinal hernia occurred after radical prostatectomy-comparisons of different approaches. BMC Surg. 2020;20(1):218.

Nilsson H, Stranne J, Hugosson J, et al. Risk of hernia formation after radical prostatectomy: a comparison between open and robot-assisted laparoscopic radical prostatectomy within the prospectively controlled LAPPRO trial. Hernia. 2022;26:157–64.

Article   CAS   PubMed   Google Scholar  

Sim KC, Sung DJ, Han NY, et al. Preoperative CT findings of subclinical hernia can predict for postoperative inguinal hernia following robot-assisted laparoscopic radical prostatectomy. Abdom Radiol (NY). 2018;43:1231–6.

Otaki T, Hasegawa M, Yuzuriha S, et al. Clinical impact of psoas muscle volume on the development of inguinal hernia after robot-assisted radical prostatectomy. Surg Endosc. 2021;35:3320–8.

Alder R, Alder R, Rosenberg J. Incidence of Inguinal Hernia after Radical Prostatectomy: a systematic review and Meta-analysis. J Urol. 2020;203(2):265–74.

Lodding P, Bergdahl C, Nyberg M, et al. Inguinal hernia after radical retropubic prostatectomy for prostate cancer: a study of incidence and risk factors in comparison to no operation and lymphadenectomy. J Urol. 2001;166:964–7.

Sun M, Lughezzani G, Alasker A, et al. Comparative study of inguinal hernia repair after radical prostatectomy, prostate biopsy, transurethral resection of the prostate or pelvic lymph node dissection. J Urol. 2010;183:970–5.

Shimbo M, Endo F, Matsushita K, et al. Risk factors and a Novel Prevention technique for Inguinal Hernia after Robot-assisted radical prostatectomy. Urol Int. 2017;98:54–60. Incidence.

Chang KD, Abdel Raheem A, Santok GDR, et al. Anatomical Retzius-space preservation is associated with lower incidence of postoperative inguinal hernia development after robot-assisted radical prostatectomy. Hernia. 2017;21:555–61.

Matsubara A, Yoneda T, Nakamoto T, et al. Inguinal hernia after radical perineal prostatectomy: comparison with the retropubic approach. Urology. 2007;70:1152–6.

Iwamoto H, Morizane S, Hikita K, et al. Postoperative inguinal hernia after robotic-assisted radical prostatectomy for prostate cancer: evaluation of risk factors and recommendation of a convenient prophylactic procedure. Cent Eur J Urol. 2019;72(4):418–24.

Google Scholar  

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This work was supported by the following funding: the grant 2019GY23 from Huzhou Science and Technology Bureau Public welfare application research project of China.

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An-Ping Xiang, Yue-Fan Shen, Xu-Feng Shen & Si-Hai Shao

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An-Ping Xiang designed the study and drafted and revised the manuscript, Yue-Fan Shen recorded the patients cases, Xu-Feng Shen participated in the follow-up. An-Ping Xiang and Si-Hai Shao analyzes the data and draw graphs.

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Xiang, AP., Shen, YF., Shen, XF. et al. Correlation between the incidence of inguinal hernia and risk factors after radical prostatic cancer surgery: a case control study. BMC Urol 24 , 131 (2024). https://doi.org/10.1186/s12894-024-01493-w

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Received : 24 September 2023

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DOI : https://doi.org/10.1186/s12894-024-01493-w

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