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

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

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

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

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

Table of contents

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Research bias

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

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10.1 Overview of Single-Subject Research

Learning objectives.

• Explain what single-subject research is, including how it differs from other types of psychological research.
• Explain what case studies are, including some of their strengths and weaknesses.
• Explain who uses single-subject research and why.

What Is Single-Subject Research?

Single-subject research is a type of quantitative research that involves studying in detail the behavior of each of a small number of participants. Note that the term single-subject does not mean that only one participant is studied; it is more typical for there to be somewhere between two and 10 participants. (This is why single-subject research designs are sometimes called small- n designs, where n is the statistical symbol for the sample size.) Single-subject research can be contrasted with group research , which typically involves studying large numbers of participants and examining their behavior primarily in terms of group means, standard deviations, and so on. The majority of this book is devoted to understanding group research, which is the most common approach in psychology. But single-subject research is an important alternative, and it is the primary approach in some areas of psychology.

Before continuing, it is important to distinguish single-subject research from two other approaches, both of which involve studying in detail a small number of participants. One is qualitative research, which focuses on understanding people’s subjective experience by collecting relatively unstructured data (e.g., detailed interviews) and analyzing those data using narrative rather than quantitative techniques. Single-subject research, in contrast, focuses on understanding objective behavior through experimental manipulation and control, collecting highly structured data, and analyzing those data quantitatively.

It is also important to distinguish single-subject research from case studies. A case study is a detailed description of an individual, which can include both qualitative and quantitative analyses. (Case studies that include only qualitative analyses can be considered a type of qualitative research.) The history of psychology is filled with influential cases studies, such as Sigmund Freud’s description of “Anna O.” (see Note 10.5 “The Case of “Anna O.”” ) and John Watson and Rosalie Rayner’s description of Little Albert (Watson & Rayner, 1920), who learned to fear a white rat—along with other furry objects—when the researchers made a loud noise while he was playing with the rat. Case studies can be useful for suggesting new research questions and for illustrating general principles. They can also help researchers understand rare phenomena, such as the effects of damage to a specific part of the human brain. As a general rule, however, case studies cannot substitute for carefully designed group or single-subject research studies. One reason is that case studies usually do not allow researchers to determine whether specific events are causally related, or even related at all. For example, if a patient is described in a case study as having been sexually abused as a child and then as having developed an eating disorder as a teenager, there is no way to determine whether these two events had anything to do with each other. A second reason is that an individual case can always be unusual in some way and therefore be unrepresentative of people more generally. Thus case studies have serious problems with both internal and external validity.

The Case of “Anna O.”

Sigmund Freud used the case of a young woman he called “Anna O.” to illustrate many principles of his theory of psychoanalysis (Freud, 1961). (Her real name was Bertha Pappenheim, and she was an early feminist who went on to make important contributions to the field of social work.) Anna had come to Freud’s colleague Josef Breuer around 1880 with a variety of odd physical and psychological symptoms. One of them was that for several weeks she was unable to drink any fluids. According to Freud,

She would take up the glass of water that she longed for, but as soon as it touched her lips she would push it away like someone suffering from hydrophobia.…She lived only on fruit, such as melons, etc., so as to lessen her tormenting thirst (p. 9).

But according to Freud, a breakthrough came one day while Anna was under hypnosis.

[S]he grumbled about her English “lady-companion,” whom she did not care for, and went on to describe, with every sign of disgust, how she had once gone into this lady’s room and how her little dog—horrid creature!—had drunk out of a glass there. The patient had said nothing, as she had wanted to be polite. After giving further energetic expression to the anger she had held back, she asked for something to drink, drank a large quantity of water without any difficulty, and awoke from her hypnosis with the glass at her lips; and thereupon the disturbance vanished, never to return.

Freud’s interpretation was that Anna had repressed the memory of this incident along with the emotion that it triggered and that this was what had caused her inability to drink. Furthermore, her recollection of the incident, along with her expression of the emotion she had repressed, caused the symptom to go away.

As an illustration of Freud’s theory, the case study of Anna O. is quite effective. As evidence for the theory, however, it is essentially worthless. The description provides no way of knowing whether Anna had really repressed the memory of the dog drinking from the glass, whether this repression had caused her inability to drink, or whether recalling this “trauma” relieved the symptom. It is also unclear from this case study how typical or atypical Anna’s experience was.

Figure 10.2

“Anna O.” was the subject of a famous case study used by Freud to illustrate the principles of psychoanalysis.

Wikimedia Commons – public domain.

Assumptions of Single-Subject Research

Again, single-subject research involves studying a small number of participants and focusing intensively on the behavior of each one. But why take this approach instead of the group approach? There are several important assumptions underlying single-subject research, and it will help to consider them now.

First and foremost is the assumption that it is important to focus intensively on the behavior of individual participants. One reason for this is that group research can hide individual differences and generate results that do not represent the behavior of any individual. For example, a treatment that has a positive effect for half the people exposed to it but a negative effect for the other half would, on average, appear to have no effect at all. Single-subject research, however, would likely reveal these individual differences. A second reason to focus intensively on individuals is that sometimes it is the behavior of a particular individual that is primarily of interest. A school psychologist, for example, might be interested in changing the behavior of a particular disruptive student. Although previous published research (both single-subject and group research) is likely to provide some guidance on how to do this, conducting a study on this student would be more direct and probably more effective.

A second assumption of single-subject research is that it is important to discover causal relationships through the manipulation of an independent variable, the careful measurement of a dependent variable, and the control of extraneous variables. For this reason, single-subject research is often considered a type of experimental research with good internal validity. Recall, for example, that Hall and his colleagues measured their dependent variable (studying) many times—first under a no-treatment control condition, then under a treatment condition (positive teacher attention), and then again under the control condition. Because there was a clear increase in studying when the treatment was introduced, a decrease when it was removed, and an increase when it was reintroduced, there is little doubt that the treatment was the cause of the improvement.

A third assumption of single-subject research is that it is important to study strong and consistent effects that have biological or social importance. Applied researchers, in particular, are interested in treatments that have substantial effects on important behaviors and that can be implemented reliably in the real-world contexts in which they occur. This is sometimes referred to as social validity (Wolf, 1976). The study by Hall and his colleagues, for example, had good social validity because it showed strong and consistent effects of positive teacher attention on a behavior that is of obvious importance to teachers, parents, and students. Furthermore, the teachers found the treatment easy to implement, even in their often chaotic elementary school classrooms.

Who Uses Single-Subject Research?

Single-subject research has been around as long as the field of psychology itself. In the late 1800s, one of psychology’s founders, Wilhelm Wundt, studied sensation and consciousness by focusing intensively on each of a small number of research participants. Herman Ebbinghaus’s research on memory and Ivan Pavlov’s research on classical conditioning are other early examples, both of which are still described in almost every introductory psychology textbook.

In the middle of the 20th century, B. F. Skinner clarified many of the assumptions underlying single-subject research and refined many of its techniques (Skinner, 1938). He and other researchers then used it to describe how rewards, punishments, and other external factors affect behavior over time. This work was carried out primarily using nonhuman subjects—mostly rats and pigeons. This approach, which Skinner called the experimental analysis of behavior —remains an important subfield of psychology and continues to rely almost exclusively on single-subject research. For excellent examples of this work, look at any issue of the Journal of the Experimental Analysis of Behavior . By the 1960s, many researchers were interested in using this approach to conduct applied research primarily with humans—a subfield now called applied behavior analysis (Baer, Wolf, & Risley, 1968). Applied behavior analysis plays an especially important role in contemporary research on developmental disabilities, education, organizational behavior, and health, among many other areas. Excellent examples of this work (including the study by Hall and his colleagues) can be found in the Journal of Applied Behavior Analysis .

Although most contemporary single-subject research is conducted from the behavioral perspective, it can in principle be used to address questions framed in terms of any theoretical perspective. For example, a studying technique based on cognitive principles of learning and memory could be evaluated by testing it on individual high school students using the single-subject approach. The single-subject approach can also be used by clinicians who take any theoretical perspective—behavioral, cognitive, psychodynamic, or humanistic—to study processes of therapeutic change with individual clients and to document their clients’ improvement (Kazdin, 1982).

Key Takeaways

• Single-subject research—which involves testing a small number of participants and focusing intensively on the behavior of each individual—is an important alternative to group research in psychology.
• Single-subject studies must be distinguished from case studies, in which an individual case is described in detail. Case studies can be useful for generating new research questions, for studying rare phenomena, and for illustrating general principles. However, they cannot substitute for carefully controlled experimental or correlational studies because they are low in internal and external validity.
• Single-subject research has been around since the beginning of the field of psychology. Today it is most strongly associated with the behavioral theoretical perspective, but it can in principle be used to study behavior from any perspective.
• Practice: Find and read a published article in psychology that reports new single-subject research. (A good source of articles published in the Journal of Applied Behavior Analysis can be found at http://seab.envmed.rochester.edu/jaba/jabaMostPop-2011.html .) Write a short summary of the study.

Practice: Find and read a published case study in psychology. (Use case study as a key term in a PsycINFO search.) Then do the following:

• Describe one problem related to internal validity.
• Describe one problem related to external validity.
• Generate one hypothesis suggested by the case study that might be interesting to test in a systematic single-subject or group study.

Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis , 1 , 91–97.

Freud, S. (1961). Five lectures on psycho-analysis . New York, NY: Norton.

Kazdin, A. E. (1982). Single-case research designs: Methods for clinical and applied settings . New York, NY: Oxford University Press.

Skinner, B. F. (1938). The behavior of organisms: An experimental analysis . New York, NY: Appleton-Century-Crofts.

Watson, J. B., & Rayner, R. (1920). Conditioned emotional reactions. Journal of Experimental Psychology , 3 , 1–14.

Wolf, M. (1976). Social validity: The case for subjective measurement or how applied behavior analysis is finding its heart. Journal of Applied Behavior Analysis, 11 , 203–214.

Research Methods in Psychology Copyright © 2016 by University of Minnesota is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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

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

Research question

• Conceptual framework
• Conceptual vs. theoretical framework

Data collection

• Qualitative research methods
• Focus groups
• Observational research

What is a case study?

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

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

Case studies

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

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

Definition of a case study

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

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

Characteristics of case studies

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

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

The role of case studies in research

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

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

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

What is the purpose of a case study?

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

Why use case studies in qualitative research?

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

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

The explanatory, exploratory, and descriptive roles of case studies

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

The impact of case studies on knowledge development

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

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

Types of case studies

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

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

Exploratory case studies

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

Descriptive case studies

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

Explanatory case studies

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

Intrinsic, instrumental, and collective case studies

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

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

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

Critical information systems research

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

Health research

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

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

Asthma research studies

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

Other fields

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

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

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

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

Propositions

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

Units of analysis

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

Argumentation

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

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

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

Defining the research question

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

Selecting and defining the case

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

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

Developing a detailed case study protocol

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

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

Collecting data

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

Analyzing and interpreting data

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

Writing the case study report

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

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

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

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

Observations

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

Documents and artifacts

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

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

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

Ensuring the quality of data collection

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

Data analysis

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

Organizing the data

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

Categorizing and coding the data

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

Identifying patterns and themes

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

Interpreting the data

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

Verification of the data

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

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

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

Benefits include the following:

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

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

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

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

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In This Article Expand or collapse the "in this article" section Single-Subject Research Design

Introduction, general overviews.

• Basics of Single-Subject Research Design
• Data Collection
• Visual Analysis
• Statistical Analysis
• Meta-analysis and Single-Subject Designs

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Single-Subject Research Design by Timothy J. Lewis , Nicholas Gage LAST REVIEWED: 25 June 2013 LAST MODIFIED: 25 June 2013 DOI: 10.1093/obo/9780199756810-0103

Single-subject research, at times referred to as single-case research, is a quantitative approach to examine functional relationships between baseline and experimental conditions over time within individual subjects. The central features of single-subject research include collecting repeated measures of behavior through direct observation across several sessions, comparing rates or amount of behavior between baseline or typical conditions to an intervention condition, and repeating baseline and intervention phases to note a functional relationship between the introduction and withdrawal of the intervention or independent variable (IV) and the subject’s behavior or dependent variable (DV). Collected observational data are converted to a standard metric and plotted in a line graph and visually analyzed to note variations in trend, level, and variability of the data across baseline and intervention conditions.

First described by Murray Sidman in 1960 ( Sidman 1960 ) to study behavioral principles within psychology and then later expanded to become a central element of applied behavior analysis ( Baer, et al. 1968 ; Baer, et al. 1987 ; Cooper, et al. 2007 ), single-subject research is used across several disciplines including special and general education, social work, communication sciences, and rehabilitative therapies. Horner and colleagues report that more than forty-five scholarly journals accept and publish single-subject research studies ( Horner, et al. 2005 ). See also Campbell and Stanley 1963 , Kazdin and Tuma 1982 , and Kratochwill and Levin 1992 .

Baer, Donald M., Montrose M. Wolf, and Todd R. Risley. 1968. Some current dimensions of applied behavior analysis . Journal of Applied Behavior Analysis 1.1: 91–97.

DOI: 10.1901/jaba.1968.1-91

A seminal article in the field of applied behavior analysis, this article operationally defines the essential features of applied behavior analysis and the experimental conditions under which applied behavior analysis principles can and should be studied.

Baer, Donald M., Montrose M. Wolf, and Todd R. Risley. 1987. Some still-current dimensions of applied behavior analysis . Journal of Applied Behavior Analysis 20.4: 313–327.

DOI: 10.1901/jaba.1987.20-313

A follow-up to the seminal Baer, et al. 1968 , this article provides the foundation for the applied behavior analysis field by outlining the general premise of applied behavior analytic research, which is the foundation of single-subject designs. The paper articulates that analysis of an effect in behavior analytic research, particularly single-subject research, should focus on practical significance that can be observed.

Campbell, Donald T., and Julian C. Stanley. 1963. Experimental and quasi-experimental designs for research . Boston: Houghton Mifflin.

A seminal text on conducting behavioral research, Campbell and Stanley provide a chapter on single-subject designs and the framework for what has become the standard in threats to internal and external validity and how each design accounts for these.

Cooper, John O., Timothy E. Heron, and William L. Heward. 2007. Applied behavior analysis . 2d ed. Upper Saddle River, NJ: Pearson/Merrill-Prentice Hall.

This textbook provides an overview of single-subject research designs and, importantly, details how to assess behavior change using visual analysis in clinical/applied and research contexts within an applied behavior analysis context.

Horner, Robert H., Edward G. Carr, James Halle, Gail McGee, Samuel Odom, and Mark Wolery. 2005. The use of single-subject research to identify evidence-based practices in special education . Exceptional Children 71.2: 165–179.

This article outlines the essential features within and across single-subject research studies to ascertain a minimal level of evidence to brand the practice under investigation “evidence-based.”

Kazdin, Alan E., and A. Hussain Tuma, eds. 1982. Single-case research designs . New Directions for Methodology of Behavioral Science 13. San Francisco: Jossey-Bass.

This edited text provides a rationale and the basic logic of single-subject research within the context of traditional psychological and clinical research. Although dated with respect to current issues and design variations, the text provides an historical context and establishes the roots of single-subject research.

Kratochwill, Thomas R., and Joel R. Levin, eds. 1992. Single-case research design and analysis: New directions for psychology and education . Hillsdale, NJ: Lawrence Erlbaum.

This text provides a series of chapters setting the stage for contemporary issues related to single-subject research including limitations of visual analysis, effect size, statistical analysis, and the appropriateness of meta-analyses across single-subject research. The book ends with a chapter on the current state of the art at the time and recommended future directions.

Sidman, Murray. 1960. Tactics of scientific research: Evaluating experimental data in psychology . New York: Basic Books.

A seminal text that laid the foundation for single-subject research within behavioral psychology.

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What is a Case Study? Definition & Examples

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Case Study Definition

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

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

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

A case study is particularly beneficial when your research:

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

Learn more about Other Types of Experimental Design .

Case Study Examples

Various fields utilize case studies, including the following:

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

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

See below for other examples.

Types of Case Studies

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

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

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

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

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

Pros and Cons

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

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

Crafting a Good Case Study: Methodology

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

The following are critical steps in developing a case study:

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

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

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

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

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

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

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

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

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

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

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The Advantages and Limitations of Single Case Study Analysis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Limitations

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

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

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

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

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

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

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

References 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Further Reading on E-International Relations

• Identity in International Conflicts: A Case Study of the Cuban Missile Crisis
• Imperialism’s Legacy in the Study of Contemporary Politics: The Case of Hegemonic Stability Theory
• Recreating a Nation’s Identity Through Symbolism: A Chinese Case Study
• Ontological Insecurity: A Case Study on Israeli-Palestinian Conflict in Jerusalem
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Research Writing and Analysis

• NVivo Group and Study Sessions
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Writing a Case Study

What is a case study?

A Case study is: 

• An in-depth research design that primarily uses a qualitative methodology but sometimes​​ includes quantitative methodology.
• Used to examine an identifiable problem confirmed through research.
• Used to investigate an individual, group of people, organization, or event.
• Used to mostly answer "how" and "why" questions.

What are the different types of case studies?

Note: These are the primary case studies. As you continue to research and learn

about case studies you will begin to find a robust list of different types. 

Who are your case study participants?

What is triangulation ? 

Validity and credibility are an essential part of the case study. Therefore, the researcher should include triangulation to ensure trustworthiness while accurately reflecting what the researcher seeks to investigate.

How to write a Case Study?

When developing a case study, there are different ways you could present the information, but remember to include the five parts for your case study.

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Methodology or method? A critical review of qualitative case study reports

Despite on-going debate about credibility, and reported limitations in comparison to other approaches, case study is an increasingly popular approach among qualitative researchers. We critically analysed the methodological descriptions of published case studies. Three high-impact qualitative methods journals were searched to locate case studies published in the past 5 years; 34 were selected for analysis. Articles were categorized as health and health services ( n= 12), social sciences and anthropology ( n= 7), or methods ( n= 15) case studies. The articles were reviewed using an adapted version of established criteria to determine whether adequate methodological justification was present, and if study aims, methods, and reported findings were consistent with a qualitative case study approach. Findings were grouped into five themes outlining key methodological issues: case study methodology or method, case of something particular and case selection, contextually bound case study, researcher and case interactions and triangulation, and study design inconsistent with methodology reported. Improved reporting of case studies by qualitative researchers will advance the methodology for the benefit of researchers and practitioners.

Case study research is an increasingly popular approach among qualitative researchers (Thomas, 2011 ). Several prominent authors have contributed to methodological developments, which has increased the popularity of case study approaches across disciplines (Creswell, 2013b ; Denzin & Lincoln, 2011b ; Merriam, 2009 ; Ragin & Becker, 1992 ; Stake, 1995 ; Yin, 2009 ). Current qualitative case study approaches are shaped by paradigm, study design, and selection of methods, and, as a result, case studies in the published literature vary. Differences between published case studies can make it difficult for researchers to define and understand case study as a methodology.

Experienced qualitative researchers have identified case study research as a stand-alone qualitative approach (Denzin & Lincoln, 2011b ). Case study research has a level of flexibility that is not readily offered by other qualitative approaches such as grounded theory or phenomenology. Case studies are designed to suit the case and research question and published case studies demonstrate wide diversity in study design. There are two popular case study approaches in qualitative research. The first, proposed by Stake ( 1995 ) and Merriam ( 2009 ), is situated in a social constructivist paradigm, whereas the second, by Yin ( 2012 ), Flyvbjerg ( 2011 ), and Eisenhardt ( 1989 ), approaches case study from a post-positivist viewpoint. Scholarship from both schools of inquiry has contributed to the popularity of case study and development of theoretical frameworks and principles that characterize the methodology.

The diversity of case studies reported in the published literature, and on-going debates about credibility and the use of case study in qualitative research practice, suggests that differences in perspectives on case study methodology may prevent researchers from developing a mutual understanding of practice and rigour. In addition, discussion about case study limitations has led some authors to query whether case study is indeed a methodology (Luck, Jackson, & Usher, 2006 ; Meyer, 2001 ; Thomas, 2010 ; Tight, 2010 ). Methodological discussion of qualitative case study research is timely, and a review is required to analyse and understand how this methodology is applied in the qualitative research literature. The aims of this study were to review methodological descriptions of published qualitative case studies, to review how the case study methodological approach was applied, and to identify issues that need to be addressed by researchers, editors, and reviewers. An outline of the current definitions of case study and an overview of the issues proposed in the qualitative methodological literature are provided to set the scene for the review.

Definitions of qualitative case study research

Case study research is an investigation and analysis of a single or collective case, intended to capture the complexity of the object of study (Stake, 1995 ). Qualitative case study research, as described by Stake ( 1995 ), draws together “naturalistic, holistic, ethnographic, phenomenological, and biographic research methods” in a bricoleur design, or in his words, “a palette of methods” (Stake, 1995 , pp. xi–xii). Case study methodology maintains deep connections to core values and intentions and is “particularistic, descriptive and heuristic” (Merriam, 2009 , p. 46).

As a study design, case study is defined by interest in individual cases rather than the methods of inquiry used. The selection of methods is informed by researcher and case intuition and makes use of naturally occurring sources of knowledge, such as people or observations of interactions that occur in the physical space (Stake, 1998 ). Thomas ( 2011 ) suggested that “analytical eclecticism” is a defining factor (p. 512). Multiple data collection and analysis methods are adopted to further develop and understand the case, shaped by context and emergent data (Stake, 1995 ). This qualitative approach “explores a real-life, contemporary bounded system (a case ) or multiple bounded systems (cases) over time, through detailed, in-depth data collection involving multiple sources of information … and reports a case description and case themes ” (Creswell, 2013b , p. 97). Case study research has been defined by the unit of analysis, the process of study, and the outcome or end product, all essentially the case (Merriam, 2009 ).

The case is an object to be studied for an identified reason that is peculiar or particular. Classification of the case and case selection procedures informs development of the study design and clarifies the research question. Stake ( 1995 ) proposed three types of cases and study design frameworks. These include the intrinsic case, the instrumental case, and the collective instrumental case. The intrinsic case is used to understand the particulars of a single case, rather than what it represents. An instrumental case study provides insight on an issue or is used to refine theory. The case is selected to advance understanding of the object of interest. A collective refers to an instrumental case which is studied as multiple, nested cases, observed in unison, parallel, or sequential order. More than one case can be simultaneously studied; however, each case study is a concentrated, single inquiry, studied holistically in its own entirety (Stake, 1995 , 1998 ).

Researchers who use case study are urged to seek out what is common and what is particular about the case. This involves careful and in-depth consideration of the nature of the case, historical background, physical setting, and other institutional and political contextual factors (Stake, 1998 ). An interpretive or social constructivist approach to qualitative case study research supports a transactional method of inquiry, where the researcher has a personal interaction with the case. The case is developed in a relationship between the researcher and informants, and presented to engage the reader, inviting them to join in this interaction and in case discovery (Stake, 1995 ). A postpositivist approach to case study involves developing a clear case study protocol with careful consideration of validity and potential bias, which might involve an exploratory or pilot phase, and ensures that all elements of the case are measured and adequately described (Yin, 2009 , 2012 ).

Current methodological issues in qualitative case study research

The future of qualitative research will be influenced and constructed by the way research is conducted, and by what is reviewed and published in academic journals (Morse, 2011 ). If case study research is to further develop as a principal qualitative methodological approach, and make a valued contribution to the field of qualitative inquiry, issues related to methodological credibility must be considered. Researchers are required to demonstrate rigour through adequate descriptions of methodological foundations. Case studies published without sufficient detail for the reader to understand the study design, and without rationale for key methodological decisions, may lead to research being interpreted as lacking in quality or credibility (Hallberg, 2013 ; Morse, 2011 ).

There is a level of artistic license that is embraced by qualitative researchers and distinguishes practice, which nurtures creativity, innovation, and reflexivity (Denzin & Lincoln, 2011b ; Morse, 2009 ). Qualitative research is “inherently multimethod” (Denzin & Lincoln, 2011a , p. 5); however, with this creative freedom, it is important for researchers to provide adequate description for methodological justification (Meyer, 2001 ). This includes paradigm and theoretical perspectives that have influenced study design. Without adequate description, study design might not be understood by the reader, and can appear to be dishonest or inaccurate. Reviewers and readers might be confused by the inconsistent or inappropriate terms used to describe case study research approach and methods, and be distracted from important study findings (Sandelowski, 2000 ). This issue extends beyond case study research, and others have noted inconsistencies in reporting of methodology and method by qualitative researchers. Sandelowski ( 2000 , 2010 ) argued for accurate identification of qualitative description as a research approach. She recommended that the selected methodology should be harmonious with the study design, and be reflected in methods and analysis techniques. Similarly, Webb and Kevern ( 2000 ) uncovered inconsistencies in qualitative nursing research with focus group methods, recommending that methodological procedures must cite seminal authors and be applied with respect to the selected theoretical framework. Incorrect labelling using case study might stem from the flexibility in case study design and non-directional character relative to other approaches (Rosenberg & Yates, 2007 ). Methodological integrity is required in design of qualitative studies, including case study, to ensure study rigour and to enhance credibility of the field (Morse, 2011 ).

Case study has been unnecessarily devalued by comparisons with statistical methods (Eisenhardt, 1989 ; Flyvbjerg, 2006 , 2011 ; Jensen & Rodgers, 2001 ; Piekkari, Welch, & Paavilainen, 2009 ; Tight, 2010 ; Yin, 1999 ). It is reputed to be the “the weak sibling” in comparison to other, more rigorous, approaches (Yin, 2009 , p. xiii). Case study is not an inherently comparative approach to research. The objective is not statistical research, and the aim is not to produce outcomes that are generalizable to all populations (Thomas, 2011 ). Comparisons between case study and statistical research do little to advance this qualitative approach, and fail to recognize its inherent value, which can be better understood from the interpretive or social constructionist viewpoint of other authors (Merriam, 2009 ; Stake, 1995 ). Building on discussions relating to “fuzzy” (Bassey, 2001 ), or naturalistic generalizations (Stake, 1978 ), or transference of concepts and theories (Ayres, Kavanaugh, & Knafl, 2003 ; Morse et al., 2011 ) would have more relevance.

Case study research has been used as a catch-all design to justify or add weight to fundamental qualitative descriptive studies that do not fit with other traditional frameworks (Merriam, 2009 ). A case study has been a “convenient label for our research—when we ‘can't think of anything ‘better”—in an attempt to give it [qualitative methodology] some added respectability” (Tight, 2010 , p. 337). Qualitative case study research is a pliable approach (Merriam, 2009 ; Meyer, 2001 ; Stake, 1995 ), and has been likened to a “curious methodological limbo” (Gerring, 2004 , p. 341) or “paradigmatic bridge” (Luck et al., 2006 , p. 104), that is on the borderline between postpositivist and constructionist interpretations. This has resulted in inconsistency in application, which indicates that flexibility comes with limitations (Meyer, 2001 ), and the open nature of case study research might be off-putting to novice researchers (Thomas, 2011 ). The development of a well-(in)formed theoretical framework to guide a case study should improve consistency, rigour, and trust in studies published in qualitative research journals (Meyer, 2001 ).

Assessment of rigour

The purpose of this study was to analyse the methodological descriptions of case studies published in qualitative methods journals. To do this we needed to develop a suitable framework, which used existing, established criteria for appraising qualitative case study research rigour (Creswell, 2013b ; Merriam, 2009 ; Stake, 1995 ). A number of qualitative authors have developed concepts and criteria that are used to determine whether a study is rigorous (Denzin & Lincoln, 2011b ; Lincoln, 1995 ; Sandelowski & Barroso, 2002 ). The criteria proposed by Stake ( 1995 ) provide a framework for readers and reviewers to make judgements regarding case study quality, and identify key characteristics essential for good methodological rigour. Although each of the factors listed in Stake's criteria could enhance the quality of a qualitative research report, in Table I we present an adapted criteria used in this study, which integrates more recent work by Merriam ( 2009 ) and Creswell ( 2013b ). Stake's ( 1995 ) original criteria were separated into two categories. The first list of general criteria is “relevant for all qualitative research.” The second list, “high relevance to qualitative case study research,” was the criteria that we decided had higher relevance to case study research. This second list was the main criteria used to assess the methodological descriptions of the case studies reviewed. The complete table has been preserved so that the reader can determine how the original criteria were adapted.

Framework for assessing quality in qualitative case study research.

Adapted from Stake ( 1995 , p. 131).

Study design

The critical review method described by Grant and Booth ( 2009 ) was used, which is appropriate for the assessment of research quality, and is used for literature analysis to inform research and practice. This type of review goes beyond the mapping and description of scoping or rapid reviews, to include “analysis and conceptual innovation” (Grant & Booth, 2009 , p. 93). A critical review is used to develop existing, or produce new, hypotheses or models. This is different to systematic reviews that answer clinical questions. It is used to evaluate existing research and competing ideas, to provide a “launch pad” for conceptual development and “subsequent testing” (Grant & Booth, 2009 , p. 93).

Qualitative methods journals were located by a search of the 2011 ISI Journal Citation Reports in Social Science, via the database Web of Knowledge (see m.webofknowledge.com). No “qualitative research methods” category existed in the citation reports; therefore, a search of all categories was performed using the term “qualitative.” In Table II , we present the qualitative methods journals located, ranked by impact factor. The highest ranked journals were selected for searching. We acknowledge that the impact factor ranking system might not be the best measure of journal quality (Cheek, Garnham, & Quan, 2006 ); however, this was the most appropriate and accessible method available.

International Journal of Qualitative Studies on Health and Well-being.

Search strategy

In March 2013, searches of the journals, Qualitative Health Research , Qualitative Research , and Qualitative Inquiry were completed to retrieve studies with “case study” in the abstract field. The search was limited to the past 5 years (1 January 2008 to 1 March 2013). The objective was to locate published qualitative case studies suitable for assessment using the adapted criterion. Viewpoints, commentaries, and other article types were excluded from review. Title and abstracts of the 45 retrieved articles were read by the first author, who identified 34 empirical case studies for review. All authors reviewed the 34 studies to confirm selection and categorization. In Table III , we present the 34 case studies grouped by journal, and categorized by research topic, including health sciences, social sciences and anthropology, and methods research. There was a discrepancy in categorization of one article on pedagogy and a new teaching method published in Qualitative Inquiry (Jorrín-Abellán, Rubia-Avi, Anguita-Martínez, Gómez-Sánchez, & Martínez-Mones, 2008 ). Consensus was to allocate to the methods category.

Outcomes of search of qualitative methods journals.

In Table III , the number of studies located, and final numbers selected for review have been reported. Qualitative Health Research published the most empirical case studies ( n= 16). In the health category, there were 12 case studies of health conditions, health services, and health policy issues, all published in Qualitative Health Research . Seven case studies were categorized as social sciences and anthropology research, which combined case study with biography and ethnography methodologies. All three journals published case studies on methods research to illustrate a data collection or analysis technique, methodological procedure, or related issue.

The methodological descriptions of 34 case studies were critically reviewed using the adapted criteria. All articles reviewed contained a description of study methods; however, the length, amount of detail, and position of the description in the article varied. Few studies provided an accurate description and rationale for using a qualitative case study approach. In the 34 case studies reviewed, three described a theoretical framework informed by Stake ( 1995 ), two by Yin ( 2009 ), and three provided a mixed framework informed by various authors, which might have included both Yin and Stake. Few studies described their case study design, or included a rationale that explained why they excluded or added further procedures, and whether this was to enhance the study design, or to better suit the research question. In 26 of the studies no reference was provided to principal case study authors. From reviewing the description of methods, few authors provided a description or justification of case study methodology that demonstrated how their study was informed by the methodological literature that exists on this approach.

The methodological descriptions of each study were reviewed using the adapted criteria, and the following issues were identified: case study methodology or method; case of something particular and case selection; contextually bound case study; researcher and case interactions and triangulation; and, study design inconsistent with methodology. An outline of how the issues were developed from the critical review is provided, followed by a discussion of how these relate to the current methodological literature.

Case study methodology or method

A third of the case studies reviewed appeared to use a case report method, not case study methodology as described by principal authors (Creswell, 2013b ; Merriam, 2009 ; Stake, 1995 ; Yin, 2009 ). Case studies were identified as a case report because of missing methodological detail and by review of the study aims and purpose. These reports presented data for small samples of no more than three people, places or phenomenon. Four studies, or “case reports” were single cases selected retrospectively from larger studies (Bronken, Kirkevold, Martinsen, & Kvigne, 2012 ; Coltart & Henwood, 2012 ; Hooghe, Neimeyer, & Rober, 2012 ; Roscigno et al., 2012 ). Case reports were not a case of something, instead were a case demonstration or an example presented in a report. These reports presented outcomes, and reported on how the case could be generalized. Descriptions focussed on the phenomena, rather than the case itself, and did not appear to study the case in its entirety.

Case reports had minimal in-text references to case study methodology, and were informed by other qualitative traditions or secondary sources (Adamson & Holloway, 2012 ; Buzzanell & D'Enbeau, 2009 ; Nagar-Ron & Motzafi-Haller, 2011 ). This does not suggest that case study methodology cannot be multimethod, however, methodology should be consistent in design, be clearly described (Meyer, 2001 ; Stake, 1995 ), and maintain focus on the case (Creswell, 2013b ).

To demonstrate how case reports were identified, three examples are provided. The first, Yeh ( 2013 ) described their study as, “the examination of the emergence of vegetarianism in Victorian England serves as a case study to reveal the relationships between boundaries and entities” (p. 306). The findings were a historical case report, which resulted from an ethnographic study of vegetarianism. Cunsolo Willox, Harper, Edge, ‘My Word’: Storytelling and Digital Media Lab, and Rigolet Inuit Community Government (2013) used “a case study that illustrates the usage of digital storytelling within an Inuit community” (p. 130). This case study reported how digital storytelling can be used with indigenous communities as a participatory method to illuminate the benefits of this method for other studies. This “case study was conducted in the Inuit community” but did not include the Inuit community in case analysis (Cunsolo Willox et al., 2013 , p. 130). Bronken et al. ( 2012 ) provided a single case report to demonstrate issues observed in a larger clinical study of aphasia and stroke, without adequate case description or analysis.

Case study of something particular and case selection

Case selection is a precursor to case analysis, which needs to be presented as a convincing argument (Merriam, 2009 ). Descriptions of the case were often not adequate to ascertain why the case was selected, or whether it was a particular exemplar or outlier (Thomas, 2011 ). In a number of case studies in the health and social science categories, it was not explicit whether the case was of something particular, or peculiar to their discipline or field (Adamson & Holloway, 2012 ; Bronken et al., 2012 ; Colón-Emeric et al., 2010 ; Jackson, Botelho, Welch, Joseph, & Tennstedt, 2012 ; Mawn et al., 2010 ; Snyder-Young, 2011 ). There were exceptions in the methods category ( Table III ), where cases were selected by researchers to report on a new or innovative method. The cases emerged through heuristic study, and were reported to be particular, relative to the existing methods literature (Ajodhia-Andrews & Berman, 2009 ; Buckley & Waring, 2013 ; Cunsolo Willox et al., 2013 ; De Haene, Grietens, & Verschueren, 2010 ; Gratton & O'Donnell, 2011 ; Sumsion, 2013 ; Wimpenny & Savin-Baden, 2012 ).

Case selection processes were sometimes insufficient to understand why the case was selected from the global population of cases, or what study of this case would contribute to knowledge as compared with other possible cases (Adamson & Holloway, 2012 ; Bronken et al., 2012 ; Colón-Emeric et al., 2010 ; Jackson et al., 2012 ; Mawn et al., 2010 ). In two studies, local cases were selected (Barone, 2010 ; Fourie & Theron, 2012 ) because the researcher was familiar with and had access to the case. Possible limitations of a convenience sample were not acknowledged. Purposeful sampling was used to recruit participants within the case of one study, but not of the case itself (Gallagher et al., 2013 ). Random sampling was completed for case selection in two studies (Colón-Emeric et al., 2010 ; Jackson et al., 2012 ), which has limited meaning in interpretive qualitative research.

To demonstrate how researchers provided a good justification for the selection of case study approaches, four examples are provided. The first, cases of residential care homes, were selected because of reported occurrences of mistreatment, which included residents being locked in rooms at night (Rytterström, Unosson, & Arman, 2013 ). Roscigno et al. ( 2012 ) selected cases of parents who were admitted for early hospitalization in neonatal intensive care with a threatened preterm delivery before 26 weeks. Hooghe et al. ( 2012 ) used random sampling to select 20 couples that had experienced the death of a child; however, the case study was of one couple and a particular metaphor described only by them. The final example, Coltart and Henwood ( 2012 ), provided a detailed account of how they selected two cases from a sample of 46 fathers based on personal characteristics and beliefs. They described how the analysis of the two cases would contribute to their larger study on first time fathers and parenting.

Contextually bound case study

The limits or boundaries of the case are a defining factor of case study methodology (Merriam, 2009 ; Ragin & Becker, 1992 ; Stake, 1995 ; Yin, 2009 ). Adequate contextual description is required to understand the setting or context in which the case is revealed. In the health category, case studies were used to illustrate a clinical phenomenon or issue such as compliance and health behaviour (Colón-Emeric et al., 2010 ; D'Enbeau, Buzzanell, & Duckworth, 2010 ; Gallagher et al., 2013 ; Hooghe et al., 2012 ; Jackson et al., 2012 ; Roscigno et al., 2012 ). In these case studies, contextual boundaries, such as physical and institutional descriptions, were not sufficient to understand the case as a holistic system, for example, the general practitioner (GP) clinic in Gallagher et al. ( 2013 ), or the nursing home in Colón-Emeric et al. ( 2010 ). Similarly, in the social science and methods categories, attention was paid to some components of the case context, but not others, missing important information required to understand the case as a holistic system (Alexander, Moreira, & Kumar, 2012 ; Buzzanell & D'Enbeau, 2009 ; Nairn & Panelli, 2009 ; Wimpenny & Savin-Baden, 2012 ).

In two studies, vicarious experience or vignettes (Nairn & Panelli, 2009 ) and images (Jorrín-Abellán et al., 2008 ) were effective to support description of context, and might have been a useful addition for other case studies. Missing contextual boundaries suggests that the case might not be adequately defined. Additional information, such as the physical, institutional, political, and community context, would improve understanding of the case (Stake, 1998 ). In Boxes 1 and 2 , we present brief synopses of two studies that were reviewed, which demonstrated a well bounded case. In Box 1 , Ledderer ( 2011 ) used a qualitative case study design informed by Stake's tradition. In Box 2 , Gillard, Witt, and Watts ( 2011 ) were informed by Yin's tradition. By providing a brief outline of the case studies in Boxes 1 and 2 , we demonstrate how effective case boundaries can be constructed and reported, which may be of particular interest to prospective case study researchers.

Article synopsis of case study research using Stake's tradition

Ledderer ( 2011 ) used a qualitative case study research design, informed by modern ethnography. The study is bounded to 10 general practice clinics in Denmark, who had received federal funding to implement preventative care services based on a Motivational Interviewing intervention. The researcher question focussed on “why is it so difficult to create change in medical practice?” (Ledderer, 2011 , p. 27). The study context was adequately described, providing detail on the general practitioner (GP) clinics and relevant political and economic influences. Methodological decisions are described in first person narrative, providing insight on researcher perspectives and interaction with the case. Forty-four interviews were conducted, which focussed on how GPs conducted consultations, and the form, nature and content, rather than asking their opinion or experience (Ledderer, 2011 , p. 30). The duration and intensity of researcher immersion in the case enhanced depth of description and trustworthiness of study findings. Analysis was consistent with Stake's tradition, and the researcher provided examples of inquiry techniques used to challenge assumptions about emerging themes. Several other seminal qualitative works were cited. The themes and typology constructed are rich in narrative data and storytelling by clinic staff, demonstrating individual clinic experiences as well as shared meanings and understandings about changing from a biomedical to psychological approach to preventative health intervention. Conclusions make note of social and cultural meanings and lessons learned, which might not have been uncovered using a different methodology.

Article synopsis of case study research using Yin's tradition

Gillard et al. ( 2011 ) study of camps for adolescents living with HIV/AIDs provided a good example of Yin's interpretive case study approach. The context of the case is bounded by the three summer camps of which the researchers had prior professional involvement. A case study protocol was developed that used multiple methods to gather information at three data collection points coinciding with three youth camps (Teen Forum, Discover Camp, and Camp Strong). Gillard and colleagues followed Yin's ( 2009 ) principles, using a consistent data protocol that enhanced cross-case analysis. Data described the young people, the camp physical environment, camp schedule, objectives and outcomes, and the staff of three youth camps. The findings provided a detailed description of the context, with less detail of individual participants, including insight into researcher's interpretations and methodological decisions throughout the data collection and analysis process. Findings provided the reader with a sense of “being there,” and are discovered through constant comparison of the case with the research issues; the case is the unit of analysis. There is evidence of researcher immersion in the case, and Gillard reports spending significant time in the field in a naturalistic and integrated youth mentor role.

This case study is not intended to have a significant impact on broader health policy, although does have implications for health professionals working with adolescents. Study conclusions will inform future camps for young people with chronic disease, and practitioners are able to compare similarities between this case and their own practice (for knowledge translation). No limitations of this article were reported. Limitations related to publication of this case study were that it was 20 pages long and used three tables to provide sufficient description of the camp and program components, and relationships with the research issue.

Researcher and case interactions and triangulation

Researcher and case interactions and transactions are a defining feature of case study methodology (Stake, 1995 ). Narrative stories, vignettes, and thick description are used to provoke vicarious experience and a sense of being there with the researcher in their interaction with the case. Few of the case studies reviewed provided details of the researcher's relationship with the case, researcher–case interactions, and how these influenced the development of the case study (Buzzanell & D'Enbeau, 2009 ; D'Enbeau et al., 2010 ; Gallagher et al., 2013 ; Gillard et al., 2011 ; Ledderer, 2011 ; Nagar-Ron & Motzafi-Haller, 2011 ). The role and position of the researcher needed to be self-examined and understood by readers, to understand how this influenced interactions with participants, and to determine what triangulation is needed (Merriam, 2009 ; Stake, 1995 ).

Gillard et al. ( 2011 ) provided a good example of triangulation, comparing data sources in a table (p. 1513). Triangulation of sources was used to reveal as much depth as possible in the study by Nagar-Ron and Motzafi-Haller ( 2011 ), while also enhancing confirmation validity. There were several case studies that would have benefited from improved range and use of data sources, and descriptions of researcher–case interactions (Ajodhia-Andrews & Berman, 2009 ; Bronken et al., 2012 ; Fincham, Scourfield, & Langer, 2008 ; Fourie & Theron, 2012 ; Hooghe et al., 2012 ; Snyder-Young, 2011 ; Yeh, 2013 ).

Study design inconsistent with methodology

Good, rigorous case studies require a strong methodological justification (Meyer, 2001 ) and a logical and coherent argument that defines paradigm, methodological position, and selection of study methods (Denzin & Lincoln, 2011b ). Methodological justification was insufficient in several of the studies reviewed (Barone, 2010 ; Bronken et al., 2012 ; Hooghe et al., 2012 ; Mawn et al., 2010 ; Roscigno et al., 2012 ; Yeh, 2013 ). This was judged by the absence, or inadequate or inconsistent reference to case study methodology in-text.

In six studies, the methodological justification provided did not relate to case study. There were common issues identified. Secondary sources were used as primary methodological references indicating that study design might not have been theoretically sound (Colón-Emeric et al., 2010 ; Coltart & Henwood, 2012 ; Roscigno et al., 2012 ; Snyder-Young, 2011 ). Authors and sources cited in methodological descriptions were inconsistent with the actual study design and practices used (Fourie & Theron, 2012 ; Hooghe et al., 2012 ; Jorrín-Abellán et al., 2008 ; Mawn et al., 2010 ; Rytterström et al., 2013 ; Wimpenny & Savin-Baden, 2012 ). This occurred when researchers cited Stake or Yin, or both (Mawn et al., 2010 ; Rytterström et al., 2013 ), although did not follow their paradigmatic or methodological approach. In 26 studies there were no citations for a case study methodological approach.

The findings of this study have highlighted a number of issues for researchers. A considerable number of case studies reviewed were missing key elements that define qualitative case study methodology and the tradition cited. A significant number of studies did not provide a clear methodological description or justification relevant to case study. Case studies in health and social sciences did not provide sufficient information for the reader to understand case selection, and why this case was chosen above others. The context of the cases were not described in adequate detail to understand all relevant elements of the case context, which indicated that cases may have not been contextually bounded. There were inconsistencies between reported methodology, study design, and paradigmatic approach in case studies reviewed, which made it difficult to understand the study methodology and theoretical foundations. These issues have implications for methodological integrity and honesty when reporting study design, which are values of the qualitative research tradition and are ethical requirements (Wager & Kleinert, 2010a ). Poorly described methodological descriptions may lead the reader to misinterpret or discredit study findings, which limits the impact of the study, and, as a collective, hinders advancements in the broader qualitative research field.

The issues highlighted in our review build on current debates in the case study literature, and queries about the value of this methodology. Case study research can be situated within different paradigms or designed with an array of methods. In order to maintain the creativity and flexibility that is valued in this methodology, clearer descriptions of paradigm and theoretical position and methods should be provided so that study findings are not undervalued or discredited. Case study research is an interdisciplinary practice, which means that clear methodological descriptions might be more important for this approach than other methodologies that are predominantly driven by fewer disciplines (Creswell, 2013b ).

Authors frequently omit elements of methodologies and include others to strengthen study design, and we do not propose a rigid or purist ideology in this paper. On the contrary, we encourage new ideas about using case study, together with adequate reporting, which will advance the value and practice of case study. The implications of unclear methodological descriptions in the studies reviewed were that study design appeared to be inconsistent with reported methodology, and key elements required for making judgements of rigour were missing. It was not clear whether the deviations from methodological tradition were made by researchers to strengthen the study design, or because of misinterpretations. Morse ( 2011 ) recommended that innovations and deviations from practice are best made by experienced researchers, and that a novice might be unaware of the issues involved with making these changes. To perpetuate the tradition of case study research, applications in the published literature should have consistencies with traditional methodological constructions, and deviations should be described with a rationale that is inherent in study conduct and findings. Providing methodological descriptions that demonstrate a strong theoretical foundation and coherent study design will add credibility to the study, while ensuring the intrinsic meaning of case study is maintained.

The value of this review is that it contributes to discussion of whether case study is a methodology or method. We propose possible reasons why researchers might make this misinterpretation. Researchers may interchange the terms methods and methodology, and conduct research without adequate attention to epistemology and historical tradition (Carter & Little, 2007 ; Sandelowski, 2010 ). If the rich meaning that naming a qualitative methodology brings to the study is not recognized, a case study might appear to be inconsistent with the traditional approaches described by principal authors (Creswell, 2013a ; Merriam, 2009 ; Stake, 1995 ; Yin, 2009 ). If case studies are not methodologically and theoretically situated, then they might appear to be a case report.

Case reports are promoted by university and medical journals as a method of reporting on medical or scientific cases; guidelines for case reports are publicly available on websites ( http://www.hopkinsmedicine.org/institutional_review_board/guidelines_policies/guidelines/case_report.html ). The various case report guidelines provide a general criteria for case reports, which describes that this form of report does not meet the criteria of research, is used for retrospective analysis of up to three clinical cases, and is primarily illustrative and for educational purposes. Case reports can be published in academic journals, but do not require approval from a human research ethics committee. Traditionally, case reports describe a single case, to explain how and what occurred in a selected setting, for example, to illustrate a new phenomenon that has emerged from a larger study. A case report is not necessarily particular or the study of a case in its entirety, and the larger study would usually be guided by a different research methodology.

This description of a case report is similar to what was provided in some studies reviewed. This form of report lacks methodological grounding and qualities of research rigour. The case report has publication value in demonstrating an example and for dissemination of knowledge (Flanagan, 1999 ). However, case reports have different meaning and purpose to case study, which needs to be distinguished. Findings of our review suggest that the medical understanding of a case report has been confused with qualitative case study approaches.

In this review, a number of case studies did not have methodological descriptions that included key characteristics of case study listed in the adapted criteria, and several issues have been discussed. There have been calls for improvements in publication quality of qualitative research (Morse, 2011 ), and for improvements in peer review of submitted manuscripts (Carter & Little, 2007 ; Jasper, Vaismoradi, Bondas, & Turunen, 2013 ). The challenging nature of editor and reviewers responsibilities are acknowledged in the literature (Hames, 2013 ; Wager & Kleinert, 2010b ); however, review of case study methodology should be prioritized because of disputes on methodological value.

Authors using case study approaches are recommended to describe their theoretical framework and methods clearly, and to seek and follow specialist methodological advice when needed (Wager & Kleinert, 2010a ). Adequate page space for case study description would contribute to better publications (Gillard et al., 2011 ). Capitalizing on the ability to publish complementary resources should be considered.

Limitations of the review

There is a level of subjectivity involved in this type of review and this should be considered when interpreting study findings. Qualitative methods journals were selected because the aims and scope of these journals are to publish studies that contribute to methodological discussion and development of qualitative research. Generalist health and social science journals were excluded that might have contained good quality case studies. Journals in business or education were also excluded, although a review of case studies in international business journals has been published elsewhere (Piekkari et al., 2009 ).

The criteria used to assess the quality of the case studies were a set of qualitative indicators. A numerical or ranking system might have resulted in different results. Stake's ( 1995 ) criteria have been referenced elsewhere, and was deemed the best available (Creswell, 2013b ; Crowe et al., 2011 ). Not all qualitative studies are reported in a consistent way and some authors choose to report findings in a narrative form in comparison to a typical biomedical report style (Sandelowski & Barroso, 2002 ), if misinterpretations were made this may have affected the review.

Case study research is an increasingly popular approach among qualitative researchers, which provides methodological flexibility through the incorporation of different paradigmatic positions, study designs, and methods. However, whereas flexibility can be an advantage, a myriad of different interpretations has resulted in critics questioning the use of case study as a methodology. Using an adaptation of established criteria, we aimed to identify and assess the methodological descriptions of case studies in high impact, qualitative methods journals. Few articles were identified that applied qualitative case study approaches as described by experts in case study design. There were inconsistencies in methodology and study design, which indicated that researchers were confused whether case study was a methodology or a method. Commonly, there appeared to be confusion between case studies and case reports. Without clear understanding and application of the principles and key elements of case study methodology, there is a risk that the flexibility of the approach will result in haphazard reporting, and will limit its global application as a valuable, theoretically supported methodology that can be rigorously applied across disciplines and fields.

Conflict of interest and funding

The authors have not received any funding or benefits from industry or elsewhere to conduct this study.

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Single Case Research Design

• First Online: 04 January 2024

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• Stefan Hunziker 3 &
• Michael Blankenagel 3  

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This chapter addresses single-case research designs’ peculiarities, characteristics, and significant fallacies. A single case research design is a collective term for an in-depth analysis of a small non-random sample. The focus of this design is in-depth. This characteristic distinguishes the case study research from other research designs that understand the individual case as a relatively insignificant and interchangeable aspect of a population or sample. Also, researchers find relevant information on writing a single case research design paper and learn about typical methods used for this research design. The chapter closes by referring to overlapping and adjacent research designs.

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Hunziker, S., Blankenagel, M. (2024). Single Case Research Design. In: Research Design in Business and Management. Springer Gabler, Wiesbaden. https://doi.org/10.1007/978-3-658-42739-9_8

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• Case Study | Definition, Examples & Methods

Case Study | Definition, Examples & Methods

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

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

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

Table of contents

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

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

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

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

Prevent plagiarism, run a free check.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Chapter 10: Single-Subject Research

Overview of Single-Subject Research

Learning Objectives

• Explain what single-subject research is, including how it differs from other types of psychological research.
• Explain what case studies are, including some of their strengths and weaknesses.
• Explain who uses single-subject research and why.

What Is Single-Subject Research?

Single-subject research  is a type of quantitative research that involves studying in detail the behaviour of each of a small number of participants. Note that the term  single-subject  does not mean that only one participant is studied; it is more typical for there to be somewhere between two and 10 participants. (This is why single-subject research designs are sometimes called small- n designs, where  n  is the statistical symbol for the sample size.) Single-subject research can be contrasted with  group research , which typically involves studying large numbers of participants and examining their behaviour primarily in terms of group means, standard deviations, and so on. The majority of this textbook is devoted to understanding group research, which is the most common approach in psychology. But single-subject research is an important alternative, and it is the primary approach in some areas of psychology.

Before continuing, it is important to distinguish single-subject research from two other approaches, both of which involve studying in detail a small number of participants. One is qualitative research, which focuses on understanding people’s subjective experience by collecting relatively unstructured data (e.g., detailed interviews) and analyzing those data using narrative rather than quantitative techniques. Single-subject research, in contrast, focuses on understanding objective behaviour through experimental manipulation and control, collecting highly structured data, and analyzing those data quantitatively.

It is also important to distinguish single-subject research from case studies. A case study  is a detailed description of an individual, which can include both qualitative and quantitative analyses. (Case studies that include only qualitative analyses can be considered a type of qualitative research.) The history of psychology is filled with influential cases studies, such as Sigmund Freud’s description of “Anna O.” (see Note 10.5 “The Case of “Anna O.””) and John Watson and Rosalie Rayner’s description of Little Albert (Watson & Rayner, 1920) [1] , who learned to fear a white rat—along with other furry objects—when the researchers made a loud noise while he was playing with the rat. Case studies can be useful for suggesting new research questions and for illustrating general principles. They can also help researchers understand rare phenomena, such as the effects of damage to a specific part of the human brain. As a general rule, however, case studies cannot substitute for carefully designed group or single-subject research studies. One reason is that case studies usually do not allow researchers to determine whether specific events are causally related, or even related at all. For example, if a patient is described in a case study as having been sexually abused as a child and then as having developed an eating disorder as a teenager, there is no way to determine whether these two events had anything to do with each other. A second reason is that an individual case can always be unusual in some way and therefore be unrepresentative of people more generally. Thus case studies have serious problems with both internal and external validity.

The Case of “Anna O.”

Sigmund Freud used the case of a young woman he called “Anna O.” to illustrate many principles of his theory of psychoanalysis (Freud, 1961) [2] . (Her real name was Bertha Pappenheim, and she was an early feminist who went on to make important contributions to the field of social work.) Anna had come to Freud’s colleague Josef Breuer around 1880 with a variety of odd physical and psychological symptoms. One of them was that for several weeks she was unable to drink any fluids. According to Freud,

She would take up the glass of water that she longed for, but as soon as it touched her lips she would push it away like someone suffering from hydrophobia.…She lived only on fruit, such as melons, etc., so as to lessen her tormenting thirst. (p. 9)

But according to Freud, a breakthrough came one day while Anna was under hypnosis.

[S]he grumbled about her English “lady-companion,” whom she did not care for, and went on to describe, with every sign of disgust, how she had once gone into this lady’s room and how her little dog—horrid creature!—had drunk out of a glass there. The patient had said nothing, as she had wanted to be polite. After giving further energetic expression to the anger she had held back, she asked for something to drink, drank a large quantity of water without any difficulty, and awoke from her hypnosis with the glass at her lips; and thereupon the disturbance vanished, never to return. (p.9)

Freud’s interpretation was that Anna had repressed the memory of this incident along with the emotion that it triggered and that this was what had caused her inability to drink. Furthermore, her recollection of the incident, along with her expression of the emotion she had repressed, caused the symptom to go away.

As an illustration of Freud’s theory, the case study of Anna O. is quite effective. As evidence for the theory, however, it is essentially worthless. The description provides no way of knowing whether Anna had really repressed the memory of the dog drinking from the glass, whether this repression had caused her inability to drink, or whether recalling this “trauma” relieved the symptom. It is also unclear from this case study how typical or atypical Anna’s experience was.

Assumptions of Single-Subject Research

Again, single-subject research involves studying a small number of participants and focusing intensively on the behaviour of each one. But why take this approach instead of the group approach? There are several important assumptions underlying single-subject research, and it will help to consider them now.

First and foremost is the assumption that it is important to focus intensively on the behaviour of individual participants. One reason for this is that group research can hide individual differences and generate results that do not represent the behaviour of any individual. For example, a treatment that has a positive effect for half the people exposed to it but a negative effect for the other half would, on average, appear to have no effect at all. Single-subject research, however, would likely reveal these individual differences. A second reason to focus intensively on individuals is that sometimes it is the behaviour of a particular individual that is primarily of interest. A school psychologist, for example, might be interested in changing the behaviour of a particular disruptive student. Although previous published research (both single-subject and group research) is likely to provide some guidance on how to do this, conducting a study on this student would be more direct and probably more effective.

A second assumption of single-subject research is that it is important to discover causal relationships through the manipulation of an independent variable, the careful measurement of a dependent variable, and the control of extraneous variables. For this reason, single-subject research is often considered a type of experimental research with good internal validity. Recall, for example, that Hall and his colleagues measured their dependent variable (studying) many times—first under a no-treatment control condition, then under a treatment condition (positive teacher attention), and then again under the control condition. Because there was a clear increase in studying when the treatment was introduced, a decrease when it was removed, and an increase when it was reintroduced, there is little doubt that the treatment was the cause of the improvement.

A third assumption of single-subject research is that it is important to study strong and consistent effects that have biological or social importance. Applied researchers, in particular, are interested in treatments that have substantial effects on important behaviours and that can be implemented reliably in the real-world contexts in which they occur. This is sometimes referred to as social validity  (Wolf, 1976) [3] . The study by Hall and his colleagues, for example, had good social validity because it showed strong and consistent effects of positive teacher attention on a behaviour that is of obvious importance to teachers, parents, and students. Furthermore, the teachers found the treatment easy to implement, even in their often-chaotic elementary school classrooms.

Who Uses Single-Subject Research?

Single-subject research has been around as long as the field of psychology itself. In the late 1800s, one of psychology’s founders, Wilhelm Wundt, studied sensation and consciousness by focusing intensively on each of a small number of research participants. Herman Ebbinghaus’s research on memory and Ivan Pavlov’s research on classical conditioning are other early examples, both of which are still described in almost every introductory psychology textbook.

In the middle of the 20th century, B. F. Skinner clarified many of the assumptions underlying single-subject research and refined many of its techniques (Skinner, 1938) [4] . He and other researchers then used it to describe how rewards, punishments, and other external factors affect behaviour over time. This work was carried out primarily using nonhuman subjects—mostly rats and pigeons. This approach, which Skinner called the experimental analysis of behaviour —remains an important subfield of psychology and continues to rely almost exclusively on single-subject research. For excellent examples of this work, look at any issue of the  Journal of the Experimental Analysis of Behaviour . By the 1960s, many researchers were interested in using this approach to conduct applied research primarily with humans—a subfield now called  applied behaviour analysis  (Baer, Wolf, & Risley, 1968) [5] . Applied behaviour analysis plays an especially important role in contemporary research on developmental disabilities, education, organizational behaviour, and health, among many other areas. Excellent examples of this work (including the study by Hall and his colleagues) can be found in the  Journal of Applied Behaviour Analysis .

Although most contemporary single-subject research is conducted from the behavioural perspective, it can in principle be used to address questions framed in terms of any theoretical perspective. For example, a studying technique based on cognitive principles of learning and memory could be evaluated by testing it on individual high school students using the single-subject approach. The single-subject approach can also be used by clinicians who take any theoretical perspective—behavioural, cognitive, psychodynamic, or humanistic—to study processes of therapeutic change with individual clients and to document their clients’ improvement (Kazdin, 1982) [6] .

Key Takeaways

• Single-subject research—which involves testing a small number of participants and focusing intensively on the behaviour of each individual—is an important alternative to group research in psychology.
• Single-subject studies must be distinguished from case studies, in which an individual case is described in detail. Case studies can be useful for generating new research questions, for studying rare phenomena, and for illustrating general principles. However, they cannot substitute for carefully controlled experimental or correlational studies because they are low in internal and external validity.
• Single-subject research has been around since the beginning of the field of psychology. Today it is most strongly associated with the behavioural theoretical perspective, but it can in principle be used to study behaviour from any perspective.
• Practice: Find and read a published article in psychology that reports new single-subject research. ( An archive of articles published in the Journal of Applied Behaviour Analysis can be found at http://www.ncbi.nlm.nih.gov/pmc/journals/309/) Write a short summary of the study.
• Describe one problem related to internal validity.
• Describe one problem related to external validity.
• Generate one hypothesis suggested by the case study that might be interesting to test in a systematic single-subject or group study.

Media Attributions

• Pappenheim 1882 by unknown is in the Public Domain .
• Watson, J. B., & Rayner, R. (1920). Conditioned emotional reactions.  Journal of Experimental Psychology, 3 , 1–14. ↵
• Freud, S. (1961).  Five lectures on psycho-analysis . New York, NY: Norton. ↵
• Wolf, M. (1976). Social validity: The case for subjective measurement or how applied behaviour analysis is finding its heart.  Journal of Applied Behaviour Analysis, 11 , 203–214. ↵
• Skinner, B. F. (1938). T he behaviour of organisms: An experimental analysis . New York, NY: Appleton-Century-Crofts. ↵
• Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behaviour analysis.  Journal of Applied Behaviour Analysis, 1 , 91–97. ↵
• Kazdin, A. E. (1982).  Single-case research designs: Methods for clinical and applied settings . New York, NY: Oxford University Press. ↵

A type of quantitative research that involves studying the behaviour of each small number of participants in detail.

The study of large numbers of participants and examining their behaviour primarily in terms of group means, standard deviations, and so on.

A detailed description of an individual, which can include both qualitative and quantitative analyses.

The study of strong and consistent effects that can be implemented reliably in the real-world contexts in which they occur.

Laboratory methods that rely on single-subject research; based upon B. F. Skinner’s philosophy of behaviourism which posits that everything organisms do is behaviour.

Starting in the 1960s, researchers began using single-subject techniques to conduct applied research with human subjects.

Research Methods in Psychology - 2nd Canadian Edition Copyright © 2015 by Paul C. Price, Rajiv Jhangiani, & I-Chant A. Chiang is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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The impact of close reading strategies on individual innovativeness and life skills: preservice teachers.

1. Introduction

• Innovators: Innovators are individuals who are willing to try new ideas, curious, willing to take risks, enterprising and well educated, and have a vision.
• Pioneers: People in this category, who come after innovators, support innovations and convey them, and are role models and guides in society regarding innovations.
• Questioners: These people, who come after pioneers in supporting innovations, adopt innovations, but are cautious about implementing innovations and are not willing to take risks.
• Skeptics: These people, who come after questioners, are more skeptical than average individuals in adopting innovations; they remain hesitant towards innovations due to factors such as social pressure and economic reasons.
• Traditionalists: These people, who are the last to adopt innovations, are prejudiced against innovations and change, do not want to go beyond their traditions, and tend to ignore and delay innovations by acting according to the perspective of the previous generation.
• Do close reading strategies create a significant difference between pre-test and post-test scores on individual innovativeness of preservice Turkish language teachers?
• Do close reading strategies create a significant difference between pre-test and post-test scores on life skills of preservice Turkish language teachers?
• What is the distribution of pre-test and post-test scores on individual innovativeness according to gender?
• What are the views of Turkish teacher candidates on the impact of using the close reading strategy on individual innovativeness traits and life skills?

2. Materials and Methods

2.1. research model, 2.2. study group, 2.3. data collection tools, 2.3.1. individual innovativeness scale, 2.3.2. life skills scale, 2.3.3. semi-structured interview form.

• What are the contributions of the close reading strategy to your reading skills?
• What are the contributions of the close reading strategy to your life skills and individual innovativeness?

2.4. Data Collection

• Identification: The instructor names the strategy.
• Teaching: The purpose of the strategy is explained, including the benefits of learning the strategy and its importance.
• Usage Explanation: Information on where the strategy can be used (e.g., while listening to a lecture, reading a text, post-reading) is provided.
• Usage Characteristics: Explanation is provided of the characteristics of the strategy and what to pay attention to while using it.
• Modeling: The teacher demonstrates the use of the strategy by thinking aloud, externalizing cognitive processes.
• Practice: Students are given the opportunity to practice the strategy. During this trial phase, they can adjust their skills in a classroom setting prior to practice.
• Group Discussion and Evaluation: Students evaluate and discuss their correct or incorrect use of the strategy as a group, encouraging them to monitor and assess their strategy use.

2.5. Data Analysis

3. findings, 3.1. quantitative findings on the impact of the close reading strategy on life skills and individual innovativeness features, 3.2. qualitative findings on the effects of the close reading strategy on turkish teacher candidates’ reading skills, life skills, and individual innovativeness.

It helped me approach texts from different perspectives. (F, 1)

It made me think critically and look at a text from different angles rather than taking it as it is. (M, 1)

Reading using different techniques motivates a person. Now, when I read books, I will use techniques from different genres. This will give me different experiences. (F, 8)

I realized that the texts I read have deeper meanings, not just one interpretation. (F, 17)

The texts we read contributed to my change as they were disruptive to my stereotypical knowledge. (F, 19)

Using the close reading strategy added a new style to my reading habits. (M, 3)

Asking different questions and doing it step by step was fun and educational. Reading in detail to find answers to the questions in the text helped us understand the texts better. (F, 11)

I can better find the cause-and-effect relationships and connections in the text. (M, 5)

I learned to look at life from different angles, to derive meaning from everything that comes our way, and to realize that nothing happens by chance. (F, 5)

I learned to see even a stone in my path as meaningful. (M, 3)

It made me open to new ideas and listen to others’ thoughts with respect. (F, 18)

I felt the need to question things after this practice. (F, 17)

Now I look at things from a broader perspective and question them, and I am much more open to new ideas as an individual. (F, 21)

Previously, I was even afraid to say the word ‘create’, let alone think critically about certain topics; I was afraid to think at all. (F, 4)

I realized that I was thinking one-dimensionally and couldn’t look at events critically. (F, 6)

I think it contributed to my development in problem-solving. (F, 11)

Since it developed my questioning and thinking skills, my decision-making skills also improved along with it. (F, 8)

With this strategy, I learned to better recognize my own thoughts and feelings. (F, 17)

Now, I started to think more deeply about a topic, event, or text. (F, 25)

I now communicate according to the characteristics of individuals. (F, 19)

It was beneficial in terms of decision-making and problem-solving. (M, 1)

I once again realized how necessary it is to see from others’ perspectives. (F, 15)

It helped me recognize my own thoughts and feelings. (M, 2)

4. Conclusions and Discussion

5. recommendations.

• The close reading strategy can be utilized for the development of life skills and individual innovation skills.
• The close reading strategy should be included in the curriculum starting from primary education and continuing to higher education, and its use should be extended to different levels across this range.
• The effectiveness of the close reading strategy on comprehension of narrative texts and poetry, as well as informative texts, can be examined.
• This strategy was implemented with preservice Turkish teachers, and its effects on different educational levels can be examined in future research.
• This study examined the strategy’s contributions to life skills, individual innovativeness, and the reading process. Future research could also examine its effects on other language skills such as writing, speaking, and listening.

Institutional Review Board Statement

Informed consent statement, data availability statement, conflicts of interest.

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Baki, Y. The Impact of Close Reading Strategies on Individual Innovativeness and Life Skills: Preservice Teachers. Behav. Sci. 2024 , 14 , 816. https://doi.org/10.3390/bs14090816

Baki Y. The Impact of Close Reading Strategies on Individual Innovativeness and Life Skills: Preservice Teachers. Behavioral Sciences . 2024; 14(9):816. https://doi.org/10.3390/bs14090816

Baki, Yasemin. 2024. "The Impact of Close Reading Strategies on Individual Innovativeness and Life Skills: Preservice Teachers" Behavioral Sciences 14, no. 9: 816. https://doi.org/10.3390/bs14090816

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A Systems View Across Time and Space

• Open access
• Published: 12 September 2024

Transforming rural women’s lives in India: the impact of microfinance and entrepreneurship on empowerment in Self-Help Groups

• Ashwini Pandhare   ORCID: orcid.org/0000-0003-1894-1207 1 ,
• Praveen Naik Bellampalli   ORCID: orcid.org/0000-0001-7888-2101 2 &
• Neelam Yadava   ORCID: orcid.org/0000-0001-5027-4104 1  

Journal of Innovation and Entrepreneurship volume  13 , Article number:  62 ( 2024 ) Cite this article

Metrics details

The study investigates how microfinance interventions and the entrepreneurial engagement of Self-Help Group (SHGs) members impact women’s social and economic empowerment in rural communities. The study employs a mixed-methods approach, combining quantitative data analysis and qualitative insights gathered through surveys, interviews, and case studies. The study’s findings demonstrated a notably positive and moderately significant impact of microfinance and entrepreneurial engagement on the social, economic, and psychological dimensions of women’s empowerment. Furthermore, the inclusion of case studies provided evidence that microfinance activities and entrepreneurship involvement have substantially empowered women across various domains, such as increasing financial independence, enhancing participation in decision-making processes, fostering social networks and support, and boosting their overall self-confidence and well-being. These insights emphasise the transformative potential of microfinance initiatives in advancing gender equality and women’s empowerment in diverse socio-economic contexts.

Introduction

Microfinance activities in India are experiencing significant growth and have absorbed the interest of both corporate and financial institutions due to their remarkable effectiveness in addressing poverty (Sinha et al., 2012 ). Significantly, the approach towards Self-Help Groups (SHGs) has evolved as an essential means to provide microcredit to impoverished rural women, enabling them to engage in entrepreneurial activities effectively (Ghosh, 2012 ; Laha & Kuri, 2014 ). These programs have gained international recognition as a subsector of the economic system, primarily for their ability to combat poverty and alleviate rural unemployment. In emerging economies, there is a concerted effort to enhance credit access and promote the mobilisation of microfinancing, thereby encouraging greater participation in Self-Help Groups (SHGs) (Joshi, 2019 ; Ray, 2008 ). The growth of women entrepreneurs acts as a substance for women’s empowerment (Deka, 2018 ). Empowerment of women as their socio-economic development is crucial for ensuring sustainable economic growth. The Constitution of India, in Article 14, guarantees the right to equality for all citizens, which is vital for achieving sustainable development. Although there has been a noticeable increase in women’s participation in the labour force, according to the Periodic Labour Survey of India, in 2017, women’s labour force participation was 23.3%, and in 2022–23, it increased to 37%. It shows the positive trend of Women’s labour force participation in the last 6 years. Also, economically empowered women still encounter numerous personal, societal, and organizational barriers that hinder their career advancement (Ghosh et al., 2023 ).

Women across the globe are disproportionately affected by poverty and frequently lack access to essential services, including healthcare, clean water, sanitation, and education. Moreover, women’s labour is often undervalued and goes unpaid, perpetuating economic inequalities. Tragically, women also endure various forms of violence, further exacerbating their vulnerable position in society. These pressing issues highlight the urgent need to address gender disparities and ensure that women have equal access to resources, opportunities, and protection from violence (United Nations, 2015 ). Microfinance initiatives have primarily focused on empowering women for several reasons. Women often face significant barriers in accessing credit to establish micro or small enterprises, especially in male-dominated societies where their roles are traditionally confined to household responsibilities (Chant, 2014 ; Khan et al., 2020 ). Microfinance is widely recognised and significantly contributes to rural transformation in India through various channels. It has successfully mobilised small savings at a lower cost from rural poor individuals with limited education, who were previously excluded from the formal banking system (Srikanth et al., 2022 ). Moreover, it has provided microcredit to low-income families without requiring security, enabling them to explore new livelihood opportunities and overcome short-term financial crises. Consequently, the accessibility of credit has enhanced the sustainability of livelihoods for the rural poor. Most importantly, microfinance has assisted the ultra-poor in fulfilling their most essential needs and safeguarding them against livelihood risks (Banerjee & Duflo, 2011 ).

The current state of development studies reflects both fortunes and misfortunes. The definition of sustainable development, popularised by the Brundtland Commission Report, remains vague and elusive despite its foundational principles. This ambiguity leads to varied interpretations, undermining a proper understanding of the term. The Sustainable Development Goals (SDGs) attempt to refine the concept but still grapple with imprecision, particularly regarding economic sustainability and gross domestic product GDP growth. As part of sustainable development, microfinance aims to empower low-income communities by providing financial services, fostering economic stability, and enabling environmental sustainability through local enterprises. The integration of microfinance in sustainable development discourse highlights the potential for a balanced approach to societal growth (Manioudis & Meramveliotakis, 2022 ). Additionally, small and medium-sized enterprises (SMEs) are critical for sustainable development, representing about 90% of businesses globally and employing over 50% of the workforce. However, the COVID-19 pandemic has severely impacted SMEs, with significant revenue losses and threats to their survival. For example, 41% of United Kingdom (UK) SMEs ceased operations in May 2020, and Spain saw a 43% decline in SMEs. About 25–36% of small businesses could permanently close within the first four months of the pandemic (Meramveliotakis & Manioudis, 2021 ).

Microfinance and women empowerment

Microfinance and Self-Help Groups (SHGs) have gained significant support from various developing countries as a powerful tool to combat poverty and enhance gender equality (Garikipati, 2012 ). These initiatives have been widely contained as effective strategies to empower individuals, particularly women, by providing them with access to financial services, resources, and skills training. Through microfinance and SHGs, marginalised individuals are able to out of from the cycle of poverty, create sustainable livelihoods, and actively participate in economic and social development, thereby fostering greater gender equality and inclusive growth (Ghosh, 2012 ; Deininger & Liu, 2013 ; Unni et al., 2021 ) Microfinance empowers women by bringing about transformative changes in household decision-making and enhancing their bargaining power (Swain & Wallentin, 2012 ). Despite India’s ongoing economic growth, gender inequality continues to persist. Women comprise nearly 48% of India’s total population and are significantly underrepresented in the employment market, comprising only 20.5% of the workforce. Out of this, 60% of women are engaged in agricultural and related sectors (Ghosh et al., 2023 ; Madgavkar et al., 2019 ).

Self-Help Groups (SHGs) significantly impact the entrepreneurship and empowerment of rural women in India. These groups provide a platform for women to come together, identify their resources, and engage in various economic activities. SHGs have been recognised as an effective means of promoting women’s empowerment and reducing poverty in rural areas (Rajagopal, 2020 ). Another study pointed out that women’s participation in microfinance activities contributes to both social change and empowerment, as it liberates them from the confines of their homes and enhances their economic roles. These programs operate on a group-based model, under the idea that women’s collective engagement promotes greater empowerment compared to individuals. By providing access to essential financial support like savings and loans, women are empowered to establish new economic ventures or expand existing ones, resulting in increased income opportunities (Osmani, 1998 ; Sahu, 2014 ). Microfinance through SHGs, women can experience significant improvements in their standard of living, social status, and decision-making within households, overcoming limitations in households (Kumar et al., 2021 ). Moreover, microfinance activities have predominantly focused on women as the primary target group due to their strong repayment performance and positive impact on family welfare (Sinha et al., 2012 ). The participation of women in these programs has led to remarkable improvements in household consumption, increased income, and savings, which has consequently led to a significant reduction in poverty within these households (Khan et al., 2022 ).

The Sustainable Development Goal ensures inclusive and sustainable progress, leaving no one behind; the fifth goal is “Gender Equality”, which addresses various women’s issues and problems. Women face discrimination, inequality, sexual abuse and exploitation, unfair labour and wage distribution, and unpaid domestic work, all of which are examples of human rights violations. Several indicators have been proposed to measure gender equality in relation to the Sustainable Development Goals (SDGs). These indicators include eliminating all forms of violence against women, ending discrimination against women and girls in all its manifestations, eradicating harmful practices and domestic work, promoting women’s participation and ensuring equal opportunities for leadership and decision-making in political, economic and access to ownership and control over land and other forms of property (UNDP, 2019 ). However, the community-based sustainable business model led to the economic, social, and cultural empowerment of rural women engaged in entrepreneurial activities (Haugh & Talwar, 2014 ; Ghosh et al., 2023 ). Through involvement in entrepreneurship, women experienced significant improvements in intra-household power relations, resulting in reduced male dependency (Hazarika & Goswami, 2016 ; Kumari & Eguruze, 2021 ).

Rationale and objectives of the study

The study exclusively focuses on the socio-cultural context of rural areas in developing countries, which has been less explored in the existing literature. Additionally, the study incorporates a mixed-methods approach, combining quantitative data with qualitative interviews, to provide a more comprehensive understanding of the impact of microfinance on women’s social inclusion. This methodological approach adds a new dimension to the scholarship by capturing both the measurable outcomes and the personal experiences of the women involved. The state of Maharashtra heavily relies on the agriculture and allied sectors, employing more than 70% of its population. However, the Osmanabad district faces challenges in terms of limited employment opportunities and a lack of entrepreneurial mindset development, leading to low participation rates (Swayam Shikhan Prayog (SSP), 2021 ). Women, who form a substantial part of the labour force in these sectors, encounter difficulties in starting and sustaining entrepreneurial activities due to inadequate marketing skills and financial management knowledge. To address this issue, the study explores the role of Self-Help Groups and microfinance activities in empowering women to engage in small enterprise activities within the district. This research also seeks to understand the impact of women’s entrepreneurial activities and assess their potential to enhance economic growth and opportunities for women in the region.

Research method

The study aims to explore and analyse the influence of microfinance interventions and the engagement of entrepreneurship exhibited by Self-Help Groups (SHGs) members on women’s social and economic empowerment in the Osmanabad district of Maharashtra, India. The methodology employed a mixed-method approach, utilising quantitative and qualitative research techniques to understand the subject matter comprehensively. A structured interview schedule was used to gather primary data, and interviews were conducted with 150 women who are active members of SHGs registered under the Maharashtra Rural Livelihood Mission. These SHGs were purposively selected from three blocks in Osmanabad district: Osmanabad, Tuljapur, and Kalamb. The selection was based on their higher concentration of bank-linked SHGs and access to significant bank loans, which would allow for a better assessment of the impact of microfinance interventions.

In the first stage, 15 SHGs groups were identified, each comprising 10 women, resulting in a total of 150 participants. Simple random sampling techniques were used to ensure a fair population representation and minimise bias in the selection process. In the second stage, the selected women were actively involved in entrepreneurial activities, indicating a strong entrepreneurial trait among the participants. This step examined the correlation between entrepreneurship and women’s empowerment in rural communities. In the third stage, five SHGs groups were selected from each of the three blocks based on the high levels of observed entrepreneurship activities. This selection process allowed the researchers to focus on groups significantly impacting women’s empowerment through entrepreneurial initiatives. A descriptive design was employed to assess the impact of the microfinance activities and entrepreneurship activities facilitated by SHGs on women’s empowerment. Through this design, the researchers could gain a detailed understanding of the current situation, trends, and relationships among the variables under investigation. In addition to the quantitative approach, the study integrated a qualitative approach to gain deeper insights into the impact of entrepreneurship and microfinance interventions on women’s empowerment. Various qualitative research tools such as in-depth interviews, observations, and case studies were used to collect comprehensive data and enhance the understanding of the situation of entrepreneurial women.

By combining quantitative and qualitative methodologies, the study aims to provide a holistic analysis of the interplay between microfinance interventions, entrepreneurial engagement, and women’s resulting social and economic empowerment in the Osmanabad district. Secondary data were also gathered from multiple sources, including books, journals, websites, block offices, and regional offices of the Maharashtra Rural Livelihood Mission. These additional sources of information add depth and context to the study’s findings and allow for an implication of the research problem. Using a mixed-method approach and carefully selecting SHGs and participants contribute to the study’s robustness and reliability. The focus on the Osmanabad district of Maharashtra provides valuable insights into the specific context of rural women’s empowerment in the region (Fig. 1 ).

(Source: Developed by a researcher by using GIS software, 2022)

Location map

As of the 2011 census, the Osmanabad district’s population in Maharashtra is 16.60 lakhs (1.66 million). Out of this total population, there are 8.64 lakhs (0.86 million) males and 7.96 lakhs (0.79 million) females. The district has a significant rural population of 13.79 lakhs (1.38 million), while the urban population is 2.81 lakhs (0.28 million). The district’s literacy rate is reported to be 76.33%. The district is known for its warm and dry climate, with temperatures dropping to around 11 °C in winters and reaching up to 43 °C during summers. The region experiences rainfall primarily during the southwest monsoon from June to October, with an average rainfall of 600–700 mm (Census of India, 2011 ).

Table 1 provides a brief profile and socio-economic status of women belonging to Self-Help Groups (SHGs) who actively engage in entrepreneurial activities. In terms of category, the table shows the distribution of women across different categories. Scheduled Caste women account for 45.3% of the respondents, followed by Other Backward Classes (42.0%), Scheduled Tribe (8.7%), and General (4.0%). The p-values indicate the statistical significance of the differences observed among the categories. The education qualification of the SHG women is also provided. Notably, 8.0% of the women are illiterate, while the majority have completed primary (42.7%) or secondary education (38.0%). A smaller proportion has attained higher secondary education (11.3%). The p -values indicate significant differences in educational attainment among the groups.

The table further presents the age distribution of the women. The largest group consists of women aged 21–30 (50.7%), followed by those aged 31–40 (31.3%), and 20 and below (15.3%). A small percentage of women falls in the 41–50 age range (2.7%). The p-values suggest significant variations in age distribution among the age groups. Land ownership is another aspect considered in the table. Most women (54.0%) own land in the 1.01–2 acres range, while 43.3% own 0–1 acre. A small proportion (2.7%) possesses land in the 2.01–3 acres range. The type of family is also indicated, with 92.0% of the women belonging to nuclear families and only 8.0% in joint families. This distribution shows a significant difference, as denoted by the p-value. The ration card status of the SHGs women is majority (68.7%) falls under the Below Poverty Line (BPL) category, followed by Above Poverty Line (APL) (8.7%) and Antyodaya Anna Yojana (AAY) (22.7%). The p -values indicate significant differences in ration card status. The women’s income source is categorised into agricultural land, agriculture labour work, and livestock/other activities. The highest proportion (56.7%) derives income from agricultural labour work, while 30.0% depend on agricultural land. A smaller percentage (13.3%) engages in livestock and other activities.

The table also displays the distribution of yearly family income. The largest group (53.3%) has an income in the range of 60,001–90,000 rupees, followed by 29.3% with 60,000 rupees and below. Smaller proportions fall in higher income brackets, with the lowest group (3.3%) having an income of 150,001 rupees and above. The p -values indicate significant differences in income distribution among the groups. The data indicate a comprehensive overview of the profile and socio-economic status of SHG women. The percentages, proportions, and p -values allow for a comparative analysis of the different components, highlighting significant variations in the data.

Tables 2 , 3 presents data on women’s involvement in entrepreneurship activities across different blocks, including tailoring, dairy farming, food processing, goat farming, poultry, and grocery/fruit shop. In the block of Osmanabad, most women are involved in dairy farming (15 women, 25.4%), and the lowest is in the grocery/fruit shop (7 women, 11.9%). In Kalamb, the most significant participation is in the grocery/fruit shop (12 women, 27.3%), while the least is in Tuljapur for tailoring (3 women, 6.4%). Looking at the overall representation for all the blocks combined, dairy farming has the highest number of women participants (36 women, 24.0%), while tailoring has the lowest (17 women, 11.3%). It is evident from the data that women are actively participating in various entrepreneurial activities in the region. Dairy farming is the most popular choice, while grocery/fruit shops also attract many women entrepreneurs. Tailoring, on the other hand, appears to be less preferred overall. The data highlight the diverse economic pursuits of women in these blocks, contributing to local economic development and empowerment.

Successful case studies on entrepreneurial activities

This research presents two successful case studies demonstrating the connection between entrepreneurial activities and women’s empowerment. The case stories shed light on the transformative impact of women’s entrepreneurship on their social and economic empowerment.

The case study highlights the transformative journey and involvement in the SHG and how this helped to break free from poverty and dependency. The narrative emphasises entrepreneurial growth, increased decision-making power, improved communication skills, and enhanced self-esteem.

My name is Jalaja (name changed), a 42-year-old residing in the Osmanabad block. I had been struggling to make ends meet and manage income through wage work before I joined the SHG program, with no hope of a better livelihood. However, my life took a positive turn when I heard about the formation of the SHG and decided to become a member. Upon joining the SHG and other women from economically disadvantaged backgrounds, we saved 50 rupees each week. After a few weeks, all members had saved around 20,000 rupees. Within a year, the SHG became eligible for bank loans, and I obtained a 50,000 rupees loan. With financial support from bank loans, I officially established a tailoring business, employing two other women from my own community. I specialise in cutting clothes and stitching work. This small business allowed me to balance my household responsibilities while pursuing my entrepreneurial goals. The income generated from my business enabled me to contribute to household expenses and provide for my children’s education, including school fees.

Participating in the SHG program empowered me to have a voice in household decision-making, a pleasure I had been denied previously. I also experienced a significant improvement in my communication skills, both within my family and while interacting with customers, including officials in the SHG program. Before joining the SHG, I felt unable to express myself confidently, but the SHG group prepared me with the knowledge of signing documents and enhanced my overall literacy skills. My involvement in the SHG program granted me the freedom to move freely, visit my maternal home, and engage in public meetings. The program helped me recognise the importance of mobility in contributing to the overall betterment of my household and community.

-Break free from poverty and dependency

My name is Savitri (name changed), and I am a resident of Kalamb block. I joined the Self-Help Group (SHG) program 2 years ago. With the program’s support and guidance, our group successfully transitioned to formal financial services and gained eligibility for bank loans. I obtained bank loans amounting to 75,000 rupees. Utilising space in my house, I built a cattle-rearing shed and effectively managed eight cattle. I sell cattle milk in the local dairy while efficiently managing my household chores. As a result, I now earn a stable income, meet personal expenses such as clothing and food, and even invest in gold.

Moreover, I contribute to overall household expenses. I acknowledge the significant impact of my participation in the SHG group, empowering me to overcome anxiety and tension. Reflecting on my situation before joining the SHG, I realize that my husband worked as a labourer, and our earnings were insufficient. I hesitated to request personal expenditures as his income barely covered our household expenses. However, now I cannot only support myself but also provide for my children and cover the entire household expenditure.

Before joining the SHG, my financial activities were limited, and I was unfamiliar with markets, banks, and interacting with outsiders. However, since joining the SHG group, my circumstances have transformed. I now move freely, explore local markets, visit banks, hospitals, and various places. I gained confidence in interacting with people without fear. My status within and outside the home has improved, and now I consider myself an essential and valued household member. I also expressed that I was never consulted on any matter at home and felt like an unworthy family member. But now, I attend public and panchayat meetings without any restrictions despite being initially unfamiliar with such gatherings. I can freely go wherever I feel. Most importantly, I have overcome feelings of loneliness by engaging and interacting with fellow group members. I hope to continue my association with the SHG group and aim to expand my cattle-rearing shed further, motivated for even greater success in my entrepreneurial activities.

-Overcome anxiety and tension

The presented case studies are persuasive evidence of the positive impact of Self-Help Groups (SHGs) on women’s empowerment and entrepreneurial success in the district. Through the transformative journeys of Jalaja and Savitri, it becomes evident that the SHGs program has been instrumental in breaking the chains of poverty and dependency, providing a platform for women to become financially independent and assertive decision-makers in their households. These case studies underscore the pivotal role of SHGs in providing women with access to financial resources, training, and a supportive community, enabling them to pursue entrepreneurial activities and overcome social barriers. The SHGs program has proven effective for women’s economic and socio-cultural empowerment, fostering an environment where they can thrive as entrepreneurs and leaders in their communities.

Table 4 provides information on the viewpoints of women who have joined Self-Help Groups (SHGs) and engaging in entrepreneurial activities, specifically regarding their income and savings status before and after joining the SHGs and entrepreneurial activities. Before joining the SHG and engaging in entrepreneurial activities, the minimum monthly income reported by the women was rupees 500, while the maximum was rupees 3000. On average, the women reported a mean monthly income of rupees 1860.33, with a standard deviation of rupees 556.63. This indicates that the income levels varied among the respondents, with some earning as high as rupees 500.00 and others earning as low as rupees 3000. After joining the SHGs and entrepreneurial activities, the minimum monthly income increased to rupees 1000.00, and the maximum increased to rupees 3200.00. The average monthly income reported by the women after joining the SHGs was rupees 2484.00, with a standard deviation of rupees 449.47. This suggests that, on average, the women experienced an increase in their monthly income after joining the SHGs and engaging in entrepreneurial activities.

Similarly, before joining the SHGs and engaging in entrepreneurial activities, the women reported a minimum monthly saving of rupees 500 and a maximum of rupees 2500. The mean monthly saving was rupees 1140.33, with a standard deviation of rupees 388.40. This indicates that the savings varied among the respondents, with some saving as much as rupees 500.00 and others saving as lesser as rupees 2500. After joining the SHGs and engaging in entrepreneurial activities, the minimum monthly saving increased to rupees 1000, while the maximum increased to rupees 2800. The average monthly saving reported by the women after joining the SHGs and engaging in entrepreneurial activities was rupees 642.00, with a standard deviation of rupees 376.18. This suggests that, on average, the women experienced an increase in their monthly savings after joining the SHGs and engaging in entrepreneurial activities. So, the data reveal that the women who joined the SHGs and engaging entrepreneurial activities experienced an improvement in both their income and savings status. Their average monthly income and savings increased after joining the SHGs and engaging in entrepreneurial activities, indicating the potential positive impact of SHGs on the financial well-being of women. However, it resulted in microfinance extending economic opportunities to women, offering avenues for micro-entrepreneurship or self-employment, ultimately elevating their standard of living (Khandelwal, 2007 ). Most notably, self-employment in micro-enterprises substantially enhances women’s economic empowerment, contrasting other employment alternatives (Senapati & Ojha, 2019 ).

Women empowerment dimensions

The studies argued that microfinance activities and engaging in entrepreneurial activities play a significant role in enlarging a woman’s decision-making power within her household, increasing her control over household resources, and expanding her physical mobility beyond the confines of her home (Amin & Pebley, 1994 ). Furthermore, it is suggested that access to loans diminishes the likelihood of women experiencing abandonment. By granting women the opportunity to secure loans, they gain a greater sense of financial stability and independence, which can serve as a protective factor against abandonment (Rajasekhar, 2000 ). The various empowerment dimensions are given in Table  5 .

In terms of the social factor, the focus is on promoting women's social liberation, which entails encouraging freedom and equality in social interactions. This can be achieved through increased public interaction, eliminating gender discrimination, enhancing decision-making power, fostering social support networks, and facilitating skill development. Similarly, the economic dimension emphasises empowering women through financial independence. This involves granting women control over household income, encouraging independent savings, enabling women’s participation in household purchasing decisions, enhancing their ability to access loans, and promoting property and land ownership. Furthermore, the ability to generate income and save through microfinance access enlarges women's bargaining power within households, strengthening their position in the households (Ghosh & Neogi, 2018 ; Swain & Wallentin, 2012 ). Engaging in entrepreneurial activities adds to the family income and enhances women’s capabilities, decision-making abilities, and overall status within the family and society (Nziku & Henry, 2020 ). The psychological factor centres on empowering women’s mental and emotional freedom. This can be achieved by fostering a positive sense of independence and freedom to choose, enhancing self-confidence, developing a sense of leadership, and helping women overcome gender stereotypes and biases. Similarly, the study identified in the in-depth interview's there has been a notable rise in self-confidence among female entrepreneurs, evident in their assertive expression of opinions during interactions with various individuals, whether male strangers or female acquaintances (Panta & Thapa, 2017 ). So, the indicators contribute to a holistic approach to women’s empowerment, encompassing social, economic, and psychological aspects. By addressing these dimensions, societies can work towards creating an environment that enables women to lead fulfilling and empowered lives.

Table 6 provides a correlation matrix that examines the relationships between entrepreneurial intervention and various factors related to empowerment.

The first section explores the correlations between Entrepreneurial intervention and social factors. The values in the table represent the strength and direction of these correlations. Notably, all correlations between Entrepreneurial Intervention and social factors are positive. This suggests that as Entrepreneurial Intervention increases, so do these social factors. The highest positive correlation is found with “Decision-Making Power (DMP)”, which has a correlation coefficient of 0.353. This indicates that individuals with higher levels of Entrepreneurial Intervention tend to have greater decision-making power. This section’s Cronbach’s Alpha values indicate good internal consistency reliability for the variables, ranging from 0.830 to 0.913.

In the second section, the table examines the correlations between Entrepreneurial Intervention and economic factors. Similar to the social factors, the correlations are generally positive. The strongest positive correlation is observed with “Household Purchasing Power (HPP)”, with a coefficient of 0.152. This suggests that higher levels of Entrepreneurial Intervention are associated with greater household purchasing power. The Cronbach’s Alpha values for the economic factors range from 0.664 to 0.879, indicating moderate to good internal consistency reliability.

Finally, the table explores the correlations between Entrepreneurial Intervention and psychological factors. The correlations here are mixed, with some positive and some weak correlations. “Feeling Motivated (FM)” has the highest positive correlation with Entrepreneurial Intervention (0.195), indicating that those with higher Entrepreneurial Intervention tend to feel more motivated. The Cronbach’s Alpha values for the psychological factors range from 0.523 to 0.607, indicating acceptable internal consistency reliability. However, the data provide insights into the relationships between Entrepreneurial Intervention and various empowerment-related factors. It suggests that Entrepreneurial Intervention is positively correlated with several social, economic, and psychological factors, indicating that it may positively influence these dimensions of empowerment. However, the strength of these correlations varies across the factors, with some showing stronger relationships than others.

The significant contribution of this study is examining the effectiveness of microfinance activities and entrepreneurship in empowering women in rural Maharashtra, providing valuable insights into the region’s economic and social dynamics. The data illustrate active participation by women in various entrepreneurial undertakings, particularly in dairy farming and grocery or fruit shops, tailoring, food processing, goat farming, and poultry. Their involvement reflects their determination and capacity to drive economic growth and achieve self-reliance. The study highlights the essential role played by microfinance activities in supporting women entrepreneurs. The availability of financial resources and support through microfinance initiatives have enabled women to overcome traditional barriers and establish independent businesses, leading to increased household income and overall economic upliftment.

Moreover, the study emphasises the importance of Self-Help Groups (SHGs) and microfinance activities to meet rural women’s specific needs and preferences in different blocks. Understanding these preferences and providing support to Self-Help Groups can amplify the impact of microfinance activities, fostering greater inclusivity and sustainable entrepreneurship. However, sectors like tailoring still face challenges with relatively lower women’s involvement. So, identifying and addressing the barriers deterring women’s participation in such industries should be prioritised to ensure comprehensive empowerment across all sectors. However, the findings underscore the positive impact of microfinance activities on women’s empowerment through entrepreneurship in rural Maharashtra. Policymakers and stakeholders can further enhance women’s economic and social well-being by strengthening and expanding these initiatives, leading to inclusive growth and sustainable development in the region. However, all stakeholders’ continuous research and collaborative efforts remain essential to create an enabling environment that empowers women, promotes gender equality, and fully unleashes their entrepreneurial potential.

Availability of data and materials

The data used in this study can be obtained upon request.

Abbreviations

• Self-Help Group

United Nations Development Programme

Sustainable Development Goals

Gross domestic product

Small and medium-sized enterprises

Swayam Shikhan Prayog

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Pandhare, A., Bellampalli, P.N. & Yadava, N. Transforming rural women’s lives in India: the impact of microfinance and entrepreneurship on empowerment in Self-Help Groups. J Innov Entrep 13 , 62 (2024). https://doi.org/10.1186/s13731-024-00419-y

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This study investigated the impact of the Integrated Customs Management System (ICUMS) on the time required to generate a Delivery Order (DO) in Ghana’s cargo clearance process, addressing a gap in quantitative evaluations of Single Window (SW) systems by focusing on this specific aspect of trade facilitation. Utilizing Causal Impact Analysis. The research analyzed 2026 DOs from July 2020 to July 2023 through Bayesian Structural Time Series models, comparing the DO creation time before and after ICUMS implementation using R statistical software. The findings reveal a reduction in DO creation time from 11 to 9.22 days following the implementation of ICUMS; however, this decrease is not statistically significant, with considerable uncertainty in the estimated impact. The relative effect analysis and p -value suggest that this observed increase may be attributable to random variation rather than the impact of the intervention. The study recommends the adoption of more robust trade facilitation strategies aimed at addressing bottlenecks in DO issuance and advocates for qualitative research to better understand operational challenges and pinpoint areas for improvement. The findings challenge the widely touted benefits of SW systems and call for a reassessment of their role in trade facilitation. This research contributes to the limited quantitative literature on the impact of SW systems, particularly through the lens of DO creation time, an essential but often overlooked element of trade facilitation.

Cargo Clearance , Container Dwell Time , Single Window , Trade Facilitation

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1. Introduction

Since the establishment of the International Convention on the Simplification and Harmonization of Customs Procedures (Kyoto Convention), which outlines a framework for simplifying, harmonizing, and modernizing customs procedures to facilitate international trade, numerous countries have attempted to establish various forms of single window environments ( Mwajita, 2016 ; Njatrijani et al., 2022 ; Peynirci, 2023 ). This trend is attributed to the benefits of simplification, harmonization, modernization, transparency, and cooperation as documented by the United Nations Economic Commission for Europe (UNECE) in 2005. UNECE defines a single window as “a system that allows traders to lodge information with a single body to fulfill all import and export-related regulatory requirements”. Prominent examples of single window systems include the Association of Southeast Asian Nations (ASEAN) for Southeast Asian countries, TradeNet in Singapore, and Asycudaworld in about 102 countries across different continents, including African nations such as The Gambia, Côte d’Ivoire, Mali, Mauritania, Malawi, and Madagascar.

Even though the idea of single window implementation is well-intended with documented benefits, the outcomes of the various implementations outlined above are varied depending on the countries and continents. Whilst the ASEAN and Tradenet have been touted to have had greater impact ( Dionisius et al., 2021 ; Suvannaphakdy & Guo, 2023 ; Teo et al., 1997 ), asycudaworld, implemented in 38 countries in Africa has not yielded the anticipated impact. A survey conducted by UNCTAD in 2021 after the COVID-19 pandemic suggests that a lot of paper submissions and lack of electronic signatures are still associated with transactions involving several Customs administrations and these affect the ease of doing business ( UNCTAD, 2021 ).

In the 1990s, with funding support from the World Bank, the United States, and the International Monetary Fund, Ghana embarked on introducing Information and Communication Technology (ICT) in trade facilitation. This led to the entry of Ghana Community Network (GCNet), introducing the Ghana Integrated Cargo Clearance System (GICCS), modeled after Singapore’s TradeNet. Subsequently, West Blue Consulting launched Ghana’s first strategic action plan for the implementation of the Ghana National Single Window (GNSW) and operated alongside GCNet until their exit. GCNet was replaced by the Integrated Customs Management System (ICUMS) in April 2020, a GNSW system implemented by Ghana Link Network Services Limited on behalf of Ghana Customs.

The introduction of ICUMS, considered a game-changer in trade facilitation, aimed to address the challenges leading to Ghana’s decline in the World Bank’s Ease of Doing Business Index from 60.4 in 2019 to 60 in 2020. Despite its significance, assessments of such systems have often been limited, focusing on Container Dwell Time (CDT) and Revenue Generation using basic descriptive analysis. This study seeks to explore the impact of ICUMS on a specific yet crucial aspect of the clearance process—the time taken to create a Delivery Order. This time frame, from the completion of container discharge to the submission of the Delivery Order for terminal/ICD release, is vital for cargo clearance ( Ghana Link Network Services, 2020 ). The study applies causal impact analysis to evaluate the effect of ICUMS on this key component of total cargo clearance time.

Defined by the World Customs Organization (WCO) as the simplification, modernization, and harmonization of export and import processes, Trade Facilitation (TF) aims to reduce constraints and streamline regulatory aspects of international trade. Chapter 7 of the revised Kyoto Convention specifically recommends the adoption of Information Communication Technology (ICT) for trade facilitation. The implementation of Single Window (SW) systems within single window environments has been a primary method for applying ICT in trade facilitation, as noted by the United Nations Economic Commission for Europe (UNECE) in 2005. According to UN/CEFACT Recommendation 33, a SW allows involved parties to lodge standardized information at a single-entry point for all regulatory requirements related to import, export, and transit. This approach has led to the implementation of various SW systems globally, driven primarily by customs authorities in countries such as Singapore (TradeNet), Sweden (Virtual Customs Office), Britain (UK International Trade Single Window), and the USA (Automated Commercial System), among others. In Africa, implementations include Ghana (GCNet system), Mauritius (TradeNet), and Nigeria (Nigeria Integrated Customs Information System), to name a few ( Mwajita, 2016 ).

Studies like ( Cha, 2017 ; Gabriel et al., 2022 ) and others have consistently demonstrated the positive benefits of TF systems, including cost reduction, revenue increase, and reduction in bureaucratic processes and crime. However, the methodologies applied in these studies, such as the Causal Impact Analysis, have been underutilized in assessing the impact of SW systems. This analysis is defined as a statistical method used to assess the impact of a specific intervention on an outcome, considering other influencing factors. Examples include ( Brodersen et al., 2015 ) on computer simulated data, ( Carbo & Graham, 2020 ) in transportation, and ( Kim & Chung, 2022 ) on environmental policies.

Despite the known benefits of Causal Impact Analysis, there is a notable absence of its application in assessing SW systems. Impact assessments have predominantly been qualitative, relying on respondent opinions, as seen in ( Mwajita, 2016 ) and others. These studies often overlook time-related measurements influencing total cargo clearance time, as indicated in research by ( Raballand et al., 2012 ; Moini et al., 2012 ), and others. Additionally, previous studies have focused on downstream factors like terminal capacity and equipment availability, neglecting critical variables such as the time to obtain a Delivery Order (DO).

The World Customs Organization’s TRS guidelines recommend computing the time for Customs to release consignments. Countries like Malawi and The Gambia have implemented TRS, with recommendations for integrating computerized systems and investing in modern port operations technology.

To bridge the methodological gap in assessing the impact of SW systems, our study applies Causal Impact Analysis to evaluate the impact of the Ghana National Single Window (GNSW), specifically the Integrated Customs Management System (ICUMS), on the time required to create a Delivery Order.

2. Methodology

The study applied Causal Impact Analysis, a quasi-experimental design to a dataset of 2026 Delivery Orders, consisting of 924 orders created by ship agents before the implementation of ICUMS and 1102 orders created after its implementation between July 2020 and July 2023. Following the methodology outlined in Brodersen et al. (2015) , the approach included pre-intervention and post-intervention data collection, selection of a control group, model specification, estimation of causal effects, and statistical inference using R statistical software.

The method involves fitting a Bayesian Structural Time Series (BSTS) model to the target and control time series observation of the time it takes to create a delivery order followed by the subsequent performance of posterior inference on the counterfactual. The following pair of structural time-series state-space models underpin the proposed BSTS model ( Qiu et al., 2018 ):

y t = Z t T ∝ t + β X t + G t ∈ t (1)

∝ t + 1 =   T t ∝ t + R t η t (2)

ϵ t ~ N ( 0 , σ t 2 ) (3)

η t ~ N ( 0 , Q t ) (4)

Equation (1) is the observation equation which links the observed data y t to a latent d-dimensional state vector, α t . Equation (2) is the state equation which is responsible for governing the evolution of the state vector α t through time t . In other words, the alpha variable refers to the “state” of the time-series, and y t is a linear combination of the states, plus a linear regression with some explanatory covariates, X , plus ϵ, of noise that is normally distributed about a mean of 0. ϵ t and η t are independent of all other unknowns.

The study analysed 2026 observations, comprising 924 observations with a mean of 11 days and a variance of 88.09 days before the introduction of ICUMS, and 1102 observations with a mean of 9.22 days and a variance of 19.34 days after its introduction ( Table 1 ). Table 1 presents a lower mean for the “Before” group, raising questions about the significance of the difference between the two groups.

Table 1 . Descriptive statistics of the two groups.

The causal impact analysis, which looks at the difference between the actual outcomes and what would have been expected without the intervention, indicates an estimated effect of 1.55 days’ increase in the time to create a DO. However, this estimate, with a 95% confidence interval ranging from −31 to 38 days, does not conclusively point to a significant impact caused by the ICUMS implementation. The large range of this confidence interval suggests a high degree of uncertainty in the estimate.

Table 2 . Causal impact output.

When we consider the cumulative figures, the post-intervention period shows a total of 1016.4 days taken to create DOs, compared to a hypothetical scenario without the intervention, where it would have been 8754.7 days. Again, the wide confidence interval of this prediction, ranging from −36,839 to 50,415 days, underscores the uncertainty and suggests that the observed changes could be due to random fluctuations rather than the intervention itself ( Table 2 ).

More strikingly, the relative effect analysis shows a −147% change, with a highly variable confidence interval of −664% to +317%. This extreme range and the relative effect value itself suggest a complex interplay of factors, where the intervention might not be the sole or even primary cause of the observed changes. Additionally, the p -value of 0.483 further diminishes the statistical significance of the findings, indicating that the observed effects could very well be due to chance.

Figure 1 . Causal impact plot of the implementation of ICUMS on the time it takes to get a delivery order.

Visual representation through Figure 1 reinforces these findings. The lack of a distinct trend changes in the time taken to get a DO before and after the introduction of ICUMS suggests that the system’s implementation did not markedly alter the efficiency or speed of the process.

4. Discussions

The discourse around the effectiveness of Single Window (SW) systems, particularly in the realm of Trade Facilitation (TF), has been largely positive, as highlighted in various studies ( Mwajita, 2016 ). However, the findings from our study present a nuanced perspective, especially when considering the case of Ghana’s implementation of the Integrated Customs Management System (ICUMS). While there is an apparent improvement in the time taken to obtain a Delivery Order (DO), reducing from 11 to 9 days, this change doesn’t significantly deviate from the pre-implementation period.

These findings challenge the widely acclaimed benefits outlined by the United Nations (UN) regarding the implementation of Single Window (SW) systems within SW environments. The three primary recommendations presented in ( UNECE, 2003 ), which include the initial proposal for developing a framework and guiding principles for SW implementation, the subsequent guidelines for SW implementation ( UNECE & UN/CEFACT, 2020 ), and the most recent revised guidelines ( United Nations (UN), 2013 ), all emphasize the importance of a single authority, a unified system, and an automated system to enhance trade outcomes, such as reducing the time required to conduct business. However, this study’s findings highlight the necessity to re-examine the key components of this framework, with a focus on identifying and rectifying potential flaws in its application, especially, given the comprehensive Trade Facilitation measures introduced alongside ICUMS, including the introduction of Pre-Manifest Declarations, simplified payment regimes, and enhanced grievance management systems.

The expectation would be that these sweeping reforms would have led to a significant decrease in the Container Dwell Time (CDT), as there’s a direct relationship between CDT and the cargo clearance process ( Al-Haddad et al., 2021 ). However, the reality presents a more complex picture, suggesting that other latent factors might be at play, diluting the expected positive impact of these reforms. This complexity is reflected in the disparity between the reduction in DO issuance time and the more significant improvements in Customs revenue post-ICUMS implementation ( Business Ghana, 2022 ).

Moreover, while the introduction of ICUMS and related measures was anticipated to improve Ghana’s position in global rankings like the World Bank’s Ease of Doing Business Index and Time Release Study (TRS), the actual impact appears to be more muted. The goal of achieving a CDT of around 4 days, as reported in other contexts ( Kgare et al., 2011 ), still seems distant. This suggests that while the implementation of ICUMS and other Trade Facilitation measures have made some positive strides, there are underlying inefficiencies and challenges that need to be addressed. These might include infrastructural bottlenecks, policy gaps, or even systemic issues within the trade and customs ecosystem, which continue to hinder the full realization of the benefits associated with such digital transformations in the trade facilitation domain.

From a policy point of view, these findings necessitate a concerted effort by all stakeholders in the sector, led by Customs, to review and refine regulations, laws, and trade facilitation processes. This is crucial for identifying and addressing potential bottlenecks that prolong cargo clearance time as effective and efficient Customs procedures play a pivotal role in clearance time, as evidenced in ( Gabriel et al., 2022 ). Addressing these issues is key to enhancing port competitiveness and achieving the exemplary levels of efficiency as described in ( Kgare et al., 2011 ).

As far as social impact is concerned, an increase in the time required to create a Delivery Order, contributes to longer overall cargo clearance time and has a notable effect on the cost of doing business. This impact has been discussed in various studies, including ( Gabriel et al., 2022 ; Kgare et al., 2011 ; Raballand et al., 2012 ; Refas & Cantens, 2011 ). Our study’s findings suggest ongoing delays in the cargo clearance chain, despite reports of increased revenue ( Essel et al., 2022 ) and other positive indicators. These prolonged clearance times inevitably lead to higher business costs, potentially deterring potential importers from using the ports. As a result, ports and governments could lose crucial traffic and revenue. This loss is particularly significant in a country like Ghana, where approximately 70% of government revenue is derived from seaport activities. As such, the consideration of these findings has the potential to reduce the burden of cost on the trading community.

5. Recommendations

Building on the insights gleaned from our study, which revealed an unexpected outcome regarding the time taken to create a delivery order post-ICUMS implementation, our recommendations focus on enhancing the effectiveness of trade facilitation measures. Firstly, it is crucial to implement more robust trade facilitation strategies that specifically target and eliminate the bottlenecks causing delays in issuing delivery orders. This approach requires a thorough examination and overhaul of existing procedures, policies, and possibly, the technology infrastructure that supports the cargo clearance process. Such targeted interventions are essential to streamline operations and enable smoother progression through the cargo clearance stages.

In addition to these strategic changes, we also advocate for the execution of qualitative studies to delve deeper into the underlying causes of the delays currently being experienced in the acquisition of delivery orders. This research should aim to gather detailed insights from various stakeholders involved in the cargo clearance process, including customs officials, traders, and logistic service providers. Understanding their experiences, challenges, and suggestions would provide a richer, more nuanced perspective on the operational realities, helping to identify specific areas for improvement. These studies could uncover aspects that quantitative analyses might overlook, such as procedural inefficiencies, gaps in stakeholder communication, or training needs for system users. By combining a comprehensive review of trade facilitation measures with in-depth qualitative research, we can develop more effective strategies to optimize the cargo clearance process, ultimately leading to significant improvements in line with the potential offered by systems like ICUMS, as envisaged in the broader context of trade facilitation ( Gabriel et al., 2022 ; Kgare et al., 2011 ).

6. Conclusions, Limitations and Future Research Direction

The study set out with the clear objective of examining the impact of the Integrated Customs Management System (ICUMS) on a crucial phase in the cargo clearance process: the time taken to create a Delivery Order (DO). This time frame is pivotal, as it stretches from the completion of container discharge to the submission of the DO for terminal or Inland Container Depot (ICD) release. By employing causal impact analysis, the study aimed to dissect and understand the specific effects of ICUMS on this vital component of the total cargo clearance time.

The conclusions drawn from this study are multifaceted. Firstly, while there was a reduction in the time taken to issue a DO—from 11 days to 9 days—this change was not statistically significant. This finding is intriguing, especially considering the array of Trade Facilitation measures introduced alongside ICUMS, which were expected to streamline and expedite the process. Measures such as Pre-Manifest Declarations, an expanded payment regime, and an integrated platform for inspections and offense management were anticipated to have a more pronounced effect.

This study indicates that the implementation of ICUMS, despite being a significant step towards digitalization and process improvement in Ghana’s customs operations, has not drastically altered the efficiency of the DO creation phase as might have been expected. The factors contributing to this could be numerous and complex, ranging from systemic inefficiencies, infrastructural limitations, to possible resistance to change among stakeholders.

Furthermore, the study underscores that the reduction in DO issuance time did not translate into a proportionate decrease in the overall Container Dwell Time (CDT), suggesting that other stages in the cargo clearance process may be contributing to delays. This points to the need for a more holistic approach in reforming the cargo clearance process, addressing all components that contribute to delays.

The primary limitation of this study is its exclusive focus on Delivery Order (DO) data from containers processed at the GPHA terminals. The absence of DO data from Meridian Ports Services, the second of the two main terminals which was occasioned by the unavailability of data may limit the representativeness of the study’s findings.

Despite this limitation, our study has demonstrated that the implementation of the Integrated Customs Management System (ICUMS) by Ghana Link Network Services has positively influenced the time required to obtain a DO, an essential part of the clearance process. Given the anticipated positive correlation between our findings on DO creation time and Container Dwell Time (CDT), future research should investigate the impact of reduced DO creation time on CDT. Such research would be valuable for pinpointing the key bottlenecks contributing to the suboptimal performance of DO lead time.

Conflicts of Interest

The authors declare no conflicts of interest regarding the publication of this paper.

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• Published: 13 September 2024

Adherence of healthcare providers to Enhanced Adherence Counseling (EAC) intervention protocol in West Amhara Public Health Facilities, Northwest Ethiopia, 2023: mixed method evaluation

• Amare Belete 1   na1 ,
• Getachew Teshale 2   na1 ,
• Andualem Yalew 2 ,
• Endalkachew Delie 2 ,
• Gebrie Getu 3 &
• Asmamaw Atnafu 2  

BMC Infectious Diseases volume  24 , Article number:  977 ( 2024 ) Cite this article

Metrics details

In Ethiopia, there were an estimated 670,906 people living with the Human Immune Virus (HIV). Implementing an HIV test and treat strategy and rapid scale-up of anti-retroviral treatment (ART) provided health facilities increased the number of the number of people living with HIV/AIDS. In the same way, the expansion of viral load monitoring in these health facilities and poor adherence to ART increase the number of high-viral load (HVL) patients. To alleviate this problem, the World Health Organization (WHO) recommended EAC intervention for HVL patients. Therefore, the aim of this research was to determine the level of healthcare providers’ adherence to the EAC intervention protocol and explore barriers and facilitators of the intervention in West Amhara, Northwest Ethiopia.

Descriptive cross-sectional study design with concurrent mixed-method evaluation was employed. The adherence dimension, with its sub-dimensions of content, coverage, frequency, and duration of the EAC intervention, was used with sixteen indicators. A total of 20 high-case-load public health facilities and 173 HVL patients were included in our study. Quantitative data was entered into Epi Info and exported to SPSS version 25 for analysis. Descriptive statistics are analyzed in terms of frequencies, percentages, variances, and means and presented as narrations, frequency tables, graphs, and charts. Qualitative data were transcribed, translated, coded, and analyzed thematically using Open Code version 4.0 software. The qualitative findings were used to triangulate the quantitative findings.

The average adherence level of health care providers (HCPs) to the EAC intervention protocol was 55.3%, from which content, coverage, frequency, and duration of the intervention contributed 70.3%, 86.3%, 36.9%, and 27.7%, respectively. Most of the intervention contents were delivered during the session, but none of the providers developed a patient adherence plan at the end of the session. All HVL patients were linked and enrolled in the EAC intervention. But only 6% of them were tested for repeat VL.

The average adherence level of HCPs to the EAC intervention protocol was very inadequate. The main gap identified was difficulties in completing the EAC intervention sessions based on schedules. Implementing adherence improvement strategies, assigning an adequate number of EAC providers in ART and Prevention of Mother-to-Child Transmission (PMTCT) clinics, and allowing sufficient time during EAC sessions are important.

Peer Review reports

Introduction

In Ethiopia, there were an estimated 670,906 people living with HIV, with an incidence rate of 36,990 per year among all ages and sexes. Although the age-standardized AIDS mortality rate declined very fast after 2005, nearly 20,000 AIDS-related deaths were predicted in 2023/24 in Ethiopia [ 1 ].

Implementing HIV test and treat strategy and rapid scale-up of ART providing health facilities led to large number of people living with HIV on ART [ 2 , 3 ]. The expansion of viral load monitoring in these health facilities, in turn, led to the detection of an increased number of HVL patients. Poor adherence is also another reason to increase the number of HVL patients [ 3 , 4 , 5 , 6 ]. As a solution, WHO has recommended EAC intervention for HVL patients and [ 7 ] following this WHO recommendation, countries has adopted and implemented EAC intervention.

EAC is a structured and targeted adherence counseling intervention for HVL patients after the client has been on ART for at least 6 months and before they are diagnosed with treatment failure. It includes assessing the adherence rate, exploring barriers, and supporting HVL patients to find solutions [ 4 , 7 ]. EAC intervention is given for all HVL patients monthly for 3–6 months to identify adherence barriers [ 4 ]. HVL patients should have at least 3 months’ good adherence record to repeat the VL test. A repeated VL test result > 1000 copies/ml is one of the indicators to switch an HIV patient from 1st line ART to 2nd or 3rd line ART in EAC, but HIV patients with a repeated VL test result of £1000 copies/ml will be discharged from EAC intervention and stay at 1st line ART (Fig.  1 ).

Algorithm of VL monitoring and EAC intervention [ 4 ]

Based on WHO recommendations, Ethiopia has implemented EAC interventions since 2017 [ 4 ]. Studies conducted in West Gojjam [ 8 ] and North Wollo [ 9 ] Ethiopia showed only 51.73% and 60.4% viral re-suppression was achieved after EAC sessions respectively. Both findings were lower than the WHO minimum target [ 3 ].

Studies suggest that the content of an intervention is its active ingredient as it primarily determines implementation success or failure. These studies noted that the inability to deliver the content of an intervention affects the extent to which full implementation is attained [ 10 , 11 , 12 ]. Programs are less effective when study participants do not receive the intended contents [ 13 ].In addition to the content of the intervention, the coverage of the intervention services has an effect on attaining the program’s expected results. An epidemiological study in Ethiopia showed that around 51% of HVL patients had defaulted on their EAC intervention before their repeated VL testing [ 14 ]. Incomplete delivery and poor coverage makes the intervention ineffective [ 15 ].Although the EAC implementation guidelines recommended that all HVL patients receive their EAC sessions on a monthly basis, they didn’t attend due to different challenges like the inaccessibility of health facilities, current peace and security problems in the country, and the limited number of EAC rooms [ 16 ]. EAC is designed to provide it services for 3 months, after which a HVL patients are being on ART regimen or switched to next regimen [ 4 ].But studies showed that the median time to start the first EAC session after HVL detection was 8 weeks, 33.2% of participants started the first EAC session 4–8 weeks after HVL detection, and around 13% of HVL patients did not start EAC sessions up to 3 months [ 9 ]. The same study in Ethiopia showed that only 46.8% of HVL patients completed EAC sessions within the recommended time duration, and 27.2% completed EAC sessions after 6 months of initiation of EAC sessions [ 9 ].

Therefore, this evaluation study determined the level of healthcare providers’ adherence to the EAC intervention protocol and program design in terms of intervention content, frequency, coverage, and duration and explored the intervention barriers and facilitators (Fig.  2 ).

Conceptual framework for implementation fidelity of EAC intervention in West Amhara public health facilities, Northwest Ethiopia Adapted from Carroll et al. [ 10 ] and Hasson [ 54 ]

Methods and materials

Evaluation area and period.

This evaluation study was conducted in 20 public HFs in West Amhara, Ethiopia, from February to July 2023. West Amhara includes seven town administrations: Debark, Gondar, Debre-Tabor, Bahir Dar, Injibara, Finote Selam, Debre-Markos, and eight zones: North Gondar, Central Gondar, South Gondar, West Gondar, West Gojjam, Awi, and East Gojjam. Based on a population estimation of 2021/22, it had a total population of 13,889,807 [ 17 ]. One hundred seventy-eight (178) public health facilities have been providing ART services in West Amhara in 2022/23.

Evaluation design and method

Descriptive cross-sectional study design with concurrent mixed method evaluation was employed. This study design aims to measure and describe healthcare providers’ adherence to EAC intervention protocol accurately and systematically and for better understanding of the intervention gaps. Using mixed method approach provides complimentary and more comprehensive evidences and for better understanding of EAC intervention. It can increase confidence and validity of the findings.

Variables and measurement

After discussion and reaching consensus with stakeholders, adherence dimension with its sub dimensions of content, coverage, frequency and duration of EAC intervention with sixteen indicators were used. Indicators for each sub dimensions were adopted from Ethiopia national EAC intervention guideline, routine monthly key performance indicator (KPI) as well as from other WHO, CDC, PEPFAR and ICAP documets [ 4 , 18 , 19 , 20 , 21 ]. Sub dimensions and indicators also wieghted based on their level of importance for the program and stakeholders’ agreement. Accordingly, a total of 16 indicators were used in the four sub-dimensions.

Content indicators

Number of EAC sessions for which patient adherence rate was assessed.

Number of EAC sessions for which patient adherence barriers were assessed.

Number of EAC sessions with EAC provider motivated and assisted HVL patients to identify solutions for their challenges.

Number of EAC sessions with patient adherence plan was prepared.

Coverage indicators

Percentage of HVL patients initiated first EAC session.

Percentage of HVL patients received second EAC session.

Percentage of HVL patients received third EAC session.

Percentage of HVL patients tested for repeat VL.

Frequency indicators19

Percentage of HVL patients who got 2nd EAC session one month after first EAC session.

Percentage of HVL patients who got 3rd EAC session one month after second EAC session.

Percentage of HVL patients who tested for repeat VL one month after third EAC session.

Duration indicators

Time to first EAC session in days from VL result received.

Time to second EAC session in days from first EAC session.

Time to third EAC session in days from second EAC session.

Time to repeat VL collection in days from third EAC session.

EAC session duration in minutes during direct EAC session observation.

Populations and sampling

In Amhara region, there were 178 ART providing health facilities. Thus, based on sampling manual for facility surveys recommendation [ 22 ] and feasibility issues of the study, we took 11% of the health facilities and these facilities were selected purposively; based on their relative high-case-load. Since all HVL patients enrolled in the EAC intervention in the selected health facilities during our study period were only 173, census was done for all cases (Table  1 ).

Besides, EAC providers, ART focal persons, EAC registrations and selected patients’ chart in the selected public health facilities were also our study population. Based on USAID recommendation [ 23 ], we conducted 32 randomly selected EAC session observations from 14 purposively selected public HFs. The health facilities used for observation were selected based on their relative performance on ART program (4, 4, 5 low, high and averagely performed facilities) and their performance status was obtained from their routine performance reports. The numbers of observation sessions were determined by the level saturation.

A total of 23 in-depth interviews with randomly selected HVL patients and 20 key informant interviews with purposively selected individuals (ART focal) from each selected health facilities were also conducted.

Data collection tool and field work

HVL patients’ charts and EAC register (logbooks) extraction tools, observation checklists, in-depth interview and KII tools adopted from EAC intervention guideline and other related literatures [ 4 , 24 , 25 ]. These tools were translated to Amharic (local language) and retranslated to English to check its consistency and validity for easily understanding. A senior research expert was involved during the tool adaptation and translation (mentioned in the acknowledgment) process.

We recruited four bachelor degree holder data collectors and two MSc holder supervisors and provided two days training. Both quantitative and qualitative data were collected simultaneously analyzed separately and integrated in result and discussion section.

Data management and analysis

Quantitative data were checked daily for its consistency and completeness, entered into Epi Info and exported to SPSS version 25 for analysis. Descriptive statistics like frequency distribution, central tendency and dispersion analysis was conducted and findings presented in terms of narrations, frequency tables, percentages, means, graphs and charts. Qualitative data were transcribed, translated, coded and analyzed schematically by using Open Code version 4.0 software. The qualitative findings were used to triangulate the quantitative results.

Matrix of analysis and judgment

The matrix of analysis and judgment were developed with full involvement of stakeholders. The weight of sub-dimensions under adherence dimension and the respective indicators were given depending on their level of relevance and stakeholders’ consensus. The sum of all sub-dimensions was attributed to the adherence of the program. Therefore, by convention the stakeholders gave the weight for content 30%, frequency 25%, coverage 20% and duration 25%.Finally, the healthcare providers’ adherence was judged by the average score of these sub-dimensions and we categorized it as very adequate(95–100%), adequate (80–94%), inadequate (60–79%) and very inadequate (< 60% ) [ 26 , 27 , 28 ].

A total of 173 HVL patients’ EAC follow up forms and 21 EAC logbook reviews, 32 direct EAC session observations, 23 in-depth interviews and 21 key informant interviews were done. Six hospitals and fifteen health centers were included in our study. From 173 HVL patients whose document reviewed, 84 (49%) were females and 89 (51%) were males, 150 (87%) were on 1st line and 23 (13%) were on 2nd line ART drugs, 79 (45.7%) had VL count between 1,001 and 10,000 copies/ml and 94 (54.3%) were above 10,000 copies/ml when they enrolled to EAC. All HVL participants had no documented mental illness. Most of HVL patients 133 (76.9%) were tested for their viral load due to their annual schedule and almost all patients’ test was done and ART started with in the same health facility. Majority 140 (80.9%) of HVL participants’ first VL test result was in the range of 1,001 to 50,000 viruses per cubic centimeter. While the remaining 17 (9.8%) and 16 (9.2%) of HVL participants’ first VL test result was in the range 50,001 to 100,000 and greater than 100,000 viruses per cubic centimeter respectively.

Content of EAC intervention

Among 32 direct observation EAC sessions, none of the healthcare provides developed or assisted to develop patient adherence plan for HVL participants at end of the session and only 59.4% (19) of the healthcare providers asked and assessed about the storage of patients’ ARV drugs (Table  2 ).

Health care workers counseled me on different issues like avoiding alcohol, timely taking ARV medicationsby using phone alarming, storing ARV drugs in dry places, using condom during intercourse and eating timely balanced diet. To tell the truth, I can not totally avoid alcohol. This is really challengig even I tried many times. [43 years old male RVI patient ]

Our observation finding also revealed that none of the observed EAC sessions adherence plan were prepared. The average content of EAC intervention was 70.3% and it was judged as adequate (Table  3 ).

Coverage of EAC intervention

All HVL patients included in our study were linked and enrolled to EAC intervention. Among these, 164 (94.8%) received first EAC intervention, 146 (84.4%) received second EAC intervention and 107 (61.8%) received EAC intervention for the third time. Seven HVL patients’ viral load test result were received during our data collection period and six of them were below 50 copies per ml while the remaining one was > 1,000 copies per ml. Nine participants in six HFs did not receive any EAC session within the three months.

About 39 charts had no EAC follow up forms and there was no EAC session recorded for 20 (11.6%) HVL patients’ charts despite EAC form were attached. There was no EAC session registered in EAC logbooks for nine (5%) of HVL patients. Numbers of EAC sessions registered in EAC follow up forms and EAC logbooks were also different (Table  4 ).

Among the HVL patients who tested for repeat VL test after completing the three EAC sessions, 6 (60%) had undetectable VL result and remained in their first line ART but one result remained HVL and not yet switched to 2nd line regimen. The remaining three tests were not returned to the HFs from viral load testing laboratories. Among all 173 HVL patients, only 10 (6%) were tested for repeat VL and163 (94%) didn’t complete EAC sessions.

Qualitative findings suggest that poor patient adherence, HVL patients’ workload and distance from health facilities are some of the challenges for EAC intervention.

I have been working in private organization. Working environment in the organization is very busy throughout the day. Because of this, frequently, coming to my follow up hospital to receive EAC session as well as medication refill was difficult for me. For example, I was on field last month and I did not receive last month EAC session but I took medication from other nearby health facility.

(37 years old male RVI patient).

The coverage of EAC intervention was measured by five indicators and it was 86.3% which was judged as adequate (Table  5 ).

Frequency of EAC intervention

Mean time between EAC session one and EAC session two was 33.94 days while from EAC two to EAC three was 31.57 days. The mean time to complete three EAC session (from EAC one to repeat VL collection) was 84 days (Table  6 ).

Over burdening with other activities and poor adherence of patients to EAC intervention are some of the barriers to conduct regular EAC session schedules and ARV refill.

“ I have received adequate counseling in the first month of EAC session but , sometimes , there are things that come in and affect me to take EAC sessions monthly and regularly. For example , the EAC session had strict schedule , when I went for social reasons in my parents and relatives for few days , I missed the sessions. I knew this would really lead to high viral load test results”. (42 years old female RVI patients).

Poor commitment of some HVL patients for adjustable and minor reasons were also considered as other barriers to conduct the session based on schedule.

“From my observation , some HVL patients were not truly committed to their counseling session due to different easily adjustable and very minor reasons. Receiving counseling session is lifesaving and the benefit is more than anything else. They did know this but simply they gave less attention. We will work focusing on these patients”. [31 years HCP serving in ART clinic for more than 7 years]

Overall, only 36.9% EAC intervention sessions were conducted based on their schedule and this was judged as very inadequate based on our judgment parameter (Table  7 ).

Duration of EAC intervention

Based on our research findings, Turnaround Time (TaT) for 1st VL was 16 days while mean time to start first EAC after receiving HVL result was 16.3 days which was late from the recommended time (7days). Despite late engagement to EAC first session after receiving HVL result, the mean time to complete three EAC sessions was 84 days which (Table  8 ).

More than half of HVL patients 95 (54.9%) at 1st EAC session received their 1st EAC session within recommended period (within 7 days) but only 28.3% and 26% of HVL patients were received their 2nd and 3rd EAC sessionsbased on recommended time (within 1 month) respectively. About one-fifth of HVL patients have started EAC sessions after more than one month of HVL result received. Similarly, 10% of HVL patients didn’t start EAC session up to 2 months.

In addition, mean time in minutes took for one EAC session during our session observation was 23 min (ranged from 9 to 59 min). EAC providers could not be able to give EAC sessions according to the protocol due to workload. A key informat intereview also revealed this:

At this health facility, we are working as EAC providers as well as ART refillers, we have to counsel new ART clients, those who were lost to follow up and those with poor adherence. This leaves very little time for HVL patients’ EAC session. [27 years old male HCP with 5 years work experience

Our finding showed that EAC session was given according to the standard duration for only 27.7% HVL patients (Table  9 ).

Based on the above four adherence sub-dimensions measured, the average adherance level of HCPs to the EAC intervention protocol was 55.3%, from which content, coverage, frequency, and duration of the intervention contributed 70.3%, 86.3%, 36.9%, and 27.7%, respectively, and were judged as very inadequate.

This study determined the adherence of EAC providers to the intervention protocol and explored barriers and facilitators of the intervention. Accordingly, the average adherence level of HCPs to the EAC intervention protocol was 55.3%. Our observation findings revealed that most of the EAC intervention contents were delivered to the target beneficiaries. The finding was in line with EAC intervention protocol expectations [ 7 , 29 ]. But it was less than a similar study in Indonesia [ 30 ]. His difference may be due to the fact that the fact that our data collection method was direct observation of EAC sessions, while the Indonesian study used self-reports of participants, which increased the intended results. This evidence was supported by Hanssen et al. [ 31 ]ho found that observational measures are more reliable and have higher validity than self-reports by implementers or participants.

Our session observation and chart review also showed that preparing the next adherence plan for HVL patients was not implemented in all study health facilities. However, the EAC intervention protocol recommends that HVL patients receive all the core contents of the of the EAC session. Similarly, studies suggest that the content of an intervention is its active ingredient, as it primarily determines implementation success or failure. These studies noted that the inability to deliver the content of an intervention affects the extent to which full implementation is attained [ 10 , 11 , 12 ].In addition, we found that some study health facilities did not document some performed activities properly in EAC follow-up charts and EAC logbooks.

All HVL patients were linked and enrolled to EAC intervention. The finding was similar to a study in Nigeria [ 32 ] where 100% HVL patients were linked to EAC sessions. The finding was alsohigher than a study in Uganda [ 33 ]. The difference may be due to the fact that our study includes facilities found in urban sites while the Ugandian study was in rural health facilities, which is characterized by transport inaccessibility to attend the EAC sessions. It was also greater than studies conducted in Zimbabwe [ 34 ], Uganda [ 35 ], Kenya [ 36 ], Nigeria [ 37 ] and Lesotho [ 38 ].

Among those HVL patients who enrolled in EAC intervention, 94.7% of HVL patients received their first EAC session. This EAC intervention coverage was in line with the EAC intervention protocol, which stated that it is satisfactory if more than 80% of HVL patients receive the first EAC session. In our study, the coverage of the EAC intervention was found to be greater than in other studies in Uganda [ 39 ], Uganda [ 40 ], Zimbabwe [ 34 ], India [ 41 ], Swaziland [ 42 ] and Lesotho [ 43 ]. The reason for this variation might be due to the measurement difference where some studies took one EAC session, some others took two EAC sessions, and the and the other remaining studies took three EAC sessions to calculate EAC intervention coverage.

Most HVL patients who were eligible for EAC intervention sessions two and three got the session, and the findings were greater than the study findings in Uganda [ 40 ], Zambiya [ 44 ], Zimbabwe [ 34 ], Swaziland [ 45 ] and India [ 41 ]. But, it was lower than study in Zimbabwe [ 34 ] and in Kenya [ 36 ]. Those who did not receive any EAC session in our study was 5.2% and this was lower than a study in Swaziland [ 42 ], Zimbabwe [ 34 ], Uganda [ 33 ] and Lesotho [ 43 ]. The reason for this variation might be due to measurement differences, and the EAC intervention got more attention recently in our study than in earlier other studies. Our qualitative findings also revealed that HVL patrients were challenged to be fully engaged in the EAC sessions due to an inconvenient schedule, difficulty avoiding alcohol consumption, and fear of stigma. This finding was supported by other previous studies [ 46 ].

The proportion of HVL patients that completed EAC sessions and achieved VL re-suppression following EAC in our study was better than the protocol set by WHO and a study in North Wollo zone of Ethiopia [ 9 ]. The difference could be because our study didn’t include children where as the Wollo study included children. Children are known to have low VL resuppression. Our finding was also greater than a study in Lesotho [ 38 ], four West african countries [ 47 ], meta analysis studies [ 48 ] and Kenya [ 36 ].

Findings from the qualitative analysis showed that HVL patients’ work-related problems and the far distance from their house to health facilities were some barriers to attending EAC sessions. Similarly, it was very difficult for EAC providers, adherence case managers, and adherence supporters to address the socio-economic constraints of HVL patients. They had linked a few clients, especially vulnerable children, to some projects such as ANPPCAN for nutritional support, but these institutions cannot take on all the clients due to resource constraints. This finding was supported by a qualitative study done in Uganda [ 49 ].

Our study showed only one third of HVL patients received three EAC sessions on a monthly basis. This finding was lower than a recommendation set by the intervention protocol, which stated that all HVL patients have to receive their EAC sessions on a monthly basis. Our finding was also lower than a study in Nairob [ 36 ]. This might be because in Kenya providers used phone alarms to remind the session schedules.

Participants reported that there were barriers like disclosing their HIV positive status to others and social and family-related barriers that negatively affected taking their EAC sessions monthly and regularly. Despite this, our key informant said that some HVL patients were not committed to their EAC session follow-up for adjustable and minor reasons. Findings from the qualitative analysis also justified the fact that the majority of HVL patients reasoned that the monthly visits of health facilities for EAC sessions usually resulted in stigma against to them.

Only one fourth of EAC sessions were delivered for recommenended duration. EAC sessions took place for a very short duration (mean of 23 min) despite to EAC intervention protocol which states that one EAC session has to be given for at least 30–45 min. Our finding was also less than a study conducted in New York [ 50 ] but greater than a study in South Africa [ 51 ]. Increasing the length of time for each sessions may increase the adherance rate and was supported by a randomized controlled trial study in New York [ 50 ], where each additional counseling hour was associated with a 20% increase in post-counseling adherence rate.

In our study, the time to start EAC sessions after the HVL result was received was late as compared to the intervention protocol. However, our finding was better than a study conducted in Lesotho [ 38 ]. About one-fifth of HVL patients have started EAC sessions after more than one month of HVL results. Similarly, 10% of HVL patients didn’t start an EAC session for up to 2 months. But this finding was better than a study in northern Wollo, Ethiopia [ 9 ]. The difference might be due to the fact that in some of our study sites, the CDC started to send an alarm to the targets’ cell phones to remind them of the session schedules.

Despite the fact that over two-thirds of HVL patients started the third EAC session, only 6% of them completed the recommended three repeat VL tests within the protocol time frame. This finding was less than studies done in northern Wollo, Ethiopia [ 9 ], Nigeria [ 37 ] and south Africa [ 52 ]. The reason for our lower finding could be that the study period in our study was only three months, whereas in other studies it was longer.

In our study, we found that the mean time from the third EAC session to the repeat VL was earlier than the protocol. This finding was also slightly earlier than the study in the north Wollo zone of Ethiopia [ 9 ]. Our finding indicated that only around one-third of HVL patients gave samples for repeat VL tests in accordance with the protocol within 30 days. This finding was lower than a study in Tanzania [ 53 ]. After having three consecutive good adherences to EAC sessions, the repeat VL has to be tested to check whether the first HVL is suppressed or not. The recommendation in the protocol stated that this repeat VL sample has to be collected within 30 days after the third EAC session given.

Our qualitative finding indicated that providers’ workload was found to be a barrier to attending the sessions. They reported that they were overwhelmed with workload and may not be able to give EAC sessions according to the intervention protocol.

Our document review clearly showed the registerees were incomplete, which implies that they did not review client records very thoroughly and often sent HVL patients by refilling their ARV only but missed conducting the sessions.

Strength and limitation of the evaluation

This study was done using a mixed-methods approach and multiple data sources like in-depth interviews, key informant interviews, document reviews, and observation of EAC sessions, which increased the validity of the findings. The study also included multiple health facilities with the maximum effort to address high-case-load facilities in the region. However, the study is descriptive, which couldn’t show a cause-and-effect relationship and unable to infer for the general population. Hawthorne effect during observation, which may increase the observation findings, was also the other limitation.

The overall adherence level of HCPs to the EAC intervention protocol was 55.3%, which was judged to be very inadequate. The main gap identified was difficulties in completing the EAC intervention sessions based on schedules. The findings also showed that a lack of transport fees, a lack of EAC session rooms, HVL patients work and social-related issues, a lack of commitment of HVL patients to the schedule, and an inadequate number of EAC providers in ART and PMTCT clinics were the barriers to poor adherence.

The regional health bureau shall implement adherence improvement strategies like providing ongoing monitoring and feedback, training, and follow-up for EAC providers and supporting their work. Health facilities have to assign an adequate number of EAC providers in ART and PMTCT clinics and create suitable rooms for counseling sessions, and HCPs should allow sufficient time during EAC sessions to explore individual-level barriers and facilitators.

Data availability

Data is provided within the manuscript or supplementary information files.

Abbreviations

Acquired Immune Deficiency Syndrome

African Network for the Prevention and Protection against Child Abuse and Neglect

Antiretroviral Therapy

Antiretroviral

Centers for Disease Control and Prevention

Enhanced Adherence Counseling

Health Center

Health Facility

Human Immunodeficiency Virus

High Viral Load

People Living with Human Immunodeficiency Virus

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Acknowledgements

We are very grateful to University of Gondar for its technical support. We would also like to thank all health facilities included in our study all participants for their information and commitment. We would like to give our deepest gratitude to Professor Amsalu Feleke for their comments, suggestions and help to improve our research quality and finally our appreciation extended to the data collectors for their unreserved contribution.

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Amare Belete and Getachew Teshale have equal contribution.

Authors and Affiliations

Gondar Branch Office, Amhara Regional Health Bureau, CDC project, Gondar, Ethiopia

Amare Belete

Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

Getachew Teshale, Andualem Yalew, Endalkachew Delie & Asmamaw Atnafu

Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

Gebrie Getu

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All authors contributed to the preparation of the manuscript. AB and GT designed the study, wrote proposal, collected and analyzed the data. AY, ED, GG and AA revised the analysis. AB and GT prepared the manuscript. All authors approved the manuscript.

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Belete, A., Teshale, G., Yalew, A. et al. Adherence of healthcare providers to Enhanced Adherence Counseling (EAC) intervention protocol in West Amhara Public Health Facilities, Northwest Ethiopia, 2023: mixed method evaluation. BMC Infect Dis 24 , 977 (2024). https://doi.org/10.1186/s12879-024-09888-8

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Received : 02 January 2024

Accepted : 05 September 2024

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DOI : https://doi.org/10.1186/s12879-024-09888-8

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