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Case Study – Methods, Examples and Guide

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

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

Types of Case Study

Types and Methods of Case Study are as follows:

Single-Case Study

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

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

Multiple-Case Study

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

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

Exploratory Case Study

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

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

Descriptive Case Study

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

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

Instrumental Case Study

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

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

Case Study Data Collection Methods

Here are some common data collection methods for case studies:

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

Observations

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

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

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

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

How to conduct Case Study Research

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

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

Examples of Case Study

Here are some examples of case study research:

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

Application of Case Study

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

Business and Management

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

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

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

Social Sciences

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

Law and Ethics

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

Purpose of Case Study

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

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

Case studies can also serve other purposes, including:

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

Advantages of Case Study Research

There are several advantages of case study research, including:

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

Limitations of Case Study Research

There are several limitations of case study research, including:

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

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

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

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

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

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

Table of contents

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Research bias

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

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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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Case Study Research

• First Online: 29 September 2022

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• Robert E. White   ORCID: orcid.org/0000-0002-8045-164X 3 &
• Karyn Cooper 4  

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As a footnote to the previous chapter, there is such a beast known as the ethnographic case study. Ethnographic case study has found its way into this chapter rather than into the previous one because of grammatical considerations. Simply put, the “case study” part of the phrase is the noun (with “case” as an adjective defining what kind of study it is), while the “ethnographic” part of the phrase is an adjective defining the type of case study that is being conducted. As such, the case study becomes the methodology, while the ethnography part refers to a method, mode or approach relating to the development of the study.

The experiential account that we get from a case study or qualitative research of a similar vein is just so necessary. How things happen over time and the degree to which they are subject to personality and how they are only gradually perceived as tolerable or intolerable by the communities and the groups that are involved is so important. Robert Stake, University of Illinois, Urbana-Champaign

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A Case in Case Study Methodology

Christine Benedichte Meyer

Norwegian School of Economics and Business Administration

Meyer, C. B. (2001). A Case in Case Study Methodology. Field Methods 13 (4), 329-352.

The purpose of this article is to provide a comprehensive view of the case study process from the researcher’s perspective, emphasizing methodological considerations. As opposed to other qualitative or quantitative research strategies, such as grounded theory or surveys, there are virtually no specific requirements guiding case research. This is both the strength and the weakness of this approach. It is a strength because it allows tailoring the design and data collection procedures to the research questions. On the other hand, this approach has resulted in many poor case studies, leaving it open to criticism, especially from the quantitative field of research. This article argues that there is a particular need in case studies to be explicit about the methodological choices one makes. This implies discussing the wide range of decisions concerned with design requirements, data collection procedures, data analysis, and validity and reliability. The approach here is to illustrate these decisions through a particular case study of two mergers in the financial industry in Norway.

In the past few years, a number of books have been published that give useful guidance in conducting qualitative studies (Gummesson 1988; Cassell & Symon 1994; Miles & Huberman 1994; Creswell 1998; Flick 1998; Rossman & Rallis 1998; Bryman & Burgess 1999; Marshall & Rossman 1999; Denzin & Lincoln 2000). One approach often mentioned is the case study (Yin 1989). Case studies are widely used in organizational studies in the social science disciplines of sociology, industrial relations, and anthropology (Hartley 1994). Such a study consists of detailed investigation of one or more organizations, or groups within organizations, with a view to providing an analysis of the context and processes involved in the phenomenon under study.

As opposed to other qualitative or quantitative research strategies, such as grounded theory (Glaser and Strauss 1967) or surveys (Nachmias & Nachmias 1981), there are virtually no specific requirements guiding case research. Yin (1989) and Eisenhardt (1989) give useful insights into the case study as a research strategy, but leave most of the design decisions on the table. This is both the strength and the weakness of this approach. It is a strength because it allows tailoring the design and data collection procedures to the research questions. On the other hand, this approach has resulted in many poor case studies, leaving it open to criticism, especially from the quantitative field of research (Cook and Campbell 1979). The fact that the case study is a rather loose design implies that there are a number of choices that need to be addressed in a principled way.

Although case studies have become a common research strategy, the scope of methodology sections in articles published in journals is far too limited to give the readers a detailed and comprehensive view of the decisions taken in the particular studies, and, given the format of methodology sections, will remain so. The few books (Yin 1989, 1993; Hamel, Dufour, & Fortin 1993; Stake 1995) and book chapters on case studies (Hartley 1994; Silverman 2000) are, on the other hand, mainly normative and span a broad range of different kinds of case studies. One exception is Pettigrew (1990, 1992), who places the case study in the context of a research tradition (the Warwick process research).

Given the contextual nature of the case study and its strength in addressing contemporary phenomena in real-life contexts, I believe that there is a need for articles that provide a comprehensive overview of the case study process from the researcher’s perspective, emphasizing methodological considerations. This implies addressing the whole range of choices concerning specific design requirements, data collection procedures, data analysis, and validity and reliability.

WHY A CASE STUDY?

Case studies are tailor-made for exploring new processes or behaviors or ones that are little understood (Hartley 1994). Hence, the approach is particularly useful for responding to how and why questions about a contemporary set of events (Leonard-Barton 1990). Moreover, researchers have argued that certain kinds of information can be difficult or even impossible to tackle by means other than qualitative approaches such as the case study (Sykes 1990). Gummesson (1988:76) argues that an important advantage of case study research is the opportunity for a holistic view of the process: “The detailed observations entailed in the case study method enable us to study many different aspects, examine them in relation to each other, view the process within its total environment and also use the researchers’ capacity for ‘verstehen.’ ”

The contextual nature of the case study is illustrated in Yin’s (1993:59) definition of a case study as an empirical inquiry that “investigates a contemporary phenomenon within its real-life context and addresses a situation in which the boundaries between phenomenon and context are not clearly evident.”

The key difference between the case study and other qualitative designs such as grounded theory and ethnography (Glaser & Strauss 1967; Strauss & Corbin 1990; Gioia & Chittipeddi 1991) is that the case study is open to the use of theory or conceptual categories that guide the research and analysis of data. In contrast, grounded theory or ethnography presupposes that theoretical perspectives are grounded in and emerge from firsthand data. Hartley (1994) argues that without a theoretical framework, the researcher is in severe danger of providing description without meaning. Gummesson (1988) says that a lack of preunderstanding will cause the researcher to spend considerable time gathering basic information. This preunderstanding may arise from general knowledge such as theories, models, and concepts or from specific knowledge of institutional conditions and social patterns. According to Gummesson, the key is not to require researchers to have split but dual personalities: “Those who are able to balance on a razor’s edge using their pre-understanding without being its slave” (p. 58).

DESCRIPTION OF THE ILLUSTRATIVE STUDY

The study that will be used for illustrative purposes is a comparative and longitudinal case study of organizational integration in mergers and acquisitions taking place in Norway. The study had two purposes: (1) to identify contextual factors and features of integration that facilitated or impeded organizational integration, and (2) to study how the three dimensions of organizational integration (integration of tasks, unification of power, and integration of cultures and identities) interrelated and evolved over time. Examples of contextual factors were relative power, degree of friendliness, and economic climate. Integration features included factors such as participation, communication, and allocation of positions and functions.

Mergers and acquisitions are inherently complex. Researchers in the field have suggested that managers continuously underestimate the task of integrating the merging organizations in the postintegration process (Haspeslaph & Jemison 1991). The process of organizational integration can lead to sharp interorganizational conflict as the different top management styles, organizational and work unit cultures, systems, and other aspects of organizational life come into contact (Blake & Mounton 1985; Schweiger & Walsh 1990; Cartwright & Cooper 1993). Furthermore, cultural change in mergers and acquisitions is compounded by additional uncertainties, ambiguities, and stress inherent in the combination process (Buono & Bowditch 1989).

I focused on two combinations: one merger and one acquisition. The first case was a merger between two major Norwegian banks, Bergen Bank and DnC (to be named DnB), that started in the late 1980s. The second case was a study of a major acquisition in the insurance industry (i.e., Gjensidige’s acquisition of Forenede), that started in the early 1990s. Both combinations aimed to realize operational synergies though merging the two organizations into one entity. This implied disruption of organizational boundaries and threat to the existing power distribution and organizational cultures.

The study of integration processes in mergers and acquisitions illustrates the need to find a design that opens for exploration of sensitive issues such as power struggles between the two merging organizations. Furthermore, the inherent complexity in the integration process, involving integration of tasks, unification of power, and cultural integration stressed the need for in-depth study of the phenomenon over time. To understand the cultural integration process, the design also had to be linked to the past history of the two organizations.

DESIGN DECISIONS

In the introduction, I stressed that a case is a rather loose design that requires that a number of design choices be made. In this section, I go through the most important choices I faced in the study of organizational integration in mergers and acquisitions. These include: (1) selection of cases; (2) sampling time; (3) choosing business areas, divisions, and sites; and (4) selection of and choices regarding data collection procedures, interviews, documents, and observation.

Selection of Cases

There are several choices involved in selecting cases. First, there is the question of how many cases to include. Second, one must sample cases and decide on a unit of analysis. I will explore these issues subsequently.

Single or Multiple Cases

Case studies can involve single or multiple cases. The problem of single cases is limitations in generalizability and several information-processing biases (Eisenhardt 1989).

One way to respond to these biases is by applying a multi-case approach (Leonard-Barton 1990). Multiple cases augment external validity and help guard against observer biases. Moreover, multi-case sampling adds confidence to findings. By looking at a range of similar and contrasting cases, we can understand a single-case finding, grounding it by specifying how and where and, if possible, why it behaves as it does. (Miles & Huberman 1994)

Given these limitations of the single case study, it is desirable to include more than one case study in the study. However, the desire for depth and a pluralist perspective and tracking the cases over time implies that the number of cases must be fairly few. I chose two cases, which clearly does not support generalizability any more than does one case, but allows for comparison and contrast between the cases as well as a deeper and richer look at each case.

Originally, I planned to include a third case in the study. Due to changes in management during the initial integration process, my access to the case was limited and I left this case entirely. However, a positive side effect was that it allowed a deeper investigation of the two original cases and in hindsight turned out to be a good decision.

Sampling Cases

The logic of sampling cases is fundamentally different from statistical sampling. The logic in case studies involves theoretical sampling, in which the goal is to choose cases that are likely to replicate or extend the emergent theory or to fill theoretical categories and provide examples for polar types (Eisenhardt 1989). Hence, whereas quantitative sampling concerns itself with representativeness, qualitative sampling seeks information richness and selects the cases purposefully rather than randomly (Crabtree and Miller 1992).

The choice of cases was guided by George (1979) and Pettigrew’s (1990) recommendations. The aim was to find cases that matched the three dimensions in the dependent variable and provided variation in the contextual factors, thus representing polar cases.

To match the choice of outcome variable, organizational integration, I chose cases in which the purpose was to fully consolidate the merging parties’ operations. A full consolidation would imply considerable disruption in the organizational boundaries and would be expected to affect the task-related, political, and cultural features of the organizations. As for the contextual factors, the two cases varied in contextual factors such as relative power, friendliness, and economic climate. The DnB merger was a friendly combination between two equal partners in an unfriendly economic climate. Gjensidige’s acquisition of Forenede was, in contrast, an unfriendly and unbalanced acquisition in a friendly economic climate.

Unit of Analysis

Another way to respond to researchers’ and respondents’ biases is to have more than one unit of analysis in each case (Yin 1993). This implies that, in addition to developing contrasts between the cases, researchers can focus on contrasts within the cases (Hartley 1994). In case studies, there is a choice of a holistic or embedded design (Yin 1989). A holistic design examines the global nature of the phenomenon, whereas an embedded design also pays attention to subunit(s).

I used an embedded design to analyze the cases (i.e., within each case, I also gave attention to subunits and subprocesses). In both cases, I compared the combination processes in the various divisions and local networks. Moreover, I compared three distinct change processes in DnB: before the merger, during the initial combination, and two years after the merger. The overall and most important unit of analysis in the two cases was, however, the integration process.

Sampling Time

According to Pettigrew (1990), time sets a reference for what changes can be seen and how those changes are explained. When conducting a case study, there are several important issues to decide when sampling time. The first regards how many times data should be collected, while the second concerns when to enter the organizations. There is also a need to decide whether to collect data on a continuous basis or in distinct periods.

Number of data collections. I studied the process by collecting real time and retrospective data at two points in time, with one-and-a-half- and two-year intervals in the two cases. Collecting data twice had some interesting implications for the interpretations of the data. During the first data collection in the DnB study, for example, I collected retrospective data about the premerger and initial combination phase and real-time data about the second step in the combination process.

Although I gained a picture of how the employees experienced the second stage of the combination process, it was too early to assess the effects of this process at that stage. I entered the organization two years later and found interesting effects that I had not anticipated the first time. Moreover, it was interesting to observe how people’s attitudes toward the merger processes changed over time to be more positive and less emotional.

When to enter the organizations. It would be desirable to have had the opportunity to collect data in the precombination processes. However, researchers are rarely given access in this period due to secrecy. The emphasis in this study was to focus on the postcombination process. As such, the precombination events were classified as contextual factors. This implied that it was most important to collect real-time data after the parties had been given government approval to merge or acquire. What would have been desirable was to gain access earlier in the postcombination process. This was not possible because access had to be negotiated. Due to the change of CEO in the middle of the merger process and the need for renegotiating access, this took longer than expected.

Regarding the second case, I was restricted by the time frame of the study. In essence, I had to choose between entering the combination process as soon as governmental approval was given, or entering the organization at a later stage. In light of the previous studies in the field that have failed to go beyond the initial two years, and given the need to collect data about the cultural integration process, I chose the latter strategy. And I decided to enter the organizations at two distinct periods of time rather than on a continuous basis.

There were several reasons for this approach, some methodological and some practical. First, data collection on a continuous basis would have required use of extensive observation that I didn’t have access to, and getting access to two data collections in DnB was difficult in itself. Second, I had a stay abroad between the first and second data collection in Gjensidige. Collecting data on a continuous basis would probably have allowed for better mapping of the ongoing integration process, but the contrasts between the two different stages in the integration process that I wanted to elaborate would probably be more difficult to detect. In Table 1 I have listed the periods of time in which I collected data in the two combinations.

Sampling Business Areas, Divisions, and Sites

Even when the cases for a study have been chosen, it is often necessary to make further choices within each case to make the cases researchable. The most important criteria that set the boundaries for the study are importance or criticality, relevance, and representativeness. At the time of the data collection, my criteria for making these decisions were not as conscious as they may appear here. Rather, being restricted by time and my own capacity as a researcher, I had to limit the sites and act instinctively. In both cases, I decided to concentrate on the core businesses (criticality criterion) and left out the business units that were only mildly affected by the integration process (relevance criterion). In the choice of regional offices, I used the representativeness criterion as the number of offices widely exceeded the number of sites possible to study. In making these choices, I relied on key informants in the organizations.

SELECTION OF DATA COLLECTION PROCEDURES

The choice of data collection procedures should be guided by the research question and the choice of design. The case study approach typically combines data collection methods such as archives, interviews, questionnaires, and observations (Yin 1989). This triangulated methodology provides stronger substantiation of constructs and hypotheses. However, the choice of data collection methods is also subject to constraints in time, financial resources, and access.

I chose a combination of interviews, archives, and observation, with main emphasis on the first two. Conducting a survey was inappropriate due to the lack of established concepts and indicators. The reason for limited observation, on the other hand, was due to problems in obtaining access early in the study and time and resource constraints. In addition to choosing among several different data collection methods, there are a number of choices to be made for each individual method.

When relying on interviews as the primary data collection method, the issue of building trust between the researcher and the interviewees becomes very important. I addressed this issue by several means. First, I established a procedure of how to approach the interviewees. In most cases, I called them first, then sent out a letter explaining the key features of the project and outlining the broad issues to be addressed in the interview. In this letter, the support from the institution’s top management was also communicated. In most cases, the top management’s support of the project was an important prerequisite for the respondent’s input. Some interviewees did, however, fear that their input would be open to the top management without disguising the information source. Hence, it became important to communicate how I intended to use and store the information.

To establish trust, I also actively used my preunderstanding of the context in the first case and the phenomenon in the second case. As I built up an understanding of the cases, I used this information to gain confidence. The active use of my preunderstanding did, however, pose important challenges in not revealing too much of the research hypotheses and in balancing between asking open-ended questions and appearing knowledgeable.

There are two choices involved in conducting interviews. The first concerns the sampling of interviewees. The second is that you must decide on issues such as the structure of the interviews, use of tape recorder, and involvement of other researchers.

Sampling Interviewees

Following the desire for detailed knowledge of each case and for grasping different participant’s views the aim was, in line with Pettigrew (1990), to apply a pluralist view by describing and analyzing competing versions of reality as seen by actors in the combination processes.

I used four criteria for sampling informants. First, I drew informants from populations representing multiple perspectives. The first data collection in DnB was primarily focused on the top management level. Moreover, most middle managers in the first data collection were employed at the head offices, either in Bergen or Oslo. In the second data collection, I compensated for this skew by including eight local middle managers in the sample. The difference between the number of employees interviewed in DnB and Gjensidige was primarily due to the fact that Gjensidige has three unions, whereas DnB only has one. The distribution of interviewees is outlined in Table 2 .

The second criterion was to use multiple informants. According to Glick et al. (1990), an important advantage of using multiple informants is that the validity of information provided by one informant can be checked against that provided by other informants. Moreover, the validity of the data used by the researcher can be enhanced by resolving the discrepancies among different informants’ reports. Hence, I selected multiple respondents from each perspective.

Third, I focused on key informants who were expected to be knowledgeable about the combination process. These people included top management members, managers, and employees involved in the integration project. To validate the information from these informants, I also used a fourth criterion by selecting managers and employees who had been affected by the process but who were not involved in the project groups.

Structured versus unstructured. In line with the explorative nature of the study, the goal of the interviews was to see the research topic from the perspective of the interviewee, and to understand why he or she came to have this particular perspective. To meet this goal, King (1994:15) recommends that one have “a low degree of structure imposed on the interviewer, a preponderance of open questions, a focus on specific situations and action sequences in the world of the interviewee rather than abstractions and general opinions.” In line with these recommendations, the collection of primary data in this study consists of unstructured interviews.

Using tape recorders and involving other researchers. The majority of the interviews were tape-recorded, and I could thus concentrate fully on asking questions and responding to the interviewees’ answers. In the few interviews that were not tape-recorded, most of which were conducted in the first phase of the DnB-study, two researchers were present. This was useful as we were both able to discuss the interviews later and had feedback on the role of an interviewer.

In hindsight, however, I wish that these interviews had been tape-recorded to maintain the level of accuracy and richness of data. Hence, in the next phases of data collection, I tape-recorded all interviews, with two exceptions (people who strongly opposed the use of this device). All interviews that were tape-recorded were transcribed by me in full, which gave me closeness and a good grasp of the data.

When organizations merge or make acquisitions, there are often a vast number of documents to choose from to build up an understanding of what has happened and to use in the analyses. Furthermore, when firms make acquisitions or merge, they often hire external consultants, each of whom produces more documents. Due to time constraints, it is seldom possible to collect and analyze all these documents, and thus the researcher has to make a selection.

The choice of documentation was guided by my previous experience with merger and acquisition processes and the research question. Hence, obtaining information on the postintegration process was more important than gaining access to the due-diligence analysis. As I learned about the process, I obtained more documents on specific issues. I did not, however, gain access to all the documents I asked for, and, in some cases, documents had been lost or shredded.

The documents were helpful in a number of ways. First, and most important, they were used as inputs to the interview guide and saved me time, because I did not have to ask for facts in the interviews. They were also useful for tracing the history of the organizations and statements made by key people in the organizations. Third, the documents were helpful in counteracting the biases of the interviews. A list of the documents used in writing the cases is shown in Table 3 .

Observation

The major strength of direct observation is that it is unobtrusive and does not require direct interaction with participants (Adler and Adler 1994). Observation produces rigor when it is combined with other methods. When the researcher has access to group processes, direct observation can illuminate the discrepancies between what people said in the interviews and casual conversations and what they actually do (Pettigrew 1990).

As with interviews, there are a number of choices involved in conducting observations. Although I did some observations in the study, I used interviews as the key data collection source. Discussion in this article about observations will thus be somewhat limited. Nevertheless, I faced a number of choices in conducting observations, including type of observation, when to enter, how much observation to conduct, and which groups to observe.

The are four ways in which an observer may gather data: (1) the complete participant who operates covertly, concealing any intention to observe the setting; (2) the participant-as-observer, who forms relationships and participates in activities, but makes no secret of his or her intentions to observe events; (3) the observer-as-participant, who maintains only superficial contact with the people being studied; and (4) the complete observer, who merely stands back and eavesdrops on the proceedings (Waddington 1994).

In this study, I used the second and third ways of observing. The use of the participant-as-observer mode, on which much ethnographic research is based, was rather limited in the study. There were two reasons for this. First, I had limited time available for collecting data, and in my view interviews made more effective use of this limited time than extensive participant observation. Second, people were rather reluctant to let me observe these political and sensitive processes until they knew me better and felt I could be trusted. Indeed, I was dependent on starting the data collection before having built sufficient trust to observe key groups in the integration process. Nevertheless, Gjensidige allowed me to study two employee seminars to acquaint me with the organization. Here I admitted my role as an observer but participated fully in the activities. To achieve variation, I chose two seminars representing polar groups of employees.

As observer-as-participant, I attended a top management meeting at the end of the first data collection in Gjensidige and observed the respondents during interviews and in more informal meetings, such as lunches. All these observations gave me an opportunity to validate the data from the interviews. Observing the top management group was by far the most interesting and rewarding in terms of input.

Both DnB and Gjensidige started to open up for more extensive observation when I was about to finish the data collection. By then, I had built up the trust needed to undertake this approach. Unfortunately, this came a little late for me to take advantage of it.

DATA ANALYSIS

Published studies generally describe research sites and data-collection methods, but give little space to discuss the analysis (Eisenhardt 1989). Thus, one cannot follow how a researcher arrives at the final conclusions from a large volume of field notes (Miles and Huberman 1994).

In this study, I went through the stages by which the data were reduced and analyzed. This involved establishing the chronology, coding, writing up the data according to phases and themes, introducing organizational integration into the analysis, comparing the cases, and applying the theory. I will discuss these phases accordingly.

The first step in the analysis was to establish the chronology of the cases. To do this, I used internal and external documents. I wrote the chronologies up and included appendices in the final report.

The next step was to code the data into phases and themes reflecting the contextual factors and features of integration. For the interviews, this implied marking the text with a specific phase and a theme, and grouping the paragraphs on the same theme and phase together. I followed the same procedure in organizing the documents.

I then wrote up the cases using phases and themes to structure them. Before starting to write up the cases, I scanned the information on each theme, built up the facts and filled in with perceptions and reactions that were illustrative and representative of the data.

The documents were primarily useful in establishing the facts, but they also provided me with some perceptions and reactions that were validated in the interviews. The documents used included internal letters and newsletters as well as articles from the press. The interviews were less factual, as intended, and gave me input to assess perceptions and reactions. The limited observation was useful to validate the data from the interviews. The result of this step was two descriptive cases.

To make each case more analytical, I introduced the three dimensions of organizational integration—integration of tasks, unification of power, and cultural integration—into the analysis. This helped to focus the case and to develop a framework that could be used to compare the cases. The cases were thus structured according to phases, organizational integration, and themes reflecting the factors and features in the study.

I took all these steps to become more familiar with each case as an individual entity. According to Eisenhardt (1989:540), this is a process that “allows the unique patterns of each case to emerge before the investigators push to generalise patterns across cases. In addition it gives investigators a rich familiarity with each case which, in turn, accelerates cross-case comparison.”

The comparison between the cases constituted the next step in the analysis. Here, I used the categories from the case chapters, filled in the features and factors, and compared and contrasted the findings. The idea behind cross-case searching tactics is to force investigators to go beyond initial impressions, especially through the use of structural and diverse lenses on the data. These tactics improve the likelihood of accurate and reliable theory, that is, theory with a close fit to the data (Eisenhardt 1989).

As a result, I had a number of overall themes, concepts, and relationships that had emerged from the within-case analysis and cross-case comparisons. The next step was to compare these emergent findings with theory from the organizational field of mergers and acquisitions, as well as other relevant perspectives.

This method of generalization is known as analytical generalization. In this approach, a previously developed theory is used as a template with which to compare the empirical results of the case study (Yin 1989). This comparison of emergent concepts, theory, or hypotheses with the extant literature involves asking what it is similar to, what it contradicts, and why. The key to this process is to consider a broad range of theory (Eisenhardt 1989). On the whole, linking emergent theory to existent literature enhances the internal validity, generalizability, and theoretical level of theory-building from case research.

According to Eisenhardt (1989), examining literature that conflicts with the emergent literature is important for two reasons. First, the chance of neglecting conflicting findings is reduced. Second, “conflicting results forces researchers into a more creative, frame-breaking mode of thinking than they might otherwise be able to achieve” (p. 544). Similarly, Eisenhardt (1989) claims that literature discussing similar findings is important because it ties together underlying similarities in phenomena not normally associated with each other. The result is often a theory with a stronger internal validity, wider generalizability, and a higher conceptual level.

The analytical generalization in the study included exploring and developing the concepts and examining the relationships between the constructs. In carrying out this analytical generalization, I acted on Eisenhardt’s (1989) recommendation to use a broad range of theory. First, I compared and contrasted the findings with the organizational stream on mergers and acquisition literature. Then I discussed other relevant literatures, including strategic change, power and politics, social justice, and social identity theory to explore how these perspectives could contribute to the understanding of the findings. Finally, I discussed the findings that could not be explained either by the merger and acquisition literature or the four theoretical perspectives.

In every scientific study, questions are raised about whether the study is valid and reliable. The issues of validity and reliability in case studies are just as important as for more deductive designs, but the application is fundamentally different.

VALIDITY AND RELIABILITY

The problems of validity in qualitative studies are related to the fact that most qualitative researchers work alone in the field, they focus on the findings rather than describe how the results were reached, and they are limited in processing information (Miles and Huberman 1994).

Researchers writing about qualitative methods have questioned whether the same criteria can be used for qualitative and quantitative studies (Kirk & Miller 1986; Sykes 1990; Maxwell 1992). The problem with the validity criteria suggested in qualitative research is that there is little consistency across the articles as each author suggests a new set of criteria.

One approach in examining validity and reliability is to apply the criteria used in quantitative research. Hence, the criteria to be examined here are objectivity/intersubjectivity, construct validity, internal validity, external validity, and reliability.

Objectivity/Intersubjectivity

The basic issue of objectivity can be framed as one of relative neutrality and reasonable freedom from unacknowledged research biases (Miles & Huberman 1994). In a real-time longitudinal study, the researcher is in danger of losing objectivity and of becoming too involved with the organization, the people, and the process. Hence, Leonard-Barton (1990) claims that one may be perceived as, and may even become, an advocate rather than an observer.

According to King (1994), however, qualitative research, in seeking to describe and make sense of the world, does not require researchers to strive for objectivity and distance themselves from research participants. Indeed, to do so would make good qualitative research impossible, as the interviewer’s sensitivity to subjective aspects of his or her relationship with the interviewee is an essential part of the research process (King 1994:31).

This does not imply, however, that the issue of possible research bias can be ignored. It is just as important as in a structured quantitative interview that the findings are not simply the product of the researcher’s prejudices and prior experience. One way to guard against this bias is for the researcher to explicitly recognize his or her presuppositions and to make a conscious effort to set these aside in the analysis (Gummesson 1988). Furthermore, rival conclusions should be considered (Miles & Huberman 1994).

My experience from the first phase of the DnB study was that it was difficult to focus the questions and the analysis of the data when the research questions were too vague and broad. As such, developing a framework before collecting the data for the study was useful in guiding the collection and analysis of data. Nevertheless, it was important to be open-minded and receptive to new and surprising data. In the DnB study, for example, the positive effect of the reorganization process on the integration of cultures came as a complete surprise to me and thus needed further elaboration.

I also consciously searched for negative evidence and problems by interviewing outliers (Miles & Huberman 1994) and asking problem-oriented questions. In Gjensidige, the first interviews with the top management revealed a much more positive perception of the cultural integration process than I had expected. To explore whether this was a result of overreliance on elite informants, I continued posing problem-oriented questions to outliers and people at lower levels in the organization. Moreover, I told them about the DnB study to be explicit about my presuppositions.

Another important issue when assessing objectivity is whether other researchers can trace the interpretations made in the case studies, or what is called intersubjectivity. To deal with this issue, Miles & Huberman (1994) suggest that: (1) the study’s general methods and procedures should be described in detail, (2) one should be able to follow the process of analysis, (3) conclusions should be explicitly linked with exhibits of displayed data, and (4) the data from the study should be made available for reanalysis by others.

In response to these requirements, I described the study’s data collection procedures and processing in detail. Then, the primary data were displayed in the written report in the form of quotations and extracts from documents to support and illustrate the interpretations of the data. Because the study was written up in English, I included the Norwegian text in a separate appendix. Finally, all the primary data from the study were accessible for a small group of distinguished researchers.

Construct Validity

Construct validity refers to whether there is substantial evidence that the theoretical paradigm correctly corresponds to observation (Kirk & Miller 1986). In this form of validity, the issue is the legitimacy of the application of a given concept or theory to established facts.

The strength of qualitative research lies in the flexible and responsive interaction between the interviewer and the respondents (Sykes 1990). Thus, meaning can be probed, topics covered easily from a number of angles, and questions made clear for respondents. This is an advantage for exploring the concepts (construct or theoretical validity) and the relationships between them (internal validity). Similarly, Hakim (1987) says the great strength of qualitative research is the validity of data obtained because individuals are interviewed in sufficient detail for the results to be taken as true, correct, and believable reports of their views and experiences.

Construct validity can be strengthened by applying a longitudinal multicase approach, triangulation, and use of feedback loops. The advantage of applying a longitudinal approach is that one gets the opportunity to test sensitivity of construct measures to the passage of time. Leonard-Barton (1990), for example, found that one of her main constructs, communicability, varied across time and relative to different groups of users. Thus, the longitudinal study aided in defining the construct more precisely. By using more than one case study, one can validate stability of construct across situations (Leonard-Barton 1990). Since my study only consists of two case studies, the opportunity to test stability of constructs across cases is somewhat limited. However, the use of more than one unit of analysis helps to overcome this limitation.

Construct validity is strengthened by the use of multiple sources of evidence to build construct measures, which define the construct and distinguish it from other constructs. These multiple sources of evidence can include multiple viewpoints within and across the data sources. My study responds to these requirements in its sampling of interviewees and uses of multiple data sources.

Use of feedback loops implies returning to interviewees with interpretations and developing theory and actively seeking contradictions in data (Crabtree & Miller 1992; King 1994). In DnB, the written report had to be approved by the bank’s top management after the first data collection. Apart from one minor correction, the bank had no objections to the established facts. In their comments on my analysis, some of the top managers expressed the view that the political process had been overemphasized, and that the CEO’s role in initiating a strategic process was undervalued. Hence, an important objective in the second data collection was to explore these comments further. Moreover, the report was not as positive as the management had hoped for, and negotiations had to be conducted to publish the report. The result of these negotiations was that publication of the report was postponed one-and-a-half years.

The experiences from the first data collection in the DnB had some consequences. I was more cautious and brought up the problems of confidentiality and the need to publish at the outset of the Gjensidige study. Also, I had to struggle to get access to the DnB case for the second data collection and some of the information I asked for was not released. At Gjensidige, I sent a preliminary draft of the case chapter to the corporation’s top management for comments, in addition to having second interviews with a small number of people. Beside testing out the factual description, these sessions gave me the opportunity to test out the theoretical categories established as a result of the within-case analysis.

Internal Validity

Internal validity concerns the validity of the postulated relationships among the concepts. The main problem of internal validity as a criterion in qualitative research is that it is often not open to scrutiny. According to Sykes (1990), the researcher can always provide a plausible account and, with careful editing, may ensure its coherence. Recognition of this problem has led to calls for better documentation of the processes of data collection, the data itself, and the interpretative contribution of the researcher. The discussion of how I met these requirements was outlined in the section on objectivity/subjectivity above.

However, there are some advantages in using qualitative methods, too. First, the flexible and responsive methods of data collection allow cross-checking and amplification of information from individual units as it is generated. Respondents’ opinions and understandings can be thoroughly explored. The internal validity results from strategies that eliminate ambiguity and contradiction, filling in detail and establishing strong connections in data.

Second, the longitudinal study enables one to track cause and effect. Moreover, it can make one aware of intervening variables (Leonard-Barton 1990). Eisenhardt (1989:542) states, “Just as hypothesis testing research an apparent relationship may simply be a spurious correlation or may reflect the impact of some third variable on each of the other two. Therefore, it is important to discover the underlying reasons for why the relationship exists.”

Generalizability

According to Mitchell (1983), case studies are not based on statistical inference. Quite the contrary, the inferring process turns exclusively on the theoretically necessary links among the features in the case study. The validity of the extrapolation depends not on the typicality or representativeness of the case but on the cogency of the theoretical reasoning. Hartley (1994:225) claims, “The detailed knowledge of the organization and especially the knowledge about the processes underlying the behaviour and its context can help to specify the conditions under which behaviour can be expected to occur. In other words, the generalisation is about theoretical propositions not about populations.”

Generalizability is normally based on the assumption that this theory may be useful in making sense of similar persons or situations (Maxwell 1992). One way to increase the generalizability is to apply a multicase approach (Leonard-Barton 1990). The advantage of this approach is that one can replicate the findings from one case study to another. This replication logic is similar to that used on multiple experiments (Yin 1993).

Given the choice of two case studies, the generalizability criterion is not supported in this study. Through the discussion of my choices, I have tried to show that I had to strike a balance between the need for depth and mapping changes over time and the number of cases. In doing so, I deliberately chose to provide a deeper and richer look at each case, allowing the reader to make judgments about the applicability rather than making a case for generalizability.

Reliability

Reliability focuses on whether the process of the study is consistent and reasonably stable over time and across researchers and methods (Miles & Huberman 1994). In the context of qualitative research, reliability is concerned with two questions (Sykes 1990): Could the same study carried out by two researchers produce the same findings? and Could a study be repeated using the same researcher and respondents to yield the same findings?

The problem of reliability in qualitative research is that differences between replicated studies using different researchers are to be expected. However, while it may not be surprising that different researchers generate different findings and reach different conclusions, controlling for reliability may still be relevant. Kirk and Miller’s (1986:311) definition takes into account the particular relationship between the researcher’s orientation, the generation of data, and its interpretation:

For reliability to be calculated, it is incumbent on the scientific investigator to document his or her procedure. This must be accomplished at such a level of abstraction that the loci of decisions internal to the project are made apparent. The curious public deserves to know how the qualitative researcher prepares him or herself for the endeavour, and how the data is collected and analysed.

The study addresses these requirements by discussing my point of departure regarding experience and framework, the sampling and data collection procedures, and data analysis.

Case studies often lack academic rigor and are, as such, regarded as inferior to more rigorous methods where there are more specific guidelines for collecting and analyzing data. These criticisms stress that there is a need to be very explicit about the choices one makes and the need to justify them.

One reason why case studies are criticized may be that researchers disagree about the definition and the purpose of carrying out case studies. Case studies have been regarded as a design (Cook and Campbell 1979), as a qualitative methodology (Cassell and Symon 1994), as a particular data collection procedure (Andersen 1997), and as a research strategy (Yin 1989). Furthermore, the purpose for carrying out case studies is unclear. Some regard case studies as supplements to more rigorous qualitative studies to be carried out in the early stage of the research process; others claim that it can be used for multiple purposes and as a research strategy in its own right (Gummesson 1988; Yin 1989). Given this unclear status, researchers need to be very clear about their interpretation of the case study and the purpose of carrying out the study.

This article has taken Yin’s (1989) definition of the case study as a research strategy as a starting point and argued that the choice of the case study should be guided by the research question(s). In the illustrative study, I used a case study strategy because of a need to explore sensitive, ill-defined concepts in depth, over time, taking into account the context and history of the mergers and the existing knowledge about the phenomenon. However, the choice of a case study strategy extended rather than limited the number of decisions to be made. In Schramm’s (1971, cited in Yin 1989:22–23) words, “The essence of a case study, the central tendency among all types of case study, is that it tries to illuminate a decision or set of decisions, why they were taken, how they were implemented, and with what result.”

Hence, the purpose of this article has been to illustrate the wide range of decisions that need to be made in the context of a particular case study and to discuss the methodological considerations linked to these decisions. I argue that there is a particular need in case studies to be explicit about the methodological choices one makes and that these choices can be best illustrated through a case study of the case study strategy.

As in all case studies, however, there are limitations to the generalizability of using one particular case study for illustrative purposes. As such, the strength of linking the methodological considerations to a specific context and phenomenon also becomes a weakness. However, I would argue that the questions raised in this article are applicable to many case studies, but that the answers are very likely to vary. The design choices are shown in Table 4 . Hence, researchers choosing a longitudinal, comparative case study need to address the same set of questions with regard to design, data collection procedures, and analysis, but they are likely to come up with other conclusions, given their different research questions.

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Christine Benedichte Meyer is an associate professor in the Department of Strategy and Management in the Norwegian School of Economics and Business Administration, Bergen-Sandviken, Norway. Her research interests are mergers and acquisitions, strategic change, and qualitative research. Recent publications include: “Allocation Processes in Mergers and Acquisitions: An Organisational Justice Perspective” (British Journal of Management 2001) and “Motives for Acquisitions in the Norwegian Financial Industry” (CEMS Business Review 1997).

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The case study approach

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

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

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

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Introduction

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

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

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

What is a case study?

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

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

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

What are case studies used for?

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

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

How are case studies conducted?

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

Defining the case

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

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

Selecting the case(s)

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

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

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

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

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

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

Collecting the data

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

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

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

Analysing, interpreting and reporting case studies

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

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

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

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

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

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

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

Conclusions

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

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Acknowledgements

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

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

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Continuing to enhance the quality of case study methodology in health services research

Shannon l. sibbald.

1 Faculty of Health Sciences, Western University, London, Ontario, Canada.

2 Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.

3 The Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.

Stefan Paciocco

Meghan fournie, rachelle van asseldonk, tiffany scurr.

Case study methodology has grown in popularity within Health Services Research (HSR). However, its use and merit as a methodology are frequently criticized due to its flexible approach and inconsistent application. Nevertheless, case study methodology is well suited to HSR because it can track and examine complex relationships, contexts, and systems as they evolve. Applied appropriately, it can help generate information on how multiple forms of knowledge come together to inform decision-making within healthcare contexts. In this article, we aim to demystify case study methodology by outlining its philosophical underpinnings and three foundational approaches. We provide literature-based guidance to decision-makers, policy-makers, and health leaders on how to engage in and critically appraise case study design. We advocate that researchers work in collaboration with health leaders to detail their research process with an aim of strengthening the validity and integrity of case study for its continued and advanced use in HSR.

Introduction

The popularity of case study research methodology in Health Services Research (HSR) has grown over the past 40 years. 1 This may be attributed to a shift towards the use of implementation research and a newfound appreciation of contextual factors affecting the uptake of evidence-based interventions within diverse settings. 2 Incorporating context-specific information on the delivery and implementation of programs can increase the likelihood of success. 3 , 4 Case study methodology is particularly well suited for implementation research in health services because it can provide insight into the nuances of diverse contexts. 5 , 6 In 1999, Yin 7 published a paper on how to enhance the quality of case study in HSR, which was foundational for the emergence of case study in this field. Yin 7 maintains case study is an appropriate methodology in HSR because health systems are constantly evolving, and the multiple affiliations and diverse motivations are difficult to track and understand with traditional linear methodologies.

Despite its increased popularity, there is debate whether a case study is a methodology (ie, a principle or process that guides research) or a method (ie, a tool to answer research questions). Some criticize case study for its high level of flexibility, perceiving it as less rigorous, and maintain that it generates inadequate results. 8 Others have noted issues with quality and consistency in how case studies are conducted and reported. 9 Reporting is often varied and inconsistent, using a mix of approaches such as case reports, case findings, and/or case study. Authors sometimes use incongruent methods of data collection and analysis or use the case study as a default when other methodologies do not fit. 9 , 10 Despite these criticisms, case study methodology is becoming more common as a viable approach for HSR. 11 An abundance of articles and textbooks are available to guide researchers through case study research, including field-specific resources for business, 12 , 13 nursing, 14 and family medicine. 15 However, there remains confusion and a lack of clarity on the key tenets of case study methodology.

Several common philosophical underpinnings have contributed to the development of case study research 1 which has led to different approaches to planning, data collection, and analysis. This presents challenges in assessing quality and rigour for researchers conducting case studies and stakeholders reading results.

This article discusses the various approaches and philosophical underpinnings to case study methodology. Our goal is to explain it in a way that provides guidance for decision-makers, policy-makers, and health leaders on how to understand, critically appraise, and engage in case study research and design, as such guidance is largely absent in the literature. This article is by no means exhaustive or authoritative. Instead, we aim to provide guidance and encourage dialogue around case study methodology, facilitating critical thinking around the variety of approaches and ways quality and rigour can be bolstered for its use within HSR.

Purpose of case study methodology

Case study methodology is often used to develop an in-depth, holistic understanding of a specific phenomenon within a specified context. 11 It focuses on studying one or multiple cases over time and uses an in-depth analysis of multiple information sources. 16 , 17 It is ideal for situations including, but not limited to, exploring under-researched and real-life phenomena, 18 especially when the contexts are complex and the researcher has little control over the phenomena. 19 , 20 Case studies can be useful when researchers want to understand how interventions are implemented in different contexts, and how context shapes the phenomenon of interest.

In addition to demonstrating coherency with the type of questions case study is suited to answer, there are four key tenets to case study methodologies: (1) be transparent in the paradigmatic and theoretical perspectives influencing study design; (2) clearly define the case and phenomenon of interest; (3) clearly define and justify the type of case study design; and (4) use multiple data collection sources and analysis methods to present the findings in ways that are consistent with the methodology and the study’s paradigmatic base. 9 , 16 The goal is to appropriately match the methods to empirical questions and issues and not to universally advocate any single approach for all problems. 21

Approaches to case study methodology

Three authors propose distinct foundational approaches to case study methodology positioned within different paradigms: Yin, 19 , 22 Stake, 5 , 23 and Merriam 24 , 25 ( Table 1 ). Yin is strongly post-positivist whereas Stake and Merriam are grounded in a constructivist paradigm. Researchers should locate their research within a paradigm that explains the philosophies guiding their research 26 and adhere to the underlying paradigmatic assumptions and key tenets of the appropriate author’s methodology. This will enhance the consistency and coherency of the methods and findings. However, researchers often do not report their paradigmatic position, nor do they adhere to one approach. 9 Although deliberately blending methodologies may be defensible and methodologically appropriate, more often it is done in an ad hoc and haphazard way, without consideration for limitations.

Cross-analysis of three case study approaches, adapted from Yazan 2015

The post-positive paradigm postulates there is one reality that can be objectively described and understood by “bracketing” oneself from the research to remove prejudice or bias. 27 Yin focuses on general explanation and prediction, emphasizing the formulation of propositions, akin to hypothesis testing. This approach is best suited for structured and objective data collection 9 , 11 and is often used for mixed-method studies.

Constructivism assumes that the phenomenon of interest is constructed and influenced by local contexts, including the interaction between researchers, individuals, and their environment. 27 It acknowledges multiple interpretations of reality 24 constructed within the context by the researcher and participants which are unlikely to be replicated, should either change. 5 , 20 Stake and Merriam’s constructivist approaches emphasize a story-like rendering of a problem and an iterative process of constructing the case study. 7 This stance values researcher reflexivity and transparency, 28 acknowledging how researchers’ experiences and disciplinary lenses influence their assumptions and beliefs about the nature of the phenomenon and development of the findings.

Defining a case

A key tenet of case study methodology often underemphasized in literature is the importance of defining the case and phenomenon. Researches should clearly describe the case with sufficient detail to allow readers to fully understand the setting and context and determine applicability. Trying to answer a question that is too broad often leads to an unclear definition of the case and phenomenon. 20 Cases should therefore be bound by time and place to ensure rigor and feasibility. 6

Yin 22 defines a case as “a contemporary phenomenon within its real-life context,” (p13) which may contain a single unit of analysis, including individuals, programs, corporations, or clinics 29 (holistic), or be broken into sub-units of analysis, such as projects, meetings, roles, or locations within the case (embedded). 30 Merriam 24 and Stake 5 similarly define a case as a single unit studied within a bounded system. Stake 5 , 23 suggests bounding cases by contexts and experiences where the phenomenon of interest can be a program, process, or experience. However, the line between the case and phenomenon can become muddy. For guidance, Stake 5 , 23 describes the case as the noun or entity and the phenomenon of interest as the verb, functioning, or activity of the case.

Designing the case study approach

Yin’s approach to a case study is rooted in a formal proposition or theory which guides the case and is used to test the outcome. 1 Stake 5 advocates for a flexible design and explicitly states that data collection and analysis may commence at any point. Merriam’s 24 approach blends both Yin and Stake’s, allowing the necessary flexibility in data collection and analysis to meet the needs.

Yin 30 proposed three types of case study approaches—descriptive, explanatory, and exploratory. Each can be designed around single or multiple cases, creating six basic case study methodologies. Descriptive studies provide a rich description of the phenomenon within its context, which can be helpful in developing theories. To test a theory or determine cause and effect relationships, researchers can use an explanatory design. An exploratory model is typically used in the pilot-test phase to develop propositions (eg, Sibbald et al. 31 used this approach to explore interprofessional network complexity). Despite having distinct characteristics, the boundaries between case study types are flexible with significant overlap. 30 Each has five key components: (1) research question; (2) proposition; (3) unit of analysis; (4) logical linking that connects the theory with proposition; and (5) criteria for analyzing findings.

Contrary to Yin, Stake 5 believes the research process cannot be planned in its entirety because research evolves as it is performed. Consequently, researchers can adjust the design of their methods even after data collection has begun. Stake 5 classifies case studies into three categories: intrinsic, instrumental, and collective/multiple. Intrinsic case studies focus on gaining a better understanding of the case. These are often undertaken when the researcher has an interest in a specific case. Instrumental case study is used when the case itself is not of the utmost importance, and the issue or phenomenon (ie, the research question) being explored becomes the focus instead (eg, Paciocco 32 used an instrumental case study to evaluate the implementation of a chronic disease management program). 5 Collective designs are rooted in an instrumental case study and include multiple cases to gain an in-depth understanding of the complexity and particularity of a phenomenon across diverse contexts. 5 , 23 In collective designs, studying similarities and differences between the cases allows the phenomenon to be understood more intimately (for examples of this in the field, see van Zelm et al. 33 and Burrows et al. 34 In addition, Sibbald et al. 35 present an example where a cross-case analysis method is used to compare instrumental cases).

Merriam’s approach is flexible (similar to Stake) as well as stepwise and linear (similar to Yin). She advocates for conducting a literature review before designing the study to better understand the theoretical underpinnings. 24 , 25 Unlike Stake or Yin, Merriam proposes a step-by-step guide for researchers to design a case study. These steps include performing a literature review, creating a theoretical framework, identifying the problem, creating and refining the research question(s), and selecting a study sample that fits the question(s). 24 , 25 , 36

Data collection and analysis

Using multiple data collection methods is a key characteristic of all case study methodology; it enhances the credibility of the findings by allowing different facets and views of the phenomenon to be explored. 23 Common methods include interviews, focus groups, observation, and document analysis. 5 , 37 By seeking patterns within and across data sources, a thick description of the case can be generated to support a greater understanding and interpretation of the whole phenomenon. 5 , 17 , 20 , 23 This technique is called triangulation and is used to explore cases with greater accuracy. 5 Although Stake 5 maintains case study is most often used in qualitative research, Yin 17 supports a mix of both quantitative and qualitative methods to triangulate data. This deliberate convergence of data sources (or mixed methods) allows researchers to find greater depth in their analysis and develop converging lines of inquiry. For example, case studies evaluating interventions commonly use qualitative interviews to describe the implementation process, barriers, and facilitators paired with a quantitative survey of comparative outcomes and effectiveness. 33 , 38 , 39

Yin 30 describes analysis as dependent on the chosen approach, whether it be (1) deductive and rely on theoretical propositions; (2) inductive and analyze data from the “ground up”; (3) organized to create a case description; or (4) used to examine plausible rival explanations. According to Yin’s 40 approach to descriptive case studies, carefully considering theory development is an important part of study design. “Theory” refers to field-relevant propositions, commonly agreed upon assumptions, or fully developed theories. 40 Stake 5 advocates for using the researcher’s intuition and impression to guide analysis through a categorical aggregation and direct interpretation. Merriam 24 uses six different methods to guide the “process of making meaning” (p178) : (1) ethnographic analysis; (2) narrative analysis; (3) phenomenological analysis; (4) constant comparative method; (5) content analysis; and (6) analytic induction.

Drawing upon a theoretical or conceptual framework to inform analysis improves the quality of case study and avoids the risk of description without meaning. 18 Using Stake’s 5 approach, researchers rely on protocols and previous knowledge to help make sense of new ideas; theory can guide the research and assist researchers in understanding how new information fits into existing knowledge.

Practical applications of case study research

Columbia University has recently demonstrated how case studies can help train future health leaders. 41 Case studies encompass components of systems thinking—considering connections and interactions between components of a system, alongside the implications and consequences of those relationships—to equip health leaders with tools to tackle global health issues. 41 Greenwood 42 evaluated Indigenous peoples’ relationship with the healthcare system in British Columbia and used a case study to challenge and educate health leaders across the country to enhance culturally sensitive health service environments.

An important but often omitted step in case study research is an assessment of quality and rigour. We recommend using a framework or set of criteria to assess the rigour of the qualitative research. Suitable resources include Caelli et al., 43 Houghten et al., 44 Ravenek and Rudman, 45 and Tracy. 46

New directions in case study

Although “pragmatic” case studies (ie, utilizing practical and applicable methods) have existed within psychotherapy for some time, 47 , 48 only recently has the applicability of pragmatism as an underlying paradigmatic perspective been considered in HSR. 49 This is marked by uptake of pragmatism in Randomized Control Trials, recognizing that “gold standard” testing conditions do not reflect the reality of clinical settings 50 , 51 nor do a handful of epistemologically guided methodologies suit every research inquiry.

Pragmatism positions the research question as the basis for methodological choices, rather than a theory or epistemology, allowing researchers to pursue the most practical approach to understanding a problem or discovering an actionable solution. 52 Mixed methods are commonly used to create a deeper understanding of the case through converging qualitative and quantitative data. 52 Pragmatic case study is suited to HSR because its flexibility throughout the research process accommodates complexity, ever-changing systems, and disruptions to research plans. 49 , 50 Much like case study, pragmatism has been criticized for its flexibility and use when other approaches are seemingly ill-fit. 53 , 54 Similarly, authors argue that this results from a lack of investigation and proper application rather than a reflection of validity, legitimizing the need for more exploration and conversation among researchers and practitioners. 55

Although occasionally misunderstood as a less rigourous research methodology, 8 case study research is highly flexible and allows for contextual nuances. 5 , 6 Its use is valuable when the researcher desires a thorough understanding of a phenomenon or case bound by context. 11 If needed, multiple similar cases can be studied simultaneously, or one case within another. 16 , 17 There are currently three main approaches to case study, 5 , 17 , 24 each with their own definitions of a case, ontological and epistemological paradigms, methodologies, and data collection and analysis procedures. 37

Individuals’ experiences within health systems are influenced heavily by contextual factors, participant experience, and intricate relationships between different organizations and actors. 55 Case study research is well suited for HSR because it can track and examine these complex relationships and systems as they evolve over time. 6 , 7 It is important that researchers and health leaders using this methodology understand its key tenets and how to conduct a proper case study. Although there are many examples of case study in action, they are often under-reported and, when reported, not rigorously conducted. 9 Thus, decision-makers and health leaders should use these examples with caution. The proper reporting of case studies is necessary to bolster their credibility in HSR literature and provide readers sufficient information to critically assess the methodology. We also call on health leaders who frequently use case studies 56 – 58 to report them in the primary research literature.

The purpose of this article is to advocate for the continued and advanced use of case study in HSR and to provide literature-based guidance for decision-makers, policy-makers, and health leaders on how to engage in, read, and interpret findings from case study research. As health systems progress and evolve, the application of case study research will continue to increase as researchers and health leaders aim to capture the inherent complexities, nuances, and contextual factors. 7

9 Best Examples of Research Instruments in Qualitative Research Explained

Introduction.

Qualitative research is a valuable approach that allows researchers to explore complex phenomena and gain in-depth insights into the experiences and perspectives of individuals. In order to conduct qualitative research effectively, researchers often utilize various research methodologies and instruments. These methodologies and instruments serve as tools to collect and analyze data, enabling researchers to uncover rich and nuanced information.

In this article, we will delve into the world of qualitative research instruments, specifically focusing on research instrument examples. We will explore the different types of qualitative research instruments, provide specific examples, and discuss the advantages and limitations of using these instruments in qualitative research. By the end of this article, you will have a comprehensive understanding of the role and significance of research instruments in qualitative research.

Goals of Research Instruments in Qualitative Research

Qualitative research instruments are tools that researchers use to collect and analyze data in qualitative research studies. These instruments help researchers gather rich and detailed information about a particular phenomenon or topic.

One of the main goals of qualitative research is to understand the subjective experiences and perspectives of individuals. To achieve this, researchers need to use instruments that allow for in-depth exploration and interpretation of data. Qualitative research instruments can take various forms, including interviews, questionnaires, observations, and focus groups. Each instrument has its own strengths and limitations, and researchers need to carefully select the most appropriate instrument for their study objectives.

Exploring qualitative research instruments involves understanding the characteristics and features of each instrument, as well as considering the research context and the specific research questions being addressed. Researchers also need to consider the ethical implications of using qualitative research instruments, such as ensuring informed consent and maintaining confidentiality and anonymity of participants.

Examples of Qualitative Research Instruments

Qualitative research instruments are tools used to collect data and gather information in qualitative research studies. These instruments help researchers explore and understand complex social phenomena in depth. There are several types of qualitative research instruments that can be used depending on the research objectives and the nature of the study.

Interviews are one of the most commonly used qualitative research instruments. They involve direct communication between the researcher and the participant, allowing for in-depth exploration of the participant’s experiences, perspectives, and opinions. Interviews can be structured, semi-structured, or unstructured , depending on the level of flexibility in the questioning process. They involve researchers asking open-ended questions to participants to gather in-depth information and insights. Interviews can be conducted face-to-face, over the phone, or through video conferencing.

Focus Groups

Focus groups are another example of qualitative research instrument that involves a group discussion led by a researcher or moderator. Participants in a focus group share their thoughts, ideas, and experiences on a specific topic. This instrument allows for the exploration of group dynamics and the interaction between participants. It also allow researchers to gather multiple perspectives and generate rich qualitative data.

Observations

Observations are a powerful qualitative research instrument that involves systematic and careful observation of participants in their natural settings. This type of qualitative research instrument allows researchers to gather data on behavior, interactions, and social processes. Observations can be participant observations, where the researcher actively participates in the setting, or non-participant observations, where the researcher remains an observer.

Document Analysis

Document analysis is a qualitative research instrument that involves the examination, analyzation and interpretation of written or recorded materials such as documents, texts, audio/video recordings or other written materials. Researchers analyze documents to gain insights into social, cultural, or historical contexts, as well as to understand the perspectives and meanings embedded in the documents.

Visual Methods

Visual methods, such as photography, video recording, or drawings, can be used as qualitative research instruments. These methods allow participants to express their experiences and perspectives visually, providing rich and nuanced data. Visual methods can be particularly useful in studying topics related to art, culture, or visual communication.

Diaries or Journals

Diaries or journals can be used as qualitative research instruments to collect data on participants’ thoughts, feelings, and experiences over a period of time. Participants record their daily activities, reflections, and emotions, providing valuable insights into their lived experiences.

While surveys are commonly associated with quantitative research, they can also be used as qualitative research instruments. Qualitative surveys typically include open-ended questions that allow participants to provide detailed responses. Surveys can be administered online, through interviews, or in written form.

Case Studies

Case studies are in-depth investigations of a particular individual, group, or phenomenon. They involve collecting and analyzing qualitative data from various sources such as interviews, observations, and document analysis. Case studies provide rich and detailed insights into specific contexts or situations.

Ethnography

Ethnography is a qualitative research instrument that involves immersing researchers in a particular social or cultural group to observe and understand their behaviors, beliefs, and practices. Ethnographic research often includes participant observation, interviews, and document analysis.

These are just a few examples of qualitative research instruments. Researchers can choose the most appropriate data collection method or combination of methods based on their research objectives, the nature of the research question, and the available resources.

Advantages of Using Qualitative Research Instruments

Gathering in-depth and detailed information.

Qualitative research instruments offer several advantages that make them valuable tools in the research process. Firstly, qualitative research instruments allow researchers to gather in-depth and detailed information. Unlike quantitative research instruments that focus on numerical data, qualitative instruments provide rich and descriptive data about participants’ feelings, opinions, and experiences. This depth of information allows researchers to gain a comprehensive understanding of the research topic .

Flexibility and Adaptability in Qualitative Research

Another advantage of qualitative research instruments is their flexibility. Researchers can adapt their methods and questions during data collection to respond to emerging insights. This flexibility allows for a more dynamic and responsive research process, enabling researchers to explore new avenues and uncover unexpected findings.

Capturing Data in Natural Settings

Qualitative research instruments also offer the advantage of capturing data in natural settings. Unlike controlled laboratory settings often used in quantitative research, qualitative research takes place in real-world contexts. This natural setting allows researchers to observe participants’ behaviors and interactions in their natural environment, providing a more authentic and realistic representation of their experiences.

Promoting Participant Engagement and Collaboration

Furthermore, qualitative research instruments promote participant engagement and collaboration. By using methods such as interviews and focus groups, researchers can actively involve participants in the research process. This engagement fosters a sense of ownership and empowerment among participants, leading to more meaningful and insightful data.

Exploring Complex Issues Through Qualitative Research

Lastly, qualitative research instruments allow for the exploration of complex issues. Qualitative research is particularly useful when studying complex phenomena that cannot be easily quantified or measured. It allows researchers to delve into the underlying meanings, motivations, and social dynamics that shape individuals’ behaviors and experiences.

Limitations of Qualitative Research Instruments

Qualitative research instruments have several limitations that researchers need to consider when conducting their studies. In this section, we will delve into the limitations of qualitative research instruments as compared to quantitative research.

Time-Consuming Nature of Qualitative Research

One of the main drawbacks of qualitative research is that the process is time-consuming. Unlike quantitative research, which can collect data from a large sample size in a relatively short period of time, qualitative research requires in-depth interviews, observations, and analysis, which can take a significant amount of time.

Subjectivity and Potential Bias in Qualitative Research

Another limitation of qualitative research instruments is that the interpretations are subjective. Since qualitative research focuses on understanding the meaning and context of phenomena, the interpretations of the data can vary depending on the researcher’s perspective and biases. This subjectivity can introduce potential bias and affect the reliability and validity of the findings.

Complexity of Data Analysis

Additionally, qualitative research instruments often involve complex data analysis. Unlike quantitative research, which can use statistical methods to analyze data, qualitative research requires researchers to analyze textual or visual data, which can be time-consuming and challenging. The analysis process involves coding, categorizing, and interpreting the data, which requires expertise and careful attention to detail.

Challenges in Maintaining Anonymity and Privacy

Furthermore, qualitative research instruments may face challenges in maintaining anonymity. In some cases, researchers may need to collect sensitive or personal information from participants, which can raise ethical concerns . Ensuring the privacy and confidentiality of participants’ data can be challenging, and researchers need to take appropriate measures to protect the participants’ identities and maintain their trust.

Limited Generalizability of Qualitative Research Findings

Another limitation of qualitative research instruments is the limited generalizability of the findings. Qualitative research often focuses on a specific context or a small sample size, which may limit the generalizability of the findings to a larger population. While qualitative research provides rich and detailed insights into a particular phenomenon, it may not be representative of the broader population or applicable to other settings.

Difficulty in Replicating Qualitative Research Findings

Lastly, replicating findings in qualitative research can be difficult. Since qualitative research often involves in-depth exploration of a specific phenomenon, replicating the exact conditions and context of the original study can be challenging. This can make it difficult for other researchers to validate or replicate the findings, which is an essential aspect of scientific research.

Despite these limitations, qualitative research instruments offer valuable insights and understanding of complex phenomena. By acknowledging and addressing these limitations, researchers can enhance the rigor and validity of their qualitative research studies.

In conclusion, qualitative research instruments are powerful tools that enable researchers to explore and uncover the complexities of human experiences. By utilizing a range of instruments and considering their advantages and limitations, researchers can enhance the rigor and depth of their qualitative research studies.

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Case Study Research Design

The case study research design have evolved over the past few years as a useful tool for investigating trends and specific situations in many scientific disciplines.

This article is a part of the guide:

• Research Designs
• Quantitative and Qualitative Research
• Literature Review
• Quantitative Research Design
• Descriptive Research

Browse Full Outline

• 1 Research Designs
• 2.1 Pilot Study
• 2.2 Quantitative Research Design
• 2.3 Qualitative Research Design
• 2.4 Quantitative and Qualitative Research
• 3.1 Case Study
• 3.2 Naturalistic Observation
• 3.3 Survey Research Design
• 3.4 Observational Study
• 4.1 Case-Control Study
• 4.2 Cohort Study
• 4.3 Longitudinal Study
• 4.4 Cross Sectional Study
• 4.5 Correlational Study
• 5.1 Field Experiments
• 5.2 Quasi-Experimental Design
• 5.3 Identical Twins Study
• 6.1 Experimental Design
• 6.2 True Experimental Design
• 6.3 Double Blind Experiment
• 6.4 Factorial Design
• 7.1 Literature Review
• 7.2 Systematic Reviews
• 7.3 Meta Analysis

The case study has been especially used in social science, psychology, anthropology and ecology.

This method of study is especially useful for trying to test theoretical models by using them in real world situations. For example, if an anthropologist were to live amongst a remote tribe, whilst their observations might produce no quantitative data, they are still useful to science.

What is a Case Study?

Basically, a case study is an in depth study of a particular situation rather than a sweeping statistical survey . It is a method used to narrow down a very broad field of research into one easily researchable topic.

Whilst it will not answer a question completely, it will give some indications and allow further elaboration and hypothesis creation on a subject.

The case study research design is also useful for testing whether scientific theories and models actually work in the real world. You may come out with a great computer model for describing how the ecosystem of a rock pool works but it is only by trying it out on a real life pool that you can see if it is a realistic simulation.

For psychologists, anthropologists and social scientists they have been regarded as a valid method of research for many years. Scientists are sometimes guilty of becoming bogged down in the general picture and it is sometimes important to understand specific cases and ensure a more holistic approach to research .

H.M.: An example of a study using the case study research design.

The Argument for and Against the Case Study Research Design

Some argue that because a case study is such a narrow field that its results cannot be extrapolated to fit an entire question and that they show only one narrow example. On the other hand, it is argued that a case study provides more realistic responses than a purely statistical survey.

The truth probably lies between the two and it is probably best to try and synergize the two approaches. It is valid to conduct case studies but they should be tied in with more general statistical processes.

For example, a statistical survey might show how much time people spend talking on mobile phones, but it is case studies of a narrow group that will determine why this is so.

The other main thing to remember during case studies is their flexibility. Whilst a pure scientist is trying to prove or disprove a hypothesis , a case study might introduce new and unexpected results during its course, and lead to research taking new directions.

The argument between case study and statistical method also appears to be one of scale. Whilst many 'physical' scientists avoid case studies, for psychology, anthropology and ecology they are an essential tool. It is important to ensure that you realize that a case study cannot be generalized to fit a whole population or ecosystem.

Finally, one peripheral point is that, when informing others of your results, case studies make more interesting topics than purely statistical surveys, something that has been realized by teachers and magazine editors for many years. The general public has little interest in pages of statistical calculations but some well placed case studies can have a strong impact.

How to Design and Conduct a Case Study

The advantage of the case study research design is that you can focus on specific and interesting cases. This may be an attempt to test a theory with a typical case or it can be a specific topic that is of interest. Research should be thorough and note taking should be meticulous and systematic.

The first foundation of the case study is the subject and relevance. In a case study, you are deliberately trying to isolate a small study group, one individual case or one particular population.

For example, statistical analysis may have shown that birthrates in African countries are increasing. A case study on one or two specific countries becomes a powerful and focused tool for determining the social and economic pressures driving this.

In the design of a case study, it is important to plan and design how you are going to address the study and make sure that all collected data is relevant. Unlike a scientific report, there is no strict set of rules so the most important part is making sure that the study is focused and concise; otherwise you will end up having to wade through a lot of irrelevant information.

It is best if you make yourself a short list of 4 or 5 bullet points that you are going to try and address during the study. If you make sure that all research refers back to these then you will not be far wrong.

With a case study, even more than a questionnaire or survey , it is important to be passive in your research. You are much more of an observer than an experimenter and you must remember that, even in a multi-subject case, each case must be treated individually and then cross case conclusions can be drawn .

How to Analyze the Results

Analyzing results for a case study tends to be more opinion based than statistical methods. The usual idea is to try and collate your data into a manageable form and construct a narrative around it.

Use examples in your narrative whilst keeping things concise and interesting. It is useful to show some numerical data but remember that you are only trying to judge trends and not analyze every last piece of data. Constantly refer back to your bullet points so that you do not lose focus.

It is always a good idea to assume that a person reading your research may not possess a lot of knowledge of the subject so try to write accordingly.

In addition, unlike a scientific study which deals with facts, a case study is based on opinion and is very much designed to provoke reasoned debate. There really is no right or wrong answer in a case study.

• Psychology 101
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Martyn Shuttleworth (Apr 1, 2008). Case Study Research Design. Retrieved Sep 09, 2024 from Explorable.com: https://explorable.com/case-study-research-design

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QUALITATIVE DATA COLLECTION INSTRUMENTS: THE MOST CHALLENGING AND EASIEST TO USE

• September 2020

• University of Cape Coast

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Instrumental case studies

A topic in research methodology

A case study is an enquiry into one specific instance among many . Sometimes the case is selected because it is the specific case we wish to know about. There is something special about that case that makes it worth investigating. Such cases are described as intrinsic cases. However, often a case is selected for study because it is considered to represent the wider class of possible cases. The case is an extrinsic case study , as we study it less for its own value, but for its value in telling us something about the wider class of such cases. This is potentially problematic, as case study recognises the idiosyncratic nature of cases and so a case study is not readily generalisable.

“The use of case study is to understand something else…instrumental to accomplishing something other than understanding this particular teacher [or…]” Stake, 1995: p.3

“Sometimes (instrumental) cases are chosen because they are considered reasonably typical of a class of instances, where the complexity of what is being studied suggests more can be learnt by detailed exploration of an instant than surveying a representative sample..” Taber, 2014

Sources cited:

• Stake, R. E. (1995). The Art of Case Study Research . Thousand Oaks, California: Sage.
• Taber, K. S. (2014). Methodological issues in science education research: a perspective from the philosophy of science. In M. R. Matthews (Ed.), International Handbook of Research in History, Philosophy and Science Teaching (Vol. 3, pp. 1839-1893). Dordrecht: Springer Netherlands.

My introduction to educational research:

Taber, K. S. (2013).  Classroom-based Research and Evidence-based Practice: An introduction (2nd ed.).  London: Sage.

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Stop or yield? New research supports law change for cyclists

Oregon state university study shows that allowing cyclists to yield at stop signs does not increase danger.

Social Sharing

Cycling advocates in British Columbia hope a new U.S. study will boost the case to allow bicyclists to yield at stop signs and safely roll through intersections.

While it's the law in jurisdictions like B.C. for cyclists to stop at stop signs, like every other road user, it's common to see people on two wheels opt for an illegal yield — rolling past the sign after checking it's safe to proceed.

"It makes it a lot more efficient," said Vancouver cyclist Ben Cooper about getting through intersections. "I'm not going to come to a full stop. Like, the amount of energy it takes to stop my entire bike and get it going again — it just doesn't make sense."

The debate over whether rolling stops for cyclists should be enshrined in law has been ongoing since the early 1980s when Idaho first made it legal, resulting in the manoeuvre being named the Idaho stop.

• Winnipeggers rallying for 'Idaho stop' law that would let cyclists slow roll through stop signs

Several other U.S. states have since followed suit, including B.C.'s Pacific Northwest neighbours of Washington and Oregon. No jurisdiction in Canada has yet adopted laws for rolling stops for bikes.

Cycling advocates in B.C. say they've been pushing the issue for years and hope a new study from researchers at Oregon State University, published this month in an academic transportation journal, will aid their argument.

"It is going at a very slow pace and we need to take dramatic, bold steps that will enable us to reform these outdated laws and have more people … cycling," said Navdeep Chhina, director of campaigns and inclusion with Metro Vancouver's HUB Cycling .

New study supports laws that allow cyclists to yield at stop signs

The Oregon study says  with proper education for both cyclists and drivers, Idaho stops do not lead either riders or motorists to act unsafely.

One of the study's authors said they wanted to look at how well rolling-stop laws work, in a change from other studies that have looked at crash-data analysis and why riders yield at stop signs rather than stop as per the law.

"It required fully connecting two independent simulators, running subjects in pairs simultaneously and having each subject interacting with an avatar of the other in a shared virtual world," said David Hurwitz, a transportation engineering professor,  in a release  about the study.

Researchers observed 60 people paired off who went through 16 virtual interaction scenarios as either a cyclist or motorist, coming together at a four-way-stop intersection.

They found that instead of drivers being aggressive toward cyclists who appeared to be breaking the law by rolling through, driving participants approached intersections either more slowly or at a similar pace after being educated about what bicycle rolling stops were.

Cyclists, after also being taught about Idaho stops, preferred to yield rather than stop and went through intersections faster, meaning they spent less time in the intersection exposed to potential danger.

Nearly four out of five crashes involving cyclists in B.C. happen at intersections , according to ICBC.

Hurwitz said the study's findings suggest more work should be done by jurisdictions over the utility of rolling-stop laws.

"This research gives decision-makers information to support prospective legislative policies, set up educational programs and design robust enforcement practices," he said.

• B.C. sets minimum distance for drivers passing vulnerable road users

B.C.'s Ministry of Transportation is not rejecting the idea that Idaho stops could be made legal, but it said in a statement that more research would be required "to consider how the change would affect the safety of all road users."

In the meantime, it's reminding cyclists to come to a complete stop at a stop sign to ensure safety for the rider and all other road users.

ABOUT THE AUTHOR

Chad Pawson is a CBC News reporter in Vancouver. Please contact him at [email protected].

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• Open access
• Published: 07 September 2024

Prevalence of Methamphetamine (Mkpurummiri) use in south east Nigeria: a community-based cross-sectional study

• Nkiru Edith Obande-Ogbuinya 1 ,
• Christian Okechukwu Aleke 2 ,
• Lois Nnenna Omaka-Amari 2 ,
• Uba Mercy Benedette Ifeoma 3 ,
• Stanley Chijioke Anyigor-Ogah 4 ,
• Emeka Usman Mong 2 ,
• Eunice Nwafor Afoke 2 ,
• Theresa Nwamaka Nnaji 5 ,
• Onyechi Nwankwo 6 ,
• Ifeyinwa Maureen Okeke 7 ,
• Anthonia Ogechukwu Nnubia 7 ,
• Uzochukwu Chimdindu Ibe 8 ,
• Raphael E. Ochiaka 9 ,
• Patricia C. Ngwakwe 2 ,
• OkochaYusuf Item 7 ,
• Kenneth Adibe Nwafor 10 ,
• Idakari Chinedu Nweke 11 &
• Arinze Francis Obasi 12  

BMC Public Health volume  24 , Article number:  2436 ( 2024 ) Cite this article

Metrics details

Methamphetamine (MA) (Mkpurummiri) is seen as the most common, accessible and new drug of use/abuse in south east Nigeria. Despite the overwhelming evidence of the dire consequences of this drug to the users, there is lack of empirical research to determine its prevalence in this area where use is assumed to be common. This study aimed to determine the prevalence of MA use, characteristics of the users and the control measures.

A descriptive cross-sectional survey research design was conducted from May through November 2023 among adolescents/adults at the age bracket of 15-64 years in the five states of south east, Nigeria. Three hundred and seventy-one (371) respondents were recruited using purposive/convenience sampling methods. A semi structured questionnaire was the instrument used. Data were analyzed using percentage, bivariate and multivariate logistics regression statistics. The Prevalence of MA was determined using percentages whereas the factors that are associated with MA use were expressed using multivariate logistics regression statistics AORs and 95%CIs. The level of significance was set at P  < 0.05.

The prevalence of Methamphetamine (Mkpurummiri) was (21.8%). The most common reason for MA use was depression (86.5%), the most common route of administration was inhalation (64.9%). The most common characteristic of MA (Mkpurummiri) user was aggressive/violent behaviour (94.1%).The control measures were self-control (92.2%), parental monitoring (85.7%), drug education (83.1%) and legal control (80.8%). The multivariate logistics regression statistics AOR shows that off-campus were 3 times (AOR = 0.298; CI = 0.12–0.73 P  = 0.008), family house 4 times (AOR = 0.241; CI = 0.09–0.65; P  = 0.005 \(\le 0.05\) ) less likely than on-campus to predict MA use. Recently married were 3.25 times (aOR = 3.25; CI = 1.47–7.18), divorced 3.45 times (aOR = 3.45; CI = 1.23–9.58), polygamy 2.3 times (aOR = 2.3; CI = 1.08–4.90; P  = 0.031 \(\le 0.05\) ), tradition 4.44 times (aOR = 4.44; CI = 1.77–11.15; P  = 0.001 \(\le 0.05)\) , more likely than others to use MA.

Conclusions

MA use prevalence was relatively high, and marital status, living arrangements, family type and religion were the predictors. These findings underscore the need for concerted effort among the relevant government agencies, community stakeholders, families, religious bodies and school authorities to designing MA use policy/laws with special focus on adopting the punitive measure used in checking cocaine users. This may help to arrest and prosecute the manufacturers, distributors and users of MA.

Peer Review reports

Introduction

Hard drugs proliferations, accessibility and use particularly Methamphetamine (commonly called Mkpurummiri in South Eastern Nigeria) by adolescents/youths is an emerging public health threat and concerns globally [ 1 , 2 , 3 , 4 ]. Research has reported that hard drugs use/abuse is high across the world with the percentage of adolescents and youth topping the previous years [ 5 ]. For instance, in 2021, research has documented that one (1) in every seventeen (17) persons from the age of 15–64 years worldwide had used any illegal drugs in the past year [ 6 ]. It was also reported that the number of users had increased from 240 million in 2011 to 296 million in 2021, with 5.8 per cent estimate of the global population aged 15–64 [ 5 ]. The trend was as well recorded in several studies both in the year 2022 and 2023 globally [ 5 , 7 , 8 ]. In Nigeria, the prevalence of 20% to 65.7% of lifetime and current use of any illicit drug among adolescent/youth population has been documented [ 1 , 9 , 10 , 11 , 12 ].

Studies have reported Methamphetamine (MA) as the most common illicit drug use by adolescents and adults [ 5 , 13 , 14 , 15 ]. Adolescents and adults being at high risk of hard drugs use/abuse has been attributed to risk factors like increased adventurous tendencies, peer influences, curiosity, depression, anxiety, behavioural disorders and risk-taking behavior [ 10 , 16 ]. Adolescence and adults has got various definitions [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. However, for the purpose of the current study, UNODC classification of adolescents/adults drug users at age bracket of 15 to 64 is adopted to elicit information from MA users among the population [ 20 , 28 ].

Prevalence of MA use by Adolescents and adults has been reported. For instance, research carried out among American adolescents reported that approximately 4.7 million (2.1% of the U.S. population) have used MA at some stages in their lives [ 21 ]. Another US National Survey conducted from 2015–2018, reported 6.6 per, 1,000 rate of past-year MA use/ abuse among youth [ 22 ]. Further, the School-based drug surveys carried out in Ontario and Manitoba to determine MA use among adolescents students revealed prevalence of 2.7% and 3.3% within the past year preceding the survey [ 23 , 24 ]. In the same vein, the study conducted in low and middle income countries on MA use among the students, revealed that both male and female abuse MA with an estimate of 1.6 million using the drug in the past year preceding the survey [ 25 , 26 , 27 ].

In Nigeria, there was little or no empirical studies conducted to determine the prevalence of MA use despite overwhelming evidence of MA production, availability and use in the country. However, a comprehensive nationwide general drug use survey carried out among people aged 15–64 years in Nigeria estimated the prevalence of psychoactive drug use [ 28 ]. According to the study, the last year prevalence of drug use/abuse from the southern region was at the range of 13.8 per cent to 22.4 per cent which was higher compared to the northern region with the prevalence ranging from 10 per cent to 13.6 per cent [ 1 , 28 ]. The study further revealed that South-Eastern Nigeria, (Abia, Anambra, Ebonyi, Enugu and Imo States) had the prevalence of any drug use estimated at 13.8 per cent of the population or 1.5 million people aged 15–64 years [ 20 , 28 ]. It was further observed that out of every 4 drug users/abusers, 1 is a woman in Nigeria. Moreover, the annual prevalence of men 21.8 per cent or 10.8 million men, and women 7.0 per cent or 3.4 million women were reported as drug users in the past-year [ 28 ]. The UNODC study focused on the general drug abuse in Nigeria not MA use/abuse in particular. Nevertheless, the general drug use survey included MA with an estimated prevalence of 0.06 per cent, this was perceived as very low [ 28 ].

The UNODC estimate of MA use prevalence of 0.06 per cent may be very low due to the high rate of MA (Mkpurummiri) use/abuse in the region. Evidence from various Nigeria newspapers, magazines, grey literature, periodicals and article reviews reports [ 2 , 29 , 30 , 31 ], suggest that use of MA is common. More so, the evidence of manufacturing MA in the region by drug merchants, accessibility with the number of seizures by NDLEA has affirmed its ubiquity and high rate of abuse in south east region [ 30 , 32 ].

Research has revealed that MA was manufactured in some parts of Nigeria particularly in Igbo of South east and sold in the form of meth of crystalline powder, capsule or pressed tablet, and pill [ 13 , 14 , 33 ]. Due to the endemic nature of the drug in the region, the people of the area nicknamed the drug in a local parlance as “Mkpurummiri”. The name comes from the appearance of MA in the form of ice, broken glass-like or crystalline rocks [ 2 , 32 ]. MA (Mkpurummiri) has other street names as meth, crystal meth, crank, speed, and kryptonite [ 2 , 34 , 35 , 36 ]. The routes of administration of MA (Mkpurummiri), as reported by other studies include smoking, injection, snorting, ingesting, inhaling, chewing, and rubbing on the skin [ 2 , 34 , 36 ].

Several reports have it on the pages of Nigerian newspapers, Magazines and periodicals that it was common to observe some adolescents/adults MA (Mkpurummiri) users on the streets of various communities of south eastern Nigeria. The MA users were observed due to the way they dressed, like some dressed naked or half naked walking around the streets without shame [ 2 , 29 , 30 , 31 , 32 ]. Some of them were reported to have killed their parents, siblings, girlfriend, boyfriend, or burnt their houses. Some students among them have assaulted their teachers/lecturers leading to dropout from school and other consequences associated with MA use [ 2 , 29 , 30 , 31 , 32 ].

Methamphetamine (MA) has been variously conceived as a potent and highly addictive psychoactive stimulant that excites and raises the level of nervous (brain and spinal cord) activities [ 14 , 22 , 37 ]. MA is regarded as a dangerous drug due to its effect on the brain, thus, the use of any minute quantity is regarded as an abuse. The primary mechanism of action to the MA users is on the brain dopamine (DA) system, leading to high rate of abuse [ 38 , 39 ]. Moreover, the major effects of MA users include depression, antisocial behavior like risky sexual behaviors, sexual assault, rape, violent behavior, mental illness, movement disorders, cognitive impairments, insomnia, suicide and death [ 40 , 41 , 42 ].

UNIDOC has grouped the burden of the adolescents/adults psychoactive drug use/abuse including MA into four areas of international concern. This includes organized crime, illicit financial flows, corruption, and terrorism/insurgency [ 43 ]. Nigeria, especially South East region has been grasping with all these factors as grouped by UNIDOC like insecurity, organized crime, terrorism/insurgency, youth unemployment, increased violence, lawlessness, kidnapping, hostage-taking and cultism [ 44 , 45 ]. There is also evidence of rising spate of people living in abject poverty and the rising rate of unemployment and underemployment among Nigerian youths [ 46 , 47 , 48 , 49 ]. Further, the current challenges of high cost of living and hardship associated with subsidy removal by the current administration in Nigeria, might be causing depression and fuelling the youths vulnerability to MA use/abuse [ 50 ]. This may be so as insecurity, gang formation leading to kidnapping for ransom and armed robbery as a means to earn a living is the order of the day in Nigeria [ 1 , 32 , 48 , 49 ].

MA (Mkpurummiri) control measures have been observed among some community leaders, and stakeholders of some affected states. For instance, some community leaders have created local vigilante group who work in synergy with security operatives to identify and banish anyone found with MA including the manufacturers and peddlers. Individuals taking the drugs are publicly punished by flogging them at the village squares [ 2 , 29 , 32 ]. Some villagers and stakeholders have equally protested through the major roads to register their displeasure towards the phenomenon of MA (Mkpurummiri) abuse in the region [ 29 , 31 ]. However, despite all these effort to curb the menace, MA use/abuse has continued to be rampant in the region. The production and sale by some drug merchants and peddlers have continue to grow assuming a more critical dimensions and causing public hysteria [ 2 , 29 , 51 ]. Moreover, public flogging as a physical punishment to MA users which has been adopted by vigilante groups and stakeholders of some communities has not yielded the desired result [ 31 , 32 ]. The approach has also been seen as uncivilized, barbaric and not scientific [ 31 , 32 ]. The worst still was the compromise reported among the police and vigilante group which is frustrating the war against MA use [ 52 ]. This has led to the palpable fear of unknown that the measure adopted might fall back on the community leaders, hence, the MA users might strategize, form a gang of cultists to fight back and attack the community and their leaders [ 32 ].

The mentioned scenarios have prompted the current researchers to find a scientific means towards curbing this menace, hence a step towards prevention of any drug abuse including MA is by establishing the prevalence, determining the characteristics of the users and its risk [ 1 , 37 ]. Moreover, the global interventions for prevention of drug use/abuse in a population including its impact has recommended a widespread understanding of the prevalence of the drug, frequently implicated drugs, the affected population, sources of the drugs and the risk factors [ 1 , 43 ]. However, due to lack of studies describing the prevalence and factors influencing the use of MA, the authors were inspired to lay this ground work to determine the prevalence of MA (Mkpurummiri) use, characteristics of the users and the control measures among the population. This is because, if prevalence and characteristics of MA users could be established, it is hoped that the government at all level in collaboration with NDLEA, law enforcement agencies and other relevant stake holders may be better equipped in designing MA use policy/laws with the punitive measures to curb the menace. The policymakers may use the findings of the study to determine the most affected group either adolescents or adults and devise a more stringent measures in combating MA use among the population.

Research design/setting

This is a descriptive cross-sectional survey research design conducted between May 2023 through November 2023, to determine the prevalence of methamphetamine (Mkpurummiri) use, characteristics of the users and the control measures among adolescents/adults of south-eastern Nigeria. South eastern Nigeria comprises of five states namely: Abia, Anambra, Ebonyi, Enugu, and Imo. This states have common boundaries with similar cultures and traditions. Due to this similar characteristics with the high rate of unemployment, increase in poverty level, low level of educational opportunities and high cost of living associated with socioeconomic implications of fuel subsidy removal in Nigeria, common sense would expect risky behaviours and social vices like, drug use/abuse among the adolescents and adults. The scenarios have necessitated the current study in the South Eastern Nigeria.

The population of the study

The population of the study comprises all adolescents and adults in the five states of South Eastern Nigeria, namely: Abia, Anambra, Ebonyi, Enugu and Imo with an estimated population of 1.5 million persons at the age bracket of 15-64 years [ 27 ]. Inclusion/exclusion criteria: All the adolescents/adults at the ages of 15 to 64yrs, residing at the South Eastern Nigeria and consented to participate in the study were recruited. Adolescents/adults who are below 15yrs and above 64years, and those who are sick or not available at the time of the study were excluded.

Sample size determination

We calculated the sample size using the past year prevalence of drug abuse among adolescents/ adults in the South East Nigeria which was 13.8% with a population of 1.5million people aged 15 to 64 [ 20 ]. Thus;

Where N  = 1,500,000, e = 0.04, P  = 0.138, Z = 1.96

Adding 20% attrition rate, the total sample is 371.

Sampling procedure

The procedure for sample selection involved multi-stages. In the first stage, the South East region was clustered into five states namely: Abia, Anambra, Ebonyi, Enugu and Imo States. In the second stage, three (3) states were selected from the five (5) states, using simple random sampling technique of balloting with replacement. The stage three involved the use of purposive/convenience sampling technique to draw 127 participants from each of the three (3) states selected in the second stage, namely: Ebonyi, Imo and Anambra. The researchers therefore administered three hundred and seventy-one copies of the questionnaire to the respondents in those states and at any point where they were accessible and convenient to fill the questionnaire. However, out of three hundred and Seventy-one (371) copies of questionnaire administered to the participants, three hundred and sixty-two (362) were properly filled and fit for data analysis. Nine (9) copies were excluded due to incomplete responses and insufficient demographic characteristics.

Research instrument

A semi structured questionnaire was used for data collection. This was developed by the researchers after thoroughly reviewing relevant literature and questionnaire of some related studies [ 1 , 27 , 37 , 53 , 54 ]. The questionnaire was entitled, “Prevalence of Methamphetamine Use among Adolescents/Adults Questionnaire (PMUAAQ). This consisted of four sections: A, B, C and D. Section A; contained Ten (10) items of demographic characteristics of the participants. Section B consisted items on prevalence of methamphetamine (Mkpurummiri) use and reasons for Use/Abuse among Adolescents/Adults. The respondents were requested to use a tick [√] on the Yes or No question. Section C consisted the items on routes of administration of MA. The respondents were requested to use tick (√) to indicate their best options on the checklist. Section D also contained a checklist for the characteristics of the users and the control measures. Respondents were required to use tick (√) to indicate their options from the list.

Validation and pre‑test of research instrument

The instrument was face-validated through the verdict of five experts before the final data collection. Two experts from the department of Human Kinetics and health education, one from the department of psychology, one from the field of Epidemiology and one from the department of community medicine, all from the universities in the south east, Nigeria. The five experts were given drafted copies of PMUAAYQ accompanied with the study objectives and research questions. The experts’ constructive criticisms, assessment of language, clarity and coverage of items, and appropriateness for the target group, viz-a-viz the specific objectives of the study were used to modify the instrument for data collection. The questionnaire was pretested among Forty (40) respondents from two other states (Enugu and Abia) that are not part of the study sample but were part of the study population. The reliability of the instrument was established with Cronbach Alpha statistics. The Cronbach’s alpha internal consistency reliability index of r = 0.923 was obtained thus, considered highly reliable to be used for the general study.

Data collection methods/procedures

Data were collected from the participants in schools, village squares, streets, parks, playground, home environments, market places, churches, and other places convenient for the researchers until the desired sample size was reached. The researchers were many and hail from different states of the studied population. Therefore, we divided ourselves into groups based on the understanding of each community’s dialect, tradition, and proximity and conversant to the various communities of each selected state. The administration and filling of the questionnaire survey lasted about seven months. The survey was strictly conducted without coercion but based on respondents’ volition and consent. The respondents whose age fall within 15–16 years were regarded as minors thus, the consent to participate was obtained from their parents or legal guardians. We offered help to clarify instructions as well as assistance based interview using the questionnaire. This was to help some respondents who were unable to fill the questionnaire due to where they were located like a rave, eatery centers, view centers, lounge and restaurants. This was strictly for those who sought for it. The data were collected and crosschecked for completeness of information and responses.

Study variables and measurements

Measurement of main outcome variables.

The dependent variable was the prevalence of methamphetamine (Mkpurummiri) use, while the independent variables (predictors) were the socio-demographic factors such as age which was categorized into two (adolescents 15-19 years and adults 20-64 years), sex (gender), marital status, level of education, residence/Living arrangements, family size, birth order, family type, family income status (Naira), and religious affiliations. These socio-demographic factors of the respondents were correlated with the prevalence of MA use among adolescents and adults using the multivariate logistics regression adjusted odds ratios (AOR).The prevalence of methamphetamine (Mkpurummiri) use was determined using the questions (Have you ever used Methamphetamine (Mkpurummiri) in the past one year?), and their reasons for use was assessed using the dichotomous response questions of Yes or No adapted from related studies [ 1 , 27 , 53 , 54 ]. The routes of administration of MA (Mkpurummiri) by the respondents including the characteristics of the users and its control measures were determined using a checklist. The respondents were requested to use tick (√) to indicate their best options on the checklist.

Data analysis

Data generated and properly filled were analyzed using IBM SPSS version 25 (Statistical Package for Social Science). The serial number was assigned to each question for easy identification and for correct data entry and analysis. The analysis of the data was done using frequencies, percentages, bivariate and multivariate logistics regression statistics, as required by the research questions. The multivariate logistics regression analysis was employed to estimate the adjusted odds ratios (AORs) along with 95% confidence intervals (CIs) to identify the independent predictors of demographic characteristics of the adolescents/adults MA use and the degree of the relationship. The level of significance was set at P  < 0.05. The percentages extracted were presented using tables and figures.

Data from a total of three hundred and sixty-two (362) properly filled copies of the questionnaire were included for data analysis. The findings in Table  1 shows the age bracket of 15-19yrs which were classified as adolescents had the highest percentage (62.2%), whereas those at the age bracket of 20–64 years classified as adults had the percentage of 37.8%. On their sex (gender), the female had the majority (50.8%) whereas the male counterpart had 49.2%. On the marital status, those who were never married had 68%, married had 19.9% whereas formerly married (Divorce) had 12.2%. Regarding the level of education, those who were not in any school/dropout had 29.8%, those in primary school had 8.6%, secondary 10.5% and tertiary 29.8%. On the participant’s residence/living arrangements, those living off-campus/streets had 44.8%, and family house 33.7% whereas those on campus had 21.5%. On the family size, the participants whose family size is 1–2 had 22.1%, 3–4 had 41.2%, 5–6 had 22.7% and over 7 had 14.1%. Regarding family order of birth, majority of the participants are first born 42.8%, followed by middle born 32.6% and last born 24.6% respectively. As for the family type/structure, majority are from monogamous family with the percentage 53.9%, followed by Polygamous 26.5%, and Single parent 19.6% respectively. Family income status (Naira), those earning less than #30000 had 27.6%, from #30,000-#99,000 had 40.9% and those earning #100,000 and above had 31.5%. On the religion, majority of the participants are Christians 75.7%, followed by Traditional religion 17.1% and Muslim 7.2% respectively (Table  1 ).

Data in Table  2 shows that out of 362 of the respondents, 74 (21.8%) have used Methamphetamine (Mkpurummiri), while 288 (79.6%) have not. Therefore, the overall prevalence of Methamphetamine (Mkpurummiri) use in the past year was 21.8%. The commonest reasons for consuming Methamphetamine (Mkpurummiri) include: To overcome stress/depression (86.5%), Calm down worries (82.4%), Eliminate shyness (82.4%), Peer pressure (81.1%), low self-confidence (81.1%), performance improvement (73.0%) and Curiosity (55.4%) (Table  2 ).

The most common routes of administration of Methamphetamine (Mkpurummiri) were through the Inhalation (64.9%), Sniffing (51.4%). Swallow/cook with food (50.0%), Injection (48.6%), Smoking Ice (43.2%), and other routes of administration not specified shows (48.6%) (Table  3 ).

The characteristics of MA (Mkpurummiri) use among adolescents/adults were determined using checklist, percentage and frequency and presented in the graph in Fig.  1 . The findings show that the greater percentage of youth who use methamphetamine (mkpurummiri) were highly aggressive/violent (94.1%), followed by suicide (88.3), Depression (87.3%), Relationship problems (86%), Psychological distress (85.3%), School dropout (84%), absenteeism (83.1), Peer group influence (82.1%), Poor academic performance (81.4%), Anxiety/panic(80.8%), Risky sexual behavior (80.1%), Financial problems(79.2), Parental deprivation (77.5%), Sensation seeking (72%), Unemployment (70%), respectively (Fig.  1 ).

Characteristics of MA (Mkpurumiri) users, n  =  362

The Data in the Fig.  2 represented the perceived control measures of MA (Mkpurummiri) use. The findings indicated that the best way to protect and avoid the use of MA (Mkpurummiri) by adolescents and adults is by self-control with the highest percentage of 92.2% followed by parental monitoring (85.7%), drug education (83.1%), legal control (80.8%), punitive measures by the concerned stakeholders (80.1%), strong neighborhood attachment (76.5) and by school based intervention mechanisms (70%) (Fig.  2 ).

Respondents’ perspectives on control measures of MA (Mkpurumiri) Use, n  =  362

In Table  4 , we used multivariable/multivariate logistic regression to evaluate the respondents’ socio-demographic characteristics that were associated with MA use. Due to the dichotomous nature of our dependent variable in the past year MA use. The following socio-demographic characteristics of the respondents such as age, gender, marital status, educational level, residence/living arrangements, family size, order of birth, family type, family income, and religious affiliation were plugged in the multivariate logistic regression. The findings from the adjusted odd ratios shows that being recently married were 3.25 times (AOR = 3.25; CI = 1.47–7.18; P  = 0.003 ≤ 0.05), and being “formerly married (divorced) 3.45 times (AOR = 3.45; CI = 1.23–9.58; P  = 0.017 \(\le 0.05\) ) respectively more likely than never married to use Ma in the past year. On the residence/living arrangements, students living off-campus were 3 times (AOR = 0.298; CI = 0.12–0.73 P  = 0.008), and family house 4 times (AOR = 0.241; CI = 0.09–0.65; P  = 0.005 \(\le 0.05\) ) less than on-campus hostel youths to use Ma in the past year. On the family type, being from a “polygamous family were 2.3 times (AOR = 2.301; CI = 1.08–4.90; P  = 0.031 \(\le 0.05)\) more likely than being from monogamous family to use Ma in the past year. Being from single parent (AOR = 0.518; CI = 0.16–1.67; P  = 0.269 \(>0.05\) ) has no statistically significant association with the prevalence of Ma use. On the religious affiliation: Being traditional religion were 4.44 times (AOR = 4.44; CI = 1.77–11.15; P  = 0.001 \(\le 0.05)\) more likely than being Christian religion to use Ma in the past year. Being Muslim (AOR = 1.606; CI = 0.58–4.45; P  = 0.363 \(>0.05\) ) has no statistically significant association with Ma use in the past year (Table  4 ).

This study was among the first to examine the prevalence of MA (Mkpurummiri) use, characteristics of the users and the control measures among adolescents/adults of south-eastern Nigeria. The finding of the study revealed the overall prevalence of 21.8% MA (Mkpurummiri) use in the past year. The finding was anticipated and consequently not a surprise, though the prevalence was below expectations due to the several reports of MA use from Nigeria newspapers, Magazines, grey literature, periodicals and article reviews. These reports indicated MA increased production, availability, accessibility, pervasiveness and endemic among adolescents/adults of South Eastern Nigeria [ 2 , 29 , 32 ]. It was also reported that it is common to observe Methamphetamine (Mkpurummiri) users on the streets of various communities walking naked or half naked without shame [ 2 , 29 , 31 , 32 ]. Some students among them have assaulted their teachers/lecturers leading to dropout from school [ 2 , 29 , 32 ]. However, the current findings were somewhat higher though agreed with the study which reported prevalence of 12.7% of methamphetamine abuse in south western Iran [ 55 ]. The present study also revealed a higher prevalence more than other studies conducted among secondary school students MA and other drugs of use/abuse in the past year [ 56 , 57 ]. Nevertheless, the prevalence of the current study was somewhat lower than the prevalence 45.38% of MA use in the study conducted in 2015 among youths in China [ 58 ], although the prevalence rate of various studies varies. Thus, the high prevalence of the current study could be attributed to the available evidence on the recent discoveries by NDLEA on illegal laboratories where methamphetamine is manufactured by drug barons and their foreign counterparts including drug traffickers who made it available to the users [ 48 ]. All these have largely contributed to the rampant use of MA in the region [ 2 , 31 , 32 ].

The reasons commonly attributed to MA use were to overcome stress/depression and to calm down worries. These findings may not be unconnected with the high rate of unemployment, increase in poverty level, lack of educational opportunities, and high cost of living among other socioeconomic implications of fuel subsidy removal in Nigeria currently. All these factors may be fuelling the adolescents/adults vulnerability to drug use/abuse including MA leading to the formation of drug users gang, insecurity, kidnapping, armed robbery, cultism and the high rate of mental illness of the youths in the south eastern Nigeria [ 44 , 45 ]. The current findings alluded to the study which revealed poverty rate of about 50% of people living in abject poverty in Nigeria [ 46 ], and the rising rate of unemployment (23.1%) [ 47 ], including the challenges of high cost of living associated with the recent fuel subsidy removal in the country [ 50 ]. All these may be fuelling youth vulnerability to drugs to enable them cope and work harder to earn a living or to ward off the stress and frustration of daily living in hardship [ 1 ]. The findings of this study are in line with other studies which consistently reported depression, anxiety, frustration, unemployment, and predominantly socio-economic problems of the country as reasons for drug use/abuse [ 1 , 7 , 59 ].

The most common routes of administration of MA by users as identified in the study were inhalation, sniffing, swallowing/cooking with food among others. The findings were consistent with other studies which reported the mode of MA intake to include smoking, injection, snorting, ingestion, inhalation, chewing and rubbing on the skin [ 34 , 36 ].

The common characteristics of MA (Mkpurummiri) use in this study were aggressive/violent behavior, suicide, relationship problems, school dropout, absenteeism, poor academic performance, financial problems. The outcome of the study is not a surprise thus, in recent years, Nigeria as a country has simultaneously faced numerous challenges ranging from COVID-19 outbreak, high rate of inflation, unemployment and increase in poverty rates. Currently these challenges seem to be worse due to another level of hardship associated with the decision to remove petroleum subsidy which has a high significant impact on the cost of living especially among the youths. The current findings were in line with other studies which associated the characteristics of MA users such as violent behaviour, hopelessness, suicide, high rate of unemployment, relationship problems, school dropout, absenteeism, poor academic performance, financial problems and parental deprivation to adolescents/youths [ 1 , 44 , 60 , 61 , 62 ]. The findings further support the reports by WHO which revealed that persistent sadness, loss of interest in activities that are normally enjoyed, including inability to carry out daily activities are as a result of high cost of living that enhances illegal drug use/abuse [ 19 ].

The perceived control measures of MA (Mkpurummiri) use as identified in this study include self-control, parental monitoring, drug education, legal control, punitive measures, strong neighborhood attachment, and school based intervention mechanisms. This finding is in line with the study which reported parental monitoring, quality education, provision of employment opportunities, and inclusion of drug education in school as the most effective control measures for MA use [ 63 ]. Regarding self-control and parental monitoring identified in the current study, it affirmed other studies which reported parental support as a preventive/control measures for multiple outcomes including an individual self-control over illicit drug use/abuse [ 63 , 64 ]. Further, there should be more stringent measures by government at all levels and other relevant authorities to uphold the preventive/ control measures of MA use as identified in this study and to checkmate and eliminate the process of MA production, trading networks, circulation and the sale in the region [ 58 ].

The findings from the adjusted odd ratios show that being recently married as well as being formerly married (divorced) were more likely than never married to use Ma in the past one year. These findings might not be out of place hence the users of MA have reported increased sexual activities, duration of sex, quality and quantity of sexual pleasure including sexual performance [ 65 ]. Therefore, recently married may be using MA during honey moon for sexual pleasures and to enable them satisfy their partners sexually. On the other hand, those who are divorced or formally married may be using MA due to loneliness, decreased level of happiness, change in economic status and emotional/psychological problems and depression associated with divorce among couples. The findings are in line with the study which reported divorce as a potent risk factor from onset of drug abuse, thus, the prevalence of drug abuse is higher among divorced individuals than married couple [ 66 , 67 ]. The finding also supports the study which revealed common drug use/ abuse particularly MA among recently married and divorced family [ 68 , 69 ].

Residence/living arrangements indicated that students living in “off-campus” and those living in “family house” were less likely than those living “on-campus hostel” to use MA in the past year. This finding was not expected because those living off-campus hostel may be living amidst different group of people like hooligans, school dropout and perhaps might be prone to MA use. However, the finding was not deceitful as it is consistent with studies which reported that students who reside on-campus were more associated with heavier drinking and other drug use/abuse than those living off-campus and peers at home with parents [ 70 , 71 ]. The finding disagrees with the study which reported that students living off-campus without parents are more frequent and heavier drinkers including other drugs with greater consequences than students living on-campus [ 72 ]. This agreement and disagreement with reference to the findings could be attributed to varied geographical locations, subject composition and other demographic factors associated with the studies.

Family type shows that being from polygamous family were more likely than others to use Ma in the past year. The finding was not deceitful thus, it is in consonance with the study which attributed psychoactive substance use including MA to family type [ 73 ]. More so, the finding further supports the study which reported family factors like polygamous family as the most important predictor of Methamphetamine use/abuse [ 74 ]. The finding was at variant with studies which reported single-parent families as important predictors for future MA use and other delinquent behaviours [ 75 , 76 ].

On the religious affiliation, belonging to traditional religion were more likely than being an adherent of Christian religion to predict Ma use in the past year. However, being Muslim has no statistically significant association with Ma use in the past year. The outcome of this finding may be attributed to some traditional religious activities associated with the people of the area like traditional wrestling, traditional dances, masquerade cult, new yam festival and other festivals which when ongoing, predispose the people of the area especially the youth to be more vulnerable to excessive drug use and abuse including MA [ 77 ]. The Christian religion and Muslim religion which are known as custodians of public morality might be preaching against this menace to strengthen the religious faith and dissuade the people from the use of MA and other illicit drugs. However, the findings of the current study are in consonance with the study which revealed religion ( P  = 0.009), as a predictor of psychoactive drug use including Ma [ 51 ]. It was also consistent with the study which revealed that the rate of drug abuse was higher among traditional religion than those of Christianity, Islam and other religions [ 73 , 78 ]. The finding further alluded to the study which reported that frequent attendance to religious fellowships was a high significant factor that reduces adolescents, youths and adults likelihood of anti-social activities including drug use/abuse [ 79 ].

Strengths and weaknesses of the study

The major strength was that this study on prevalence of methamphetamine (Mkpurummiri) use/ abuse was among the first in the south eastern Nigeria. This is because despite the availability of MA and its rampant use in the region, there was little or no empirical study to establish its prevalence. This necessitated the current study.

The weakness may be that we used prevalence of MA (Mkpurummiri) use/abuse in the past year because MA was assumed to be a new drug of abuse by adolescents/youths at the time of the study. Hence, we did not include the prevalence of life time and current MA use during data collection. Additionally, the method of data collection was quantitative that used closed ended questions which may not have captured all the predictors of MA use. The study suggested the use of mixed study or qualitative data collection like in-depth interview and/or Focus Group Discussion. Hence, in-depth interview and FGDs have the potential to facilitate group interaction which would help to understand other factors predicting MA use.

Our study provided the first data on the prevalence of MA (Mkpurummiri) use, characteristics of the users and the control measures among adolescents/adults of south-eastern Nigeria. The study revealed that the prevalence of MA use was relatively high thus requiring an urgent response to halt the spread and use/abuse of this dangerous drug in the region. The relevant government agencies, in collaboration with stakeholders in various communities, families, religious bodies and school managements/authorities should as a matter of urgency design and implement effective MA use policy/law and its consequences same with cocaine and other illicit drug users. This will help to arrest and prosecute the manufacturers, distributors, promoters and users of this dangerous drug. Other measures are to rehabilitate the MA users by providing employment opportunities and upholding the control measures of MA use among adolescents/adults as indicated in this study.

Availability of data and materials

The data sets generated and analyzed during this study are available from the corresponding author on reasonable request through the email address of [email protected] or [email protected].

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Acknowledgements

We thank the stakeholders of various communities, state and university communities for their prompt approval and direction provided towards the successful conduct of this study in South East Nigeria. Special thanks also go to all the adolescents/adults who consented and participated actively in this study.

The authors received no financial support for this work.

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Nkiru Edith Obande-Ogbuinya

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Christian Okechukwu Aleke, Lois Nnenna Omaka-Amari, Emeka Usman Mong, Eunice Nwafor Afoke & Patricia C. Ngwakwe

Department of Guidance and Counselling Alex, Ekwueme Federal University Ndufu Alike, Abakaliki, Nigeria

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NEO-O and COA, conceived and commissioned the study. COA and NEO-O performed the literature search and screened for the selected studies, extracted the data and wrote the first draft of the manuscript. COA, AFO, EUM and LNO-A proposed the methodology, performed the analysis and interpretation of the study. COA, ENA, SCA-O, UMBI, UCI, ON, IMO, OYI, TNN, AON, REO, PCN, KAN and ICN revised and supervised all aspects of the study. All the authors reviewed and approved the final manuscript.

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Correspondence to Christian Okechukwu Aleke .

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Ethical approval was obtained from Ebonyi State University Research Ethics committee (EBSU/DRIC/UREC/vol.7/05223). The approval letter introduced the researchers to the relevant stakeholders of various communities and respondents stating the objectives of the study. This helped the researchers to gain access to and cooperation from the respondents and the stakeholders of the study population. Before the commencement of the study, a written informed consent was obtained from all the participants. Regarding the minors, which refers to individuals below the age of 16 years, informed consent to take part in the study was obtained from their parents or legal guardians. In the consent letter, they were fully assured of confidentiality and anonymity of the data. All procedures were strictly performed in accordance with the Declaration of Helsinki ethical standards in 1964 and its amendments.

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Obande-Ogbuinya, N.E., Aleke, C.O., Omaka-Amari, L.N. et al. Prevalence of Methamphetamine (Mkpurummiri) use in south east Nigeria: a community-based cross-sectional study. BMC Public Health 24 , 2436 (2024). https://doi.org/10.1186/s12889-024-19921-9

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Received : 26 March 2024

Accepted : 28 August 2024

Published : 07 September 2024

DOI : https://doi.org/10.1186/s12889-024-19921-9

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• Methamphetamine (Mkpurummiri)
• Adolescents/adults
• Characteristics of the users
• Control measures
• South Eastern Nigeria

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