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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.

About the author

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Methodology: Multiple-Case Qualitative Study

• First Online: 01 July 2021

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• Feng Ding 2  

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This longitudinal multiple-case study is qualitative in nature, with data collection lasting for more than a year. As this study set out to understand the experiences, feelings, emotions, conceptions, and understanding of students about their experiences, a qualitative research approach was adopted to “identify issues from the perspective of” the participants, and to study them in a natural setting (Hennink et al., 2011, p. 9).

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Research Guides

Multiple Case Studies

Nadia Alqahtani and Pengtong Qu

Description

The case study approach is popular across disciplines in education, anthropology, sociology, psychology, medicine, law, and political science (Creswell, 2013). It is both a research method and a strategy (Creswell, 2013; Yin, 2017). In this type of research design, a case can be an individual, an event, or an entity, as determined by the research questions. There are two variants of the case study: the single-case study and the multiple-case study. The former design can be used to study and understand an unusual case, a critical case, a longitudinal case, or a revelatory case. On the other hand, a multiple-case study includes two or more cases or replications across the cases to investigate the same phenomena (Lewis-Beck, Bryman & Liao, 2003; Yin, 2017). …a multiple-case study includes two or more cases or replications across the cases to investigate the same phenomena

The difference between the single- and multiple-case study is the research design; however, they are within the same methodological framework (Yin, 2017). Multiple cases are selected so that “individual case studies either (a) predict similar results (a literal replication) or (b) predict contrasting results but for anticipatable reasons (a theoretical replication)” (p. 55). When the purpose of the study is to compare and replicate the findings, the multiple-case study produces more compelling evidence so that the study is considered more robust than the single-case study (Yin, 2017).

To write a multiple-case study, a summary of individual cases should be reported, and researchers need to draw cross-case conclusions and form a cross-case report (Yin, 2017). With evidence from multiple cases, researchers may have generalizable findings and develop theories (Lewis-Beck, Bryman & Liao, 2003).

Creswell, J. W. (2013). Qualitative inquiry and research design: Choosing among five approaches (3rd ed.). Los Angeles, CA: Sage.

Lewis-Beck, M., Bryman, A. E., & Liao, T. F. (2003). The Sage encyclopedia of social science research methods . Los Angeles, CA: Sage.

Yin, R. K. (2017). Case study research and applications: Design and methods . Los Angeles, CA: Sage.

Key Research Books and Articles on Multiple Case Study Methodology

Yin discusses how to decide if a case study should be used in research. Novice researchers can learn about research design, data collection, and data analysis of different types of case studies, as well as writing a case study report.

Chapter 2 introduces four major types of research design in case studies: holistic single-case design, embedded single-case design, holistic multiple-case design, and embedded multiple-case design. Novice researchers will learn about the definitions and characteristics of different designs. This chapter also teaches researchers how to examine and discuss the reliability and validity of the designs.

Creswell, J. W., & Poth, C. N. (2017). Qualitative inquiry and research design: Choosing among five approaches . Los Angeles, CA: Sage.

This book compares five different qualitative research designs: narrative research, phenomenology, grounded theory, ethnography, and case study. It compares the characteristics, data collection, data analysis and representation, validity, and writing-up procedures among five inquiry approaches using texts with tables. For each approach, the author introduced the definition, features, types, and procedures and contextualized these components in a study, which was conducted through the same method. Each chapter ends with a list of relevant readings of each inquiry approach.

This book invites readers to compare these five qualitative methods and see the value of each approach. Readers can consider which approach would serve for their research contexts and questions, as well as how to design their research and conduct the data analysis based on their choice of research method.

Günes, E., & Bahçivan, E. (2016). A multiple case study of preservice science teachers’ TPACK: Embedded in a comprehensive belief system. International Journal of Environmental and Science Education, 11 (15), 8040-8054.

In this article, the researchers showed the importance of using technological opportunities in improving the education process and how they enhanced the students’ learning in science education. The study examined the connection between “Technological Pedagogical Content Knowledge” (TPACK) and belief system in a science teaching context. The researchers used the multiple-case study to explore the effect of TPACK on the preservice science teachers’ (PST) beliefs on their TPACK level. The participants were three teachers with the low, medium, and high level of TPACK confidence. Content analysis was utilized to analyze the data, which were collected by individual semi-structured interviews with the participants about their lesson plans. The study first discussed each case, then compared features and relations across cases. The researchers found that there was a positive relationship between PST’s TPACK confidence and TPACK level; when PST had higher TPACK confidence, the participant had a higher competent TPACK level and vice versa.

Recent Dissertations Using Multiple Case Study Methodology

Milholland, E. S. (2015). A multiple case study of instructors utilizing Classroom Response Systems (CRS) to achieve pedagogical goals . Retrieved from ProQuest Dissertations & Theses Global. (Order Number 3706380)

The researcher of this study critiques the use of Classroom Responses Systems by five instructors who employed this program five years ago in their classrooms. The researcher conducted the multiple-case study methodology and categorized themes. He interviewed each instructor with questions about their initial pedagogical goals, the changes in pedagogy during teaching, and the teaching techniques individuals used while practicing the CRS. The researcher used the multiple-case study with five instructors. He found that all instructors changed their goals during employing CRS; they decided to reduce the time of lecturing and to spend more time engaging students in interactive activities. This study also demonstrated that CRS was useful for the instructors to achieve multiple learning goals; all the instructors provided examples of the positive aspect of implementing CRS in their classrooms.

Li, C. L. (2010). The emergence of fairy tale literacy: A multiple case study on promoting critical literacy of children through a juxtaposed reading of classic fairy tales and their contemporary disruptive variants . Retrieved from ProQuest Dissertations & Theses Global. (Order Number 3572104)

To explore how children’s development of critical literacy can be impacted by their reactions to fairy tales, the author conducted a multiple-case study with 4 cases, in which each child was a unit of analysis. Two Chinese immigrant children (a boy and a girl) and two American children (a boy and a girl) at the second or third grade were recruited in the study. The data were collected through interviews, discussions on fairy tales, and drawing pictures. The analysis was conducted within both individual cases and cross cases. Across four cases, the researcher found that the young children’s’ knowledge of traditional fairy tales was built upon mass-media based adaptations. The children believed that the representations on mass-media were the original stories, even though fairy tales are included in the elementary school curriculum. The author also found that introducing classic versions of fairy tales increased children’s knowledge in the genre’s origin, which would benefit their understanding of the genre. She argued that introducing fairy tales can be the first step to promote children’s development of critical literacy.

Asher, K. C. (2014). Mediating occupational socialization and occupational individuation in teacher education: A multiple case study of five elementary pre-service student teachers . Retrieved from ProQuest Dissertations & Theses Global. (Order Number 3671989)

This study portrayed five pre-service teachers’ teaching experience in their student teaching phase and explored how pre-service teachers mediate their occupational socialization with occupational individuation. The study used the multiple-case study design and recruited five pre-service teachers from a Midwestern university as five cases. Qualitative data were collected through interviews, classroom observations, and field notes. The author implemented the case study analysis and found five strategies that the participants used to mediate occupational socialization with occupational individuation. These strategies were: 1) hindering from practicing their beliefs, 2) mimicking the styles of supervising teachers, 3) teaching in the ways in alignment with school’s existing practice, 4) enacting their own ideas, and 5) integrating and balancing occupational socialization and occupational individuation. The study also provided recommendations and implications to policymakers and educators in teacher education so that pre-service teachers can be better supported.

Multiple Case Studies Copyright © 2019 by Nadia Alqahtani and Pengtong Qu is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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

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

Research question

• Conceptual framework
• Conceptual vs. theoretical framework

Data collection

• Qualitative research methods
• Focus groups
• Observational research

What is a case study?

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

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

Case studies

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

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

Definition of a case study

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

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

Characteristics of case studies

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

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

The role of case studies in research

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

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

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

What is the purpose of a case study?

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

Why use case studies in qualitative research?

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

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

The explanatory, exploratory, and descriptive roles of case studies

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

The impact of case studies on knowledge development

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

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

Types of case studies

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

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

Exploratory case studies

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

Descriptive case studies

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

Explanatory case studies

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

Intrinsic, instrumental, and collective case studies

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

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

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

Critical information systems research

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

Health research

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

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

Asthma research studies

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

Other fields

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

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

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

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

Propositions

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

Units of analysis

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

Argumentation

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

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

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

Defining the research question

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

Selecting and defining the case

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

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

Developing a detailed case study protocol

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

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

Collecting data

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

Analyzing and interpreting data

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

Writing the case study report

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

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

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

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

Observations

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

Documents and artifacts

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

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

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

Ensuring the quality of data collection

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

Data analysis

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

Organizing the data

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

Categorizing and coding the data

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

Identifying patterns and themes

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

Interpreting the data

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

Verification of the data

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

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

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

Benefits include the following:

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

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

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

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

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The Multiple Case Study Design

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Most organizations today operate in volatile economic and social environments and qualitative research plays an essential role in investigating leadership and management problems. This unique volume offers novice and experienced researchers a brief, student-centric research methods text specifically devoted to the multiple case study design.

The multiple case study design is a valuable qualitative research tool in studying the links between the personal, social, behavioral, psychological, organizational, cultural, and environmental factors that guide organizational and leadership development. Case study research is essential for the in-depth study of participants' perspectives on the phenomenon within its natural context. Rigorously designed management and leadership case studies in the extant literature have a central focus on individual managers' and leaders' stories and their perceptions of the broader forces operating within and outside their organizations.

This is a comprehensive methodology book exploring the multiple case study design with step-by-step and easily accessible guidelines on the topic, making it especially valuable to researchers, academics, and students in the areas of business, management, and leadership.

TABLE OF CONTENTS

Chapter 1 | 6  pages, a refresher on the philosophical foundations of academic research, chapter 2 | 6  pages, research methodologies, chapter 3 | 3  pages, the role of theory in qualitative research, chapter 4 | 6  pages, how does the novice researcher design a multiple case study, chapter 5 | 5  pages, the advantage of the multiple case study design for management researchers, chapter 6 | 6  pages, applying data collection methods in multiple case study research, chapter 7 | 9  pages, the data analysis process for multiple case study research, chapter 8 | 3  pages, extending theory with multiple case study design, chapter 9 | 7  pages, incorporating multiple case design and methodologies into teaching and professional practice, chapter 10 | 9  pages, writing and publishing multiple case study research, chapter 11 | 2  pages, concluding thoughts.

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The Multiple Case Study Design Methodology and Application for Management Education

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Most organizations today operate in volatile economic and social environments and qualitative research plays an essential role in investigating leadership and management problems. This unique volume offers novice and experienced researchers a brief, student-centric research methods text specifically devoted to the multiple case study design. The multiple case study design is a valuable qualitative research tool in studying the links between the personal, social, behavioral, psychological, organizational, cultural, and environmental factors that guide organizational and leadership development. Case study research is essential for the in-depth study of participants' perspectives on the phenomenon within its natural context. Rigorously designed management and leadership case studies in the extant literature have a central focus on individual managers' and leaders' stories and their perceptions of the broader forces operating within and outside their organizations. This is a comprehensive methodology book exploring the multiple case study design with step-by-step and easily accessible guidelines on the topic, making it especially valuable to researchers, academics, and students in the areas of business, management, and leadership.

Table of Contents

Daphne Halkias is Professor and Distinguished Research Fellow at École des Ponts Business School in Paris, France. Michael Neubert is Associate Professor in Business and Management Studies and a Member of the Academic Council at UIBS in Zurich, Switzerland. Paul W. Thurman is Professor of Management and Analytics at Columbia University's Mailman School of Public Health, New York, USA. Nicholas Harkiolakis is on the Faculty of the School of Technology at Northcentral University, San Diego, California, USA.

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Perspectives from Researchers on Case Study Design

by Janet Salmons, PhD, Research Community Manager for SAGE Methodspace

Research design is the focus for the first quarter of 2023. Find a post about case study design , and read the unfolding series of posts here .

What is a “case study” research design?

Linda Bloomberg describes a case study as:

An in-depth exploration from multiple perspectives of the richness and complexity of a particular social unit, system, or phenomenon. Its primary purpose is to generate understanding and insights in order to gain knowledge and inform professional practice, policy development, and community or social action. Case study research is typically extensive; it draws on multiple methods of data collection and involves multiple data sources.

The researcher begins by identifying a specific case or set of cases to be studied. Each case is an entity that is described within certain parameters, such as a specific time frame, place, event, and process. Hence, the case becomes a  bounded system . Typically, case study researchers analyze the real-life cases that are currently in progress so that they can gather accurate information that is not lost by time.

This method culminates in the production of a detailed description of a setting and its participants, accompanied by an analysis of the data for themes, patterns, and issues. A case study is therefore both a process of inquiry about the case at hand and the product of that inquiry. (Bloomberg, 2018, p. 276)

Case studies use more than one form of data either within a research paradigm (multimodal ), or more than one form of data from different paradigms (mixed methods). As Bloomberg notes, the case study method is employed across disciplines, including education, health care, social work, history, sociology, management studies, and organizational studies. When you look at lists of most-read and most-cited articles you will find that this flexible approach is widely used and published. Here are some open-access articles about multimodal qualitative or mixed methods designs that include both qualitative and quantitative elements.

Qualitative Research with Case Studies

Brannen, J., & Nilsen, A. (2011). Comparative Biographies in Case-based Cross-national Research: Methodological Considerations. Sociology, 45(4), 603–618. https://doi.org/10.1177/0038038511406602

Abstract. This article examines some methodological issues relating to an embedded case study design adopted in a comparative cross-national study of working parents covering three levels of social context: the macro level; the workplace level; and the individual level. It addresses issues of generalizability, in particular the importance of criteria for the selection of cases in the research design and analysis phases. To illustrate the benefits of the design the article focuses on the level of individual biographies. Three exemplars of biographical trajectories and experiences are presented and discussed. It is argued that a multi-tiered design and a comparative biographical approach can add to the understanding of individual experience by placing it in context and thus yield knowledge that is of general sociological relevance by demonstrating the interrelatedness of agency and structure.

Ebneyamini, S., & Sadeghi Moghadam, M. R. (2018). Toward Developing a Framework for Conducting Case Study Research. International Journal of Qualitative Methods, 17(1). https://doi.org/10.1177/1609406918817954

Abstract. This article reviews the use of case study research for both practical and theoretical issues especially in management field with the emphasis on management of technology and innovation. Many researchers commented on the methodological issues of the case study research from their point of view thus, presenting a comprehensive framework was missing. We try representing a general framework with methodological and analytical perspective to design, develop, and conduct case study research. To test the coverage of our framework, we have analyzed articles in three major journals related to the management of technology and innovation to approve our framework. This study represents a general structure to guide, design, and fulfill a case study research with levels and steps necessary for researchers to use in their research.

Flyvbjerg, B. (2006). Five Misunderstandings About Case-Study Research. Qualitative Inquiry, 12(2), 219–245. https://doi.org/10.1177/1077800405284363

Abstract. This article examines five common misunderstandings about case-study research: (a) theoretical knowledge is more valuable than practical knowledge; (b) one cannot generalize from a single case, therefore, the single-case study cannot contribute to scientific development; (c) the case study is most useful for generating hypotheses, whereas other methods are more suitable for hypotheses testing and theory building; (d) the case study contains a bias toward verification; and (e) it is often difficult to summarize specific case studies. This article explains and corrects these misunderstandings one by one and concludes with the Kuhnian insight that a scientific discipline without a large number of thoroughly executed case studies is a discipline without systematic production of exemplars, and a discipline without exemplars is an ineffective one. Social science may be strengthened by the execution of a greater number of good case studies.

Morgan SJ, Pullon SRH, Macdonald LM, McKinlay EM, Gray BV. Case Study Observational Research: A Framework for Conducting Case Study Research Where Observation Data Are the Focus. Qualitative Health Research. 2017;27(7):1060-1068. doi:10.1177/1049732316649160

Abstract. Case study research is a comprehensive method that incorporates multiple sources of data to provide detailed accounts of complex research phenomena in real-life contexts. However, current models of case study research do not particularly distinguish the unique contribution observation data can make. Observation methods have the potential to reach beyond other methods that rely largely or solely on self-report. This article describes the distinctive characteristics of case study observational research, a modified form of Yin’s 2014 model of case study research the authors used in a study exploring interprofessional collaboration in primary care. In this approach, observation data are positioned as the central component of the research design. Case study observational research offers a promising approach for researchers in a wide range of health care settings seeking more complete understandings of complex topics, where contextual influences are of primary concern. Future research is needed to refine and evaluate the approach.

Rule, P., & John, V. M. (2015). A Necessary Dialogue: Theory in Case Study Research. International Journal of Qualitative Methods , 14 (4). https://doi.org/10.1177/1609406915611575

Abstract. This article is premised on the understanding that there are multiple dimensions of the case–theory relation and examines four of these: theory of the case, theory for the case, theory from the case, and a dialogical relation between theory and case. This fourth dimension is the article’s key contribution to theorizing case study. Dialogic engagement between theory and case study creates rich potential for mutual formation and generative tension. The article argues that the process of constructing and conducting the case is theory laden, while the outcomes of the study might also have theoretical implications. Case study research that is contextually sensitive and theoretically astute can contribute not only to the application and revision of existing theory but also to the development of new theory. The case thus provides a potentially generative nexus for the engagement of theory, context, and research.

Thomas, G. (2011). A Typology for the Case Study in Social Science Following a Review of Definition, Discourse, and Structure. Qualitative Inquiry, 17(6), 511–521. https://doi.org/10.1177/1077800411409884

Abstract. The author proposes a typology for the case study following a definition wherein various layers of classificatory principle are disaggregated. First, a clear distinction is drawn between two parts: (1) the subject of the study, which is the case itself, and (2) the object, which is the analytical frame or theory through which the subject is viewed and which the subject explicates. Beyond this distinction the case study is presented as classifiable by its purposes and the approaches adopted— principally with a distinction drawn between theory-centered and illustrative study. Beyond this, there are distinctions to be drawn among various operational structures that concern comparative versus noncomparative versions of the form and the ways that the study may employ time. The typology reveals that there are numerous valid permutations of these dimensions and many trajectories, therefore, open to the case inquirer.

VanWynsberghe, R., & Khan, S. (2007). Redefining Case Study. International Journal of Qualitative Methods , 6 (2), 80–94. https://doi.org/10.1177/160940690700600208

Abstract. In this paper the authors propose a more precise and encompassing definition of case study than is usually found. They support their definition by clarifying that case study is neither a method nor a methodology nor a research design as suggested by others. They use a case study prototype of their own design to propose common properties of case study and demonstrate how these properties support their definition. Next, they present several living myths about case study and refute them in relation to their definition. Finally, they discuss the interplay between the terms case study and unit of analysis to further delineate their definition of case study. The target audiences for this paper include case study researchers, research design and methods instructors, and graduate students interested in case study research.

Mixed Methods Research with Case Studies

Guetterman, T. C., & Fetters, M. D. (2018). Two Methodological Approaches to the Integration of Mixed Methods and Case Study Designs: A Systematic Review. American Behavioral Scientist, 62(7), 900–918. https://doi.org/10.1177/0002764218772641

Abstract. Case study has a tradition of collecting multiple forms of data—qualitative and quantitative—to gain a more complete understanding of the case. Case study integrates well with mixed methods, which seeks a more complete understanding through the integration of qualitative and quantitative research. We identify and characterize “mixed methods–case study designs” as mixed methods studies with a nested case study and “case study–mixed methods designs” as case studies with nested mixed methods. Based on a review of published research integrating mixed methods and case study designs, we describe key methodological features and discuss four exemplar interdisciplinary studies.

Luyt, R. (2012). A Framework for Mixing Methods in Quantitative Measurement Development, Validation, and Revision: A Case Study. Journal of Mixed Methods Research, 6(4), 294–316. https://doi.org/10.1177/1558689811427912

Abstract. A framework for quantitative measurement development, validation, and revision that incorporates both qualitative and quantitative methods is introduced. It extends and adapts Adcock and Collier’s work, and thus, facilitates understanding of quantitative measurement development, validation, and revision as an integrated and cyclical set of procedures best achieved through mixed methods research. It also offers a systematic guide concerning how these procedures may be undertaken through detailing key “stages,” “levels,” and practical “tasks.” A case study illustrates how qualitative and quantitative methods may be mixed through the use of the proposed framework in the cross-cultural content- and construct-related validation and subsequent revision of a quantitative measure. The contribution of this article to mixed methods research literature is briefly discussed.

Mason, W., Morris, K., Webb, C., Daniels, B., Featherstone, B., Bywaters, P., Mirza, N., Hooper, J., Brady, G., Bunting, L., & Scourfield, J. (2020). Toward Full Integration of Quantitative and Qualitative Methods in Case Study Research: Insights From Investigating Child Welfare Inequalities. Journal of Mixed Methods Research, 14(2), 164–183. https://doi.org/10.1177/1558689819857972

Abstract. Delineation of the full integration of quantitative and qualitative methods throughout all stages of multisite mixed methods case study projects remains a gap in the methodological literature. This article offers advances to the field of mixed methods by detailing the application and integration of mixed methods throughout all stages of one such project; a study of child welfare inequalities. By offering a critical discussion of site selection and the management of confirmatory, expansionary and discordant data, this article contributes to the limited body of mixed methods exemplars specific to this field. We propose that our mixed methods approach provided distinctive insights into a complex social problem, offering expanded understandings of the relationship between poverty, child abuse, and neglect.

Onghena, P., Maes, B., & Heyvaert, M. (2019). Mixed Methods Single Case Research: State of the Art and Future Directions. Journal of Mixed Methods Research, 13(4), 461–480. https://doi.org/10.1177/1558689818789530

Abstract. Mixed methods single case research (MMSCR) is research in which single case experimental and qualitative case study methodologies, and their accompanying sets of methods and techniques, are integrated to answer research questions that concern a single case. This article discusses the historical roots and the distinct nature of MMSCR, the kinds of knowledge MMSCR produces, its philosophical underpinnings, examples of MMSCR, and the trustworthiness and validity of MMSCR. Methodological challenges relate to the development of a critical appraisal tool for MMSCR, to the team work that is involved in designing and conducting MMSCR studies, and to the application of mixed methods research synthesis for multiple case studies and single case experiments.

Sharp, J. L., Mobley, C., Hammond, C., Withington, C., Drew, S., Stringfield, S., & Stipanovic, N. (2012). A Mixed Methods Sampling Methodology for a Multisite Case Study. Journal of Mixed Methods Research, 6(1), 34–54. https://doi.org/10.1177/1558689811417133

Abstract. The flexibility of mixed methods research strategies makes such approaches especially suitable for multisite case studies. Yet the utilization of mixed methods to select sites for these studies is rarely reported. The authors describe their pragmatic mixed methods approach to select a sample for their multisite mixed methods case study of a statewide education policy initiative in the United States. The authors designed a four-stage sequential mixed methods site selection strategy to select eight sites in order to capture the broader context of the research, as well as any contextual nuances that shape policy implementation. The authors anticipate that their experience would provide guidance to other mixed methods researchers seeking to maximize the rigor of their multisite case study sampling designs.

Bloomberg, L. (2018). Case study. In B. B. Frey (Ed.), The SAGE encyclopedia of educational research, measurement, and evaluation . https://doi.org/10.4135/9781506326139

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Designing Survey Research

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Distinguishing case study as a research method from case reports as a publication type

The purpose of this editorial is to distinguish between case reports and case studies. In health, case reports are familiar ways of sharing events or efforts of intervening with single patients with previously unreported features. As a qualitative methodology, case study research encompasses a great deal more complexity than a typical case report and often incorporates multiple streams of data combined in creative ways. The depth and richness of case study description helps readers understand the case and whether findings might be applicable beyond that setting.

Single-institution descriptive reports of library activities are often labeled by their authors as “case studies.” By contrast, in health care, single patient retrospective descriptions are published as “case reports.” Both case reports and case studies are valuable to readers and provide a publication opportunity for authors. A previous editorial by Akers and Amos about improving case studies addresses issues that are more common to case reports; for example, not having a review of the literature or being anecdotal, not generalizable, and prone to various types of bias such as positive outcome bias [ 1 ]. However, case study research as a qualitative methodology is pursued for different purposes than generalizability. The authors’ purpose in this editorial is to clearly distinguish between case reports and case studies. We believe that this will assist authors in describing and designating the methodological approach of their publications and help readers appreciate the rigor of well-executed case study research.

Case reports often provide a first exploration of a phenomenon or an opportunity for a first publication by a trainee in the health professions. In health care, case reports are familiar ways of sharing events or efforts of intervening with single patients with previously unreported features. Another type of study categorized as a case report is an “N of 1” study or single-subject clinical trial, which considers an individual patient as the sole unit of observation in a study investigating the efficacy or side effect profiles of different interventions. Entire journals have evolved to publish case reports, which often rely on template structures with limited contextualization or discussion of previous cases. Examples that are indexed in MEDLINE include the American Journal of Case Reports , BMJ Case Reports, Journal of Medical Case Reports, and Journal of Radiology Case Reports . Similar publications appear in veterinary medicine and are indexed in CAB Abstracts, such as Case Reports in Veterinary Medicine and Veterinary Record Case Reports .

As a qualitative methodology, however, case study research encompasses a great deal more complexity than a typical case report and often incorporates multiple streams of data combined in creative ways. Distinctions include the investigator’s definitions and delimitations of the case being studied, the clarity of the role of the investigator, the rigor of gathering and combining evidence about the case, and the contextualization of the findings. Delimitation is a term from qualitative research about setting boundaries to scope the research in a useful way rather than describing the narrow scope as a limitation, as often appears in a discussion section. The depth and richness of description helps readers understand the situation and whether findings from the case are applicable to their settings.

CASE STUDY AS A RESEARCH METHODOLOGY

Case study as a qualitative methodology is an exploration of a time- and space-bound phenomenon. As qualitative research, case studies require much more from their authors who are acting as instruments within the inquiry process. In the case study methodology, a variety of methodological approaches may be employed to explain the complexity of the problem being studied [ 2 , 3 ].

Leading authors diverge in their definitions of case study, but a qualitative research text introduces case study as follows:

Case study research is defined as a qualitative approach in which the investigator explores a real-life, contemporary bounded system (a case) or multiple bound systems (cases) over time, through detailed, in-depth data collection involving multiple sources of information, and reports a case description and case themes. The unit of analysis in the case study might be multiple cases (a multisite study) or a single case (a within-site case study). [ 4 ]

Methodologists writing core texts on case study research include Yin [ 5 ], Stake [ 6 ], and Merriam [ 7 ]. The approaches of these three methodologists have been compared by Yazan, who focused on six areas of methodology: epistemology (beliefs about ways of knowing), definition of cases, design of case studies, and gathering, analysis, and validation of data [ 8 ]. For Yin, case study is a method of empirical inquiry appropriate to determining the “how and why” of phenomena and contributes to understanding phenomena in a holistic and real-life context [ 5 ]. Stake defines a case study as a “well-bounded, specific, complex, and functioning thing” [ 6 ], while Merriam views “the case as a thing, a single entity, a unit around which there are boundaries” [ 7 ].

Case studies are ways to explain, describe, or explore phenomena. Comments from a quantitative perspective about case studies lacking rigor and generalizability fail to consider the purpose of the case study and how what is learned from a case study is put into practice. Rigor in case studies comes from the research design and its components, which Yin outlines as (a) the study’s questions, (b) the study’s propositions, (c) the unit of analysis, (d) the logic linking the data to propositions, and (e) the criteria for interpreting the findings [ 5 ]. Case studies should also provide multiple sources of data, a case study database, and a clear chain of evidence among the questions asked, the data collected, and the conclusions drawn [ 5 ].

Sources of evidence for case studies include interviews, documentation, archival records, direct observations, participant-observation, and physical artifacts. One of the most important sources for data in qualitative case study research is the interview [ 2 , 3 ]. In addition to interviews, documents and archival records can be gathered to corroborate and enhance the findings of the study. To understand the phenomenon or the conditions that created it, direct observations can serve as another source of evidence and can be conducted throughout the study. These can include the use of formal and informal protocols as a participant inside the case or an external or passive observer outside of the case [ 5 ]. Lastly, physical artifacts can be observed and collected as a form of evidence. With these multiple potential sources of evidence, the study methodology includes gathering data, sense-making, and triangulating multiple streams of data. Figure 1 shows an example in which data used for the case started with a pilot study to provide additional context to guide more in-depth data collection and analysis with participants.

Key sources of data for a sample case study

VARIATIONS ON CASE STUDY METHODOLOGY

Case study methodology is evolving and regularly reinterpreted. Comparative or multiple case studies are used as a tool for synthesizing information across time and space to research the impact of policy and practice in various fields of social research [ 9 ]. Because case study research is in-depth and intensive, there have been efforts to simplify the method or select useful components of cases for focused analysis. Micro-case study is a term that is occasionally used to describe research on micro-level cases [ 10 ]. These are cases that occur in a brief time frame, occur in a confined setting, and are simple and straightforward in nature. A micro-level case describes a clear problem of interest. Reporting is very brief and about specific points. The lack of complexity in the case description makes obvious the “lesson” that is inherent in the case; although no definitive “solution” is necessarily forthcoming, making the case useful for discussion. A micro-case write-up can be distinguished from a case report by its focus on briefly reporting specific features of a case or cases to analyze or learn from those features.

DATABASE INDEXING OF CASE REPORTS AND CASE STUDIES

Disciplines such as education, psychology, sociology, political science, and social work regularly publish rich case studies that are relevant to particular areas of health librarianship. Case reports and case studies have been defined as publication types or subject terms by several databases that are relevant to librarian authors: MEDLINE, PsycINFO, CINAHL, and ERIC. Library, Information Science & Technology Abstracts (LISTA) does not have a subject term or publication type related to cases, despite many being included in the database. Whereas “Case Reports” are the main term used by MEDLINE’s Medical Subject Headings (MeSH) and PsycINFO’s thesaurus, CINAHL and ERIC use “Case Studies.”

Case reports in MEDLINE and PsycINFO focus on clinical case documentation. In MeSH, “Case Reports” as a publication type is specific to “clinical presentations that may be followed by evaluative studies that eventually lead to a diagnosis” [ 11 ]. “Case Histories,” “Case Studies,” and “Case Study” are all entry terms mapping to “Case Reports”; however, guidance to indexers suggests that “Case Reports” should not be applied to institutional case reports and refers to the heading “Organizational Case Studies,” which is defined as “descriptions and evaluations of specific health care organizations” [ 12 ].

PsycINFO’s subject term “Case Report” is “used in records discussing issues involved in the process of conducting exploratory studies of single or multiple clinical cases.” The Methodology index offers clinical and non-clinical entries. “Clinical Case Study” is defined as “case reports that include disorder, diagnosis, and clinical treatment for individuals with mental or medical illnesses,” whereas “Non-clinical Case Study” is a “document consisting of non-clinical or organizational case examples of the concepts being researched or studied. The setting is always non-clinical and does not include treatment-related environments” [ 13 ].

Both CINAHL and ERIC acknowledge the depth of analysis in case study methodology. The CINAHL scope note for the thesaurus term “Case Studies” distinguishes between the document and the methodology, though both use the same term: “a review of a particular condition, disease, or administrative problem. Also, a research method that involves an in-depth analysis of an individual, group, institution, or other social unit. For material that contains a case study, search for document type: case study.” The ERIC scope note for the thesaurus term “Case Studies” is simple: “detailed analyses, usually focusing on a particular problem of an individual, group, or organization” [ 14 ].

PUBLICATION OF CASE STUDY RESEARCH IN LIBRARIANSHIP

We call your attention to a few examples published as case studies in health sciences librarianship to consider how their characteristics fit with the preceding definitions of case reports or case study research. All present some characteristics of case study research, but their treatment of the research questions, richness of description, and analytic strategies vary in depth and, therefore, diverge at some level from the qualitative case study research approach. This divergence, particularly in richness of description and analysis, may have been constrained by the publication requirements.

As one example, a case study by Janke and Rush documented a time- and context-bound collaboration involving a librarian and a nursing faculty member [ 15 ]. Three objectives were stated: (1) describing their experience of working together on an interprofessional research team, (2) evaluating the value of the librarian role from librarian and faculty member perspectives, and (3) relating findings to existing literature. Elements that signal the qualitative nature of this case study are that the authors were the research participants and their use of the term “evaluation” is reflection on their experience. This reads like a case study that could have been enriched by including other types of data gathered from others engaging with this team to broaden the understanding of the collaboration.

As another example, the description of the academic context is one of the most salient components of the case study written by Clairoux et al., which had the objectives of (1) describing the library instruction offered and learning assessments used at a single health sciences library and (2) discussing the positive outcomes of instruction in that setting [ 16 ]. The authors focus on sharing what the institution has done more than explaining why this institution is an exemplar to explore a focused question or understand the phenomenon of library instruction. However, like a case study, the analysis brings together several streams of data including course attendance, online material page views, and some discussion of results from surveys. This paper reads somewhat in between an institutional case report and a case study.

The final example is a single author reporting on a personal experience of creating and executing the role of research informationist for a National Institutes of Health (NIH)–funded research team [ 17 ]. There is a thoughtful review of the informationist literature and detailed descriptions of the institutional context and the process of gaining access to and participating in the new role. However, the motivating question in the abstract does not seem to be fully addressed through analysis from either the reflective perspective of the author as the research participant or consideration of other streams of data from those involved in the informationist experience. The publication reads more like a case report about this informationist’s experience than a case study that explores the research informationist experience through the selection of this case.

All of these publications are well written and useful for their intended audiences, but in general, they are much shorter and much less rich in depth than case studies published in social sciences research. It may be that the authors have been constrained by word counts or page limits. For example, the submission category for Case Studies in the Journal of the Medical Library Association (JMLA) limited them to 3,000 words and defined them as “articles describing the process of developing, implementing, and evaluating a new service, program, or initiative, typically in a single institution or through a single collaborative effort” [ 18 ]. This definition’s focus on novelty and description sounds much more like the definition of case report than the in-depth, detailed investigation of a time- and space-bound problem that is often examined through case study research.

Problem-focused or question-driven case study research would benefit from the space provided for Original Investigations that employ any type of quantitative or qualitative method of analysis. One of the best examples in the JMLA of an in-depth multiple case study that was authored by a librarian who published the findings from her doctoral dissertation represented all the elements of a case study. In eight pages, she provided a theoretical basis for the research question, a pilot study, and a multiple case design, including integrated data from interviews and focus groups [ 19 ].

We have distinguished between case reports and case studies primarily to assist librarians who are new to research and critical appraisal of case study methodology to recognize the features that authors use to describe and designate the methodological approaches of their publications. For researchers who are new to case research methodology and are interested in learning more, Hancock and Algozzine provide a guide [ 20 ].

We hope that JMLA readers appreciate the rigor of well-executed case study research. We believe that distinguishing between descriptive case reports and analytic case studies in the journal’s submission categories will allow the depth of case study methodology to increase. We also hope that authors feel encouraged to pursue submitting relevant case studies or case reports for future publication.

Editor’s note: In response to this invited editorial, the Journal of the Medical Library Association will consider manuscripts employing rigorous qualitative case study methodology to be Original Investigations (fewer than 5,000 words), whereas manuscripts describing the process of developing, implementing, and assessing a new service, program, or initiative—typically in a single institution or through a single collaborative effort—will be considered to be Case Reports (formerly known as Case Studies; fewer than 3,000 words).

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Qualitative case study data analysis: an example from practice

Affiliation.

• 1 School of Nursing and Midwifery, National University of Ireland, Galway, Republic of Ireland.
• PMID: 25976531
• DOI: 10.7748/nr.22.5.8.e1307

Aim: To illustrate an approach to data analysis in qualitative case study methodology.

Background: There is often little detail in case study research about how data were analysed. However, it is important that comprehensive analysis procedures are used because there are often large sets of data from multiple sources of evidence. Furthermore, the ability to describe in detail how the analysis was conducted ensures rigour in reporting qualitative research.

Data sources: The research example used is a multiple case study that explored the role of the clinical skills laboratory in preparing students for the real world of practice. Data analysis was conducted using a framework guided by the four stages of analysis outlined by Morse ( 1994 ): comprehending, synthesising, theorising and recontextualising. The specific strategies for analysis in these stages centred on the work of Miles and Huberman ( 1994 ), which has been successfully used in case study research. The data were managed using NVivo software.

Review methods: Literature examining qualitative data analysis was reviewed and strategies illustrated by the case study example provided. Discussion Each stage of the analysis framework is described with illustration from the research example for the purpose of highlighting the benefits of a systematic approach to handling large data sets from multiple sources.

Conclusion: By providing an example of how each stage of the analysis was conducted, it is hoped that researchers will be able to consider the benefits of such an approach to their own case study analysis.

Implications for research/practice: This paper illustrates specific strategies that can be employed when conducting data analysis in case study research and other qualitative research designs.

Keywords: Case study data analysis; case study research methodology; clinical skills research; qualitative case study methodology; qualitative data analysis; qualitative research.

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Qualitative Research Methods: Collecting Evidence, Crafting Analysis, Communicating Impact, 3rd Edition

ISBN: 978-1-119-98867-0

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Wiley-Blackwell

Digital Evaluation Copy

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Step-by-step advice for constructing a qualitative project from beginning to end, covering both foundational theory and real-world application

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Employing a practical, problem-based contextual approach, the third edition of Qualitative Research Methods incorporates developments in textual, media, visual, arts-based, and digital analysis. New coverage includes social media data-scraping techniques, AI and ChatGPT, fieldwork and interviewing, digital ethnography, working with neurodivergent populations, adopting digital and traditional archival approaches, and much more. This edition includes a wealth of new examples, case studies, discussion questions, full-color visuals, and hands-on “Project Building Blocks” activities you can use at any stage of your qualitative research project.

Supported by a companion website containing extensive teaching and learning tools, Qualitative Research Methods: Collecting Evidence, Crafting Analysis, Communicating Impact is an indispensable resource for undergraduates, graduate students, and faculty across multiple disciplines, as well as researchers, ethnographers, and user experience professionals looking to hone their methodological practice.

SARAH J. TRACY is Professor and School Director of The Hugh Downs School of Human Communication at Arizona State University. She developed the “Big Tent” model for high-quality qualitative research and has published more than 100 scholarly monographs, in publications such as Communication Monographs, Management Communication Quarterly, and Communication Theory .

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Doctoral Dissertations and Projects

Executive leader perspectives of rural school district organizational resilience: a qualitative multiple-case study inquiry.

Todd S. Burke , Liberty University Follow

School of Education

Doctor of Philosophy

Meredith Park

Organizational Resilience, Organizational Grit, Grit, Rural Executive School District Leadership, Adversity, Student Achievement

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Educational Leadership

Recommended Citation

Burke, Todd S., "Executive Leader Perspectives of Rural School District Organizational Resilience: A Qualitative Multiple-Case Study Inquiry" (2024). Doctoral Dissertations and Projects . 5970. https://digitalcommons.liberty.edu/doctoral/5970

The purpose of this qualitative embedded multiple-case study was to explore and describe how rural executive school district leaders overcome significant organizational adversity (low-income student factors) and sustain high student achievement outcomes. Organizational resilience theory provided the basis for the qualitative embedded multiple-case study. The multiple-case study design explored the perspectives of rural school district executive leaders at three levels of qualitative meaning: a) individual-level executive leader perspectives, b) organization function-level (program and department) perspectives, and c) district-wide organizational perspectives. Three small Utah rural school districts with higher-than-average student achievement trends, all of which have student populations experiencing low-income factors, were the sites for the study. The analysis included data from 11 executive leader participants, and evidence was collected through interviews, surveys, organizational documents, and artifactual evidence. Precoding, deductive, exploratory, and pattern coding techniques were used to analyze the data. Two broad thematic patterns emerged with professional learning communities (PLC) and human resource management (HR) constructs. Executive leaders were highly committed to three entrenched sub-thematic core values and beliefs: 1) a continual improvement and a goal mindset, 2) collaboration, and 3) effective teachers who place a high priority on student achievement outcomes. Five essential sub-thematic strategies also emerged in the analysis: 1) instructional coaches, mentors, and support networks; 2) data-driven decisions; 3) training and professional development; 4) consistent and effective leadership meetings; and 5) employee compensation and hiring the right people.

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• Open access
• Published: 11 September 2024

Implementing peer support into practice in mental health services: a qualitative comparative case study

• Steve Gillard 1 ,
• Rhiannon Foster 1 ,
• Sarah White 2 ,
• Rahul Bhattacharya 3 ,
• Paul Binfield 3 ,
• Rachel Eborall 4 ,
• Sarah L Gibson 5 ,
• Daniella Harnett 3 ,
• Alan Simpson 6 ,
• Mike Lucock 7 ,
• Jacqueline Marks 8 ,
• Julie Repper 9 ,
• Miles Rinaldi 10 , 11 ,
• Anthony Salla 1 &
• Jessica Worner 12  

BMC Health Services Research volume  24 , Article number:  1050 ( 2024 ) Cite this article

Metrics details

Peer workers are people with personal experience of mental distress, employed within mental health services to support others with similar experiences. Research has identified a range of factors that might facilitate or hinder the introduction of new peer worker roles into mental health services. While there is mixed evidence for the effectiveness of peer worker delivered interventions, there are no studies exploring how implementation might be associated with effect.

This was a qualitative comparative case study using data from interviews with 20 peer workers and their five supervisors. Peer workers delivered peer support for discharge from inpatient to community mental health care as part of a randomised controlled trial. In the trial, level of participant engagement with peer support was associated with better outcome (hospital readmission). Study sites with higher levels of engagement also had higher scores on a measure of fidelity to peer support principles. We compared data from sites with contrasting levels of engagement and fidelity using an analytical framework derived from implementation theory.

In high engagement-high fidelity sites, there was regular work with clinical teams preparing for working alongside peer workers, and a positive relationship between staff on inpatient wards and peer workers. The supervisor role was well resourced, and delivery of peer support was highly consistent with the intervention manual. In low engagement-low fidelity sites peer workers were employed in not-for-profit organisations to support people using public mental health services and in rural areas. Supervisors faced constrained resources and experienced barriers to joint working between organisations. In these sites, peer workers could experience challenging relationships with ward staff. Issues of geography and capacity limited opportunities for supervision and team-building, impacting consistency of delivery.

Conclusions

This study provides clear indication that implementation can impact delivery of peer support, with implications for engagement and, potentially, outcomes of peer worker interventions. Resourcing issues can have knock-on effects on consistency of delivery, alongside challenges of access, authority and relationship with clinical teams, especially where peer workers were employed in not-for-profit organisations. Attention needs to be paid to the impact of geography on implementation.

Trial registration

ISRCTN registry number ISRCTN10043328, registered 28 November 2016.

Peer Review reports

Peer support in mental health services

People with personal experience of mental distress, often referred to as peer workers, are increasingly employed within mental health services internationally to support others with similar experiences. An extensive literature explores a range of implementation issues that might dilute the distinctive qualities of peer support when introduced into public mental health services [ 1 , 2 ]. These include adequate provision of role specific training for PWs, [ 3 , 4 ] support and supervision for PWs, [ 5 ] clarity of expectation around the way in which PWs bring experience-based knowledge to mental healthcare, [ 2 . 6 ] and preparation of clinical teams to work alongside PWs [ 7 ]. It has been argued that ‘over-professionalisation’ or ‘institutionalisation’ of the PW role constrains the distinctive contribution of peer support [ 8 , 9 , 10 , 11 ].

Trials of peer support in mental health services continue to demonstrate inconsistent results, with some studies indicating that peer support might be superior to care-as-usual or a comparator intervention, [ 12 , 13 ] while others indicate no difference in effect [ 14 , 15 ]. Some of this variation might be explained by heterogeneity of interventions, population or outcome, but it is also possible that the quality of implementation of peer support into mental healthcare settings is associated with the effect of peer support interventions [ 16 , 17 ].

It has been noted that peer support is often poorly described in the trial literature, [ 17 , 18 ] with a lack of research assessing association between implementation and outcome. A recent review of one-to-one peer support in mental health services categorised peer support as being well implemented where at least two of the following criteria were reported: dedicated peer support training; clear description of the underlying processes of peer support; well-defined support structures for PWs (e.g. supervision) [ 19 ]. However, only a small number of studies reported sufficient data to conduct an analysis and results were unclear. There is a need for research that explicitly considers the possible relationship between quality of implementation and the outcomes of peer support.

Implementation theory

Implementation science offers a range of frameworks for understanding the facilitators and barriers to successful implementation of healthcare innovation into practice [ 20 ]. There is a clear recognition that the effects of any intervention will always depend on successful implementation [ 21 ]. The well-established Promoting Action on Research Implementation in Health Services (PARIHS) framework conceptualises successful implementation of research-based innovation into healthcare in terms of the nature of the evidence on which the innovation is based, the context or environment into which the innovation is placed, and the method by which implementation is facilitated [ 22 ]. In recent years, the co-design [ 23 ] or coproduction [ 24 ] of new interventions in mental health has gained prominence, with people who use mental health services bringing experience-based knowledge to the process, alongside the professional and practice-based knowledge brought by healthcare professionals. Given that this experiential knowledge is core to peer support, and that a number of members of the research term brought their own experiences of mental distress and/ or of using mental health services to the design and conduct of the research, we adapted the PARIHS framework for the purposes of this study. An earlier scoping review of implementation literature and an empirical case study, [ 25 ] undertaken by members of the team (SG and RF), identified five domains where experiential knowledge might impact research implementation, and we mapped these domains directly onto the framework (Table  1 ).

The ENRICH trial

A trial of peer support for discharge from inpatient to community mental health care indicated that peer support was not superior to care-as-usual (follow up by community mental health services within seven days of discharge) in terms of either the primary outcome – readmission within 12 months of discharge – or a range of secondary outcomes [ 26 ]. PWs received eight days of training focused on individual strengths and connecting to community, met the people they were supporting at least once while still inpatients and then weekly for up to four months post-discharge. Peer support was flexible and collaborative, informed by a peer support principles framework [ 27 ]. PWs received group and individual supervision from an experienced peer worker coordinator (PWC) who had access to an action learning set with other PWCs across study sites. The trial and intervention are described in detail in a protocol paper [ 28 ].

Findings from the trial indicated that 62.5% of participants offered peer support had at least two contacts with their PW, at least one of which was post-discharge, and that those participants were significantly less likely to be readmitted than a similar group of PWs in the care-as-usual group [ 26 ]. There might be many reasons why people chose not to, or were unable to engage with their PW, including the possibility that peer support was not always well implemented into practice in the trial.

This paper aims to explore if and how levels of engagement in a new peer support intervention were associated with implementation of the intervention, and therefore how implementation of peer support in mental health services might be optimised in the future.

Study design

We take a comparative case study approach, informed by case-orientated Qualitative Comparative Analysis [ 29 ] and pattern-matching [ 30 ] techniques, considering the seven sites where the study took place as cases. Sites were National Health Services (NHS) mental health trusts (public healthcare provider organisations) in England, where the new peer support intervention was delivered as part of the ENRICH trial. Sites were selected to provide contrast in urban, town and rural localities, geographical spread across England, and where mental health trusts were committed to introducing new PW roles into mental health services. In most sites PWs were directly employed by the mental health trust, while in others a much smaller, voluntary (not-for-profit) sector organisation was sub-contracted by the trust to employ PWs to provide support to people using mental health trust services. Information about each site is given in Table  2 below.

To inform case selection for the comparative analysis we charted level of engagement at each site – percentage of trial participants offered peer support who had at least two contacts with their PW, at least one of which was post-discharge – against site fidelity score, measured using an index designed to assess fidelity of delivery of peer support at site level against a set of principles articulating what is distinctive about peer support compared to other forms of mental health support [ 31 ] (Fig.  1 ). Fidelity was assessed through a semi-structured interview with PWs, the people they supported and their supervisor, rated by researchers against criteria based on the principles framework. A high fidelity score indicates that peer support had been implemented according to those principles. Fidelity was assessed after peer support had been delivered for at least six months at each site.

Relationship between engagement with peer support and fidelity

Figure  1 is indicative of a direct relationship between engagement with peer support and fidelity, offering rationale for selecting sites with higher or lower levels of both engagement and fidelity as cases for comparative analysis. There was one outlier, site 2, where fidelity was high (11) but engagement was mid-range (51%). We included this site in the comparative analysis as engagement might be explained by implementation issues not related to fidelity of delivery.

We report on the Evidence domain of the framework in a paper describing how experiential knowledge was central to developing the ENRICH peer support intervention [ 32 ]. Our research questions here are based on the Context and Facilitation domains of the framework, with context referring largely to the NHS Trust in which implementation took place (question 1), and facilitators being the PWs and PWCs who delivered the peer support (questions 2–4):

How did the culture of organisations, leadership (including issues of access and authority ) and monitoring and feedback impact implementation of peer support?

How did PWs and PWCs feel that their roles were characterised?

How did PWs and PWCs feel they were able to exercise flexibility while remaining consistent in their approach to delivering peer support?

How did experiential knowledge underpin peer support as it was delivered at each site?

Data sources

Peer worker interviews. Thirty-two PWs delivered peer support in the ENRICH trial and were invited to give written informed consent to participate in the research. All 32 consented and were interviewed after 12 months of delivering peer support. Interviews explored how well training prepared them for the role, their experiences of working as a PW, the support they received in the role and their relationship with clinical teams they worked alongside.

Peer worker coordinator interviews. Eight PWCs supervised PWs in the trial. Seven PWCs were themselves experienced PWs and one was a mental health nurse who shared the role with an experienced PW. All 8 PWCs gave informed consent to participate in the research and were interviewed at the same timepoint as PWs. Interviews explored PWCs’ experiences of supporting PWs, how well they thought the role was supported and organisational issues impacting delivery of peer support.

Interviews were conducted by researchers working from a perspective of having experienced mental distress and/ or having used mental health services, and played a key role in schedule development. Interview schedules can be found in the Supplementary Material file.

Data analysis

Interviews were audio-recorded, pseudonymised at the point of collection and transcribed verbatim.

Interview data were analysed using a framework approach [ 33 ] based on the Context and Facilitation domains of the modified PARIHS framework (see Table  1 ). Data were first coded to the constructs within those domains, with inductive space retained to code factors not related to the framework that participants described as impacting delivery of peer support. Second, a comparative, cross-case analysis was used to look for patterns of implementation that were: A, shared across cases; B, characterised high fidelity-high engagement cases; C, characterised low fidelity-low engagement cases; D, described implementation in the outlier case [ 30 ]. Preliminary analyses were undertaken by the first author and refined through iterative rounds of discussion with the whole team.

Characteristics of included cases

The two high engagement-high fidelity cases (sites 3,5), and the outlier high fidelity-low engagement case (site 2), were in urban areas with PWs directly employed in mental health NHS Trusts (see Table  2 ). The two low engagement-low fidelity cases (sites 4,6) were in areas that were a mix of rural localities with small towns or urban localities respectively. In both the latter sites PWs were employed by voluntary sector organisations outside of the NHS.

Characteristics of participants

A total of 20 PWs were included in the analysis, five each from sites 3 and 4, three each from sites 2 and 5, and two from site 6. Twelve PWs were female, seven were male and one preferred not to say. Three PWs were aged under 35 years of age, 12 aged from 35 to 55 years, one over 55 and four preferred not to say. Eleven PWs were White British, two were White Irish, one White other, one Black/ Black British, one Asian/ Asian British, one Arab, one Mixed White Asian with two preferring not to say.

There were five PWCs, one from each site. Four PWCs were female and one was male; two were aged from 35 to 55 and three over 55; all were White British.

Participant quotes presented below are identified with a site code (e.g. S1 = site 1) and role identifier (PW = Peer Worker; PWC = Peer Worker Coordinator) plus an additional number to distinguish between PWs at each site.

Implementation across cases

A number of implementation features were evident across all five cases, including characterisation of the PW role as largely consistent with the principles that were used to inform development of the intervention; [ 27 , 32 ] taking a non-judgemental approach and sharing experiences to create a safe space, make connections and build relationships:

‘We’re not going to be judgemental so to speak. It’s a safe place really for people to be themselves regardless of what their mental health issues are or mental health diagnoses are.’ (S5PW2). ‘I’m always sharing lived experience, whether that’s just generally or whether that’s personally with mental health … obviously you share when appropriate but you try to match that experience together so you have something in common, and then there is that mutuality and reciprocity and creating that trusting relationship.’ (S3PW3).

On the whole, training – as specified in the ENRICH manual – was consistently delivered and worked well to provide PWs with the range of skills they felt they needed for the role:

‘We did a lot about strengths-based approaches and I think that’s really informed the way that I interact with people, so I think I’m always trying to bring it back to what can you do, what is strong for you … we did a lot about active listening and also about discussing difficult issues … I think it’s been very helpful the stuff we did in training … definitely the boundaries and relationships sessions that we did …’ (S3PW1).

The importance of group supervision facilitated by the PWC, as well as individual supervision where required (both specified in the handbook), was indicated across sites, providing the opportunity for PWs to share experiences and receive feedback from one another as well as from the PWC:

‘I will hold these feelings until supervision and that’s when I let it out, offload it to my colleagues. And it’s been great because we’ve been bouncing it off each other and I’ve noticed that it’s not just me that was going through it, so it’s such a relief …’ (S2PW2). ‘… [PWC] will always ask how I am, if anything has triggered me or anything like that and she’s quite easy to talk to and it’s OK to be open with her.’ (S6PW3).

Participants in all sites described differences between the culture of clinical services in the host trust and the ethos underpinning peer support:

‘…it’s about the values because what I find with the other types of support, it all tends to be clinical and deficits based … very directive and judgemental … some of the clinical teams are stuck in that way of seeing things, that deficit-based thing and they don’t really know too much about peer support.’ (S5PW1).

At all sites, there was a perceived lack of contact with, and feedback from, community mental health teams, sometimes accompanied by a lack of understanding of the PW role:

‘Whenever I got a new service user, I’d email their [Community Psychiatric Nurse] or care coordinator … to give them more information about it and nobody, apart from I think one person, got back to me. So that’s been quite challenging, not really having any communication or contact really with the mental health teams that are working with the service users …’ (S5PW3).

Interviewees in all sites remarked that the timing of the offer of peer support - prior to discharge from hospital - was particularly challenging for some, especially in relation to maintaining contact with the PW following discharge. This represented a barrier to engagement that was related to the clinical context, rather than implementation:

‘… they are being introduced to it as soon as they come out … they are going through a tough period of fear, of not knowing what’s next for them. The last thing they want is to commit to 16 weeks of meeting someone that they don’t even know.’ (S2PW2). ‘I suspect that the post-discharge needs more targeting, that would be my sense. There are people who really get so much out of it, but then there are an awful lot who just disengage. It’s another stress for them I think.’ (S4PWC).

Implementation in high fidelity-high engagement cases

There was evidence of features supporting implementation in the high fidelity-engagement cases which contrasted with low fidelity-lowengagement cases (see below). In high fidelity cases, cultural differences between clinical services and peer support were generally seen as an asset and were valued, rather than as a source of tension:

‘… you need a values-based practice and how important it is, as opposed to the clinical based practice and how helpful that is … I’m not saying the clinical approach is wrong or anything like that, what I’m saying is we need to complement each other, we need to take a holistic approach.’ (S5PW1).

Some aspects of organisational culture were seen as supportive of peer support, including the role of recovery colleges in preparing PWs for the role or providing additional training once in post (recovery colleges employ an adult education model to supporting people with their mental health, often co-delivered by people using mental health services [ 34 ]):

‘… we were in a really fortunate position being linked with a Recovery College, that, where later in their work they then wanted to do specific recovery focused training around diagnosis we were able to provide that for people.’ (S3PWC).

In these cases, staff on the wards (inpatient units) were reported as largely familiar with and valuing the role of peer support:

‘… when I’d go on the ward … they seemed to see great value in the transparency of people being there because they’ve got lived experience. That aspect of it was really nice … good for the culture of the organisation in many ways.’ (S5PWC). ‘… the clinical teams are aware … they’re very excited that we’ve got peer workers on the ward. They’re very positive about it.’ (S3PW3).

PWCs described PW recruitment as having followed the process specified in the intervention handbook, and as such the PWs who were appointed were well equipped to deliver the role:

‘… we had the right people to execute these roles effectively really … we had quite a diverse selection panel … we had the right people that expressed the interest I think …’ (S5PWC).

There was evidence that PWs and PWCs – as intervention facilitators - had worked hard in delivering clinical team preparation sessions, as specified in the handbook, offering repeat sessions where necessary, and that this had supported a good relationship with ward teams:

‘… [in] the early days we went in to talk about ENRICH and then if they’d had significant staff turnover, which is really happening a lot … we’d then go back to the teams just so that they were aware of what ENRICH was about, what their role was … it certainly meant that staff were much more welcoming of the ENRICH peer workers when they came onto the wards.’ (S3PWC).

PWCs reported being well resourced in their leadership role, both in terms of having sufficient time to do the work and having sufficient supervision themselves around any difficult issues that might arise:

‘… [my role] was two days a week and that was plenty of time…’ (S3PWC). ‘I have had unconditional support from my manager … it’s been part of my regular monthly supervision … any kind of difficulties I’ve had or frustrations or whatever that has come up, that has been an ideal time to go through it. But I’ve also been supported to discuss things as and when they come up …’ (S5PWC).

In these sites, there was evidence that delivery of peer support was highly consistent with the manual. There was notable emphasis on flexible application of peer support, especially around pacing support in response to the individual’s needs, spending as much time as necessary alongside the participant to build a trusting relationship:

‘… it doesn’t necessarily follow a linear path a lot of the time. Sometimes, somebody might be having a really bad week and they actually want you to listen to what’s been going on for them … at the beginning, because you are getting to know the person as well, I think the kind of conversation you’d have is a bit more general … and then it might actually take a completely different path however many meetings down the line and they’ll actually go … “I haven’t told anyone about a particular issue, but I want to talk it through with you and see what you think”.’ (S3PW1).

PWs at these sites demonstrated confidence in taking a lead from the person they were supporting, consistent with the principles of choice and control that underpinned the intervention:

‘… I’m kind of getting to know things that they’re interested in and this is influencing where I signpost them to … it’s just about giving them the option and then they can make their own decision then whether they want to go, and again that’s putting them back in control, which is all about helping people to recover really and take control back of their lives.’ (S5PW2).

PWs also described learning from the people they were supporting, and the importance of validating their experiences, consistent with the principle of reciprocity in the underpinning framework:

‘There are people who I’m supporting who … realise that the medication is very important to them and that they will probably always be on it. So, I gain insight from that, just because maybe I found that medication in my own lived experience wasn’t particularly fantastic but for others it’s very important. So, you learn from other things … you’ve got to validate their experience because … they know what works for them and you can’t tell somebody else what will work for them …’ (S5PW1).

Implementation in low fidelity-low engagement cases

There was evidence of barriers to implementation in low fidelity-lowengagement cases. In both, PWs were employed in not-for-profit organisations, resulting in organisational context-related barriers to implementation. Resource issues impacted leadership of the intervention with, in one site, the organisation not having capacity to provide cover or suitable supervision for the PWC:

‘… we’ve had different staff line managing me over the past year because of maternity. But to be fair none of them really knew about ENRICH … there was nobody who could have covered my role here … it’s felt like a bit of pressure to continue doing it because I took a bit of time off … I couldn’t physically go out and do anything when I wasn’t well …’ (S6PWC).

Support for PWCs at these sites, including an Action Learning Set with other PWCs, was difficult to access because of lack of sufficient funding to travel to meetings:

‘I think the action learning sets worked really well … maybe they should have been planned for a bit more financially … because ultimately we had to go back to our Trust and say we need to find more money or I’m not going.’ (S4PWC).

Being outside of the NHS also created issues of access and authority for PWCs:

‘I would have thought there should be regular team meetings, but we never seemed to be able to get in on them … an additional disadvantage from being an organisation outside of the Trust …’ (S4PWC). ‘… it’s been difficult with the [NHS Trust], some of the staff there … I don’t want to say too much, but that’s been difficult.’ (S6PWC).

This extended to PWs being able to communicate with clinical teams about the people using:

‘A few times they didn’t want to talk to me because I didn’t have enough information for them … to establish who I was … I just wanted to know whether they were seeing [participant] or whether they’d stopped seeing him, and they wouldn’t tell me.’ (S4PW3).

At these sites there was, generally, a challenging relationship with ward-based clinical staff, potentially impacting on the initial relationship building phase of the peer support:

‘There were certainly, on that site, a lot of suspicious looks and “what on earth is this all about” type conversations. However much we tried to prepare the staff team, and we’d gone in and visited and talked to them all, but there was still that “what’s this all about”? People didn’t get it straight off.’ (S4PWC).

Cultural differences with the host NHS Trust were keenly felt by PWs employed in not-for-profit organisations:

‘… the ward environment is, well obviously it’s clinical. It sometimes feels some staff, but not all staff, who work on the wards are not really sure what my role is or have a vague understanding. There’s perhaps a little bit of a difference in terms of pecking order and me in the pecking order.’ (S6PW2). ‘… they will be looking at the patient’s files … they can build up a judgement before seeing you … when the patient sees the peer support worker they might talk to us because we’re non-judgemental, we don’t feedback unless there is a safeguarding issue or danger to themselves or others … I don’t think peers should be seeing files …’ (S4PW44).

Both sites also combined rural localities with urban areas, with issues of geography hindering timely delivery of peer support at remote hospital sites:

‘… the geography issue was a great challenge in itself in our area because I was one bit of the triangle and the [hospitals] were in two different places … I’d have had an hour or so travelling and then get there and “oh, they’re on leave until 10pm tonight”.’ (S4PWC).

Geography could also impact on building a strong sense of PW team:

‘I did lots of talking to [the PWC] but not so much my fellow peers. There was one fellow peer that I talk quite a lot to … the other two were very close to each other and so they were almost functioning as one … I got on OK with the people at [the other town] … it’s just that we had differences of opinion.’ (S4PW3).

There was some inconsistent delivery of training, with one PW reporting having received a truncated version of the training programme as a result of capacity issues:

‘I didn’t actually do [the full training] … because I was covering a maternity leave it was the girl did all the training. So, I basically had a morning with the coordinator where we went through the whole bumph together … ’ (S6PW3).

While the importance of group supervision was acknowledged in these sites, there was disruption leading to inconsistency with the pattern of weekly group supervision as a result geography in one site, and capacity in the other:

‘We don’t generally do weekly anymore … generally we do monthly although I check in by phone with them.’ (S4PWC). ‘… a lot of the supervision has ended up being one-to-one just because it’s a small team here … sometimes I would be able to meet with them together but often because my day, I’ve only got one a day week, I’d have to fit them in if one of them couldn’t do it that day …’ (S6PWC).

Possibly as a result of disruption to supervision or opportunities to support each other as a team, PWs at these sites at times appeared to lack confidence in delivering peer support:

‘… it made me feel that I was getting it all wrong … she didn’t really talk at all about, and I felt that I couldn’t, I just felt that I had to wait for her to give information to me … because that’s what I understood you are supposed to do, is wait for them to give you information to talk about their problems …’ (S4PW3). ‘… I’m imagining it’s going to be quite hard for a long time because the expression that I’ve used that comes to mind is pulling teeth. It’s going to be probably like that every time we meet … it is frustrating because you want to help them.’ (S6PW2).

Implementation in the outlier high fidelity-low engagement case

The outlier case shared contrasting sets of features with the other cases. Like high fidelity and engagement sites, the outlier case reported feedback from management describing a positive impact of peer support on culture in the NHS trust:

‘… within senior management they’ve seen the power of peer working and they really like it … we’re in discussions on when ENRICH finishes, that we’re going to have a number of peer workers within teams, exactly to try and change the nature and change the culture …’ (S2PWC).

PWs in this site also demonstrated a more confident, patient approach to relationship building:

‘… trying to build that friendly rapport, getting them to trust you, showing them that you understand them in a way … creating that safe space environment for them to be able to talk about how they are feeling or what’s going on for them … just finding out what they want to do for themselves not someone else telling them what to do … ’ (S2PW0).

However, as in the two low fidelity-low engagement cases, in the outlier site barriers to implementation included a challenging relationship with ward staff:

‘… [I feel] looked down upon sometimes, “oh, you’re just a peer support worker” … it’s the environment. The days that I do go for ward meetings are usually the days I need a long break, I’ll be honest with you …’ (S2PW2).

In this site there was also disruption to group supervision, with some PWs needing considerable additional support from the PWC and a challenging team dynamic emerging:

‘I was definitely doing weekly one-to-one supervisions with the peer workers when they first started … it kind of came apparent that it was what people needed … for me it didn’t work very well, I was exhausted … people want one-to-one sessions to talk about colleagues and issues they are having with their colleagues … I think there are two other peer workers who are less, they don’t see themselves as much as part of the team.’ (S2PWC).

The PWC indicated that they would have benefitted from additional support for their role:

‘I feel like we could have done more support around, more training kind of stuff on managing people with lived experience … … maybe one thing would have been more meetings with other peer worker coordinators and just see how other people are doing it … more guidance on what group supervision actually was … ’ (S2PWC).

This study used a qualitative, comparative case study design to explore how implementation of a peer support intervention might be associated with engagement with peer support and, as indicated in results elsewhere, [ 26 ] with outcomes. We noted clear differences related to organisational context between high fidelity-high engagement cases and low fidelity-low engagement cases. Lack of a positive working relationship between PW and ward (inpatient) clinical teams, exacerbated by lack of awareness of the potential role of peer support, is likely to be crucial to engagement where people begin peer support in hospital. Levels of engagement were highest in cases where those relationships were reported as largely positive and where differences in approach (between clinical practice and peer support) were highly valued [ 6 , 35 ].

We note that the two low fidelity-low engagement sites employed PWs in the not-for-profit sector rather than within the NHS. Elsewhere, research has indicated that the principles underpinning peer support might be better maintained within peer-led or not-for-profit organisations, [ 7 ] and that doing so might provide an opportunity to bring a change of culture into statutory services [ 35 ]. However, we observed constraints on resourcing for leadership roles, and lack of access and authority for managers in the not-for-profit sector, compounded, perhaps coincidentally, by the additional challenges of geography. Neither did we observe, in those sites, evidence of leadership for peer support from within the host NHS organisation that might have facilitated better implementation [ 36 ]. In our outlier high fidelity-low engagement case, resourcing for leadership also impacted support for PWs. Proper resourcing for PWCs has been identified elsewhere as crucial to providing good peer support [ 5 , 37 ]. PWCs at sites that struggled with levels of engagement identified the need for a wider network of mutual support beyond their immediate organisation, with work elsewhere highlighting the need to develop communities of practice around lived experience leadership roles in mental health services [ 38 , 39 ]. As such, our findings reinforce the link that has been observed elsewhere between leadership in implementation, and the outcomes of a newly implemented intervention [ 40 ].

At the two high engagement-high fidelity sites, PWCs noted that robust recruitment processes resulted in a PW team that were well equipped to deliver what was a challenging role. An experience of the PW team as mutually supportive, complemented with group supervision led by a PWC bringing experiential knowledge to their role, was identified as important at all five sites included in our analysis, as it is in the wider literature [ 2 , 5 ]. The PW training programme was equally valued across all sites with PWs indicating that it prepared them well for their roles. Again, the importance of training that is specifically tailored to peer support having been widely noted [ 3 , 4 ]. In sites where there were inconsistencies in delivery of supervision and training, this appeared to impact confidence among PWs in offering peer support that reflected the underpinning principles framework. Sites with high fidelity scores were indicative of a clear focus on relationship and trust building, characterised by spending time alongside the individual offered peer support, learning from them, before taking their lead in exploring new possibilities. These values have been identified as fundamental to peer support, [ 41 ] and our own analysis of data from the trial indicated that relationship building at the beginning of the peer support was predictive of ongoing engagement [ 42 ].

It is worth noting here that not all challenges to engaging people with the peer support were attributable to implementation issues. Across sites, interviewees felt that discharge from hospital was a challenging time for some people to consider taking up peer support. Other trials of peer support for discharge have also struggled in this respect, [ 43 ] especially where participants were those with a higher level of need (people with multiple admissions) as they were in our study [ 15 ].

Strengths and limitations

We employed a robust, theoretically informed comparative case study design, with case selection determined by a priori measures of fidelity [ 31 ] and engagement [ 26 ] made independently of this analysis. We analysed a complete data set – interviews of PWs and PWCs – in all sites included in the analysis, although we might usefully have also interviewed NHS clinicians and managers as they also played a role in implementation. Analysis of in-depth interviews exploring the experiences of people offered peer support will be reported elsewhere. Our original interview schedules were not directly informed by the PAHRIS framework [ 22 ] and so may not have elicited a full range of data relating to implementation variables. Other frameworks might have been indicative of different barriers and facilitators of successful implementation. Nevertheless, we note the work adapting the PAHRIS framework to elucidate the role of experiential knowledge in implementation was particularly suited to a study of peer support and informed by lived experience on the research team [ 25 ].

Implications for policy, practice and research

Mental health workforce policy in England, as elsewhere, is encouraging employment of large numbers of PWs into mental health services.[ 44 ]. A range of training programmes have emerged [ 45 ] that, to some degree, share a set of principles similar to those that informed ENRICH. This study suggests that specific supports for PWs need to be properly resourced as integral to the offer of peer support in mental health services. These include supervision from an experienced PW, opportunities for group supervision, and an emphasis on relationship building in PW training that is consistent with a principles-based peer support framework. While it has been suggested that peer support can drive cultural change in mental health provider organisations, [ 46 ] our research suggests that lack of supportive culture can constrain delivery. Peer leadership, provided with sufficient support and authority, is needed to support change work with clinical teams, in hospital and in the community, so that peer support and clinical care are part of a complementary offer.

This study identifies policy and practice implications when peers are employed through not-for-profit organisations to work in partnership with public mental health providers. Research elsewhere highlights the potential challenges and opportunities of this ‘hybrid’ approach, [ 35 , 47 ] indicating a need for strategies that effectively align implementation expectations between the not-for-profit organisation and the mental health provider.

Further research to develop and evaluate the introduction of peer support in mental health might usefully be informed by a change model that incorporates this range of implementation variables to optimise delivery of peer support. We also note that in our study, PWs were employed to, and supervised within a dedicated PW team that provided peer support across several clinical teams, while in many mental health services internationally PWs are employed as embedded members of multi-disciplinary clinical teams. There is a need for research that considers the implications for implementation and outcome of these contrasting organisational configurations.

This study provides clear indication that implementation issues can impact delivery of peer support, with implications for engagement and, potentially, outcomes. Resourcing can impact consistency of delivery, alongside challenges of access, authority and relationship with clinical teams, especially where PWs are employed outside of the mental health service. Attention needs to be paid to the impact of geography on implementation.

Data availability

The datasets used and analysed during the current study are available from the corresponding author on reasonable request.

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This study was funded by the UK National Institute for Health Research (NIHR), Programme Grants for Applied Research funding programme (grant number RP-PG-1212-20019). This paper presents independent research funded by NIHR. The views expressed are those of the authors and not necessarily those of the UK National Health Service (NHS), the NIHR or the Department of Health and Social Care.

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SG, SW, SLG, AlS, ML, JR, MR and JW contributed to the conception of the original study. SG, RF, SW, RB, PB, RE, DH, AlS and AnS contributed to the design of the work reported here. SG, RF, SW, RB, RE, AlS, ML, JR, MR and JW contributed to interpretation of the data. SG, RF, SW and JM contributed to the acquisition and analysis of data. SG, RF and SW drafted and substantively revised the work. All authors approved the submitted version of the study.

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Correspondence to Steve Gillard .

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Gillard, S., Foster, R., White, S. et al. Implementing peer support into practice in mental health services: a qualitative comparative case study. BMC Health Serv Res 24 , 1050 (2024). https://doi.org/10.1186/s12913-024-11447-5

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Received : 24 May 2024

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DOI : https://doi.org/10.1186/s12913-024-11447-5

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• Peer support
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