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Understanding the Case Study Method in Sociology

In the field of sociology, researchers employ various methods to study and understand social phenomena. One such method is the case study. A case study is an in-depth investigation of a particular individual, group, or event, aiming to provide a comprehensive understanding of the subject matter. In this article, we will outline and explain the case study method in sociology and its significance in social research.

Defining the Case Study Method

The case study method involves the detailed examination of a single case or a small number of cases. It is a qualitative research method that focuses on understanding the complexities and intricacies of a particular social phenomenon. Researchers using the case study method collect and analyze a wide range of data, including interviews, observations, documents, and artifacts, to gain a holistic understanding of the case under investigation.

Case studies can be conducted in various social contexts, such as educational institutions, communities, organizations, or even entire societies. The subjects of study can be individuals, groups, or events that are considered representative or unique in some way.

Purposes of Case Studies in Sociology

Case studies serve several purposes in sociological research:

1. Exploratory Purposes

Case studies can be used to explore new or emerging social phenomena that have not been extensively studied before. By conducting in-depth investigations, researchers can generate new insights and theories about the subject matter.

2. Descriptive Purposes

Case studies can provide rich and detailed descriptions of specific social situations or events. They allow researchers to capture the complexity and uniqueness of a case, providing a comprehensive account of the social dynamics at play.

3. Explanatory Purposes

Case studies can help researchers understand the underlying causes and mechanisms behind social phenomena. By analyzing various aspects of a case, researchers can identify patterns, relationships, and factors that contribute to the observed outcomes.

4. Theory Testing and Development

Case studies can be used to test existing sociological theories or develop new ones. By examining a specific case in light of theoretical frameworks, researchers can evaluate the applicability and validity of these theories.

Steps Involved in Conducting a Case Study

The process of conducting a case study in sociology typically involves the following steps:

1. Selecting a Case

Researchers must carefully choose a case that is relevant to their research question and aligns with their research objectives. The case should provide sufficient depth and complexity to explore the desired aspects of the social phenomenon under investigation.

2. Collecting Data

Data collection in case studies involves a combination of methods, including interviews, observations, and document analysis. Researchers may conduct interviews with key individuals involved in the case, observe the case in its natural setting, and analyze relevant documents and artifacts.

3. Analyzing Data

Once the data is collected, researchers analyze it to identify patterns, themes, and relationships. They may use various analytical frameworks, such as content analysis or thematic analysis, to make sense of the data and draw meaningful conclusions.

4. Drawing Conclusions

Based on the analysis of the data, researchers draw conclusions about the case under investigation. These conclusions should be supported by evidence and contribute to the existing body of sociological knowledge.

5. Generalizing Findings

While case studies focus on specific cases, researchers may attempt to generalize their findings to broader contexts or populations. However, it is important to note that generalizability in case studies is limited, and findings are often context-specific.

Advantages and Limitations of Case Studies

Case studies offer several advantages in sociological research:

• They provide rich and detailed insights into complex social phenomena.
• They allow researchers to explore new or unique cases.
• They facilitate theory testing and development.
• They offer a holistic and in-depth understanding of the subject matter.

However, case studies also have limitations:

• They are time-consuming and resource-intensive.
• They may suffer from researcher bias or subjectivity.
• Their findings may lack generalizability to broader populations.
• They do not provide causal explanations but rather focus on descriptive and explanatory aspects.

The case study method is a valuable tool in sociology for exploring, describing, explaining, and testing social phenomena. By conducting in-depth investigations of specific cases, researchers can gain a comprehensive understanding of the complexities and dynamics of the social world. While case studies have their limitations, they offer unique insights that contribute to the broader field of sociological knowledge.

Mr Edwards has a PhD in sociology and 10 years of experience in sociological knowledge

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Conducting Case Study Research in Sociology

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A case study is a research method that relies on a single case rather than a population or sample. When researchers focus on a single case, they can make detailed observations over a long period of time, something that cannot be done with large samples without costing a lot of money. Case studies are also useful in the early stages of research when the goal is to explore ideas, test, and perfect measurement instruments, and to prepare for a larger study. The case study research method is popular not just within ​the field of sociology, but also within the fields of anthropology, psychology, education, political science, clinical science, social work, and administrative science.

Overview of the Case Study Research Method

A case study is unique within the social sciences for its focus of study on a single entity, which can be a person, group or organization, event, action, or situation. It is also unique in that, as a focus of research, a case is chosen for specific reasons, rather than randomly , as is usually done when conducting empirical research. Often, when researchers use the case study method, they focus on a case that is exceptional in some way because it is possible to learn a lot about social relationships and social forces when studying those things that deviate from norms. In doing so, a researcher is often able, through their study, to test the validity of the social theory, or to create new theories using the grounded theory method .

The first case studies in the social sciences were likely conducted by Pierre Guillaume Frédéric Le Play, a 19th-century French sociologist and economist who studied family budgets. The method has been used in sociology, psychology, and anthropology since the early 20th century.

Within sociology, case studies are typically conducted with qualitative research methods . They are considered micro rather than macro in nature , and one cannot necessarily generalize the findings of a case study to other situations. However, this is not a limitation of the method, but a strength. Through a case study based on ethnographic observation and interviews, among other methods, sociologists can illuminate otherwise hard to see and understand social relations, structures, and processes. In doing so, the findings of case studies often stimulate further research.

Types and Forms of Case Studies

There are three primary types of case studies: key cases, outlier cases, and local knowledge cases.

• Key cases are those which are chosen because the researcher has ​a particular interest in it or the circumstances surrounding it.
• Outlier cases are those that are chosen because the case stands out from other events, organizations, or situations, for some reason, and social scientists recognize that we can learn a lot from those things that differ from the norm .
• Finally, a researcher may decide to conduct a local knowledge case study when they already have amassed a usable amount of information about a given topic, person, organization, or event, and so is well-poised to conduct a study of it.

Within these types, a case study may take four different forms: illustrative, exploratory, cumulative, and critical.

• Illustrative case studies are descriptive in nature and designed to shed light on a particular situation, set of circumstances, and the social relations and processes that are embedded in them. They are useful in bringing to light something about which most people are not aware of.
• Exploratory case studies are also often known as pilot studies . This type of case study is typically used when a researcher wants to identify research questions and methods of study for a large, complex study. They are useful for clarifying the research process, which can help a researcher make the best use of time and resources in the larger study that will follow it.
• Cumulative case studies are those in which a researcher pulls together already completed case studies on a particular topic. They are useful in helping researchers to make generalizations from studies that have something in common.
• Critical instance case studies are conducted when a researcher wants to understand what happened with a unique event and/or to challenge commonly held assumptions about it that may be faulty due to a lack of critical understanding.

Whatever type and form of case study you decide to conduct, it's important to first identify the purpose, goals, and approach for conducting methodologically sound research.

• An Overview of Qualitative Research Methods
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• Definition of Idiographic and Nomothetic
• What Is Participant Observation Research?
• Understanding Secondary Data and How to Use It in Research
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• The Sociology of the Internet and Digital Sociology
• What Is Ethnography?
• The Different Types of Sampling Designs in Sociology
• Understanding Purposive Sampling
• Anthropology vs. Sociology: What's the Difference?
• What Is Naturalistic Observation? Definition and Examples
• Social Surveys: Questionnaires, Interviews, and Telephone Polls
• The Sociology of the Family Unit
• Units of Analysis as Related to Sociology
• Deductive Versus Inductive Reasoning

• First Online: 27 October 2022

Cite this chapter

• R. M. Channaveer 4 &
• Rajendra Baikady 5  

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This chapter reviews the strengths and limitations of case study as a research method in social sciences. It provides an account of an evidence base to justify why a case study is best suitable for some research questions and why not for some other research questions. Case study designing around the research context, defining the structure and modality, conducting the study, collecting the data through triangulation mode, analysing the data, and interpreting the data and theory building at the end give a holistic view of it. In addition, the chapter also focuses on the types of case study and when and where to use case study as a research method in social science research.

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Channaveer, R.M., Baikady, R. (2022). Case Study. In: Islam, M.R., Khan, N.A., Baikady, R. (eds) Principles of Social Research Methodology. Springer, Singapore. https://doi.org/10.1007/978-981-19-5441-2_21

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Exploring Real-life Contexts: Types and Applications of Case Studies

Table of Contents

Have you ever wondered how researchers uncover the intricate details of real-world phenomena? They often use a powerful tool called the case study . This method is like a high-resolution camera, zooming in on a subject to capture its essence in vivid detail. Case studies allow researchers to explore, explain, or describe a subject within its real-life context, revealing insights that might otherwise be lost in broader surveys or experiments. But not all case studies are created equal. They come in different types, each with a unique focus and purpose. Let’s dive into the world of case studies and discover how they help us understand complex issues one case at a time.

What is a case study?

At its core, a case study is an in-depth investigation of a single person, group, event, or community. It’s a research strategy that unpacks the dynamics of a case within its natural environment, often employing multiple sources of evidence. Case studies are particularly useful when the boundaries between the phenomenon being studied and its context are not clearly evident. They can offer a rich understanding of a subject, providing a nuanced perspective that quantitative methods may not capture.

Types of case studies

Case studies are not a one-size-fits-all approach. Depending on the research question and objectives, a case study can be classified into three main types: exploratory, explanatory, and descriptive. Each serves a distinct purpose, and choosing the right type is critical for achieving the research goals.

Exploratory case studies

Setting the stage for further research: Exploratory case studies are like the scouts of the research world. They are conducted when a researcher has identified a potential area of study but needs more information before developing a detailed research plan. These case studies help to identify questions, select measurement constructs, and develop hypotheses.

• When to use: Ideal in the early stages of a research project.
• Methods: Typically involves a flexible research design that can adapt as understanding deepens.
• Examples: A preliminary study of a start-up’s organizational culture or an initial look at a community affected by a new policy.

Explanatory case studies

Unraveling complexities: Explanatory case studies dig deeper into the causes and effects within a case. They are instrumental when a situation is too complex to be understood through a simple cause-and-effect analysis, and they typically address ‘how’ and ‘why’ questions.

• When to use: Suitable for clarifying complex interventions or processes.
• Methods: May employ longitudinal studies to observe outcomes over time.
• Examples: Investigating the success factors of a long-standing social program or analyzing the failure of a major construction project.

Descriptive case studies

Painting a detailed picture: Descriptive case studies are aptly named for their focus on describing the characteristics of a case within its context. These studies follow a structured protocol to ensure comprehensive coverage of all relevant aspects of the case.

• When to use: Ideal for providing a complete, systematic description of a phenomenon.
• Methods: Involves a detailed and in-depth approach, often with predefined data collection methods.
• Examples: A detailed account of a company’s approach to corporate social responsibility or the stages of development in a community-led conservation effort.

Conducting a case study

Embarking on a case study research project is not a decision to be taken lightly. It requires a systematic approach and a clear understanding of the research question. Here are the typical steps a researcher would follow:

Define and select the case

The first step is to identify and define the case that will be studied. This could be based on a unique characteristic, a representative quality, or a particular relevance to the research question. Once the case is selected, the researcher needs to explain why this case is important and what it can reveal about the larger issue.

Develop a theoretical framework

Next, a theoretical framework helps to guide the research. This involves reviewing the literature, identifying relevant theories, and formulating hypotheses or questions that the case study will address. This framework provides a lens through which the data will be interpreted.

Collect data

Data collection is a critical phase in case study research. Researchers may use interviews, observations, documents, and other sources to gather a full picture of the case. The data should be collected systematically and ethically, with a clear record of all sources and methods.

Analyze and interpret data

Once the data is collected, the researcher must organize, sift through, and make sense of it. This involves identifying patterns, crafting narratives, and drawing conclusions. The researcher must remain open to where the data leads, avoiding preconceived notions or biases.

Report findings

The final step is to communicate the findings to a broader audience. This involves crafting a narrative that is compelling and accessible, with clear explanations of how the data led to the conclusions. Visual aids, such as charts or diagrams, can help illustrate complex ideas.

Applications in various fields

Case studies are versatile and can be applied across numerous disciplines. In business, they can shed light on management practices or corporate strategies. In education, they can illustrate pedagogical approaches. In social sciences, they can offer insights into societal issues. And in health sciences, they can help understand patient experiences or treatment outcomes.

Challenges and considerations

While case studies are a valuable research method, they come with their own set of challenges. The depth of analysis required can be time-consuming and resource-intensive. Additionally, the findings from a single case may not be generalizable to other cases. Researchers must be careful to acknowledge these limitations and avoid overgeneralizations.

Case studies are a window into the complexities of real-life situations. They offer a depth of understanding that is invaluable for researchers across various fields. By selecting the appropriate type of case study and following a rigorous methodology, researchers can uncover the nuances and richness of any phenomenon they choose to explore.

What do you think? How might the insights gained from a well-conducted case study influence decisions in your field of interest? Can you think of a situation where a case study would be the ideal research approach?

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Research Methodologies & Methods

1 Logic of Inquiry in Social Research

• A Science of Society
• Comte’s Ideas on the Nature of Sociology
• Observation in Social Sciences
• Logical Understanding of Social Reality

2 Empirical Approach

• Empirical Approach
• Rules of Data Collection
• Cultural Relativism
• Problems Encountered in Data Collection
• Difference between Common Sense and Science
• What is Ethical?
• What is Normal?
• Understanding the Data Collected
• Managing Diversities in Social Research
• Problematising the Object of Study
• Conclusion: Return to Good Old Empirical Approach

3 Diverse Logic of Theory Building

• Concern with Theory in Sociology
• Concepts: Basic Elements of Theories
• Why Do We Need Theory?
• Hypothesis Description and Experimentation
• Controlled Experiment
• Designing an Experiment
• How to Test a Hypothesis
• Sensitivity to Alternative Explanations
• Rival Hypothesis Construction
• The Use and Scope of Social Science Theory
• Theory Building and Researcher’s Values

4 Theoretical Analysis

• Premises of Evolutionary and Functional Theories
• Critique of Evolutionary and Functional Theories
• Turning away from Functionalism
• What after Functionalism
• Post-modernism
• Trends other than Post-modernism

5 Issues of Epistemology

• Some Major Concerns of Epistemology
• Rationalism
• Phenomenology: Bracketing Experience

6 Philosophy of Social Science

• Foundations of Science
• Science, Modernity, and Sociology
• Rethinking Science
• Crisis in Foundation

7 Positivism and its Critique

• Heroic Science and Origin of Positivism
• Early Positivism
• Consolidation of Positivism
• Critiques of Positivism

8 Hermeneutics

• Methodological Disputes in the Social Sciences
• Tracing the History of Hermeneutics
• Hermeneutics and Sociology
• Philosophical Hermeneutics
• The Hermeneutics of Suspicion
• Phenomenology and Hermeneutics

9 Comparative Method

• Relationship with Common Sense; Interrogating Ideological Location
• The Historical Context
• Elements of the Comparative Approach

10 Feminist Approach

• Features of the Feminist Method
• Feminist Methods adopt the Reflexive Stance
• Feminist Discourse in India

11 Participatory Method

• Delineation of Key Features

12 Types of Research

• Basic and Applied Research
• Descriptive and Analytical Research
• Empirical and Exploratory Research
• Quantitative and Qualitative Research
• Explanatory (Causal) and Longitudinal Research
• Experimental and Evaluative Research
• Participatory Action Research

13 Methods of Research

• Evolutionary Method
• Comparative Method
• Historical Method
• Personal Documents

14 Elements of Research Design

• Structuring the Research Process

15 Sampling Methods and Estimation of Sample Size

• Classification of Sampling Methods
• Sample Size

16 Measures of Central Tendency

• Relationship between Mean, Mode, and Median
• Choosing a Measure of Central Tendency

17 Measures of Dispersion and Variability

• The Variance
• The Standard Deviation
• Coefficient of Variation

18 Statistical Inference- Tests of Hypothesis

• Statistical Inference
• Tests of Significance

19 Correlation and Regression

• Correlation
• Method of Calculating Correlation of Ungrouped Data
• Method Of Calculating Correlation Of Grouped Data

20 Survey Method

• Rationale of Survey Research Method
• History of Survey Research
• Defining Survey Research
• Sampling and Survey Techniques
• Operationalising Survey Research Tools
• Advantages and Weaknesses of Survey Research

21 Survey Design

• Preliminary Considerations
• Stages / Phases in Survey Research
• Formulation of Research Question
• Survey Research Designs
• Sampling Design

22 Survey Instrumentation

• Techniques/Instruments for Data Collection
• Questionnaire Construction
• Issues in Designing a Survey Instrument

23 Survey Execution and Data Analysis

• Problems and Issues in Executing Survey Research
• Data Analysis
• Ethical Issues in Survey Research

24 Field Research – I

• History of Field Research
• Ethnography
• Theme Selection
• Gaining Entry in the Field
• Key Informants
• Participant Observation

25 Field Research – II

• Interview its Types and Process
• Feminist and Postmodernist Perspectives on Interviewing
• Narrative Analysis
• Interpretation
• Case Study and its Types
• Life Histories
• Oral History
• PRA and RRA Techniques

26 Reliability, Validity and Triangulation

• Concepts of Reliability and Validity
• Three Types of “Reliability”
• Working Towards Reliability
• Procedural Validity
• Field Research as a Validity Check
• Method Appropriate Criteria
• Triangulation
• Ethical Considerations in Qualitative Research

27 Qualitative Data Formatting and Processing

• Qualitative Data Processing and Analysis
• Description
• Classification
• Making Connections
• Theoretical Coding
• Qualitative Content Analysis

28 Writing up Qualitative Data

• Problems of Writing Up
• Grasp and Then Render
• “Writing Down” and “Writing Up”
• Write Early
• Writing Styles
• First Draft

29 Using Internet and Word Processor

• What is Internet and How Does it Work?
• Internet Services
• Searching on the Web: Search Engines
• Accessing and Using Online Information
• Online Journals and Texts
• Statistical Reference Sites
• Data Sources
• Uses of E-mail Services in Research

30 Using SPSS for Data Analysis Contents

• Introduction
• Starting and Exiting SPSS
• Creating a Data File
• Univariate Analysis
• Bivariate Analysis

31 Using SPSS in Report Writing

• Why to Use SPSS
• Working with SPSS Output
• Copying SPSS Output to MS Word Document

32 Tabulation and Graphic Presentation- Case Studies

• Structure for Presentation of Research Findings
• Data Presentation: Editing, Coding, and Transcribing
• Case Studies
• Qualitative Data Analysis and Presentation through Software
• Types of ICT used for Research

33 Guidelines to Research Project Assignment

• Overview of Research Methodologies and Methods (MSO 002)
• Research Project Objectives
• Preparation for Research Project
• Stages of the Research Project
• Supervision During the Research Project
• Submission of Research Project
• Methodology for Evaluating Research Project

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Case Study Methods

• Jacques Hamel - University of Montreal, Canada
• Stephane Dufour - University of Montreal, Canada
• Dominic Fortin - University of Montreal, Canada
• Description

The use of the case study goes back to the beginnings of social science research and is still one of the most common forms of qualitative research. This book is a handy introduction to understanding, researching, and doing case studies in the social sciences and related fields. In this brief monograph, Jacques Hamel outlines several differing traditions of case study research—the Chicago School of Sociology, the anthropological case studies of Malinowski and others, and the French Le Play school tradition. Hamel shows how each developed, changed, and has been practiced over time. Practical suggestions are included for doing case study research and a comprehensive bibliography on case study methods in social science allows for further exploration.

See what’s new to this edition by selecting the Features tab on this page. Should you need additional information or have questions regarding the HEOA information provided for this title, including what is new to this edition, please email [email protected] . Please include your name, contact information, and the name of the title for which you would like more information. For information on the HEOA, please go to http://ed.gov/policy/highered/leg/hea08/index.html .

For assistance with your order: Please email us at [email protected] or connect with your SAGE representative.

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Detailed text, more suited to PG level students and those wanting a more 'philosophical' text. This book was originally published in French. It is a thought provoking book, and worthy of extended reading, but not really suitable for many UG level students. I have certainly found it to be a book which outlines concepts and sets out the parameters and contexts for using case studies. Intriguing indeed!

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This title is also available on SAGE Research Methods , the ultimate digital methods library. If your library doesn’t have access, ask your librarian to start a trial .

Organizing Your Social Sciences Research Assignments

• Annotated Bibliography
• Analyzing a Scholarly Journal Article
• Group Presentations
• Dealing with Nervousness
• Using Visual Aids
• Grading Someone Else's Paper
• Types of Structured Group Activities
• Group Project Survival Skills
• Leading a Class Discussion
• Multiple Book Review Essay
• Reviewing Collected Works
• Writing a Case Analysis Paper
• Writing a Case Study
• About Informed Consent
• Writing Field Notes
• Writing a Policy Memo
• Writing a Reflective Paper
• Writing a Research Proposal
• Generative AI and Writing
• Acknowledgments

A case study research paper examines a person, place, event, condition, phenomenon, or other type of subject of analysis in order to extrapolate  key themes and results that help predict future trends, illuminate previously hidden issues that can be applied to practice, and/or provide a means for understanding an important research problem with greater clarity. A case study research paper usually examines a single subject of analysis, but case study papers can also be designed as a comparative investigation that shows relationships between two or more subjects. The methods used to study a case can rest within a quantitative, qualitative, or mixed-method investigative paradigm.

Case Studies. Writing@CSU. Colorado State University; Mills, Albert J. , Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010 ; “What is a Case Study?” In Swanborn, Peter G. Case Study Research: What, Why and How? London: SAGE, 2010.

How to Approach Writing a Case Study Research Paper

General information about how to choose a topic to investigate can be found under the " Choosing a Research Problem " tab in the Organizing Your Social Sciences Research Paper writing guide. Review this page because it may help you identify a subject of analysis that can be investigated using a case study design.

However, identifying a case to investigate involves more than choosing the research problem . A case study encompasses a problem contextualized around the application of in-depth analysis, interpretation, and discussion, often resulting in specific recommendations for action or for improving existing conditions. As Seawright and Gerring note, practical considerations such as time and access to information can influence case selection, but these issues should not be the sole factors used in describing the methodological justification for identifying a particular case to study. Given this, selecting a case includes considering the following:

• The case represents an unusual or atypical example of a research problem that requires more in-depth analysis? Cases often represent a topic that rests on the fringes of prior investigations because the case may provide new ways of understanding the research problem. For example, if the research problem is to identify strategies to improve policies that support girl's access to secondary education in predominantly Muslim nations, you could consider using Azerbaijan as a case study rather than selecting a more obvious nation in the Middle East. Doing so may reveal important new insights into recommending how governments in other predominantly Muslim nations can formulate policies that support improved access to education for girls.
• The case provides important insight or illuminate a previously hidden problem? In-depth analysis of a case can be based on the hypothesis that the case study will reveal trends or issues that have not been exposed in prior research or will reveal new and important implications for practice. For example, anecdotal evidence may suggest drug use among homeless veterans is related to their patterns of travel throughout the day. Assuming prior studies have not looked at individual travel choices as a way to study access to illicit drug use, a case study that observes a homeless veteran could reveal how issues of personal mobility choices facilitate regular access to illicit drugs. Note that it is important to conduct a thorough literature review to ensure that your assumption about the need to reveal new insights or previously hidden problems is valid and evidence-based.
• The case challenges and offers a counter-point to prevailing assumptions? Over time, research on any given topic can fall into a trap of developing assumptions based on outdated studies that are still applied to new or changing conditions or the idea that something should simply be accepted as "common sense," even though the issue has not been thoroughly tested in current practice. A case study analysis may offer an opportunity to gather evidence that challenges prevailing assumptions about a research problem and provide a new set of recommendations applied to practice that have not been tested previously. For example, perhaps there has been a long practice among scholars to apply a particular theory in explaining the relationship between two subjects of analysis. Your case could challenge this assumption by applying an innovative theoretical framework [perhaps borrowed from another discipline] to explore whether this approach offers new ways of understanding the research problem. Taking a contrarian stance is one of the most important ways that new knowledge and understanding develops from existing literature.
• The case provides an opportunity to pursue action leading to the resolution of a problem? Another way to think about choosing a case to study is to consider how the results from investigating a particular case may result in findings that reveal ways in which to resolve an existing or emerging problem. For example, studying the case of an unforeseen incident, such as a fatal accident at a railroad crossing, can reveal hidden issues that could be applied to preventative measures that contribute to reducing the chance of accidents in the future. In this example, a case study investigating the accident could lead to a better understanding of where to strategically locate additional signals at other railroad crossings so as to better warn drivers of an approaching train, particularly when visibility is hindered by heavy rain, fog, or at night.
• The case offers a new direction in future research? A case study can be used as a tool for an exploratory investigation that highlights the need for further research about the problem. A case can be used when there are few studies that help predict an outcome or that establish a clear understanding about how best to proceed in addressing a problem. For example, after conducting a thorough literature review [very important!], you discover that little research exists showing the ways in which women contribute to promoting water conservation in rural communities of east central Africa. A case study of how women contribute to saving water in a rural village of Uganda can lay the foundation for understanding the need for more thorough research that documents how women in their roles as cooks and family caregivers think about water as a valuable resource within their community. This example of a case study could also point to the need for scholars to build new theoretical frameworks around the topic [e.g., applying feminist theories of work and family to the issue of water conservation].

Eisenhardt, Kathleen M. “Building Theories from Case Study Research.” Academy of Management Review 14 (October 1989): 532-550; Emmel, Nick. Sampling and Choosing Cases in Qualitative Research: A Realist Approach . Thousand Oaks, CA: SAGE Publications, 2013; Gerring, John. “What Is a Case Study and What Is It Good for?” American Political Science Review 98 (May 2004): 341-354; Mills, Albert J. , Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010; Seawright, Jason and John Gerring. "Case Selection Techniques in Case Study Research." Political Research Quarterly 61 (June 2008): 294-308.

Structure and Writing Style

The purpose of a paper in the social sciences designed around a case study is to thoroughly investigate a subject of analysis in order to reveal a new understanding about the research problem and, in so doing, contributing new knowledge to what is already known from previous studies. In applied social sciences disciplines [e.g., education, social work, public administration, etc.], case studies may also be used to reveal best practices, highlight key programs, or investigate interesting aspects of professional work.

In general, the structure of a case study research paper is not all that different from a standard college-level research paper. However, there are subtle differences you should be aware of. Here are the key elements to organizing and writing a case study research paper.

I.  Introduction

As with any research paper, your introduction should serve as a roadmap for your readers to ascertain the scope and purpose of your study . The introduction to a case study research paper, however, should not only describe the research problem and its significance, but you should also succinctly describe why the case is being used and how it relates to addressing the problem. The two elements should be linked. With this in mind, a good introduction answers these four questions:

• What is being studied? Describe the research problem and describe the subject of analysis [the case] you have chosen to address the problem. Explain how they are linked and what elements of the case will help to expand knowledge and understanding about the problem.
• Why is this topic important to investigate? Describe the significance of the research problem and state why a case study design and the subject of analysis that the paper is designed around is appropriate in addressing the problem.
• What did we know about this topic before I did this study? Provide background that helps lead the reader into the more in-depth literature review to follow. If applicable, summarize prior case study research applied to the research problem and why it fails to adequately address the problem. Describe why your case will be useful. If no prior case studies have been used to address the research problem, explain why you have selected this subject of analysis.
• How will this study advance new knowledge or new ways of understanding? Explain why your case study will be suitable in helping to expand knowledge and understanding about the research problem.

Each of these questions should be addressed in no more than a few paragraphs. Exceptions to this can be when you are addressing a complex research problem or subject of analysis that requires more in-depth background information.

II.  Literature Review

The literature review for a case study research paper is generally structured the same as it is for any college-level research paper. The difference, however, is that the literature review is focused on providing background information and  enabling historical interpretation of the subject of analysis in relation to the research problem the case is intended to address . This includes synthesizing studies that help to:

• Place relevant works in the context of their contribution to understanding the case study being investigated . This would involve summarizing studies that have used a similar subject of analysis to investigate the research problem. If there is literature using the same or a very similar case to study, you need to explain why duplicating past research is important [e.g., conditions have changed; prior studies were conducted long ago, etc.].
• Describe the relationship each work has to the others under consideration that informs the reader why this case is applicable . Your literature review should include a description of any works that support using the case to investigate the research problem and the underlying research questions.
• Identify new ways to interpret prior research using the case study . If applicable, review any research that has examined the research problem using a different research design. Explain how your use of a case study design may reveal new knowledge or a new perspective or that can redirect research in an important new direction.
• Resolve conflicts amongst seemingly contradictory previous studies . This refers to synthesizing any literature that points to unresolved issues of concern about the research problem and describing how the subject of analysis that forms the case study can help resolve these existing contradictions.
• Point the way in fulfilling a need for additional research . Your review should examine any literature that lays a foundation for understanding why your case study design and the subject of analysis around which you have designed your study may reveal a new way of approaching the research problem or offer a perspective that points to the need for additional research.
• Expose any gaps that exist in the literature that the case study could help to fill . Summarize any literature that not only shows how your subject of analysis contributes to understanding the research problem, but how your case contributes to a new way of understanding the problem that prior research has failed to do.
• Locate your own research within the context of existing literature [very important!] . Collectively, your literature review should always place your case study within the larger domain of prior research about the problem. The overarching purpose of reviewing pertinent literature in a case study paper is to demonstrate that you have thoroughly identified and synthesized prior studies in relation to explaining the relevance of the case in addressing the research problem.

III.  Method

In this section, you explain why you selected a particular case [i.e., subject of analysis] and the strategy you used to identify and ultimately decide that your case was appropriate in addressing the research problem. The way you describe the methods used varies depending on the type of subject of analysis that constitutes your case study.

If your subject of analysis is an incident or event . In the social and behavioral sciences, the event or incident that represents the case to be studied is usually bounded by time and place, with a clear beginning and end and with an identifiable location or position relative to its surroundings. The subject of analysis can be a rare or critical event or it can focus on a typical or regular event. The purpose of studying a rare event is to illuminate new ways of thinking about the broader research problem or to test a hypothesis. Critical incident case studies must describe the method by which you identified the event and explain the process by which you determined the validity of this case to inform broader perspectives about the research problem or to reveal new findings. However, the event does not have to be a rare or uniquely significant to support new thinking about the research problem or to challenge an existing hypothesis. For example, Walo, Bull, and Breen conducted a case study to identify and evaluate the direct and indirect economic benefits and costs of a local sports event in the City of Lismore, New South Wales, Australia. The purpose of their study was to provide new insights from measuring the impact of a typical local sports event that prior studies could not measure well because they focused on large "mega-events." Whether the event is rare or not, the methods section should include an explanation of the following characteristics of the event: a) when did it take place; b) what were the underlying circumstances leading to the event; and, c) what were the consequences of the event in relation to the research problem.

If your subject of analysis is a person. Explain why you selected this particular individual to be studied and describe what experiences they have had that provide an opportunity to advance new understandings about the research problem. Mention any background about this person which might help the reader understand the significance of their experiences that make them worthy of study. This includes describing the relationships this person has had with other people, institutions, and/or events that support using them as the subject for a case study research paper. It is particularly important to differentiate the person as the subject of analysis from others and to succinctly explain how the person relates to examining the research problem [e.g., why is one politician in a particular local election used to show an increase in voter turnout from any other candidate running in the election]. Note that these issues apply to a specific group of people used as a case study unit of analysis [e.g., a classroom of students].

If your subject of analysis is a place. In general, a case study that investigates a place suggests a subject of analysis that is unique or special in some way and that this uniqueness can be used to build new understanding or knowledge about the research problem. A case study of a place must not only describe its various attributes relevant to the research problem [e.g., physical, social, historical, cultural, economic, political], but you must state the method by which you determined that this place will illuminate new understandings about the research problem. It is also important to articulate why a particular place as the case for study is being used if similar places also exist [i.e., if you are studying patterns of homeless encampments of veterans in open spaces, explain why you are studying Echo Park in Los Angeles rather than Griffith Park?]. If applicable, describe what type of human activity involving this place makes it a good choice to study [e.g., prior research suggests Echo Park has more homeless veterans].

If your subject of analysis is a phenomenon. A phenomenon refers to a fact, occurrence, or circumstance that can be studied or observed but with the cause or explanation to be in question. In this sense, a phenomenon that forms your subject of analysis can encompass anything that can be observed or presumed to exist but is not fully understood. In the social and behavioral sciences, the case usually focuses on human interaction within a complex physical, social, economic, cultural, or political system. For example, the phenomenon could be the observation that many vehicles used by ISIS fighters are small trucks with English language advertisements on them. The research problem could be that ISIS fighters are difficult to combat because they are highly mobile. The research questions could be how and by what means are these vehicles used by ISIS being supplied to the militants and how might supply lines to these vehicles be cut off? How might knowing the suppliers of these trucks reveal larger networks of collaborators and financial support? A case study of a phenomenon most often encompasses an in-depth analysis of a cause and effect that is grounded in an interactive relationship between people and their environment in some way.

NOTE:   The choice of the case or set of cases to study cannot appear random. Evidence that supports the method by which you identified and chose your subject of analysis should clearly support investigation of the research problem and linked to key findings from your literature review. Be sure to cite any studies that helped you determine that the case you chose was appropriate for examining the problem.

IV.  Discussion

The main elements of your discussion section are generally the same as any research paper, but centered around interpreting and drawing conclusions about the key findings from your analysis of the case study. Note that a general social sciences research paper may contain a separate section to report findings. However, in a paper designed around a case study, it is common to combine a description of the results with the discussion about their implications. The objectives of your discussion section should include the following:

Reiterate the Research Problem/State the Major Findings Briefly reiterate the research problem you are investigating and explain why the subject of analysis around which you designed the case study were used. You should then describe the findings revealed from your study of the case using direct, declarative, and succinct proclamation of the study results. Highlight any findings that were unexpected or especially profound.

Explain the Meaning of the Findings and Why They are Important Systematically explain the meaning of your case study findings and why you believe they are important. Begin this part of the section by repeating what you consider to be your most important or surprising finding first, then systematically review each finding. Be sure to thoroughly extrapolate what your analysis of the case can tell the reader about situations or conditions beyond the actual case that was studied while, at the same time, being careful not to misconstrue or conflate a finding that undermines the external validity of your conclusions.

Relate the Findings to Similar Studies No study in the social sciences is so novel or possesses such a restricted focus that it has absolutely no relation to previously published research. The discussion section should relate your case study results to those found in other studies, particularly if questions raised from prior studies served as the motivation for choosing your subject of analysis. This is important because comparing and contrasting the findings of other studies helps support the overall importance of your results and it highlights how and in what ways your case study design and the subject of analysis differs from prior research about the topic.

Consider Alternative Explanations of the Findings Remember that the purpose of social science research is to discover and not to prove. When writing the discussion section, you should carefully consider all possible explanations revealed by the case study results, rather than just those that fit your hypothesis or prior assumptions and biases. Be alert to what the in-depth analysis of the case may reveal about the research problem, including offering a contrarian perspective to what scholars have stated in prior research if that is how the findings can be interpreted from your case.

Acknowledge the Study's Limitations You can state the study's limitations in the conclusion section of your paper but describing the limitations of your subject of analysis in the discussion section provides an opportunity to identify the limitations and explain why they are not significant. This part of the discussion section should also note any unanswered questions or issues your case study could not address. More detailed information about how to document any limitations to your research can be found here .

Suggest Areas for Further Research Although your case study may offer important insights about the research problem, there are likely additional questions related to the problem that remain unanswered or findings that unexpectedly revealed themselves as a result of your in-depth analysis of the case. Be sure that the recommendations for further research are linked to the research problem and that you explain why your recommendations are valid in other contexts and based on the original assumptions of your study.

V.  Conclusion

As with any research paper, you should summarize your conclusion in clear, simple language; emphasize how the findings from your case study differs from or supports prior research and why. Do not simply reiterate the discussion section. Provide a synthesis of key findings presented in the paper to show how these converge to address the research problem. If you haven't already done so in the discussion section, be sure to document the limitations of your case study and any need for further research.

The function of your paper's conclusion is to: 1) reiterate the main argument supported by the findings from your case study; 2) state clearly the context, background, and necessity of pursuing the research problem using a case study design in relation to an issue, controversy, or a gap found from reviewing the literature; and, 3) provide a place to persuasively and succinctly restate the significance of your research problem, given that the reader has now been presented with in-depth information about the topic.

Consider the following points to help ensure your conclusion is appropriate:

• If the argument or purpose of your paper is complex, you may need to summarize these points for your reader.
• If prior to your conclusion, you have not yet explained the significance of your findings or if you are proceeding inductively, use the conclusion of your paper to describe your main points and explain their significance.
• Move from a detailed to a general level of consideration of the case study's findings that returns the topic to the context provided by the introduction or within a new context that emerges from your case study findings.

Note that, depending on the discipline you are writing in or the preferences of your professor, the concluding paragraph may contain your final reflections on the evidence presented as it applies to practice or on the essay's central research problem. However, the nature of being introspective about the subject of analysis you have investigated will depend on whether you are explicitly asked to express your observations in this way.

Problems to Avoid

Overgeneralization One of the goals of a case study is to lay a foundation for understanding broader trends and issues applied to similar circumstances. However, be careful when drawing conclusions from your case study. They must be evidence-based and grounded in the results of the study; otherwise, it is merely speculation. Looking at a prior example, it would be incorrect to state that a factor in improving girls access to education in Azerbaijan and the policy implications this may have for improving access in other Muslim nations is due to girls access to social media if there is no documentary evidence from your case study to indicate this. There may be anecdotal evidence that retention rates were better for girls who were engaged with social media, but this observation would only point to the need for further research and would not be a definitive finding if this was not a part of your original research agenda.

Failure to Document Limitations No case is going to reveal all that needs to be understood about a research problem. Therefore, just as you have to clearly state the limitations of a general research study , you must describe the specific limitations inherent in the subject of analysis. For example, the case of studying how women conceptualize the need for water conservation in a village in Uganda could have limited application in other cultural contexts or in areas where fresh water from rivers or lakes is plentiful and, therefore, conservation is understood more in terms of managing access rather than preserving access to a scarce resource.

Failure to Extrapolate All Possible Implications Just as you don't want to over-generalize from your case study findings, you also have to be thorough in the consideration of all possible outcomes or recommendations derived from your findings. If you do not, your reader may question the validity of your analysis, particularly if you failed to document an obvious outcome from your case study research. For example, in the case of studying the accident at the railroad crossing to evaluate where and what types of warning signals should be located, you failed to take into consideration speed limit signage as well as warning signals. When designing your case study, be sure you have thoroughly addressed all aspects of the problem and do not leave gaps in your analysis that leave the reader questioning the results.

Case Studies. Writing@CSU. Colorado State University; Gerring, John. Case Study Research: Principles and Practices . New York: Cambridge University Press, 2007; Merriam, Sharan B. Qualitative Research and Case Study Applications in Education . Rev. ed. San Francisco, CA: Jossey-Bass, 1998; Miller, Lisa L. “The Use of Case Studies in Law and Social Science Research.” Annual Review of Law and Social Science 14 (2018): TBD; Mills, Albert J., Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010; Putney, LeAnn Grogan. "Case Study." In Encyclopedia of Research Design , Neil J. Salkind, editor. (Thousand Oaks, CA: SAGE Publications, 2010), pp. 116-120; Simons, Helen. Case Study Research in Practice . London: SAGE Publications, 2009;  Kratochwill,  Thomas R. and Joel R. Levin, editors. Single-Case Research Design and Analysis: New Development for Psychology and Education .  Hilldsale, NJ: Lawrence Erlbaum Associates, 1992; Swanborn, Peter G. Case Study Research: What, Why and How? London : SAGE, 2010; Yin, Robert K. Case Study Research: Design and Methods . 6th edition. Los Angeles, CA, SAGE Publications, 2014; Walo, Maree, Adrian Bull, and Helen Breen. “Achieving Economic Benefits at Local Events: A Case Study of a Local Sports Event.” Festival Management and Event Tourism 4 (1996): 95-106.

Writing Tip

At Least Five Misconceptions about Case Study Research

Social science case studies are often perceived as limited in their ability to create new knowledge because they are not randomly selected and findings cannot be generalized to larger populations. Flyvbjerg examines five misunderstandings about case study research and systematically "corrects" each one. To quote, these are:

Misunderstanding 1 :  General, theoretical [context-independent] knowledge is more valuable than concrete, practical [context-dependent] knowledge. Misunderstanding 2 :  One cannot generalize on the basis of an individual case; therefore, the case study cannot contribute to scientific development. Misunderstanding 3 :  The case study is most useful for generating hypotheses; that is, in the first stage of a total research process, whereas other methods are more suitable for hypotheses testing and theory building. Misunderstanding 4 :  The case study contains a bias toward verification, that is, a tendency to confirm the researcher’s preconceived notions. Misunderstanding 5 :  It is often difficult to summarize and develop general propositions and theories on the basis of specific case studies [p. 221].

While writing your paper, think introspectively about how you addressed these misconceptions because to do so can help you strengthen the validity and reliability of your research by clarifying issues of case selection, the testing and challenging of existing assumptions, the interpretation of key findings, and the summation of case outcomes. Think of a case study research paper as a complete, in-depth narrative about the specific properties and key characteristics of your subject of analysis applied to the research problem.

Flyvbjerg, Bent. “Five Misunderstandings About Case-Study Research.” Qualitative Inquiry 12 (April 2006): 219-245.

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Case Study Method Key Issues, Key Texts

• Roger Gomm - The Open University
• Martyn Hammersley - The Open University, UK
• Peter Foster
• Description

`This is a worthwhile book which will be useful to readers. It collects

together key sources on a topic which is a "hardy perennial", guaranteeing

its relevance for academics, researchers, and students on higher level

methods programmes. The editorial contributions are by well-known

authorities in the field, are carefully-constructed, and take a clear

position. I would certainly want this book on my shelf' - Nigel Fielding, University of Surrey

". . .the book enlightens researchers concerning the contributions of case studies to research and could serve as an informative reader for doctoral students considering case study methods for their dissertations." 

Extremely well written with range of chapters by various authors. Invaluable reading for any student considering using a case study approach for their research project.

offers deep theoretical insight to the issue of generalizability; language could be a bit difficult for 3rd year UG students; however, I would adopt it as supplemental - for students that wish to go the extra mile.

So many well established names in the field of case study research makes this book a fascinating and very helpful resource. Its two main sections cover two vital areas that are often controversial within this method. The multitude of references from each chapter's Bibliography, leave the reader with a gold mine of sources to further investigate.

One of the key considerations in Cast Study research is the complexity relating to generalisability. This text explores generalisability in depth, giving the novice and more mature researcher greater depth and understanding of transferrability of research findings to the wider population.

For anyone thinking about undertaking case study research, I would highly recommend this text. The phrase 'case study' itself is something that is difficult to agree on and this book helps clarify thinking about what a 'case study' really is and then how to go about designing and carrying out case study research.

An excellent book for students undertaking Case Study Research

This is an excellent text for students undertaking case study research.

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Section Summary

2.1 approaches to sociological research.

Using the scientific method, a researcher conducts a study in six phases: asking a question, researching existing sources, formulating a hypothesis, research design, collecting & analyzing data, and drawing conclusions. The scientific method is useful in that it provides a clear method of organizing a study. Some sociologists conduct research through an interpretive framework rather than employing the scientific method.

Scientific sociological studies often observe relationships between variables. Researchers study how one variable influences another. Prior to conducting a study, researchers are careful to apply operational definitions to their terms and to establish dependent and independent variables.

2.2 Research Methods

Sociological research is a fairly complex process. As you can see, a lot goes into even a simple research design. There are many steps and much to consider when collecting data on human behavior, as well as in interpreting and analyzing data in order to form conclusive results. Sociologists use the scientific methods for good reasons. The scientific method provides a system of organization to help researchers plan and conduct a study to ensure data and results are reliable, valid, and objective.

The many methods available to researchers—including experiments, surveys, participant observation, ethnography, case study, and secondary data analysis—all come with advantages and disadvantages. The strength of a study can depend on the choice and implementation of the appropriate method of gathering data. Depending on the topic, a study might use a single method or a combination of methods. It is important to plan a research design before undertaking a study. The information gathered may in itself be surprising, and the study design should provide a solid framework in which to analyze predicted and unpredicted data.

2.3 Ethical Concerns

Sociologists and sociology students must take ethical responsibility for any study they conduct. They must first and foremost guarantee the safety of their participants. Whenever possible, they must ensure that participants have been fully informed consent before participating in a study.

The American Sociological Association (ASA) establishes parameters for ethical guidelines that sociologists must take into account as they conduct research. The guidelines address conducting studies, properly using existing sources, accepting funding, and publishing results. Unfortunately, the code of ethics were not in existence and in some cases researchers did not adhere to ASA guidelines resulting in unethical practices in which humans were caused either physical or psychological harm.

Sociologists must try to maintain value neutrality. They must gather and analyze data objectively and set aside their personal preferences, beliefs, and opinions. They must report findings accurately, even if they contradict personal values and convictions.

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Case Study: Types, Advantages And Disadvantages

  Case Study: Types, Advantages And Disadvantages 

Case study is both method and tool for research. Case study is the intensive study of a phenomenon, but it gives subjective information rather than objective. It gives detailed knowledge about the phenomena and is not able to generalize beyond the knowledge.

Case studies aim to analyze specific issues within the boundaries of a specific environment, situation or organization. According to its design, case study research method can be divided into three categories: explanatory, descriptive and exploratory.

Explanatory case studies aim to answer ‘how’ or ‘why’ questions with little control on behalf of the researcher over occurrence of events. This type of case study focuses on phenomena within the contexts of real-life situations.

Descriptive case studies aim to analyze the sequence of interpersonal events after a certain amount of time has passed. Case studies belonging to this category usually describe culture or sub-culture, and they attempt to discover the key phenomena.

Exploratory case studies aim to find answers to the questions of ‘what’ or ‘who’. Exploratory case study data collection method is often accompanied by additional data collection method(s) such as interviews, questionnaires, experiments etc.

DEFINITION OF CASE STUDY

The case study or case history method is not a newer thing, but it is a linear descendent of very ancient methods of sociological description and generalization namely, the ‘parable’, the ‘allegory’, the ‘story’ and the ‘novel’.

According to P.V. Young . “A fairly exhaustive study of a person or group is called a life of case history.”

Thus, the case study is more intensive in nature; the field of study is comparatively limited but has more depth in it.

TYPES OF CASE STUDY

Six types of case studies are conducted which are as follows:

Community Studies: The community study is a careful description and analysis of a group of people living together in a particular geographic location in a corporative way. The community study deals with such elements of the community as location, appearance, prevailing economic activity, climate and natural sources, historical development, how the people live, the social structure, goals and life values, an evaluation of the social institutions within the community that meet the human needs etc. Such studies are case studies, with the community serving as the case under investigation.

Casual Comparative Studies: Another type of study seeks to find the answers to the problems through the analysis of casual relationships. What factors seem to be associated with certain occurrences, conditions or types of behaviour? By the methodology of descriptive research, the relative importance of these factors may be investigated.

Activity Analysis: The analysis of the activities or processes that an individual is called upon to perform is important, both in industry and in various types of social agencies. This process of analysis is appropriate in any field of work and at all levels of responsibility. In social system, the roles of superintendent, the principal, the teacher and the custodian have been carefully analyzed to discover what these individuals do and need to be able to do.

Content or Document Analysis: Content analysis, sometimes known as document analysis. Deals with the systematic examination of current records or documents as sources of data. In documentary analysis, the following may be used as sources of data: official records and reports, printed forms, text-books, reference books, letters, autobiographies diaries, pictures, films and cartoons etc . But in using documentary sources, one must bear in mind the fact that data appearing in print is not necessarily trustworthy. This content or document analysis should serve a useful purpose in research, adding important knowledge to a field to study or yielding information that is helpful in evaluating and improving social or educational practices.

A Follow-up Study: A follow-up study investigates individuals who have left an institution after having completed programme, a treatment or a course of study, to know what has been the impact of the institutions and its programme upon them. By examining their status or seeking their opinions, one may get some idea of the adequacy or inadequacy of the institutes programme. Studies of this type enable an institution to evaluate various aspects of its programme in the light of actual results.

Trend Studies: The trend or predictive study is an interesting application of the descriptive method. In essence, it is based upon a longitudinal consideration of recorded data, indicating what has been happening in the past, what does the present situation reveal and on the basis of these data, what will be likely to happen in the future.

Whatever type of case study is to conduct, it’s important to first identify the purpose, goals, and approach for conducting methodologically sound research.

ADVANTAGES OF CASE STUDY

The main points of advantages of case study are given below:

Formation of valid hypothesis: Case study helps in formulating valid hypothesis. Once the various cases are extensively studied and analyze, the researcher can deduce various generalizations, which may be developed into useful hypotheses. It is admitted by all that the study of relevant literature and case study form the only potent sources of hypothesis.

  Useful in framing questionnaires and schedules: Case study is of great help in framing questionnaires, schedules or other forms. When a questionnaire is prepared after thorough case study the peculiarities of the group as well as individual units, become known also the type of response likely to be available, liking and aversions of the people. This helps in getting prompt response.

Sampling: Case study is of help in the stratification of the sample. By studying the individual units the researcher can put them in definite classes or types and thereby facilitate the perfect stratification of the sample.

Location of deviant cases: The case study makes it possible to locate deviant cases. There exists a general tendency to ignore them, but for scientific analysis, they are very important. The analysis of such cases is of valuable help in clarifying the theory itself.

Study of process: In cases where the problem under study constitutes a process and not one incident e.g. courtship process, clique formation etc., case study is the appropriate method as the case data is essential for valid study of such problems.

Enlarges experience: The range of personal experience of the researcher is enlarged by the case study on the other hand in statistical methods a narrow range of topics is selected, and the researcher’s knowledge is restricted to the particular aspect only.

Qualitative analysis in actual situation: Case study enables the establishment of the significance of the recorded data when the individual is alive and later on within the life of the classes of individuals. The researcher has the opportunity to come into contact with different classes of people and he is in a position to watch their life and hear their experiences. This provides him with an opportunity to acquire experiences of such life situations which he is never expected to lead.

This discussion highlights the advantages of the case data in social research. Social scientists developed the techniques to make it more perfect and remove the chances of bias.

LIMITATIONS/DISADVANTAGES OF CASE STUDY METHOD

Subjective bias: Research subjectivity in collecting data for supporting or refuting a particular explanation, personal view of investigation influences the findings and conclusion of the study.

Problem of objectivity: Due to excessive association with the social unit under investigation the researcher may develop self-justificatory data which are far from being factual.

Difficulty in comparison: Because of wide variations among human beings in terms of their response and behaviour, attitudes and values, social setting and circumstances, etc., the researcher actually finds it difficult to trace out two social units which are identical in all respects. This hinders proper comparison of cases.

A time, energy and money consuming method: The preparation of a case history involves a lot of time and expenditure of human energy, therefore, there is every possibility that most of the cases may get stray. Due to such difficulties, only a few researchers can afford to case study method.

Time span: Long time span may be another factor that is likely to distort the information provided by the social unit to the researcher.

Unreliable source material: The two major sources of case study are: Personal documents and life history. But in both these cases, the records or the own experience of the social units may not present a true picture. On the contrary, the social unit may try to suppress his unpleasant facts or add colour to them. As a result, the conclusions drawn do not give a true picture and dependable findings.

Scope for wrong conclusions: The case study is laden with inaccurate observation, wrong inferences, faulty reporting, memory failure, repression or omission of unpleasant facts in an unconscious manner, dramatization of facts, more imaginary description, and difficulty in choosing a case typical of the group. All these problems provide the researcher with every possibility of drawing wrong conclusions and errors.

Case studies are complex because they generally involve multiple sources of data, may include multiple cases within a study and produce large amounts of data for analysis. Researchers from many disciplines use the case study method to build upon theory, to produce new theory, to dispute or challenge theory, to explain a situation, to provide a basis to apply solutions to situations, to explore, or to describe an object or phenomenon. The advantages of the case study method are its applicability to real-life, contemporary, human situations and its public accessibility through written reports. Case study results relate directly to the common readers everyday experience and facilitate an understanding of complex real-life situations.

__________________________________________________________________________

Research Methodology Methods and Techniques~C. R. Kothari (p.113) - Link

Fundamental of Research Methodology and Statistics~Yogesh Kumar Singh (Chapter–10: Case Study Method p. 147) - Link

Social Research Methods: Qualitative and Quantitative Approaches~W. Lawrence Neuman (p.42) - Link

The Basics of Social Research~Earl Babbie (p.280) - Link

Social Science Research Principles, Methods, and Practices~Anol Bhattacherjee (93) - Link

PREPARING A CASE STUDY: A Guide for Designing and Conducting a Case Study for Evaluation Input - Link

A Case in Case Study Methodology - Link

Case Study Method - Link1 & Link 2

Unit-4 Case Study - Link

Case study as a research method - Link

Case_Study~Tanya Sammut-Bonnici and John McGee - Link

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Case Study

A case study is where sociologists investigate in great detail a particular individual or group, as opposed to trying to gather a representative sample from the target population. Normally a case study will feature methodological pluralism (using a range of research methods to achieve triangulation ) and they are often longitudinal studies (the researcher regularly revisiting the case over a long period of time).

Advantages of case studies include the ability to gather qualitative and quantitative data and the comparative lack of expense compared with attempting the same research with a large sample.

Disadvantages would be the inability to ensure the reliability of the data and the extent to which it could be generalisable.

An example of a Case Study is Paul Willis’ ‘Learning to Labour’ which involved an in-depth study of a group of male students from a school in Wolverhampton. Another is Heelas and Woodhead’s case study of spirituality in Kendal (the Kendal Project).

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Case Studies

Case studies and life histories.

Both case studies and life histories are favoured by interpretivist researchers and tend to yield qualitative data.

Case studies & life histories

• For example, Willis’s study of specific counter-school sub-cultures tried to explore using interviews at schools why children from certain social backgrounds got certain types of jobs.
• Life histories are specific kind of case study that looks at the overall life of one individual or small group, often using in-depth unstructured interviews supported by personal documents, such as diaries and letters.

• They can be useful to test wider theories, such as working class boys’ attitudes towards education.
• They can be useful for generating new hypotheses or testing in further research or as an adjunct to other types of research.

Advantages cont.

• They provide more valid in-depth detail and understanding from the point of view of the individual or group than can be obtained by positivist methods such as surveys and questionnaires.

Disadvantages

• They are not representative of the larger population, so findings cannot be generalised.
• They may not be valid; life histories, for example, view the past from the standpoint of the present and facts might be misremembered.

1 Theory & Methods

1.1 Sociological Theories

1.1.1 Marxism

1.1.2 Feminism

1.1.3 Social Action Theories

1.2 Sociological Methods

1.2.1 Types of Data

1.2.2 Positivism & Interpretivism

1.2.3 Research Design

1.2.4 Research Considerations

1.2.5 Values in Research

1.2.6 Modernity & Post-Modernity

1.2.7 Sociology as a Science

1.2.8 Sociology & Social Policy

1.2.9 End of Topic Test - Sociology Methods & Theories

1.3 Sources of Data

1.3.1 Introduction

1.3.2 Experiments

1.3.3 Surveys

1.3.4 Longitudinal Studies

1.3.5 Questionnaires

1.3.6 Types of Questionnaires

1.3.7 Interviews

1.3.8 Observation

1.3.9 Case Studies

1.3.10 Documents

1.3.11 Official Statistics

1.3.12 End of Topic Test - Sources of Data

2 Education with Methods in Context

2.1 Role & Function of the Education System

2.1.1 Introduction

2.1.2 Functionalist Theories

2.1.3 Marxist & Feminist Theories

2.1.4 The New Right

2.2 Educational Achievement

2.2.1 Social Class: Internal Factors

2.2.2 Social Class: External Factors

2.2.3 Social Class: Attitudes to Education

2.2.4 Social Class: Difference in Achievement

2.2.5 Gender

2.2.6 Ethnicity

2.3 Relationships & Processes Within Schools

2.3.1 Processes

2.3.2 Labelling

2.3.3 Categorisations

2.3.4 Student Experience

2.3.5 End of Topic Test -Education with Methods

2.4 Educational Policies

2.4.1 Equality

2.4.2 Privatisation

2.4.3 Marketisation

2.4.4 Government Policies by Party

2.4.5 Globalisation

2.4.6 End of Topic Test- Educational Policies

2.4.7 Practice Exam Question - Social Policies

3 Option 1: Culture & Identity

3.1 Conceptions of Culture

3.1.1 Culture

3.1.2 Mass Culture

3.1.3 Popular Culture

3.1.4 Global Culture

3.1.5 End of Topic Test - Culture and Identity

3.2 Identity & Socialisation

3.2.1 Identities

3.2.2 Socialisation

3.2.3 Secondary Socialisation

3.2.4 Theories of Socialisation

3.2.5 End of Topic Test - Identity

3.2.6 Practice Exam Question - Socialisation & Equality

3.3 Social Identity

3.3.1 Social Class

3.3.2 Upper & Middle Class

3.3.3 Working & Underclass

3.3.4 Social Class Evaluation

3.3.5 Gender

3.3.6 Changing Gender Identities

3.3.7 Ethnicity

3.3.9 Disability

3.3.10 Nationality

3.3.11 End of Topic Test - Social Identity

3.4 Production, Consumption & Globalisation

3.4.1 Production & Consumption

3.4.2 Globalisation

3.4.3 Evaluation

3.4.4 End of Topic Test - Production

4 Option 1: Families & Households

4.1 Families & Households

4.1.1 Definitions

4.1.2 Functionalist & New Right Perspectives

4.1.3 Marxist & Feminist Perspectives

4.1.4 Postmodernist Perspective

4.1.5 End of Topic Test - Families & Households

4.1.6 Practice Exam Question - Function of Family

4.2 Changing Patterns

4.2.1 Marriage

4.2.2 Divorce

4.2.3 LAT Relationships

4.2.4 Child-Bearing

4.2.5 Lone Parenthood

4.2.6 Diversity

4.2.7 The Sociology of Personal Life

4.2.8 Government Policies Post-WW2

4.2.9 End of Topic Test - Changing Patterns

4.3 The Symmetrical Family

4.3.1 The Symmetrical Family

4.3.2 Evaluation

4.4 Children & Childhood

4.4.1 Childhood

4.4.2 Childhood in the UK

4.4.3 Childhood as a Social Construct

4.4.4 The Disappearance of Childhood

4.4.5 Child Abuse

4.4.6 Domestic Violence

4.4.7 End of Topic Test - Family & Childhood

4.5 Demographic Trends UK

4.5.1 Introduction

4.5.2 Birth Rates

4.5.3 Death Rates

4.5.4 The Ageing Population

4.5.5 Studies on the Ageing Population

4.5.6 Migration

4.5.7 Globalisation

4.5.8 End of Topic Test - Demographics UK

5 Option 1: Health

5.1 Social Constructions

5.1.1 The Body

5.1.2 Health, Illness & Disease

5.1.3 Disability

5.1.4 Models of Health & Illness

5.1.5 End of Topic Test - Social Constructions

5.2 Social Distribution of Healthcare

5.2.1 Social Class

5.2.2 Gender

5.2.3 Ethnicity

5.2.4 Regional

5.3 Provision & Access to Healthcare

5.3.1 The NHS

5.3.2 Inequalities in Provision

5.3.3 Sociological Explanations

5.3.4 Inequalities in Access

5.3.5 Inequalities in Access 2

5.3.6 End of Topic Test - Distribution Health

5.4 Mental Health

5.4.1 The Biomedical Approach

5.4.2 Social Patterns

5.4.3 Social Constructionist Approach

5.5 The Globalised Health Industry

5.5.1 The Functionalist Approach

5.5.2 The Postmodernist Approach

5.5.3 The Globalised Health Industry

5.5.4 End of Topic Test - Mental Health & Globalisation

6 Option 1: Work, Poverty & Welfare

6.1 Poverty & Wealth

6.1.1 Types of Poverty

6.1.2 Types of Poverty 2

6.1.3 Distribution of Wealth UK

6.1.4 Sociological Theories

6.1.5 Sociological Theories 2

6.1.6 Distribution of Poverty UK

6.1.7 End of Topic Test - Poverty & Wealth

6.2 Welfare

6.2.1 The Welfare State

6.2.2 Theoretical Approaches to Welfare

6.3 Labour Process

6.3.1 Nature of Work

6.3.2 Technology & Control

6.3.3 Work & Life

6.3.4 The Effects of Globalisation

6.3.5 Globalisation & Worklessness

6.3.6 End of Topic Test - Welfare & Labour

7 Option 2: Beliefs in Society

7.1 Ideology, Science & Religion

7.1.1 Types of Religion

7.1.2 Ideology & Belief Systems

7.1.3 Social Stability & Religion

7.1.4 Social Change & Religion

7.1.5 End of Topic Test - Ideology, Science & Religion

7.2 Religious Movements

7.2.1 Religious Organisations

7.2.2 New Religious Movements

7.2.3 New Age Movements

7.2.4 Practice Exam Question - Growth of NRMs

7.3 Society & Religion

7.3.1 Social Groups & Religion

7.3.2 Gender & Religion

7.3.3 End of Topic Test- Religious Movements & Society

7.4 Contemporary Religion

7.4.1 Secularisation UK

7.4.2 Against Secularisation

7.4.3 Secularisation US

7.4.4 Fundamentalism

7.4.5 Economic Development & Religion

7.4.6 End of Topic - Contemporary Religion

8 Option 2: Global Development

8.1 Development, Underdevelopment & Global Inequality

8.1.1 Development

8.1.2 Underdevelopment & Global Inequality

8.2 Globalisation & Global Organisations

8.2.1 Globalisation

8.2.2 Transnational Corporations & International Agency

8.2.3 Non-Governmental Organisations (NGOs)

8.3 Aid, Trade, Industrialisation, Urbanisation

8.3.1 Development: Aid & Trade

8.3.2 Development: Industrialisation & Urbanisation

8.3.3 Development: Environment & War

9 Option 2: The Media

9.1 Contemporary Media

9.1.1 New Media

9.1.2 Control of the Media

9.1.3 Sociological Approaches: New Media

9.1.4 Globalisation

9.1.5 News Selection

9.1.6 Moral Panics

9.1.7 End of Topic Test - Contemporary Media

9.2 Media Representations

9.2.2 Social Class & Ethnicity

9.2.3 Gender

9.2.4 Sexuality & Disability

9.2.5 Practice Exam Questions - Presentation of Women

9.3 Audiences

9.3.1 Media Theories

9.3.2 Media Theories 2

9.3.3 Media Representations & Audiences

10 Crime & Deviance

10.1 Crime & Society

10.1.1 Functionalism

10.1.2 Subcultural Theory

10.1.3 Marxism

10.1.4 Realism

10.1.5 Other Approaches

10.1.6 End of Topic Test - Crime & Society

10.1.7 Practice Exam Questions - Social Construction

10.2 Social Distribution of Crime

10.2.1 Ethnicity

10.2.2 Gender

10.2.3 Globalisation & Crime

10.2.4 Media & Crime

10.2.5 Types of Crimes

10.2.6 End of Topic Test - Social Distribution of Crime

10.3 Prevention & Punishment

10.3.1 Surveillance

10.3.2 Prevention

10.3.3 Punishment

10.3.4 Victimology

10.3.5 End of Topic Test - Prevention & Punishment

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Observation

• Open access
• Published: 14 May 2024

Developing a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in Medical Assistance in Dying (MAiD): a mixed method modified e-Delphi study

• Jocelyn Schroeder 1 ,
• Barbara Pesut 1 , 2 ,
• Lise Olsen 2 ,
• Nelly D. Oelke 2 &
• Helen Sharp 2  

BMC Nursing volume  23 , Article number:  326 ( 2024 ) Cite this article

181 Accesses

Metrics details

Medical Assistance in Dying (MAiD) was legalized in Canada in 2016. Canada’s legislation is the first to permit Nurse Practitioners (NP) to serve as independent MAiD assessors and providers. Registered Nurses’ (RN) also have important roles in MAiD that include MAiD care coordination; client and family teaching and support, MAiD procedural quality; healthcare provider and public education; and bereavement care for family. Nurses have a right under the law to conscientious objection to participating in MAiD. Therefore, it is essential to prepare nurses in their entry-level education for the practice implications and moral complexities inherent in this practice. Knowing what nursing students think about MAiD is a critical first step. Therefore, the purpose of this study was to develop a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in MAiD in the Canadian context.

The design was a mixed-method, modified e-Delphi method that entailed item generation from the literature, item refinement through a 2 round survey of an expert faculty panel, and item validation through a cognitive focus group interview with nursing students. The settings were a University located in an urban area and a College located in a rural area in Western Canada.

During phase 1, a 56-item survey was developed from existing literature that included demographic items and items designed to measure experience with death and dying (including MAiD), education and preparation, attitudes and beliefs, influences on those beliefs, and anticipated future involvement. During phase 2, an expert faculty panel reviewed, modified, and prioritized the items yielding 51 items. During phase 3, a sample of nursing students further evaluated and modified the language in the survey to aid readability and comprehension. The final survey consists of 45 items including 4 case studies.

Systematic evaluation of knowledge-to-date coupled with stakeholder perspectives supports robust survey design. This study yielded a survey to assess nursing students’ attitudes toward MAiD in a Canadian context.

The survey is appropriate for use in education and research to measure knowledge and attitudes about MAiD among nurse trainees and can be a helpful step in preparing nursing students for entry-level practice.

Peer Review reports

Medical Assistance in Dying (MAiD) is permitted under an amendment to Canada’s Criminal Code which was passed in 2016 [ 1 ]. MAiD is defined in the legislation as both self-administered and clinician-administered medication for the purpose of causing death. In the 2016 Bill C-14 legislation one of the eligibility criteria was that an applicant for MAiD must have a reasonably foreseeable natural death although this term was not defined. It was left to the clinical judgement of MAiD assessors and providers to determine the time frame that constitutes reasonably foreseeable [ 2 ]. However, in 2021 under Bill C-7, the eligibility criteria for MAiD were changed to allow individuals with irreversible medical conditions, declining health, and suffering, but whose natural death was not reasonably foreseeable, to receive MAiD [ 3 ]. This population of MAiD applicants are referred to as Track 2 MAiD (those whose natural death is foreseeable are referred to as Track 1). Track 2 applicants are subject to additional safeguards under the 2021 C-7 legislation.

Three additional proposed changes to the legislation have been extensively studied by Canadian Expert Panels (Council of Canadian Academics [CCA]) [ 4 , 5 , 6 ] First, under the legislation that defines Track 2, individuals with mental disease as their sole underlying medical condition may apply for MAiD, but implementation of this practice is embargoed until March 2027 [ 4 ]. Second, there is consideration of allowing MAiD to be implemented through advanced consent. This would make it possible for persons living with dementia to receive MAID after they have lost the capacity to consent to the procedure [ 5 ]. Third, there is consideration of extending MAiD to mature minors. A mature minor is defined as “a person under the age of majority…and who has the capacity to understand and appreciate the nature and consequences of a decision” ([ 6 ] p. 5). In summary, since the legalization of MAiD in 2016 the eligibility criteria and safeguards have evolved significantly with consequent implications for nurses and nursing care. Further, the number of Canadians who access MAiD shows steady increases since 2016 [ 7 ] and it is expected that these increases will continue in the foreseeable future.

Nurses have been integral to MAiD care in the Canadian context. While other countries such as Belgium and the Netherlands also permit euthanasia, Canada is the first country to allow Nurse Practitioners (Registered Nurses with additional preparation typically achieved at the graduate level) to act independently as assessors and providers of MAiD [ 1 ]. Although the role of Registered Nurses (RNs) in MAiD is not defined in federal legislation, it has been addressed at the provincial/territorial-level with variability in scope of practice by region [ 8 , 9 ]. For example, there are differences with respect to the obligation of the nurse to provide information to patients about MAiD, and to the degree that nurses are expected to ensure that patient eligibility criteria and safeguards are met prior to their participation [ 10 ]. Studies conducted in the Canadian context indicate that RNs perform essential roles in MAiD care coordination; client and family teaching and support; MAiD procedural quality; healthcare provider and public education; and bereavement care for family [ 9 , 11 ]. Nurse practitioners and RNs are integral to a robust MAiD care system in Canada and hence need to be well-prepared for their role [ 12 ].

Previous studies have found that end of life care, and MAiD specifically, raise complex moral and ethical issues for nurses [ 13 , 14 , 15 , 16 ]. The knowledge, attitudes, and beliefs of nurses are important across practice settings because nurses have consistent, ongoing, and direct contact with patients who experience chronic or life-limiting health conditions. Canadian studies exploring nurses’ moral and ethical decision-making in relation to MAiD reveal that although some nurses are clear in their support for, or opposition to, MAiD, others are unclear on what they believe to be good and right [ 14 ]. Empirical findings suggest that nurses go through a period of moral sense-making that is often informed by their family, peers, and initial experiences with MAID [ 17 , 18 ]. Canadian legislation and policy specifies that nurses are not required to participate in MAiD and may recuse themselves as conscientious objectors with appropriate steps to ensure ongoing and safe care of patients [ 1 , 19 ]. However, with so many nurses having to reflect on and make sense of their moral position, it is essential that they are given adequate time and preparation to make an informed and thoughtful decision before they participate in a MAID death [ 20 , 21 ].

It is well established that nursing students receive inconsistent exposure to end of life care issues [ 22 ] and little or no training related to MAiD [ 23 ]. Without such education and reflection time in pre-entry nursing preparation, nurses are at significant risk for moral harm. An important first step in providing this preparation is to be able to assess the knowledge, values, and beliefs of nursing students regarding MAID and end of life care. As demand for MAiD increases along with the complexities of MAiD, it is critical to understand the knowledge, attitudes, and likelihood of engagement with MAiD among nursing students as a baseline upon which to build curriculum and as a means to track these variables over time.

Aim, design, and setting

The aim of this study was to develop a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in MAiD in the Canadian context. We sought to explore both their willingness to be involved in the registered nursing role and in the nurse practitioner role should they chose to prepare themselves to that level of education. The design was a mixed-method, modified e-Delphi method that entailed item generation, item refinement through an expert faculty panel [ 24 , 25 , 26 ], and initial item validation through a cognitive focus group interview with nursing students [ 27 ]. The settings were a University located in an urban area and a College located in a rural area in Western Canada.

Participants

A panel of 10 faculty from the two nursing education programs were recruited for Phase 2 of the e-Delphi. To be included, faculty were required to have a minimum of three years of experience in nurse education, be employed as nursing faculty, and self-identify as having experience with MAiD. A convenience sample of 5 fourth-year nursing students were recruited to participate in Phase 3. Students had to be in good standing in the nursing program and be willing to share their experiences of the survey in an online group interview format.

The modified e-Delphi was conducted in 3 phases: Phase 1 entailed item generation through literature and existing survey review. Phase 2 entailed item refinement through a faculty expert panel review with focus on content validity, prioritization, and revision of item wording [ 25 ]. Phase 3 entailed an assessment of face validity through focus group-based cognitive interview with nursing students.

Phase I. Item generation through literature review

The goal of phase 1 was to develop a bank of survey items that would represent the variables of interest and which could be provided to expert faculty in Phase 2. Initial survey items were generated through a literature review of similar surveys designed to assess knowledge and attitudes toward MAiD/euthanasia in healthcare providers; Canadian empirical studies on nurses’ roles and/or experiences with MAiD; and legislative and expert panel documents that outlined proposed changes to the legislative eligibility criteria and safeguards. The literature review was conducted in three online databases: CINAHL, PsycINFO, and Medline. Key words for the search included nurses , nursing students , medical students , NPs, MAiD , euthanasia , assisted death , and end-of-life care . Only articles written in English were reviewed. The legalization and legislation of MAiD is new in many countries; therefore, studies that were greater than twenty years old were excluded, no further exclusion criteria set for country.

Items from surveys designed to measure similar variables in other health care providers and geographic contexts were placed in a table and similar items were collated and revised into a single item. Then key variables were identified from the empirical literature on nurses and MAiD in Canada and checked against the items derived from the surveys to ensure that each of the key variables were represented. For example, conscientious objection has figured prominently in the Canadian literature, but there were few items that assessed knowledge of conscientious objection in other surveys and so items were added [ 15 , 21 , 28 , 29 ]. Finally, four case studies were added to the survey to address the anticipated changes to the Canadian legislation. The case studies were based upon the inclusion of mature minors, advanced consent, and mental disorder as the sole underlying medical condition. The intention was to assess nurses’ beliefs and comfort with these potential legislative changes.

Phase 2. Item refinement through expert panel review

The goal of phase 2 was to refine and prioritize the proposed survey items identified in phase 1 using a modified e-Delphi approach to achieve consensus among an expert panel [ 26 ]. Items from phase 1 were presented to an expert faculty panel using a Qualtrics (Provo, UT) online survey. Panel members were asked to review each item to determine if it should be: included, excluded or adapted for the survey. When adapted was selected faculty experts were asked to provide rationale and suggestions for adaptation through the use of an open text box. Items that reached a level of 75% consensus for either inclusion or adaptation were retained [ 25 , 26 ]. New items were categorized and added, and a revised survey was presented to the panel of experts in round 2. Panel members were again asked to review items, including new items, to determine if it should be: included, excluded, or adapted for the survey. Round 2 of the modified e-Delphi approach also included an item prioritization activity, where participants were then asked to rate the importance of each item, based on a 5-point Likert scale (low to high importance), which De Vaus [ 30 ] states is helpful for increasing the reliability of responses. Items that reached a 75% consensus on inclusion were then considered in relation to the importance it was given by the expert panel. Quantitative data were managed using SPSS (IBM Corp).

Phase 3. Face validity through cognitive interviews with nursing students

The goal of phase 3 was to obtain initial face validity of the proposed survey using a sample of nursing student informants. More specifically, student participants were asked to discuss how items were interpreted, to identify confusing wording or other problematic construction of items, and to provide feedback about the survey as a whole including readability and organization [ 31 , 32 , 33 ]. The focus group was held online and audio recorded. A semi-structured interview guide was developed for this study that focused on clarity, meaning, order and wording of questions; emotions evoked by the questions; and overall survey cohesion and length was used to obtain data (see Supplementary Material 2  for the interview guide). A prompt to “think aloud” was used to limit interviewer-imposed bias and encourage participants to describe their thoughts and response to a given item as they reviewed survey items [ 27 ]. Where needed, verbal probes such as “could you expand on that” were used to encourage participants to expand on their responses [ 27 ]. Student participants’ feedback was collated verbatim and presented to the research team where potential survey modifications were negotiated and finalized among team members. Conventional content analysis [ 34 ] of focus group data was conducted to identify key themes that emerged through discussion with students. Themes were derived from the data by grouping common responses and then using those common responses to modify survey items.

Ten nursing faculty participated in the expert panel. Eight of the 10 faculty self-identified as female. No faculty panel members reported conscientious objector status and ninety percent reported general agreement with MAiD with one respondent who indicated their view as “unsure.” Six of the 10 faculty experts had 16 years of experience or more working as a nurse educator.

Five nursing students participated in the cognitive interview focus group. The duration of the focus group was 2.5 h. All participants identified that they were born in Canada, self-identified as female (one preferred not to say) and reported having received some instruction about MAiD as part of their nursing curriculum. See Tables  1 and 2 for the demographic descriptors of the study sample. Study results will be reported in accordance with the study phases. See Fig.  1 for an overview of the results from each phase.

Fig. 1  Overview of survey development findings

Phase 1: survey item generation

Review of the literature identified that no existing survey was available for use with nursing students in the Canadian context. However, an analysis of themes across qualitative and quantitative studies of physicians, medical students, nurses, and nursing students provided sufficient data to develop a preliminary set of items suitable for adaptation to a population of nursing students.

Four major themes and factors that influence knowledge, attitudes, and beliefs about MAiD were evident from the literature: (i) endogenous or individual factors such as age, gender, personally held values, religion, religiosity, and/or spirituality [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ], (ii) experience with death and dying in personal and/or professional life [ 35 , 40 , 41 , 43 , 44 , 45 ], (iii) training including curricular instruction about clinical role, scope of practice, or the law [ 23 , 36 , 39 ], and (iv) exogenous or social factors such as the influence of key leaders, colleagues, friends and/or family, professional and licensure organizations, support within professional settings, and/or engagement in MAiD in an interdisciplinary team context [ 9 , 35 , 46 ].

Studies of nursing students also suggest overlap across these categories. For example, value for patient autonomy [ 23 ] and the moral complexity of decision-making [ 37 ] are important factors that contribute to attitudes about MAiD and may stem from a blend of personally held values coupled with curricular content, professional training and norms, and clinical exposure. For example, students report that participation in end of life care allows for personal growth, shifts in perception, and opportunities to build therapeutic relationships with their clients [ 44 , 47 , 48 ].

Preliminary items generated from the literature resulted in 56 questions from 11 published sources (See Table  3 ). These items were constructed across four main categories: (i) socio-demographic questions; (ii) end of life care questions; (iii) knowledge about MAiD; or (iv) comfort and willingness to participate in MAiD. Knowledge questions were refined to reflect current MAiD legislation, policies, and regulatory frameworks. Falconer [ 39 ] and Freeman [ 45 ] studies were foundational sources for item selection. Additionally, four case studies were written to reflect the most recent anticipated changes to MAiD legislation and all used the same open-ended core questions to address respondents’ perspectives about the patient’s right to make the decision, comfort in assisting a physician or NP to administer MAiD in that scenario, and hypothesized comfort about serving as a primary provider if qualified as an NP in future. Response options for the survey were also constructed during this stage and included: open text, categorical, yes/no , and Likert scales.

Phase 2: faculty expert panel review

Of the 56 items presented to the faculty panel, 54 questions reached 75% consensus. However, based upon the qualitative responses 9 items were removed largely because they were felt to be repetitive. Items that generated the most controversy were related to measuring religion and spirituality in the Canadian context, defining end of life care when there is no agreed upon time frames (e.g., last days, months, or years), and predicting willingness to be involved in a future events – thus predicting their future selves. Phase 2, round 1 resulted in an initial set of 47 items which were then presented back to the faculty panel in round 2.

Of the 47 initial questions presented to the panel in round 2, 45 reached a level of consensus of 75% or greater, and 34 of these questions reached a level of 100% consensus [ 27 ] of which all participants chose to include without any adaptations) For each question, level of importance was determined based on a 5-point Likert scale (1 = very unimportant, 2 = somewhat unimportant, 3 = neutral, 4 = somewhat important, and 5 = very important). Figure  2 provides an overview of the level of importance assigned to each item.

Ranking level of importance for survey items

After round 2, a careful analysis of participant comments and level of importance was completed by the research team. While the main method of survey item development came from participants’ response to the first round of Delphi consensus ratings, level of importance was used to assist in the decision of whether to keep or modify questions that created controversy, or that rated lower in the include/exclude/adapt portion of the Delphi. Survey items that rated low in level of importance included questions about future roles, sex and gender, and religion/spirituality. After deliberation by the research committee, these questions were retained in the survey based upon the importance of these variables in the scientific literature.

Of the 47 questions remaining from Phase 2, round 2, four were revised. In addition, the two questions that did not meet the 75% cut off level for consensus were reviewed by the research team. The first question reviewed was What is your comfort level with providing a MAiD death in the future if you were a qualified NP ? Based on a review of participant comments, it was decided to retain this question for the cognitive interviews with students in the final phase of testing. The second question asked about impacts on respondents’ views of MAiD and was changed from one item with 4 subcategories into 4 separate items, resulting in a final total of 51 items for phase 3. The revised survey was then brought forward to the cognitive interviews with student participants in Phase 3. (see Supplementary Material 1 for a complete description of item modification during round 2).

Phase 3. Outcomes of cognitive interview focus group

Of the 51 items reviewed by student participants, 29 were identified as clear with little or no discussion. Participant comments for the remaining 22 questions were noted and verified against the audio recording. Following content analysis of the comments, four key themes emerged through the student discussion: unclear or ambiguous wording; difficult to answer questions; need for additional response options; and emotional response evoked by questions. An example of unclear or ambiguous wording was a request for clarity in the use of the word “sufficient” in the context of assessing an item that read “My nursing education has provided sufficient content about the nursing role in MAiD.” “Sufficient” was viewed as subjective and “laden with…complexity that distracted me from the question.” The group recommended rewording the item to read “My nursing education has provided enough content for me to care for a patient considering or requesting MAiD.”

An example of having difficulty answering questions related to limited knowledge related to terms used in the legislation such as such as safeguards , mature minor , eligibility criteria , and conscientious objection. Students were unclear about what these words meant relative to the legislation and indicated that this lack of clarity would hamper appropriate responses to the survey. To ensure that respondents are able to answer relevant questions, student participants recommended that the final survey include explanation of key terms such as mature minor and conscientious objection and an overview of current legislation.

Response options were also a point of discussion. Participants noted a lack of distinction between response options of unsure and unable to say . Additionally, scaling of attitudes was noted as important since perspectives about MAiD are dynamic and not dichotomous “agree or disagree” responses. Although the faculty expert panel recommended the integration of the demographic variables of religious and/or spiritual remain as a single item, the student group stated a preference to have religion and spirituality appear as separate items. The student focus group also took issue with separate items for the variables of sex and gender, specifically that non-binary respondents might feel othered or “outed” particularly when asked to identify their sex. These variables had been created based upon best practices in health research but students did not feel they were appropriate in this context [ 49 ]. Finally, students agreed with the faculty expert panel in terms of the complexity of projecting their future involvement as a Nurse Practitioner. One participant stated: “I certainly had to like, whoa, whoa, whoa. Now let me finish this degree first, please.” Another stated, “I'm still imagining myself, my future career as an RN.”

Finally, student participants acknowledged the array of emotions that some of the items produced for them. For example, one student described positive feelings when interacting with the survey. “Brought me a little bit of feeling of joy. Like it reminded me that this is the last piece of independence that people grab on to.” Another participant, described the freedom that the idea of an advance request gave her. “The advance request gives the most comfort for me, just with early onset Alzheimer’s and knowing what it can do.” But other participants described less positive feelings. For example, the mature minor case study yielded a comment: “This whole scenario just made my heart hurt with the idea of a child requesting that.”

Based on the data gathered from the cognitive interview focus group of nursing students, revisions were made to 11 closed-ended questions (see Table  4 ) and 3 items were excluded. In the four case studies, the open-ended question related to a respondents’ hypothesized actions in a future role as NP were removed. The final survey consists of 45 items including 4 case studies (see Supplementary Material 3 ).

The aim of this study was to develop and validate a survey that can be used to track the growth of knowledge about MAiD among nursing students over time, inform training programs about curricular needs, and evaluate attitudes and willingness to participate in MAiD at time-points during training or across nursing programs over time.

The faculty expert panel and student participants in the cognitive interview focus group identified a need to establish core knowledge of the terminology and legislative rules related to MAiD. For example, within the cognitive interview group of student participants, several acknowledged lack of clear understanding of specific terms such as “conscientious objector” and “safeguards.” Participants acknowledged discomfort with the uncertainty of not knowing and their inclination to look up these terms to assist with answering the questions. This survey can be administered to nursing or pre-nursing students at any phase of their training within a program or across training programs. However, in doing so it is important to acknowledge that their baseline knowledge of MAiD will vary. A response option of “not sure” is important and provides a means for respondents to convey uncertainty. If this survey is used to inform curricular needs, respondents should be given explicit instructions not to conduct online searches to inform their responses, but rather to provide an honest appraisal of their current knowledge and these instructions are included in the survey (see Supplementary Material 3 ).

Some provincial regulatory bodies have established core competencies for entry-level nurses that include MAiD. For example, the BC College of Nurses and Midwives (BCCNM) requires “knowledge about ethical, legal, and regulatory implications of medical assistance in dying (MAiD) when providing nursing care.” (10 p. 6) However, across Canada curricular content and coverage related to end of life care and MAiD is variable [ 23 ]. Given the dynamic nature of the legislation that includes portions of the law that are embargoed until 2024, it is important to ensure that respondents are guided by current and accurate information. As the law changes, nursing curricula, and public attitudes continue to evolve, inclusion of core knowledge and content is essential and relevant for investigators to be able to interpret the portions of the survey focused on attitudes and beliefs about MAiD. Content knowledge portions of the survey may need to be modified over time as legislation and training change and to meet the specific purposes of the investigator.

Given the sensitive nature of the topic, it is strongly recommended that surveys be conducted anonymously and that students be provided with an opportunity to discuss their responses to the survey. A majority of feedback from both the expert panel of faculty and from student participants related to the wording and inclusion of demographic variables, in particular religion, religiosity, gender identity, and sex assigned at birth. These and other demographic variables have the potential to be highly identifying in small samples. In any instance in which the survey could be expected to yield demographic group sizes less than 5, users should eliminate the demographic variables from the survey. For example, the profession of nursing is highly dominated by females with over 90% of nurses who identify as female [ 50 ]. Thus, a survey within a single class of students or even across classes in a single institution is likely to yield a small number of male respondents and/or respondents who report a difference between sex assigned at birth and gender identity. When variables that serve to identify respondents are included, respondents are less likely to complete or submit the survey, to obscure their responses so as not to be identifiable, or to be influenced by social desirability bias in their responses rather than to convey their attitudes accurately [ 51 ]. Further, small samples do not allow for conclusive analyses or interpretation of apparent group differences. Although these variables are often included in surveys, such demographics should be included only when anonymity can be sustained. In small and/or known samples, highly identifying variables should be omitted.

There are several limitations associated with the development of this survey. The expert panel was comprised of faculty who teach nursing students and are knowledgeable about MAiD and curricular content, however none identified as a conscientious objector to MAiD. Ideally, our expert panel would have included one or more conscientious objectors to MAiD to provide a broader perspective. Review by practitioners who participate in MAiD, those who are neutral or undecided, and practitioners who are conscientious objectors would ensure broad applicability of the survey. This study included one student cognitive interview focus group with 5 self-selected participants. All student participants had held discussions about end of life care with at least one patient, 4 of 5 participants had worked with a patient who requested MAiD, and one had been present for a MAiD death. It is not clear that these participants are representative of nursing students demographically or by experience with end of life care. It is possible that the students who elected to participate hold perspectives and reflections on patient care and MAiD that differ from students with little or no exposure to end of life care and/or MAiD. However, previous studies find that most nursing students have been involved with end of life care including meaningful discussions about patients’ preferences and care needs during their education [ 40 , 44 , 47 , 48 , 52 ]. Data collection with additional student focus groups with students early in their training and drawn from other training contexts would contribute to further validation of survey items.

Future studies should incorporate pilot testing with small sample of nursing students followed by a larger cross-program sample to allow evaluation of the psychometric properties of specific items and further refinement of the survey tool. Consistent with literature about the importance of leadership in the context of MAiD [ 12 , 53 , 54 ], a study of faculty knowledge, beliefs, and attitudes toward MAiD would provide context for understanding student perspectives within and across programs. Additional research is also needed to understand the timing and content coverage of MAiD across Canadian nurse training programs’ curricula.

The implementation of MAiD is complex and requires understanding of the perspectives of multiple stakeholders. Within the field of nursing this includes clinical providers, educators, and students who will deliver clinical care. A survey to assess nursing students’ attitudes toward and willingness to participate in MAiD in the Canadian context is timely, due to the legislation enacted in 2016 and subsequent modifications to the law in 2021 with portions of the law to be enacted in 2027. Further development of this survey could be undertaken to allow for use in settings with practicing nurses or to allow longitudinal follow up with students as they enter practice. As the Canadian landscape changes, ongoing assessment of the perspectives and needs of health professionals and students in the health professions is needed to inform policy makers, leaders in practice, curricular needs, and to monitor changes in attitudes and practice patterns over time.

Availability of data and materials

The datasets used and/or analysed during the current study are not publicly available due to small sample sizes, but are available from the corresponding author on reasonable request.

Abbreviations

British Columbia College of Nurses and Midwives

Medical assistance in dying

Nurse practitioner

Registered nurse

University of British Columbia Okanagan

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Acknowledgements

We would like to acknowledge the faculty and students who generously contributed their time to this work.

JS received a student traineeship through the Principal Research Chairs program at the University of British Columbia Okanagan.

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JS made substantial contributions to the conception of the work; data acquisition, analysis, and interpretation; and drafting and substantively revising the work. JS has approved the submitted version and agreed to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. BP made substantial contributions to the conception of the work; data acquisition, analysis, and interpretation; and drafting and substantively revising the work. BP has approved the submitted version and agreed to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. LO made substantial contributions to the conception of the work; data acquisition, analysis, and interpretation; and substantively revising the work. LO has approved the submitted version and agreed to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. NDO made substantial contributions to the conception of the work; data acquisition, analysis, and interpretation; and substantively revising the work. NDO has approved the submitted version and agreed to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. HS made substantial contributions to drafting and substantively revising the work. HS has approved the submitted version and agreed to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.

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JS conducted this study as part of their graduate requirements in the School of Nursing, University of British Columbia Okanagan.

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Correspondence to Barbara Pesut .

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The research was approved by the Selkirk College Research Ethics Board (REB) ID # 2021–011 and the University of British Columbia Behavioral Research Ethics Board ID # H21-01181.

All participants provided written and informed consent through approved consent processes. Research was conducted in accordance with the Declaration of Helsinki.

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Not applicable.

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The authors declare they have no competing interests.

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Schroeder, J., Pesut, B., Olsen, L. et al. Developing a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in Medical Assistance in Dying (MAiD): a mixed method modified e-Delphi study. BMC Nurs 23 , 326 (2024). https://doi.org/10.1186/s12912-024-01984-z

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Received : 24 October 2023

Accepted : 28 April 2024

Published : 14 May 2024

DOI : https://doi.org/10.1186/s12912-024-01984-z

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• Medical assistance in dying (MAiD)
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