Case study-based research for context in complex interventions
Methodology to improve the quality of case study-based research into the influences of context on complex system-level interventions
Meaningful evaluation of new innovations in healthcare and public health (from focussed interventions to changes in service delivery and policy) is vital if evidence-based practices are to be developed and implemented. Many currently used research designs and methods do not sufficiently consider the context(s) in which the innovation is being tested/implemented, leading to uncertainty around generalisability of the results and how best to translate/implement new knowledge into other contexts – “it may work in context X, but how can we know whether it will work in context Y?”. In various fields, the terms generalisability, transferability and transportability are used to cover this concept; this highlight notice applies across them, and for simplicity, generalisability will be used.
Case studies offer flexibility, depth and agility when the aim is to evaluate complex interventions. When experimental designs are not feasible, case studies may be the only available evidence to assess a major change in how services are delivered. Though the use of case studies as a means of studying healthcare has a long and distinguished history, their value has never been fully realised.
In part, this is because of fears over the generalisability of case studies to other contexts, but is also linked to broader confusion about the status of case studies as a legitimate technique in health research. Compounding these problems is the lack of comprehensive guidance on case study research methodology in healthcare and to specify what “good” looks like for reporting purposes: no EQUATOR guideline for case studies in health research exists, resulting in lack of clarity for researchers, funders, publishers and users of research. These issues are touched on in a recent review/consensus report on the evaluation of complex system-level innovations in healthcare and public health (Raine et al, 2016).
A substantial methodological literature on case studies has now emerged in the social and political sciences. This literature is characterised by diversity, with a number of different strains now evident.
One of these is the influential approach developed by Robert Yin over several decades (Yin, 2013). Many other approaches have also been described, considering both primarily qualitative (Denzin & Lincoln, 2011) and primarily quantitative (King et al, 1994) conceptions and differing epistemological underpinnings (Flyvbjerg 2006, Mahoney & Goertz 2006, Seawright & Gerring, 2008).
Few of these approaches have been formally evaluated in a health context, such that the proliferation of approaches has further added to the challenges affecting the use and utility of case studies for evaluation of complex interventions.
MRC/NIHR is seeking to support a project to comprehensively review the state-of-the-art in methodologies for the design, conduct, analysis and reporting of case study-based research. The review will target the interrelation of context with complex system-level interventions. The project should entail the following components:
- A systematic review and synthesis of the literature on case studies methods, across health and social science (and any other relevant fields) to determine relevance to the study of the contextual influences on complex interventions in health systems and public health research.
- Development and publication of guidance on the design, conduct, analysis and reporting of case studies in health systems/public health research (drawing from this field’s literature and beyond) covering areas such as case selection, generalisability, characterisation of mechanisms, context and their interrelation, and methods for synthesising the findings of case studies.
The proposed review and guidance development should focus on how to design/conduct/analyse/report/synthesise case studies such that the results are useful for further research and for informing care/commissioning/policy decisions. The project should cover methodologies for case studies as retrospective evaluation (did it work/fail and how did it work/fail in that context?) and use of case studies to inform future action (will it work/fail if implemented in another context?).
Application process and schedule
Applications for projects are invited through the normal MRC funding grant schemes and will be considered at the regular Methodology Research Programme Panel meetings. These will be in competition with other applications received, but the Panel will be mindful of the strategic importance of this area.
Proposals should be for no more than £200,000 (80% FEC) and are anticipated to be of around 18 months duration. Only one award will be funded against this highlight notice.
Contact and guidance
It is essential to discuss your proposals with MRC Head Office at an early stage. All applications must be approved by the Methodology Programme Manager prior to submission. Please contact:
Dr Samuel Rowley
Raine R, Fitzpatrick R, Barratt H, Bevan G, Black N, Boaden R, et al. Challenges, solutions and future directions in the evaluation of service innovations in health care and public health. Health Serv Deliv Res 2016;4(16).
Yin, Robert K. Case study research: Design and methods. Sage publications, 2013.
Denzin, N. K., & Lincoln, Y. S. (Eds.) (2011). The SAGE handbook of qualitative research (4th ed.). Thousand Oaks, CA: Sag
King, G., Keohane, R.O. and Verba, S., 1994. Designing social inquiry: Scientific inference in qualitative research. Princeton university press.
Flyvbjerg, Bent. "Five misunderstandings about case-study research." Qualitative inquiry 12, no. 2 (2006): 219-245.
Mahoney, James, and Gary Goertz. "A tale of two cultures: Contrasting quantitative and qualitative research." Political analysis 14, no. 3 (2006): 227-249.
Seawright, J., & Gerring, J. (2008). Case selection techniques in case study research a menu of qualitative and quantitative options. Political Research Quarterly, 61(2), 294-308.