Four types: single holistic, single embedded, multiple holistic, multiple embedded
The post-positive paradigm postulates there is one reality that can be objectively described and understood by “bracketing” oneself from the research to remove prejudice or bias. 27 Yin focuses on general explanation and prediction, emphasizing the formulation of propositions, akin to hypothesis testing. This approach is best suited for structured and objective data collection 9 , 11 and is often used for mixed-method studies.
Constructivism assumes that the phenomenon of interest is constructed and influenced by local contexts, including the interaction between researchers, individuals, and their environment. 27 It acknowledges multiple interpretations of reality 24 constructed within the context by the researcher and participants which are unlikely to be replicated, should either change. 5 , 20 Stake and Merriam’s constructivist approaches emphasize a story-like rendering of a problem and an iterative process of constructing the case study. 7 This stance values researcher reflexivity and transparency, 28 acknowledging how researchers’ experiences and disciplinary lenses influence their assumptions and beliefs about the nature of the phenomenon and development of the findings.
A key tenet of case study methodology often underemphasized in literature is the importance of defining the case and phenomenon. Researches should clearly describe the case with sufficient detail to allow readers to fully understand the setting and context and determine applicability. Trying to answer a question that is too broad often leads to an unclear definition of the case and phenomenon. 20 Cases should therefore be bound by time and place to ensure rigor and feasibility. 6
Yin 22 defines a case as “a contemporary phenomenon within its real-life context,” (p13) which may contain a single unit of analysis, including individuals, programs, corporations, or clinics 29 (holistic), or be broken into sub-units of analysis, such as projects, meetings, roles, or locations within the case (embedded). 30 Merriam 24 and Stake 5 similarly define a case as a single unit studied within a bounded system. Stake 5 , 23 suggests bounding cases by contexts and experiences where the phenomenon of interest can be a program, process, or experience. However, the line between the case and phenomenon can become muddy. For guidance, Stake 5 , 23 describes the case as the noun or entity and the phenomenon of interest as the verb, functioning, or activity of the case.
Yin’s approach to a case study is rooted in a formal proposition or theory which guides the case and is used to test the outcome. 1 Stake 5 advocates for a flexible design and explicitly states that data collection and analysis may commence at any point. Merriam’s 24 approach blends both Yin and Stake’s, allowing the necessary flexibility in data collection and analysis to meet the needs.
Yin 30 proposed three types of case study approaches—descriptive, explanatory, and exploratory. Each can be designed around single or multiple cases, creating six basic case study methodologies. Descriptive studies provide a rich description of the phenomenon within its context, which can be helpful in developing theories. To test a theory or determine cause and effect relationships, researchers can use an explanatory design. An exploratory model is typically used in the pilot-test phase to develop propositions (eg, Sibbald et al. 31 used this approach to explore interprofessional network complexity). Despite having distinct characteristics, the boundaries between case study types are flexible with significant overlap. 30 Each has five key components: (1) research question; (2) proposition; (3) unit of analysis; (4) logical linking that connects the theory with proposition; and (5) criteria for analyzing findings.
Contrary to Yin, Stake 5 believes the research process cannot be planned in its entirety because research evolves as it is performed. Consequently, researchers can adjust the design of their methods even after data collection has begun. Stake 5 classifies case studies into three categories: intrinsic, instrumental, and collective/multiple. Intrinsic case studies focus on gaining a better understanding of the case. These are often undertaken when the researcher has an interest in a specific case. Instrumental case study is used when the case itself is not of the utmost importance, and the issue or phenomenon (ie, the research question) being explored becomes the focus instead (eg, Paciocco 32 used an instrumental case study to evaluate the implementation of a chronic disease management program). 5 Collective designs are rooted in an instrumental case study and include multiple cases to gain an in-depth understanding of the complexity and particularity of a phenomenon across diverse contexts. 5 , 23 In collective designs, studying similarities and differences between the cases allows the phenomenon to be understood more intimately (for examples of this in the field, see van Zelm et al. 33 and Burrows et al. 34 In addition, Sibbald et al. 35 present an example where a cross-case analysis method is used to compare instrumental cases).
Merriam’s approach is flexible (similar to Stake) as well as stepwise and linear (similar to Yin). She advocates for conducting a literature review before designing the study to better understand the theoretical underpinnings. 24 , 25 Unlike Stake or Yin, Merriam proposes a step-by-step guide for researchers to design a case study. These steps include performing a literature review, creating a theoretical framework, identifying the problem, creating and refining the research question(s), and selecting a study sample that fits the question(s). 24 , 25 , 36
Using multiple data collection methods is a key characteristic of all case study methodology; it enhances the credibility of the findings by allowing different facets and views of the phenomenon to be explored. 23 Common methods include interviews, focus groups, observation, and document analysis. 5 , 37 By seeking patterns within and across data sources, a thick description of the case can be generated to support a greater understanding and interpretation of the whole phenomenon. 5 , 17 , 20 , 23 This technique is called triangulation and is used to explore cases with greater accuracy. 5 Although Stake 5 maintains case study is most often used in qualitative research, Yin 17 supports a mix of both quantitative and qualitative methods to triangulate data. This deliberate convergence of data sources (or mixed methods) allows researchers to find greater depth in their analysis and develop converging lines of inquiry. For example, case studies evaluating interventions commonly use qualitative interviews to describe the implementation process, barriers, and facilitators paired with a quantitative survey of comparative outcomes and effectiveness. 33 , 38 , 39
Yin 30 describes analysis as dependent on the chosen approach, whether it be (1) deductive and rely on theoretical propositions; (2) inductive and analyze data from the “ground up”; (3) organized to create a case description; or (4) used to examine plausible rival explanations. According to Yin’s 40 approach to descriptive case studies, carefully considering theory development is an important part of study design. “Theory” refers to field-relevant propositions, commonly agreed upon assumptions, or fully developed theories. 40 Stake 5 advocates for using the researcher’s intuition and impression to guide analysis through a categorical aggregation and direct interpretation. Merriam 24 uses six different methods to guide the “process of making meaning” (p178) : (1) ethnographic analysis; (2) narrative analysis; (3) phenomenological analysis; (4) constant comparative method; (5) content analysis; and (6) analytic induction.
Drawing upon a theoretical or conceptual framework to inform analysis improves the quality of case study and avoids the risk of description without meaning. 18 Using Stake’s 5 approach, researchers rely on protocols and previous knowledge to help make sense of new ideas; theory can guide the research and assist researchers in understanding how new information fits into existing knowledge.
Columbia University has recently demonstrated how case studies can help train future health leaders. 41 Case studies encompass components of systems thinking—considering connections and interactions between components of a system, alongside the implications and consequences of those relationships—to equip health leaders with tools to tackle global health issues. 41 Greenwood 42 evaluated Indigenous peoples’ relationship with the healthcare system in British Columbia and used a case study to challenge and educate health leaders across the country to enhance culturally sensitive health service environments.
An important but often omitted step in case study research is an assessment of quality and rigour. We recommend using a framework or set of criteria to assess the rigour of the qualitative research. Suitable resources include Caelli et al., 43 Houghten et al., 44 Ravenek and Rudman, 45 and Tracy. 46
Although “pragmatic” case studies (ie, utilizing practical and applicable methods) have existed within psychotherapy for some time, 47 , 48 only recently has the applicability of pragmatism as an underlying paradigmatic perspective been considered in HSR. 49 This is marked by uptake of pragmatism in Randomized Control Trials, recognizing that “gold standard” testing conditions do not reflect the reality of clinical settings 50 , 51 nor do a handful of epistemologically guided methodologies suit every research inquiry.
Pragmatism positions the research question as the basis for methodological choices, rather than a theory or epistemology, allowing researchers to pursue the most practical approach to understanding a problem or discovering an actionable solution. 52 Mixed methods are commonly used to create a deeper understanding of the case through converging qualitative and quantitative data. 52 Pragmatic case study is suited to HSR because its flexibility throughout the research process accommodates complexity, ever-changing systems, and disruptions to research plans. 49 , 50 Much like case study, pragmatism has been criticized for its flexibility and use when other approaches are seemingly ill-fit. 53 , 54 Similarly, authors argue that this results from a lack of investigation and proper application rather than a reflection of validity, legitimizing the need for more exploration and conversation among researchers and practitioners. 55
Although occasionally misunderstood as a less rigourous research methodology, 8 case study research is highly flexible and allows for contextual nuances. 5 , 6 Its use is valuable when the researcher desires a thorough understanding of a phenomenon or case bound by context. 11 If needed, multiple similar cases can be studied simultaneously, or one case within another. 16 , 17 There are currently three main approaches to case study, 5 , 17 , 24 each with their own definitions of a case, ontological and epistemological paradigms, methodologies, and data collection and analysis procedures. 37
Individuals’ experiences within health systems are influenced heavily by contextual factors, participant experience, and intricate relationships between different organizations and actors. 55 Case study research is well suited for HSR because it can track and examine these complex relationships and systems as they evolve over time. 6 , 7 It is important that researchers and health leaders using this methodology understand its key tenets and how to conduct a proper case study. Although there are many examples of case study in action, they are often under-reported and, when reported, not rigorously conducted. 9 Thus, decision-makers and health leaders should use these examples with caution. The proper reporting of case studies is necessary to bolster their credibility in HSR literature and provide readers sufficient information to critically assess the methodology. We also call on health leaders who frequently use case studies 56 – 58 to report them in the primary research literature.
The purpose of this article is to advocate for the continued and advanced use of case study in HSR and to provide literature-based guidance for decision-makers, policy-makers, and health leaders on how to engage in, read, and interpret findings from case study research. As health systems progress and evolve, the application of case study research will continue to increase as researchers and health leaders aim to capture the inherent complexities, nuances, and contextual factors. 7
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Methodology
Published on May 8, 2019 by Shona McCombes . Revised on November 20, 2023.
A case study is a detailed study of a specific subject, such as a person, group, place, event, organization, or phenomenon. Case studies are commonly used in social, educational, clinical, and business research.
A case study research design usually involves qualitative methods , but quantitative methods are sometimes also used. Case studies are good for describing , comparing, evaluating and understanding different aspects of a research problem .
When to do a case study, step 1: select a case, step 2: build a theoretical framework, step 3: collect your data, step 4: describe and analyze the case, other interesting articles.
A case study is an appropriate research design when you want to gain concrete, contextual, in-depth knowledge about a specific real-world subject. It allows you to explore the key characteristics, meanings, and implications of the case.
Case studies are often a good choice in a thesis or dissertation . They keep your project focused and manageable when you don’t have the time or resources to do large-scale research.
You might use just one complex case study where you explore a single subject in depth, or conduct multiple case studies to compare and illuminate different aspects of your research problem.
Research question | Case study |
---|---|
What are the ecological effects of wolf reintroduction? | Case study of wolf reintroduction in Yellowstone National Park |
How do populist politicians use narratives about history to gain support? | Case studies of Hungarian prime minister Viktor Orbán and US president Donald Trump |
How can teachers implement active learning strategies in mixed-level classrooms? | Case study of a local school that promotes active learning |
What are the main advantages and disadvantages of wind farms for rural communities? | Case studies of three rural wind farm development projects in different parts of the country |
How are viral marketing strategies changing the relationship between companies and consumers? | Case study of the iPhone X marketing campaign |
How do experiences of work in the gig economy differ by gender, race and age? | Case studies of Deliveroo and Uber drivers in London |
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Once you have developed your problem statement and research questions , you should be ready to choose the specific case that you want to focus on. A good case study should have the potential to:
TipIf your research is more practical in nature and aims to simultaneously investigate an issue as you solve it, consider conducting action research instead.
Unlike quantitative or experimental research , a strong case study does not require a random or representative sample. In fact, case studies often deliberately focus on unusual, neglected, or outlying cases which may shed new light on the research problem.
Example of an outlying case studyIn the 1960s the town of Roseto, Pennsylvania was discovered to have extremely low rates of heart disease compared to the US average. It became an important case study for understanding previously neglected causes of heart disease.
However, you can also choose a more common or representative case to exemplify a particular category, experience or phenomenon.
Example of a representative case studyIn the 1920s, two sociologists used Muncie, Indiana as a case study of a typical American city that supposedly exemplified the changing culture of the US at the time.
While case studies focus more on concrete details than general theories, they should usually have some connection with theory in the field. This way the case study is not just an isolated description, but is integrated into existing knowledge about the topic. It might aim to:
To ensure that your analysis of the case has a solid academic grounding, you should conduct a literature review of sources related to the topic and develop a theoretical framework . This means identifying key concepts and theories to guide your analysis and interpretation.
There are many different research methods you can use to collect data on your subject. Case studies tend to focus on qualitative data using methods such as interviews , observations , and analysis of primary and secondary sources (e.g., newspaper articles, photographs, official records). Sometimes a case study will also collect quantitative data.
Example of a mixed methods case studyFor a case study of a wind farm development in a rural area, you could collect quantitative data on employment rates and business revenue, collect qualitative data on local people’s perceptions and experiences, and analyze local and national media coverage of the development.
The aim is to gain as thorough an understanding as possible of the case and its context.
In writing up the case study, you need to bring together all the relevant aspects to give as complete a picture as possible of the subject.
How you report your findings depends on the type of research you are doing. Some case studies are structured like a standard scientific paper or thesis , with separate sections or chapters for the methods , results and discussion .
Others are written in a more narrative style, aiming to explore the case from various angles and analyze its meanings and implications (for example, by using textual analysis or discourse analysis ).
In all cases, though, make sure to give contextual details about the case, connect it back to the literature and theory, and discuss how it fits into wider patterns or debates.
If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.
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Home » Case Study – Methods, Examples and Guide
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A case study is a research method that involves an in-depth examination and analysis of a particular phenomenon or case, such as an individual, organization, community, event, or situation.
It is a qualitative research approach that aims to provide a detailed and comprehensive understanding of the case being studied. Case studies typically involve multiple sources of data, including interviews, observations, documents, and artifacts, which are analyzed using various techniques, such as content analysis, thematic analysis, and grounded theory. The findings of a case study are often used to develop theories, inform policy or practice, or generate new research questions.
Types and Methods of Case Study are as follows:
A single-case study is an in-depth analysis of a single case. This type of case study is useful when the researcher wants to understand a specific phenomenon in detail.
For Example , A researcher might conduct a single-case study on a particular individual to understand their experiences with a particular health condition or a specific organization to explore their management practices. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as content analysis or thematic analysis. The findings of a single-case study are often used to generate new research questions, develop theories, or inform policy or practice.
A multiple-case study involves the analysis of several cases that are similar in nature. This type of case study is useful when the researcher wants to identify similarities and differences between the cases.
For Example, a researcher might conduct a multiple-case study on several companies to explore the factors that contribute to their success or failure. The researcher collects data from each case, compares and contrasts the findings, and uses various techniques to analyze the data, such as comparative analysis or pattern-matching. The findings of a multiple-case study can be used to develop theories, inform policy or practice, or generate new research questions.
Exploratory Case Study
An exploratory case study is used to explore a new or understudied phenomenon. This type of case study is useful when the researcher wants to generate hypotheses or theories about the phenomenon.
For Example, a researcher might conduct an exploratory case study on a new technology to understand its potential impact on society. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as grounded theory or content analysis. The findings of an exploratory case study can be used to generate new research questions, develop theories, or inform policy or practice.
A descriptive case study is used to describe a particular phenomenon in detail. This type of case study is useful when the researcher wants to provide a comprehensive account of the phenomenon.
For Example, a researcher might conduct a descriptive case study on a particular community to understand its social and economic characteristics. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as content analysis or thematic analysis. The findings of a descriptive case study can be used to inform policy or practice or generate new research questions.
An instrumental case study is used to understand a particular phenomenon that is instrumental in achieving a particular goal. This type of case study is useful when the researcher wants to understand the role of the phenomenon in achieving the goal.
For Example, a researcher might conduct an instrumental case study on a particular policy to understand its impact on achieving a particular goal, such as reducing poverty. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as content analysis or thematic analysis. The findings of an instrumental case study can be used to inform policy or practice or generate new research questions.
Here are some common data collection methods for case studies:
Interviews involve asking questions to individuals who have knowledge or experience relevant to the case study. Interviews can be structured (where the same questions are asked to all participants) or unstructured (where the interviewer follows up on the responses with further questions). Interviews can be conducted in person, over the phone, or through video conferencing.
Observations involve watching and recording the behavior and activities of individuals or groups relevant to the case study. Observations can be participant (where the researcher actively participates in the activities) or non-participant (where the researcher observes from a distance). Observations can be recorded using notes, audio or video recordings, or photographs.
Documents can be used as a source of information for case studies. Documents can include reports, memos, emails, letters, and other written materials related to the case study. Documents can be collected from the case study participants or from public sources.
Surveys involve asking a set of questions to a sample of individuals relevant to the case study. Surveys can be administered in person, over the phone, through mail or email, or online. Surveys can be used to gather information on attitudes, opinions, or behaviors related to the case study.
Artifacts are physical objects relevant to the case study. Artifacts can include tools, equipment, products, or other objects that provide insights into the case study phenomenon.
Conducting a case study research involves several steps that need to be followed to ensure the quality and rigor of the study. Here are the steps to conduct case study research:
Here are some examples of case study research:
Case studies have a wide range of applications across various fields and industries. Here are some examples:
Case studies are widely used in business and management to examine real-life situations and develop problem-solving skills. Case studies can help students and professionals to develop a deep understanding of business concepts, theories, and best practices.
Case studies are used in healthcare to examine patient care, treatment options, and outcomes. Case studies can help healthcare professionals to develop critical thinking skills, diagnose complex medical conditions, and develop effective treatment plans.
Case studies are used in education to examine teaching and learning practices. Case studies can help educators to develop effective teaching strategies, evaluate student progress, and identify areas for improvement.
Case studies are widely used in social sciences to examine human behavior, social phenomena, and cultural practices. Case studies can help researchers to develop theories, test hypotheses, and gain insights into complex social issues.
Case studies are used in law and ethics to examine legal and ethical dilemmas. Case studies can help lawyers, policymakers, and ethical professionals to develop critical thinking skills, analyze complex cases, and make informed decisions.
The purpose of a case study is to provide a detailed analysis of a specific phenomenon, issue, or problem in its real-life context. A case study is a qualitative research method that involves the in-depth exploration and analysis of a particular case, which can be an individual, group, organization, event, or community.
The primary purpose of a case study is to generate a comprehensive and nuanced understanding of the case, including its history, context, and dynamics. Case studies can help researchers to identify and examine the underlying factors, processes, and mechanisms that contribute to the case and its outcomes. This can help to develop a more accurate and detailed understanding of the case, which can inform future research, practice, or policy.
Case studies can also serve other purposes, including:
There are several advantages of case study research, including:
There are several limitations of case study research, including:
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What is qualitative research, about this guide, introduction.
The purpose of this guide is to provide a starting point for learning about qualitative research. In this guide, you'll find:
Qualitative research involves collecting and analyzing non-numerical data (e.g., text, video, or audio) to understand concepts, opinions, or experiences. It can be used to gather in-depth insights into a problem or generate new ideas for research. It answers the hows and whys instead of how many or how much. It could be structured as a stand-alone study, purely relying on qualitative data or it could be part of mixed-methods research that combines qualitative and quantitative data.
Qualitative researchers use multiple systems of inquiry for the study of human phenomena including biography, case study, historical analysis, discourse analysis, ethnography, grounded theory, and phenomenology.
Watch the following video to learn more about Qualitative Research:
(Video best viewed in Edge and Chrome browsers, or click here to view in the Sage Research Methods Database )
The case study approach is useful to employ when there is a need to obtain an in-depth appreciation of an issue, event or phenomenon of interest, in its natural real-life context.
Ethnographies are an in-depth, holistic type of research used to capture cultural practices, beliefs, traditions, and so on. Here, the researcher observes and interviews members of a culture an ethnic group, a clique, members of a religion, etc. and then analyzes their findings.
Researchers will create and test a hypothesis using qualitative data. Often, researchers use grounded theory to understand decision-making, problem-solving, and other types of behavior.
Researchers use this type of framework to understand different aspects of the human experience and how their subjects assign meaning to their experiences. Researchers use interviews to collect data from a small group of subjects, then discuss those results in the form of a narrative or story.
This type of research attempts to understand the lived experiences of a group and/or how members of that group find meaning in their experiences. Researchers use interviews, observation, and other qualitative methods to collect data.
Watch the video "Choosing among the Five Qualitative Approaches" from Sage Research Methods database for more on these qualitative approaches:
Note: Video is best viewed using Chrome, Edge, or Safari browsers.
Poth, C. (Academic). (2023). Choosing among five qualitative approaches [Video]. Sage Research Methods. doi.org/10.4135/9781529629866
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Students in social sciences frequently seek to understand how people feel, think, and behave in specific situations or relationships that evolve over time. To achieve this, they employ various techniques and data collection methods in qualitative research allowing for a deeper exploration of human experiences. Participant observation, in-depth interviews, and other qualitative methods are commonly used to gather rich, detailed data to uncover key aspects of social behavior and relationships. What is qualitative research? This article will answer this question and guide you through the essentials of this methodology, including data collection techniques and analytical approaches.
This inquiry method is helpful for learners interested in how to conduct research . It focuses on understanding human behavior, experiences, and social phenomena from the perspective of those involved. What does qualitative mean? It uses non-numerical data, such as interviews, observations, and textual analysis, to understand people’s feelings, thoughts, and actions.
Qualitative analysis is crucial in education, healthcare, social sciences, marketing, and business. It helps gain detailed insights into behaviors, experiences, and cultural phenomena. This approach is fundamental during exploratory phases, for understanding complex issues, and when context-specific insights are required. By focusing on depth over breadth, this approach is often employed when researchers seek to explore complex issues, understand the context of a phenomenon, or investigate things that are not easily quantifiable. It uncovers rich, nuanced data essential for developing theories and evaluating programs.
Now that you know the answer to “Why is qualitative data important?”, let’s consider how this method differs from quantitative. Both studies represent two main types of research methods. The qualitative approach focuses on understanding behaviors, experiences, and perspectives using interviews, observations, and analyzing texts. These studies are based on reflexivity and aim to explore complexities and contexts, often generating new ideas or theories. Researchers analyze data to find patterns and themes, clarifying the details. However, findings demonstrated in the results section of a research paper may not apply broadly because they often use small, specific groups rather than large, random samples.
Quantitative studies, on the other hand, emphasize numerical data and statistical analysis to measure variables and relationships. They use methods such as surveys, experiments, or analyzing existing data to collect structured information. The goal is quantifying phenomena, testing hypotheses, and determining correlations or causes. Statistical methods are used to analyze data, identifying patterns and significance. Quantitative studies produce results that can be applied to larger populations, providing generalizable findings. However, they may lack the detailed context that qualitative methods offer.
To better understand the answer to “What is qualitative research?”, it’s necessary to consider various approaches within this methodology, each with its unique focus, implications, and functions.
This theory aims to understand and describe the lived experiences of individuals regarding a particular phenomenon.
Peculiarities:
Example: Studying the experiences of people living with chronic illness to understand how it affects their daily lives.
The approach involves immersive, long-term observation and participation in particular cultural or social contexts.
Example: Observing and participating in the daily life of a rural village to understand its social structure and cultural practices.
This approach seeks to develop a research paper problem statement and theories based on participant data.
Example: Developing a theory on how people cope with job loss by interviewing and analyzing the experiences of unemployed individuals.
Case studies involve an in-depth examination of a single case or a small number of cases.
Example: One of the qualitative research examples is analyzing a specific company’s approach to innovation to understand its success factors.
This methodology focuses on the stories and personal interpretations of individuals.
Example: Collecting and analyzing the life stories of veterans to understand their experiences during and after military service.
This theoretical model involves a collaborative approach in which researchers and participants work together to solve a problem or improve a situation.
Example: Teachers collaborating with researchers to develop and test new teaching approaches to improve student engagement.
It examines language use in texts, conversations, and other forms of communication.
Example: Analyzing political speeches to understand how leaders construct and convey their messages to the public.
Each of these examples of qualitative research offers unique tools and perspectives, enabling researchers to delve deeply into complex issues and gain a rich understanding of the issue they study.
Various techniques exist to explore phenomena in depth and understand the complexities of human behavior, experiences, and social interactions. Some key methodologies that are commonly used in different sciences include several approaches.
These are informal and open-ended, designed to capture detailed narratives without imposing preconceived notions. Researchers typically start with a broad question and encourage interviewees to share their stories freely.
They involve a core set of questions that allow researchers to explore topics deeply, adapting their inquiries based on responses received. This method of qualitative research design aims to gather rich, descriptive information, such as understanding what qualities make a good teacher.
They differ from closed-ended surveys in that they seek opinions and descriptions through open-ended questions. They allow for gathering diverse viewpoints from a larger group than one-on-one interviews would permit.
It relies on researchers' skills to observe and interpret unbiased behaviors or activities. For instance, in education research, observation might track how students stay focused and manage distractions, recorded through field notes taken during or shortly after the observation.
This involves participants or researchers documenting daily activities or study contexts. Participants might record their social interactions or exercise routines, giving detailed data for later analysis. Researchers may also maintain diaries to document study contexts, helping to explain findings and other information sources.
All types of qualitative research have their strengths for gathering detailed information and exploring the social, cultural, and psychological aspects of exploration topics. Learners often use several methods (triangulation) to confirm their findings and deepen their understanding of complex subjects. If you need assistance choosing the most appropriate method to explore, feel free to contact our website, as we offer essays for sale and support with academic papers.
This approach has unique strengths, making it valuable in many sciences. One of the primary advantages of qualitative research is its ability to capture participants' voices and perspectives accurately. It is highly adaptable, allowing researchers to modify the technique as new questions and ideas arise. This flexibility allows researchers to investigate new ideas and trends without being limited to set methods from the start. While this approach has many strengths, it also has significant drawbacks. A research paper writer faces practical and theoretical limitations when analyzing and interpreting data. Let’s consider all the pros and cons of this methodology in detail.
So, qualitative methodology offers significant benefits, such as adaptability, real-world context, rich insights, and fostering innovation. However, it also presents challenges like unpredictability, bias, limited applicability, or time- and labor-intensive. Understanding these pros and cons helps researchers make informed decisions about when and how to effectively utilize various types of qualitative research designs in their studies.
Qualitative research provides a valuable understanding of complicated human experiences and social situations, making it a strong tool in various areas of study. Despite its challenges, such as unreliability, subjectivity, and limited generalizability, its strengths in flexibility, natural settings, and generating meaningful insights make it an essential approach. If you are one of the students looking to incorporate qualitative methodology into their academic papers, EduBirdie is here to help. Our experts can guide you through the process, ensuring your work is thorough, credible, and impactful.
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Implementation Science volume 19 , Article number: 49 ( 2024 ) Cite this article
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Implementation of new practices in team-based settings requires teams to work together to respond to new demands and changing expectations. However, team constructs and team-based implementation approaches have received little attention in the implementation science literature. This systematic review summarizes empirical research examining associations between teamwork and implementation outcomes when evidence-based practices and other innovations are implemented in healthcare and human service settings.
We searched MEDLINE, CINAHL, APA PsycINFO and ERIC for peer-reviewed empirical articles published from January 2000 to March 2022. Additional articles were identified by searches of reference lists and a cited reference search for included articles (completed in February 2023). We selected studies using quantitative, qualitative, or mixed methods to examine associations between team constructs and implementation outcomes in healthcare and human service settings. We used the Mixed Methods Appraisal Tool to assess methodological quality/risk of bias and conducted a narrative synthesis of included studies. GRADE and GRADE-CERQual were used to assess the strength of the body of evidence.
Searches identified 10,489 results. After review, 58 articles representing 55 studies were included. Relevant studies increased over time; 71% of articles were published after 2016. We were unable to generate estimates of effects for any quantitative associations because of very limited overlap in the reported associations between team variables and implementation outcomes. Qualitative findings with high confidence were: 1) Staffing shortages and turnover hinder implementation; 2) Adaptive team functioning (i.e., positive affective states, effective behavior processes, shared cognitive states) facilitates implementation and is associated with better implementation outcomes; Problems in team functioning (i.e., negative affective states, problematic behavioral processes, lack of shared cognitive states) act as barriers to implementation and are associated with poor implementation outcomes; and 3) Open, ongoing, and effective communication within teams facilitates implementation of new practices; poor communication is a barrier.
Teamwork matters for implementation. However, both team constructs and implementation outcomes were often poorly specified, and there was little overlap of team constructs and implementation outcomes studied in quantitative studies. Greater specificity and rigor are needed to understand how teamwork influences implementation processes and outcomes. We provide recommendations for improving the conceptualization, description, assessment, analysis, and interpretation of research on teams implementing innovations.
This systematic review was registered in PROSPERO, the international prospective register of systematic reviews. Registration number: CRD42020220168.
Peer Review reports
This paper reviews more than 20 years of research on teams and implementation of new practices in healthcare and human service settings.
We concluded with high confidence that adaptive team functioning is associated with better implementation outcomes and problems in team functioning are associated with poorer implementation outcomes. While not surprising, the implementation science literature has lacked clear empirical evidence for this finding.
Use of the provided recommendations will improve the quality of future research on teams and implementation of evidence-based practices.
Healthcare and human service providers (e.g., clinicians, case managers) often work in team-based settings where professionals work collaboratively with one another and service recipients toward shared goals [ 1 , 2 ]. Team-based care is intended to include multiple professionals with varying skills and expertise [ 1 , 3 ]. It requires shared responsibility for outcomes and increases team members’ dependence on one another to complete work [ 1 , 3 , 4 ]. Effective team-based care and higher quality teamwork are associated with improvements in care access and quality, patient safety, patient satisfaction, clinical outcomes, and costs [ 2 , 4 , 5 , 6 , 7 , 8 , 9 ].
We use the term ‘teamwork’ to refer to an array of team constructs using the input-mediator-outcome-input (IMOI) framework (Fig. 1 ) [ 10 , 11 , 12 ]. The IMOI framework recognizes that team interactions are dynamic and complex, with processes unfolding over time and feedback loops between processes, outcomes, and inputs [ 10 ]. Team inputs include team structure and composition, task demands, and contextual features [ 13 ]. Mediators are aspects of team functioning (i.e., what team members think, feel, and do [ 12 ]) through which inputs influence outcomes. These processes and emergent states may be cognitive, affective, or behavioral [ 5 , 14 , 15 , 16 ]. Team effectiveness outcomes are multidimensional and include team performance as well as team viability and the impact of the team on members’ development [ 12 , 17 , 18 , 19 ].
Conceptual model of team effectiveness and key terminology. Figure adapted from “Advancing research on teams and team effectiveness in implementation science: An application of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework” by E.A. McGuier, D.J. Kolko, N.A. Stadnick, L. Brookman-Frazee, C.B. Wolk, C.T. Yuan, C.S. Burke, & G.A. Aarons, 2023, Implementation Research and Practice , 4 , 26334895231190855. [CC BY-NC]
Implementation of new practices in team-based service settings requires team members to work together to respond to changing demands and expectations. Extensive research has identified barriers and facilitators to implementation of new practices at the individual provider, organization, and system levels; however, the team level has received little empirical attention [ 20 , 21 ]. This is a problem because implementation efforts increasingly rely on teams, and responses to a new practice are likely to be influenced by team characteristics and processes. See McGuier and colleagues [ 20 ] for an overview of team constructs in the context of implementation science and the Exploration, Preparation, Implementation, Sustainment (EPIS) framework [ 22 , 23 ]. Given increasing use of team-based care and interest in implementation strategies targeting teams, examining how teamwork is associated with implementation processes and outcomes is critical. This systematic review identified and summarized empirical research examining associations between teamwork and implementation outcomes when evidence-based practices (EBPs) and other innovations were implemented in healthcare and human service settings.
This systematic review was registered (PROSPERO; registration number: CRD42020220168) and conducted following the published protocol [ 24 ]. The review was conducted in accordance with PRISMA and SWiM guidance [ 25 , 26 ]; relevant checklists are in Additional File 1.
We searched the following databases: MEDLINE (Ovid), CINAHL (Ebsco), APA PsycINFO (Ovid), and ERIC (Ebsco). Database searches were run on August 7, 2020, and again on March 8, 2022. For all searches, a publication date from 2000 to current was applied; there were no language restrictions (see [ 24 ]). An experienced health sciences librarian (MLK) designed the Ovid MEDLINE search and translated that search for use in the other databases (see additional file in [ 24 ]). The search strings consisted of controlled vocabulary (when available) and natural language terms representing concepts of teamwork and implementation science or innovation or evidence-based practice. Results were downloaded to an EndNote (version X9.3.3) library and duplicate records removed [ 27 ]. Additional relevant articles were identified by hand searches of reference lists of included articles, a cited reference search for included articles in the Web of Science (Clarivate) bibliographic database (completed in February 2023), and requests sent to implementation science listservs and centers for suggestions of relevant articles.
We included empirical journal articles describing studies using quantitative, qualitative, or mixed methods. Study protocols, reviews, and commentaries were excluded. All studies were conducted in healthcare or human service settings (e.g., hospitals, clinics, child welfare) and described the implementation of a practice to improve patient care. Studies of interventions to improve teamwork (e.g., team building interventions) and studies of teams created to implement the innovation (e.g., quality improvement teams, implementation support teams) were excluded. Eligible studies assessed at least one team construct and described its influence on implementation processes and outcomes.
Several changes were made from our systematic review protocol (PROSPERO CRD42020220168; [ 24 ]). Specifically, during the full-text review stage, we broadened the scope from team functioning (i.e., processes and states) to include team structure and performance because of the small number of studies that assessed and reported specific processes or states. This change increased the number of included studies. Similarly, because implementation outcomes were often inconsistently defined and poorly reported [ 28 , 29 , 30 ], we broadened our scope to include studies that identified team constructs as implementation determinants (i.e., barriers/facilitators) without explicitly defining and measuring an implementation outcome. Because of changes in university access to bibliographic databases, the cited reference search was performed in the Web of Science only instead of the Web of Science and Scopus. This bibliographic database indexes more than 21,000 scientific journals [ 31 ]. Lastly, because of time and resource constraints, we did not search conference abstracts or contact authors for unreported data.
Title/abstract screening and review of full-text articles were conducted by pairs of trained independent reviewers in DistillerSR. Conflicts were resolved through re-review, discussion between reviewers, and when needed, discussion with a senior team member (EAM). A final review of all included articles was conducted by EAM. Relevant data from each article was extracted into an Excel spreadsheet by one reviewer (AS). A second reviewer (EAM) conducted a line-by-line review and verification. Our data extraction form was informed by existing forms and guides (e.g., [ 32 , 33 ]). For each included study, we extracted information on measures of teamwork and implementation-relevant outcomes, characteristics of the setting, teams, and participants, analysis methods, and results. For quantitative studies, we recorded correlation coefficients and/or regression coefficients as standardized metrics of association. For qualitative studies, we recorded themes [ 33 ].
The Mixed Methods Appraisal Tool (MMAT) [ 34 ] was used to evaluate quality and risk of bias for each included study. Multiple publications from the same study were evaluated separately because they reported different outcomes. Consistent with Powell and colleagues [ 35 ], quality evaluations were only made for the components of the study relevant to our question. Quality evaluations were conducted by two independent reviewers (EAM, MAD) with discrepancies resolved through consensus discussion. After completing the MMAT, the reviewers jointly categorized each article as high, moderate, or low quality. High quality studies were those with affirmative responses to all MMAT questions. Moderate quality studies had at least one minor methodological problem, and low-quality studies had serious flaws (e.g., qualitative studies with poor coherence between data, analysis, and conclusions; quantitative studies with biased samples and/or inappropriate statistical analyses).
We rated the relevance of each publication to our research question as high, moderate, or low. Highly relevant studies reported implementation of a well-defined innovation, thoroughly described team constructs and implementation outcomes, and clearly linked team constructs to implementation outcomes. Most studies rated as low relevance provided very limited information about teamwork and/or implementation outcomes. Studies that only described barriers/facilitators were rated as low or moderate relevance. Ratings were conducted by two independent reviewers (EAM, CBW) with discrepancies resolved through consensus discussion.
We conducted a narrative synthesis of included studies following guidelines for synthesis without meta-analysis (SWiM) [ 36 ]. We prioritized reporting of high quality, highly relevant studies. Studies categorized as low quality and/or low relevance were not included in the synthesis but are included in the description of study characteristics to convey the breadth of the literature. We organized studies based on the IMOI framework (i.e., team inputs, processes/states, and outputs) and organized studies of processes/states by affective, behavioral, and cognitive constructs when possible. Because of the heterogeneity in team constructs and implementation outcomes, we were unable to quantitatively synthesize results using meta-analysis or formally investigate heterogeneity; this challenge is common in implementation science systematic reviews [ 30 ]. We assessed the strength of the overall body of evidence with GRADE for quantitative studies [ 37 ] and GRADE-CERQual for qualitative studies [ 38 , 39 ]. GRADE results in ratings of high, moderate, low, or very low quality of evidence for each outcome of interest. GRADE-CERQual results in ratings of high, moderate, low, or very low confidence in each review finding. GRADE ratings were made independently with discrepancies resolved through consensus discussion; GRADE-CERQual ratings were made through iterative discussions as recommended [ 39 ]. All ratings and decisions were made by the first and senior authors.
Our initial search, after removal of duplicates, yielded 7181 results. The second search (August 2020-March 2022) captured an additional 1341 results. The cited reference search yielded 1961 results. A total of 10,489 results were included in title/abstract review. Figure 2 provides a PRISMA flow diagram for included studies. After full-text review, 58 articles from 55 studies were included in analyses [ 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 ].
PRISMA flow diagram of included articles. From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. https://doi.org/10.1136/bmj.n71 . For more information, visit: http://www.prisma-statement.org/
As shown in Fig. 3 , publications on teamwork and implementation have increased substantially since 2000. Three articles on this topic (5%) were published between 2000 and 2007, 14 (24%) between 2008 and 2015, and 41 (71%) between 2016 and early 2023.
Included articles by year of publication
Interrater agreement was good for assessment of study quality (81% agreement on MMAT questions) and ratings of relevance (88% agreement). There were 20 high quality articles, 23 moderate quality articles, and 15 low quality articles. Fourteen articles were rated as high relevance, 22 as moderate, and 22 as low relevance. Only 4 were rated as both high quality and high relevance. We report study characteristics for all 58 eligible articles. Our narrative synthesis includes 32 articles categorized as moderate/high quality and moderate/high relevance; it excludes 26 articles categorized as low quality and/or relevance.
Studies were conducted in inpatient healthcare ( n = 22), outpatient/ambulatory healthcare ( n = 21), mental health settings ( n = 9), and other settings (e.g., residential facilities, multiple settings; n = 6). There were 33 qualitative, 15 quantitative, and 10 mixed methods studies. All quantitative studies were descriptive observational studies.
Most studies examined team processes/states ( n = 53); fewer examined team inputs ( n = 27). Only two studies examined a team effectiveness outcome. The most common implementation outcomes were fidelity ( n = 16) and other specified implementation outcomes (e.g., “extent of use,” “implementation success”) ( n = 15). Less frequently identified implementation outcomes included adoption ( n = 5), sustainment ( n = 4), reach ( n = 4), and perceptions of the innovation (e.g., acceptability, appropriateness, feasibility; n = 3). Approximately one-third of studies ( n = 21) did not report specific implementation outcomes but described implementation determinants (i.e., barriers and facilitators).
Team inputs examined in studies included team stability/instability and staffing shortages, aspects of team structure and composition, interdependence, and hierarchy and professional roles. Quantitative findings are presented in Table 1 . A CERQual Summary of Qualitative Findings related to team inputs is shown in Table 2 . A CERQual Evidence Profile is provided in Additional File 2 (Table A1).
Team stability/instability (i.e., consistency in membership over time) was examined in one mixed methods study [ 48 , 49 ] and three qualitative studies [ 70 , 81 , 94 ]. A study of surgical teams found variations in membership stability but no association between stability and “implementation success” (i.e., composite measure based on number of uses of new technique, proportion of uses, and changes in use) [ 48 , 49 ]. The authors suggested that stability facilitates the development of team coordination but that selecting small and exclusive teams may limit the spread of innovations within the organization. Another study found that a dedicated and stable team in which members were selected and trained together in the use of a new surgical technique led to quicker uptake and better integration into practice, theorizing that dedicated and stable teams increased trust, motivation, and collaborative problem-solving [ 81 ]. However, dedicated teams were difficult to sustain, and some sites instead used rotating team members from a larger pool of trained staff. In rural primary care, stability of team members facilitated sustainment of memory care clinics [ 70 ]. Lastly, another study in primary care found mixed perceptions of stable vs. rotating staff when adding a new team role (i.e., health coach); some team members liked rotating through different roles while others wanted more stability [ 94 ]. Across studies, we found that dedicated and stable team members facilitate implementation while instability in team membership is a barrier to implementation (moderate confidence).
Qualitative studies identified staffing shortages and turnover on teams as barriers to implementation [ 50 , 67 , 75 , 78 , 92 ]. In Veterans Health Administration (VA) clinics, “inadequate staffing posed an insurmountable barrier,” hindering communication and delivery of optimal care during the implementation of the patient-centered medical home (PCMH) model [ 92 ]. Similarly, staff shortages, turnover, and high workloads hindered guideline implementation in Kenyan hospitals [ 75 ]. Two studies found negative impacts of staffing shortages and turnover on sustainment. Staff turnover contributed to discontinuity in Dialectical Behavior Therapy (DBT) team members [ 78 ], and appropriate staffing (i.e., ensuring manageable workloads) and blocking time for team members were identified as critical to sustainment of a team-based model in the VA [ 67 ]. We found that staffing shortages and turnover hinder implementation (high confidence).
Studies examined multiple aspects of team structure and composition, specifically team size, workload, longevity (i.e., how long team members had worked together), history of change, and team member characteristics. Team size was examined in two studies of DBT. In a mixed methods study, team size was positively correlated with fidelity, and qualitative data suggested that team size may increase as a result of successful implementation [ 47 ]. In contrast, another study found that DBT team size was not associated with the number of DBT components adopted and was negatively associated with reach, suggesting reach may reflect high workloads [ 72 ]. In VA mental health clinics, team workload (i.e., number of patients seen) was negatively associated with sustainment of trauma-focused therapies [ 68 ]. In these studies, team longevity and history of change were not associated with implementation outcomes [ 47 , 68 ]. Team member characteristics, specifically team member competency/expertise, experience, and commitment/engagement, were identified as facilitators of implementation in some qualitative studies [ 40 , 70 , 81 , 84 , 95 ].
Overall, few findings could be made from quantitative studies examining team structure and composition. Two studies of team size found mixed results, and workload, longevity, and history of change were examined in only one study each. Across qualitative studies, we found team member competency/expertise, experience, and commitment/engagement facilitate implementation (moderate confidence).
One quantitative study examined team interdependence [ 65 ]. In multidisciplinary child abuse teams implementing a mental health screening/referral protocol, task interdependence (i.e., reliance on team members to share resources and coordinate workflows) was positively associated with reach but not time to adoption. Outcome interdependence (i.e., extent to which outcomes are evaluated at the team vs. individual level) was significantly negatively correlated with time to adoption but not reach. Neither task nor outcome interdependence were associated with team members’ perceptions of acceptability, appropriateness, or feasibility of the innovation [ 65 ]. Because only one study examined interdependence, no review findings were made.
Hierarchy, power distributions, and rigid roles were identified as barriers to implementation in several qualitative studies [ 50 , 53 , 74 , 97 ]. Flatter hierarchies (i.e., more equal distribution of power and authority) supported guideline implementation in pediatric primary care; practices with low compliance to guidelines had more hierarchical relationships while practices with high compliance had more shared decision-making [ 97 ]. In a setting with hierarchy and rigid division of roles, nurses trained in an innovation reported concern that their decisions would be questioned by physicians without expertise in the innovation but more authority [ 74 ]. Similarly, in surgical teams, rigid professional roles and a hierarchical team culture constrained open discussion and created contention over how and when a “time-out” should be completed, resulting in inconsistent use and poor fidelity [ 50 , 53 ]. Across studies, we found that in multidisciplinary settings, rigid professional roles, hierarchical relationships, and power differentials are barriers to implementation (moderate confidence).
There was no overlap among team input variables and implementation outcomes examined in quantitative studies (Table 1 ). Accordingly, we were unable to generate estimates of effects or ratings of evidence quality. Qualitative review findings are shown in Table 2 . We found: 1) Dedicated and stable team members facilitate implementation while instability in team membership is a barrier to implementation (moderate confidence); 2) Staffing shortages and turnover hinder implementation (high confidence); 3) Team member competency/expertise, experience, and commitment/engagement facilitate implementation (moderate confidence); and 4) In multidisciplinary settings, rigid professional roles, hierarchical relationships, and power differentials are barriers to implementation (moderate confidence).
Studies examined overall team functioning as well as specific affective states, behavioral processes, and cognitive states. Quantitative findings are presented in Table 3 , and a GRADE Evidence Profile is provided in Additional File 2 (Table A2). A CERQual Summary of Qualitative Findings related to team processes and states is shown in Table 4 . A CERQual Evidence Profile is provided in Additional File 2 (Table A3).
Nine studies examined quantitative associations between overall team functioning and implementation outcomes. Team functioning was positively associated with intervention fidelity in 2 of 3 studies. One study examined implementation of transition programs for adolescents with chronic health conditions in 29 teams. More positive team climate, measured by the Team Climate Inventory (i.e., shared vision, participative safety, task orientation, support for innovation), at study start was associated with greater improvements in quality of chronic care delivery one year later [ 45 ]. Additionally, improvements in team climate were associated with greater improvement in care delivery [ 45 ]. These findings were consistent across teams working with different patient populations, suggesting the influence of team climate generalizes across teams and settings [ 45 ]. Greater team climate for innovation was also associated with greater fidelity (i.e., implementation of more program elements) among DBT teams [ 47 ]. In contrast, no significant associations were found between team climate and fidelity to a multifaceted cardiovascular disease management intervention, with qualitative data suggesting variation in the influence of teamwork across practices [ 77 ]. There was no overlap in the metrics of association reported in these studies; therefore, we were unable to generate an estimate of the effect of team functioning on fidelity. The quality of the evidence for fidelity was rated very low because of serious methodological limitations, serious inconsistency, and very serious imprecision due to the small number of studies.
Three studies examined associations between teamwork and adoption, with no significant associations found. The first study found that teamwork climate (i.e., perceived quality of collaboration between personnel) was not significantly associated with adoption of a comprehensive safety program in intensive care units, although there were associations between adoption and organizational constructs (e.g., lower safety climate, more management support) [ 59 ]. In a study of DBT teams, neither positive nor negative team functioning was associated with the number of DBT modes adopted [ 72 ]. The third study assessed relational coordination (i.e., shared goals, communication, respect) in primary care practices implementing patient engagement strategies. Relational coordination was high across practices initially and did not differ for practices with high vs. low adoption, although it increased over time in practices with high adoption [ 83 ]. There was no overlap in the metrics of association reported in these studies; therefore, we were unable to generate an estimate of the effect of team functioning on adoption. The quality of the evidence was rated very low because of serious methodological limitations and very serious imprecision due to the small number of studies.
Reach and sustainment were each examined in one quantitative study. DBT teams with more negative functioning had greater reach, suggesting that reach may reflect high workloads; positive functioning was not associated with reach [ 72 ]. In VA mental health clinics, team functioning was positively correlated with sustainment of evidence-based trauma-focused psychotherapies and significantly associated with sustainment after controlling for covariates [ 68 ]. Two studies examined other implementation outcomes. One found that better team functioning was associated with greater implementation of changes to improve access to care in VA clinics [ 62 ]. In the other, primary care practices reporting better teamwork were more likely to be in later stages of transformation to PCMHs than practices with poorer teamwork [ 88 ]. Because of the small number of studies examining reach, sustainment, and other implementation outcomes, we were unable to generate estimates of effects or ratings of evidence quality for these outcomes.
Our qualitative review findings are based on 12 studies describing how team functioning influenced implementation processes and outcomes. There was considerable variation across studies in how team functioning was defined and what implementation outcomes were examined. Most findings were based on relatively thin and superficial data. Studies occurred in a variety of healthcare settings with varying resources and implemented diverse interventions. We found with high confidence that 1) Adaptive team functioning, characterized by positive affective states (e.g., trust, mutual respect, belonging), effective behavior processes (e.g., frequent communication and coordination), and shared cognitive states (e.g., clear roles, shared mental models of how to provide care), facilitates implementation and is associated with better implementation outcomes; and 2) Problems in team functioning, including negative affective states (e.g., tension, lack of trust), problematic behavioral processes (e.g., conflict, competition, poor communication), and a lack of shared cognitive states (e.g., unclear roles, lack of shared awareness, competing goals), act as barriers to implementation and are associated with poor implementation outcomes.
Specific affective states were examined in one quantitative study, three mixed methods studies, and one qualitative study. There was no overlap in the associations between affective states and implementation outcomes reported in quantitative studies (Table 3 ). In a study of multidisciplinary teams responding to child abuse, affective integration (i.e., liking, trust, respect) was positively associated with acceptability, appropriateness, and feasibility but not time to adoption or reach [ 65 ]. In DBT teams, cohesion was associated with fidelity, and qualitative data indicated that liking one’s team members and having a shared team identity were critical to effective implementation [ 47 ]. Another study of DBT teams described conflicts and lack of safety and trust within teams resulting in their dissolution [ 78 ].
Edmondson and colleagues found that psychological safety and ease of speaking up (i.e., interpersonal climate that allows members to share questions and concerns) were associated with implementation success [ 48 , 49 ]. In teams with low psychological safety, lower-status team members were hesitant to speak up, hindering change and proficiency in the new practice [ 49 ]. Psychological safety was closely related to learning behavior within the team, including speaking up with questions and concerns [ 48 , 49 ]. From the mixed methods and qualitative studies, we found that trust, cohesion, and psychological safety within teams facilitate implementation by contributing to team members’ willingness to speak up and share experiences and feedback. Negative affective states, fear of judgment, conflict, and lack of safety hinder implementation (moderate confidence).
Specific behavioral processes, including communication, learning behavior, and coordination, were examined in two quantitative studies, two mixed methods studies, and five qualitative studies. There was no overlap in the associations between behavioral processes and implementation outcomes reported in quantitative studies (Table 3 ).
Only one study reported quantitative findings for communication. Communication in DBT teams was positively associated with fidelity [ 47 ]. Qualitative studies frequently identified communication as a determinant of implementation (Table 4 ). From qualitative studies, we found that open, ongoing, and effective communication within teams facilitates implementation of new practices; poor communication is a barrier (high confidence).
Quantitative associations between team learning behavior and implementation outcomes were reported in three studies. Team learning behavior in child abuse teams was positively correlated with acceptability and feasibility; it was not associated with appropriateness, time to adoption, or reach [ 65 ]. Learning behavior was positively associated with knowledge and use of innovations in nursing teams [ 91 ] and with implementation success in surgical teams [ 48 ]. Because each of these studies examined different implementation outcomes, we were unable to generate an estimate of the effect of learning behavior or rate evidence quality.
Inter-team communication, specifically speaking up and learning from other teams (i.e., boundary spanning), was identified as a critical part of team learning processes associated with successful implementation [ 48 ]. Communication beyond the team was also identified as a facilitator of implementation in two qualitative studies [ 47 , 75 ]. We found that communication beyond the team facilitates implementation by providing opportunities for team learning (low confidence).
Lastly, two qualitative studies examined coordination among healthcare teams [ 40 , 95 ]. Findings were somewhat ambiguous and based on thin data. We found with low confidence that poor coordination among healthcare professionals interferes with providing high-quality care and can be a barrier to implementation of new approaches (low confidence).
Specific cognitive states were examined in two quantitative studies. There was no overlap in the associations between cognitive states and implementation outcomes reported (Table 3 ). The first study found no significant associations between shared goals and implementation outcomes [ 65 ]. The second study found that greater team knowledge and skills were associated with greater implementation of key changes to improve access to care; team problem recognition was not associated with implementation [ 62 ].
Two studies reported qualitative findings related to shared goals. In VA mental health teams, shared mission differentiated teams with sustained high reach of EBPs from those with low reach [ 84 ]. Commitment to a shared goal consistent with the EBP supported sustainment [ 84 ]. Similarly, shared goals and vision were identified as a facilitator of DBT programs [ 47 ]. We found that shared goals, mission, and vision within teams facilitate implementation and sustainment (low confidence).
There was very little overlap in the reported associations between team processes/states and implementation outcomes (Table 3 ). We were unable to generate estimates of effects for any associations. When there was sufficient overlap to rate evidence quality, the evidence was rated very low quality (Table A2, Additional File 2).
Qualitative review findings are shown in Table 4 . We found the following: 1) Adaptive team functioning, characterized by positive affective states (e.g., trust, mutual respect, belonging), effective behavior processes (e.g., frequent communication and coordination), and shared cognitive states (e.g., clear roles, shared mental models of how to provide care), facilitates implementation and is associated with better implementation outcomes (high confidence); 2) Problems in team functioning, including negative affective states (e.g., tension, lack of trust), problematic behavioral processes (e.g., conflict, competition, poor communication), and a lack of shared cognitive states (e.g., unclear roles, lack of shared awareness, competing goals), act as barriers to implementation and are associated with poor implementation outcomes (high confidence); 3) Trust, cohesion, and psychological safety within teams facilitate implementation by contributing to team members’ willingness to speak up and openly share experiences and feedback. Negative affective states, fear of judgment, conflict, and lack of safety hinder implementation (moderate confidence); 4) Open, ongoing, and effective communication within teams facilitates implementation of new practices; poor communication is a barrier (high confidence); 5) Communication beyond the team facilitates implementation by providing opportunities for team learning (low confidence); 6) Poor coordination among healthcare professionals interferes with providing high-quality care and can be a barrier to implementation of new approaches (low confidence); and 7) Shared goals, mission, and vision within teams facilitate implementation and sustainment (low confidence).
Team effectiveness outcomes are multidimensional and include performance (i.e., productivity, efficiency, and quality of the team’s work), team viability, and the impact of the team on members’ development [ 12 , 17 , 18 , 19 ]. Only two studies examined associations between team effectiveness and implementation outcomes. Quantitative findings are presented in Table 5 . One quantitative study found that team members’ ratings of team performance were associated with innovation acceptability, appropriateness, and feasibility; performance was not associated with time to adoption or reach [ 65 ]. One qualitative study found that positive outcomes for team members (e.g., increased comfort working together, greater knowledge) were associated with sustainment [ 70 ]. No studies examined associations of team viability and implementation outcomes.
Only one quantitative study examined associations between a dimension of team effectiveness and implementation outcomes (Table 5 ). Accordingly, we were unable to generate ratings of evidence quality or estimates of any effects. Similarly, because there was only one qualitative study, we were unable to make a review finding.
This systematic review summarizes over 20 years of empirical literature on the associations between teamwork and implementation outcomes in the context of implementation of new practices in health and human services. Consistent with increased attention to teams and reliance on team-based models of care, as well as the growth of implementation science, studies increased substantially over time. We included studies that used quantitative, qualitative, or mixed methods, yielding a total of 58 articles representing 55 studies. Included studies spanned naturalistic implementation evaluations and planned implementation research.
Key findings with high confidence were: 1) Staffing shortages and turnover hinder implementation, 2) Adaptive team functioning, characterized by positive affective states, effective behavior processes, and shared cognitive states, facilitates implementation and is associated with better implementation outcomes. Problems in team functioning, including negative affective states, problematic behavioral processes, and a lack of shared cognitive states, act as barriers to implementation and are associated with poor implementation outcomes, and 3) Open, ongoing, and effective communication within teams facilitates implementation of new practices; poor communication is a barrier. Our results generally align with conventional wisdom and scientific research outside of healthcare, increasing confidence in the findings. Team effectiveness and change management research in other types of organizations and settings (e.g., military, aviation, space exploration) [ 98 , 99 , 100 , 101 , 102 , 103 ] is largely converging.
Overall, the literature was heterogeneous, and many studies lacked specificity regarding team composition and implementation activities and outcomes. Teamwork was defined and measured inconsistently and with limited precision across studies, which hindered our ability to draw conclusions about how teams influence implementation processes and outcomes. There was also poor measurement and reporting of implementation outcomes in many studies, consistent with a recent review of research on implementation outcomes [ 28 , 29 ]. Many studies used broad measures encompassing multiple dimensions of teamwork. Among studies that assessed specific team processes and states, there was very little overlap across constructs assessed. Qualitative studies identified a rich array of specific team processes and states; research to confirm the presence of these factors in other settings and determine their associations with implementation outcomes is needed.
In Table 6 , we summarize the limitations of existing research on teams and implementation and provide recommendations for future research. Notably, increased specificity and rigor in how teamwork is conceptualized and assessed is needed to advance our understanding of how teamwork affects implementation processes and outcomes. Limited inclusion of teams and team constructs in implementation theories, models, and frameworks has likely contributed to the neglect of teams in implementation science [ 20 ]. Updates to theories, models, and framework should consider integrating teams and team-level constructs [ 20 ]. In addition, there are well-established theories of team effectiveness that could inform hypotheses about how specific team constructs affect implementation [ 104 , 105 , 106 , 107 ].
There is considerable room for improvement in the definition and description of teams and analysis of data from teams. Describing the structure and purpose of teams, as well as interdependencies within the team, can help differentiate teams from groups of individuals who do not constitute a team, an important conceptual distinction that can be difficult to discern in study descriptions. Reporting of sampling and recruitment procedures for teams and team-level response rates is needed. For quantitative studies, use of standardized, validated measures of teamwork constructs is recommended. Researchers should be careful to base inferences about teams on team-level data. Lastly, future research should follow recommendations for improving measurement and reporting of implementation outcomes [ 29 , 108 ] and consider the multilevel context of teams in theory, measurement, analysis, and interpretation of results [ 109 ].
As with all systematic reviews, it is possible that we failed to identify some relevant articles or data. We did not search gray literature or conference abstracts or contact authors for unreported data. Our organization of studies by the IMOI framework is likely imperfect given the broad array of team constructs included and poor reporting in many studies. We included diverse innovations intended to improve patient care, including specific EBPs, clinical practice guidelines, models of care, care bundles, procedural changes, and technological innovations. This diversity in objects of implementation reflects ongoing debates about the necessary strength of evidence for objects of implementation and varying thresholds in different contexts [ 110 ]. In this review, high quality studies tended to involve clinical interventions with strong research evidence (e.g., DBT) and clinics in structured and often team-based healthcare systems (e.g., VA). Diversity of innovations and settings provides greater external validity for our findings but may mask some findings specific to certain innovations or settings.
We only included studies of existing teams providing clinical services, however, many studies provided limited descriptions of teams, and in some cases the distinction between clinical teams and implementation/quality improvement teams was unclear. There is increasing attention to use of teams in implementation frameworks [ 20 , 111 ] and evidence that functioning of implementation teams matters [ 112 , 113 ]. Research on the composition and functioning of implementation teams is an important area for future research.
Our systematic review findings indicate that teamwork matters for implementation. However, greater specificity and rigor are needed to advance our understanding of how teamwork influences implementation processes and outcomes. We provide recommendations for improving the conceptualization, description, assessment, analysis, and interpretation of research on teams implementing new practices.
All data cited in this review came from published papers and are therefore already available. The data created as part of the review process are included in this published article and its supplementary information files.
Mitchell P, Wynia M, Golden R, McNellis B, Okun S, Webb CE, et al. Core principles and values of effective team-based health care. NAM Perspectives. 2012. Available from: https://nam.edu/perspectives-2012-core-principles-values-of-effective-team-based-health-care/ Cited 2020 Sep 23
Reiss-Brennan B, Brunisholz KD, Dredge C, Briot P, Grazier K, Wilcox A, et al. Association of integrated team-based care with health care quality, utilization, and cost. JAMA. 2016;316(8):826–34.
Article PubMed Google Scholar
Katkin JP, Kressly SJ, Edwards AR, Perrin JM, Kraft CA, Richerson JE, et al. Guiding principles for team-based pediatric care. Pediatrics. 2017;140(2):e20171489.
Lipton HL. Home is where the health is: Advancing team-based care in chronic disease management. Arch Intern Med. 2009;169(21):1945–8.
Dinh JV, Traylor AM, Kilcullen MP, Perez JA, Schweissing EJ, Venkatesh A, et al. Cross-disciplinary care: A systematic review on teamwork processes in health care. Small Group Research. 2020;51(1):125–66.
Article Google Scholar
Fiscella K, McDaniel SH. The complexity, diversity, and science of primary care teams. Am Psychol. 2018;73(4):451–67.
Herbert JL, Bromfield LM. A quasi-experimental study of the Multi-Agency Investigation & Support Team (MIST): A collaborative response to child sexual abuse. Child Abuse Negl. 2020;27:104827.
Google Scholar
Reiss-Brennan B. Mental Health Integration: Normalizing Team Care. J Prim Care Community Health. 2014;5(1):55–60.
Schmutz J, Manser T. Do team processes really have an effect on clinical performance? A systematic literature review. Br J Anaesth. 2013;110(4):529–44.
Article CAS PubMed Google Scholar
Ilgen DR, Hollenbeck JR, Johnson M, Jundt D. Teams in organizations: From input-process-output models to IMOI models. Annu Rev Psychol. 2005;56:517–43.
Kozlowski SWJ, Bell BS. Work groups and teams in organization. In: Borman WC, Ilgen DR, Klimoski RJ, editors. Handbook of Psychology (Vol 12): Industrial and Organizational Psychology. New York: Wiley-Blackwell. 2003. p. 333–75. Available from: http://onlinelibrary.wiley.com/doi/abs/ https://doi.org/10.1002/9781118133880.hop212017 Cited 2020 Apr 10
Mathieu JE, Maynard MT, Rapp T, Gilson L. Team effectiveness 1997–2007: A review of recent advancements and a glimpse into the future. J Manag. 2008;34(3):410–76.
Cordery JL, Tian AW. Team Design. In: The Wiley Blackwell Handbook of the Psychology of Team Working and Collaborative Processes. John Wiley & Sons, Ltd. 2017;p. 103–28. Available from: http://onlinelibrary.wiley.com/doi/abs/ https://doi.org/10.1002/9781118909997.ch5 Cited 2021 Apr 2
Kozlowski SWJ, Bell BS. Work groups and teams in organizations: Review update. In: Schmitt N, Highhouse S, editors. Handbook of Psychology (Vol 12): Industrial and Organizational Psychology. 2nd ed. Hoboken, NJ: Wiley; 2013. p. 111.
Kozlowski SWJ, Ilgen DR. Enhancing the effectiveness of work groups and teams. Psychol Sci Public Interest. 2006;7(3):77–124.
Marks MA, Mathieu JE, Zaccaro SJ. A temporally based framework and taxonomy of team processes. AMR. 2001;26(3):356–76.
Hackman JR. A normative model of work team effectiveness. Arlington, VA: Office of Naval Research; 1983. Available from: https://apps.dtic.mil/sti/citations/ADA136398 Cited 2022 May 16
Mathieu JE, Hollenbeck JR, van Knippenberg D, Ilgen DR. A century of work teams in the Journal of Applied Psychology. J Appl Psychol. 2017;102(3):452–67.
Rosen MA, Dietz AS. Team performance measurement. In: The Wiley Blackwell Handbook of the Psychology of Team Working and Collaborative Processes. John Wiley & Sons, Ltd; 2017. p. 479–502.
Chapter Google Scholar
McGuier EA, Kolko DJ, Stadnick NA, Brookman-Frazee L, Wolk CB, Yuan CT, et al. Advancing research on teams and team effectiveness in implementation science: An application of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Implementation Research and Practice. 2023;1(4):26334895231190856.
Williams NJ, Beidas RS. Annual research review: The state of implementation science in child psychology and psychiatry: A review and suggestions to advance the field. J Child Psychol Psychiatry. 2019;60:430–50.
Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health. 2011;38(1):4–23.
Moullin JC, Dickson KS, Stadnick NA, Rabin B, Aarons GA. Systematic review of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Implement Sci. 2019;14(1):1.
Article PubMed PubMed Central Google Scholar
McGuier EA, Kolko DJ, Klem ML, Feldman J, Kinkler G, Diabes MA, et al. Team functioning and implementation of innovations in healthcare and human service settings: a systematic review protocol. Syst Rev. 2021;10(1):189.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339. Available from: http://www.bmj.com/content/339/bmj.b2535 Cited 2020 Apr 1
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;29(372):n71.
Bramer WM, Giustini D, de Jonge GB, Holland L, Bekhuis T. De-duplication of database search results for systematic reviews in EndNote. J Med Libr Assoc. 2016;104(3):240–3.
Lengnick-Hall R, Gerke DR, Proctor EK, Bunger AC, Phillips RJ, Martin JK, et al. Six practical recommendations for improved implementation outcomes reporting. Implement Sci. 2022;17(1):16.
Proctor EK, Bunger AC, Lengnick-Hall R, Gerke DR, Martin JK, Phillips RJ, et al. Ten years of implementation outcomes research: a scoping review. Implement Sci. 2023;18(1):31.
Chapman A, Rankin NM, Jongebloed H, Yoong SL, White V, Livingston PM, et al. Overcoming challenges in conducting systematic reviews in implementation science: a methods commentary. Syst Rev. 2023;12(1):116.
Pranckutė R. Web of Science (WoS) and Scopus: The Titans of Bibliographic Information in Today’s Academic World. Publications. 2021;9(1):12.
Effective Practice and Organisation of Care (EPOC). Data collection form. EPOC Resources for review authors. Norwegian Knowledge Centre for the Health Services. 2013. Available from: http://epoc.cochrane.org/epoc-specific-resources-review-authors .
Noyes J, Lewin S. Extracting qualitative evidence. In: Noyes J, Booth A, Hannes K, Harden A, Harris J, Lewin S, et al., editors. Supplementary Guidance for Inclusion of Qualitative Research in Cochrane Systematic Reviews of Interventions. Version 1 (updated August 2011). Cochrane Collaboration Qualitative Methods Group; 2011. Available from: http://cqrmg.cochrane.org/supplemental-handbook-guidance
Hong QN, Pluye P, Fàbregues S, Bartlett G, Boardman F, Cargo M, et al. Improving the content validity of the mixed methods appraisal tool: a modified e-Delphi study. J Clin Epidemiol. 2019;1(111):49-59.e1.
Powell BJ, Patel SV, Haley AD, Haines ER, Knocke KE, Chandler S, Determinants of implementing evidence-based trauma-focused interventions for children and youth: A systematic review. Adm Policy Ment Health, et al. cited 2020 Feb 20. Available from: 2019. https://doi.org/10.1007/s10488-019-01003-3 .
Article PubMed Central Google Scholar
Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S, et al. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ. 2020;16(368):l6890.
Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. Journal of Clinical Epidemiology. 2011;64(4):383–94.
Lewin S, Bohren M, Rashidian A, Munthe-Kaas H, Glenton C, Colvin CJ, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings—paper 2: how to make an overall CERQual assessment of confidence and create a Summary of Qualitative Findings table. Implementation Sci. 2018;13(1):11–23.
Lewin S, Booth A, Glenton C, Munthe-Kaas H, Rashidian A, Wainwright M, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings: introduction to the series. Implementation Sci. 2018;13(1):1–10.
Adjognon OL, Shin MH, Steffen MJA, Moye J, Solimeo S, Sullivan JL. Factors affecting primary care implementation for older veterans with multimorbidity in Veterans Health Administration (VA). Health Serv Res. 2021;56(S1):1057–68.
Alidina S, Chatterjee P, Zanial N, Alreja SS, Balira R, Barash D, et al. Improving surgical quality in low-income and middle-income countries: why do some health facilities perform better than others? BMJ Qual Saf. 2021;30(12):937–49.
Boltey EM, Iwashyna TJ, Hyzy RC, Watson SR, Ross C, Costa DK. Ability to predict team members’ behaviors in ICU teams is associated with routine ABCDE implementation. J Crit Care. 2019;51:192–7.
Chenoweth L, Jeon YH, Stein-Parbury J, Forbes I, Fleming R, Cook J, et al. PerCEN trial participant perspectives on the implementation and outcomes of person-centered dementia care and environments. Int Psychogeriatr. 2015;27(12):2045–57.
Costa DK, Valley TS, Miller MA, Manojlovich M, Watson SR, McLellan P, et al. ICU team composition and its association with ABCDE implementation in a quality collaborative. J Crit Care. 2018;44:1–6.
Cramm JM, Strating MMH, Nieboer AP. The role of team climate in improving the quality of chronic care delivery: a longitudinal study among professionals working with chronically ill adolescents in transitional care programmes. BMJ Open. 2014;4(5):e005369.
DePuccio MJ, Gaughan AA, Sova LN, MacEwan SR, Walker DM, Gregory ME, et al. An examination of the barriers to and facilitators of implementing nurse-driven protocols to remove indwelling urinary catheters in acute care hospitals. The Joint Commission Journal on Quality and Patient Safety. 2020;46(12):691–8.
Ditty MS, Landes SJ, Doyle A, Beidas RS. It takes a village: A mixed method analysis of inner setting variables and Dialectical Behavior Therapy implementation. Adm Policy Ment Health. 2015;42(6):672–81.
Edmondson AC. Speaking up in the operating room: How team leaders promote learning in interdisciplinary action teams. J Manage Stud. 2003;40(6):1419–52.
Edmondson AC, Bohmer RM, Pisano GP. Disrupted routines: Team learning and new technology implementation in hospitals. Adm Sci Q. 2001;46(4):685–716.
Gillespie BM, Chaboyer W, Wallis M, Fenwick C. Why isn’t “time out” being implemented? An exploratory study. Qual Saf Health Care. 2010;19(2):103–6.
Gillespie BM, Harbeck E, Lavin J, Gardiner T, Withers TK, Marshall AP. Using normalisation process theory to evaluate the implementation of a complex intervention to embed the surgical safety checklist. BMC Health Serv Res. 2018;18(1):170.
Gillespie BM, Marshall AP, Gardiner T, Lavin J, Withers TK. Impact of workflow on the use of the Surgical Safety Checklist: a qualitative study: Surgical Safety Checklist and work flow. ANZ J Surg. 2016;86(11):864–7.
Gillespie BM, Withers TK, Lavin J, Gardiner T, Marshall AP. Factors that drive team participation in surgical safety checks: a prospective study. Patient Saf Surg. 2016;10(3):1–9.
Gosling AS. Clinical team functioning and IT innovation: A study of the diffusion of a point-of-care online evidence system. J Am Med Inform Assoc. 2003;10(3):244–51.
Graetz I, Huang J, Brand R, Shortell SM, Rundall TG, Bellows J, et al. The impact of electronic health records and teamwork on diabetes care quality. American Journal of Managed Care. 2015;21(12):878–84.
PubMed Google Scholar
Haider S, Ali RF, Ahmed M, Humayon AA, Sajjad M, Ahmad J. Barriers to implementation of emergency obstetric and neonatal care in rural Pakistan. Sawyer A, editor. PLoS ONE. 2019;14(11):e0224161.
Article CAS PubMed PubMed Central Google Scholar
Harvey C, Killaspy H, Martino S, White S, Priebe S, Wright C, et al. A comparison of the implementation of Assertive Community Treatment in Melbourne, Australia and London. England Epidemiol Psychiatr Sci. 2011;20(2):151–61.
Harvey C, Killaspy H, Martino S, Johnson S. Implementation of Assertive Community Treatment in Australia: Model fidelity, patient characteristics and staff experiences. Community Ment Health J. 2012;48(5):652–61.
Hsu YJ, Marsteller JA. Who applies an intervention to influence cultural attributes in a quality improvement collaborative? J Patient Saf. 2020;16(1):1–6.
Irimu GW, Greene A, Gathara D, Kihara H, Maina C, Mbori-Ngacha D, et al. Explaining the uptake of paediatric guidelines in a Kenyan tertiary hospital – mixed methods research. BMC Health Serv Res. 2014;14(1):119.
Lall D, Engel N, Devadasan N, Horstman K, Criel B. Team-based primary health care for non-communicable diseases: complexities in South India. Health Policy Plan. 2020;35(Supplement_2):ii22-34.
Lukas CV, Mohr D, Meterko M. Team effectiveness and organizational context in the implementation of a clinical innovation. Qual Manag Health Care. 2009;18(1):25–39.
Mariani E, Vernooij-Dassen M, Koopmans R, Engels Y, Chattat R. Shared decision-making in dementia care planning: barriers and facilitators in two European countries. Aging Ment Health. 2017;21(1):31–9.
Martinez RN, Hogan TP, Balbale S, Lones K, Goldstein B, Woo C, et al. Sociotechnical perspective on implementing clinical video telehealth for veterans with spinal cord injuries and disorders. Telemedicine and e-Health. 2017;23(7):567–76.
McGuier EA, Aarons GA, Byrne KA, Campbell KA, Keeshin B, Rothenberger SD, et al. Associations between teamwork and implementation outcomes in multidisciplinary cross-sector teams implementing a mental health screening and referral protocol. Implementation Science Communications. 2023;4(1):13.
Meloncelli N, Barnett A, de Jersey S. Staff resourcing, guideline implementation and models of care for gestational diabetes mellitus management. Aust N Z J Obstet Gynaecol. 2020;60(1):115–22.
Miller CJ, Kim B, Connolly SL, Spitzer EG, Brown M, Bailey HM, et al. Sustainability of the Collaborative Chronic Care Model in outpatient mental health teams three years post-Implementation: A qualitative analysis. Adm Policy Ment Health. 2023;50(1):151–9.
Mohr DC, Rosen CS, Schnurr PP, Orazem RJ, Noorbaloochi S, Clothier BA, et al. The influence of team functioning and workload on sustainability of trauma-focused evidence-based psychotherapies. PS. 2018;69(8):879–86.
Morgan D, Kosteniuk J, O’Connell ME, Kirk A, Stewart NJ, Seitz D, et al. Barriers and facilitators to development and implementation of a rural primary health care intervention for dementia: a process evaluation. BMC Health Serv Res. 2019;19(1):709.
Morgan D, Kosteniuk J, O’Connell ME, Seitz D, Elliot V, Bayly M, et al. Factors influencing sustainability and scale-up of rural primary healthcare memory clinics: perspectives of clinic team members. BMC Health Serv Res. 2022;22(1):148.
Munce SEP, Graham ID, Salbach NM, Jaglal SB, Richards CL, Eng JJ, et al. Perspectives of health care professionals on the facilitators and barriers to the implementation of a stroke rehabilitation guidelines cluster randomized controlled trial. BMC Health Serv Res. 2017;17(1):440.
Navarro-Haro MV, Harned MS, Korslund KE, DuBose A, Chen T, Ivanoff A, et al. Predictors of adoption and reach following Dialectical Behavior Therapy Intensive Training™. Community Ment Health J. 2019;55(1):100–11.
Newbould L, Ariss S, Mountain G, Hawley MS. Exploring factors that affect the uptake and sustainability of videoconferencing for healthcare provision for older adults in care homes: a realist evaluation. BMC Med Inform Decis Mak. 2021;21(1):13.
Nyondo-Mipando AL, Woo Kinshella ML, Bohne C, Suwedi-Kapesa LC, Salimu S, Banda M, et al. Barriers and enablers of implementing bubble Continuous Positive Airway Pressure (CPAP): Perspectives of health professionals in Malawi. Ameh CA, editor. PLoS ONE. 2020;15(2):e0228915.
Nzinga J, Mbindyo P, Mbaabu L, Warira A, English M. Documenting the experiences of health workers expected to implement guidelines during an intervention study in Kenyan hospitals. Implementation Sci. 2009;4(1):44.
Papoutsi C, Poots A, Clements J, Wyrko Z, Offord N, Reed JE. Improving patient safety for older people in acute admissions: implementation of the Frailsafe checklist in 12 hospitals across the UK. Age Ageing. 2018;47(2):311–7.
Patel B, Usherwood T, Harris M, Patel A, Panaretto K, Zwar N, et al. What drives adoption of a computerised, multifaceted quality improvement intervention for cardiovascular disease management in primary healthcare settings? A mixed methods analysis using normalisation process theory. Implementation Sci. 2018;13(1):140.
Popowich AD, Mushquash AR, Pearson E, Schmidt F, Mushquash CJ. Barriers and facilitators affecting the sustainability of dialectical behaviour therapy programmes: A qualitative study of clinician perspectives. Couns Psychother Res. 2020;20(1):68–80.
Prom MC, Canelos V, Fernandez PJ, Gergen Barnett K, Gordon CM, Pace CA, et al. Implementation of integrated behavioral health care in a large medical center: Benefits, challenges, and recommendations. J Behav Health Serv Res. 2021;48(3):346–62.
Provost S, Pineault R, Grimard D, Pérez J, Fournier M, Lévesque Y, et al. Implementation of an integrated primary care cardiometabolic risk prevention and management network in Montréal: does greater coordination of care with primary care physicians have an impact on health outcomes? Health Promot Chronic Dis Prev Can. 2017;37(4):105–13.
Randell R, Honey S, Alvarado N, Greenhalgh J, Hindmarsh J, Pearman A, et al. Factors supporting and constraining the implementation of robot-assisted surgery: a realist interview study. BMJ Open. 2019;9(6):e028635.
Robbins J, McAlearney AS. Encouraging employees to speak up to prevent infections: Opportunities to leverage quality improvement and care management processes. Am J Infect Control. 2016;44(11):1224–30.
Rodriguez HP, Poon BY, Wang E, Shortell SM. Linking practice adoption of patient engagement strategies and relational coordination to patient-reported outcomes in accountable care organizations. Milbank Q. 2019;97(3):692–735.
Sayer NA, Rosen CS, Bernardy NC, Cook JM, Orazem RJ, Chard KM, et al. Context matters: Team and organizational factors associated with reach of evidence-based psychotherapies for PTSD in the Veterans Health Administration. Adm Policy Ment Health. 2017;44(6):904–18.
Shin MH, Montano ARL, Adjognon OL, Harvey KLL, Solimeo SL, Sullivan JL. Identification of implementation strategies using the CFIR-ERIC matching tool to mitigate barriers in a primary care model for older veterans. Gerontologist. 2022;63(3):439–50.
Sopcak N, Aguilar C, O’Brien MA, Nykiforuk C, Aubrey-Bassler K, Cullen R, et al. Implementation of the BETTER 2 program: a qualitative study exploring barriers and facilitators of a novel way to improve chronic disease prevention and screening in primary care. Implementation Sci. 2016;11(1):158.
Steinmo SH, Michie S, Fuller C, Stanley S, Stapleton C, Stone SP. Bridging the gap between pragmatic intervention design and theory: using behavioural science tools to modify an existing quality improvement programme to implement “Sepsis Six.” Implementation Sci. 2016;11(1):14.
Stout S, Zallman L, Arsenault L, Sayah A, Hacker K. Developing high-functioning teams: Factors associated with operating as a “real team” and implications for patient-centered medical home development. Inquiry. 2017;12(54):0046958017707296.
Svensson B, Hansson L, Markström U, Lexén A. What matters when implementing Flexible Assertive Community Treatment in a Swedish healthcare context: A two-year implementation study. Int J Ment Health. 2017;46(4):284–98.
Tadyanemhandu C, van Aswegen H, Ntsiea V. Barriers and facilitators to implementation of early mobilisation of critically ill patients in Zimbabwean and South African public sector hospitals: a qualitative study. Disabil Rehabil. 2021;44(22):6699–709.
Timmermans O, Van Linge R, Van Petegem P, Van Rompaey B, Denekens J. A contingency perspective on team learning and innovation in nursing: Team learning and innovation in nursing teams. J Adv Nurs. 2013;69(2):363–73.
Tuepker A, Kansagara D, Skaperdas E, Nicolaidis C, Joos S, Alperin M, et al. “We’ve not gotten even close to what we want to do”: A qualitative study of early patient-centered medical home implementation. J GEN INTERN MED. 2014;29(S2):614–22.
van Bruggen S, Kasteleyn MJ, Rauh SP, Meijer JS, Busch KJG, Numans ME, et al. Experiences with tailoring of primary diabetes care in well-organised general practices: a mixed-methods study. BMC Health Serv Res. 2021;21(1):1218.
Van der Wees PJ, Friedberg MW, Guzman EA, Ayanian JZ, Rodriguez HP. Comparing the implementation of team approaches for improving diabetes care in community health centers. BMC Health Serv Res. 2014;14(1):608.
von Meyenfeldt EM, van Nassau F, de Betue CTI, Barberio L, Schreurs WH, Marres GMH, et al. Implementing an enhanced recovery after thoracic surgery programme in the Netherlands: a qualitative study investigating facilitators and barriers for implementation. BMJ Open. 2022;12(1):e051513.
Wakefield BJ, Lampman MA, Paez MB, Stewart GL. Care management and care coordination within a patient-centered medical home. J Nurs Admin. 2020;50(11):565–70.
Wiener-Ogilvie S, Huby G, Pinnock H, Gillies J, Sheikh A. Practice organisational characteristics can impact on compliance with the BTS/SIGN asthma guideline: Qualitative comparative case study in primary care. BMC Fam Pract. 2008;9(1):32.
Errida A, Lotfi B. The determinants of organizational change management success: Literature review and case study. International Journal of Engineering Business Management. 2021;1(13):18479790211016270.
Phillips J, Klein JD. Change management: From theory to practice. TechTrends. 2023;67(1):189–97.
Rousseau DM, ten Have S. Evidence-based change management. Organ Dyn. 2022;51(3):100899.
Goodwin GF, Blacksmith N, Coats MR. The science of teams in the military: Contributions from over 60 years of research. Am Psychol. 2018;73(4):322–33.
DiazGranados D, Woods JJ, Wilder A, Curtis MT. Team dynamics in the air: A review of team research relevant to aviation. Human factors in aviation and aerospace. 2023. p. 199–215.
Salas E, Tannenbaum SI, Kozlowski SWJ, Miller CA, Mathieu JE, Vessey WB. Teams in space exploration: A new frontier for the science of team effectiveness. Curr Dir Psychol Sci. 2015;24(3):200–7.
Hackman JR. From causes to conditions in group research. J Organ Behav. 2012;33(3):428–44.
Tannenbaum SI, Salas E. Teams that work: The seven drivers of team effectiveness. Illustrated. New York, NY: Oxford University Press; 2020. p. 272.
Book Google Scholar
Tuckman BW. Developmental sequence in small groups. Psychol Bull. 1965;63:384–99.
Salas E, Stagl KC, Burke CS. 25 years of team effectiveness in organizations: Research themes and emerging needs. In: International Review of Industrial and Organizational Psychology 2004. John Wiley & Sons, Ltd. 2004; p. 47–91. Available from: https://onlinelibrary.wiley.com/doi/abs/ https://doi.org/10.1002/0470013311.ch2 Cited 2022 May 16
Proctor EK, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al. Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38(2):65–76.
Lengnick-Hall R, Williams NJ, Ehrhart MG, Willging CE, Bunger AC, Beidas RS, et al. Eight characteristics of rigorous multilevel implementation research: a step-by-step guide. Implement Sci. 2023;18(1):52.
Wensing M, Sales A, Aarons GA, Xu D (Roman), Wilson P. Evidence for objects of implementation in healthcare: considerations for Implementation Science and Implementation Science Communications. Implementation Sci. 2022;17(1):83.
Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci. 2022;17(1):75.
Shortell SM, Marsteller JA, Lin M, Pearson ML, Wu SY, Mendel P, et al. The role of perceived team effectiveness in improving chronic illness care. Med Care. 2004;42(11):1040–8.
Yakovchenko V, Morgan TR, Chinman MJ, Powell BJ, Gonzalez R, Park A, et al. Mapping the road to elimination: a 5-year evaluation of implementation strategies associated with hepatitis C treatment in the veterans health administration. BMC Health Serv Res. 2021;21(1):1348.
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Thank you to Ikzzui Chu, Jamie Feldman, Grace Kinkler, Rachael Park, and Jaely Wright for their assistance with article screening.
This work was supported by the National Institute of Mental Health grants MH123729 (EAM), MH124914 (DJK), and MH126231 (GAA), the National Cancer Institute U01CA275118 (GAA), National Institute on Drug Abuse R01DA049891 (GAA), the Agency for Healthcare Research and Quality grant R18HS026862 (CBW), and the Collaboration and Conflict Research Lab at Carnegie Mellon University Tepper School of Business. The content of this manuscript does not represent the views of funding agencies and is solely the responsibility of the authors.
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EAM conceptualized and developed the protocol for this review, participated in article screening, data extraction, quality appraisal, and analysis, and led manuscript development and writing. DJK, GAA, LRW, ES, and CBW provided guidance and input into the protocol and methods and interpretation of results. AS participated in article screening, data extraction, and preparation of supplementary files. MLK developed the search strategy and conducted database searches. MAD participated in quality appraisal. DJK, GAA, LRW, ES, and CBW reviewed multiple drafts of the manuscript and provided critical input and editing. All authors reviewed and approved the final manuscript.
Correspondence to Elizabeth A. McGuier .
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GAA is a Co-Editor-in-Chief of Implementation Science and on the Editorial Board of Implementation Science Communications ; all decisions on this paper were made by another editor. The authors declare that they have no other competing interests.
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McGuier, E.A., Kolko, D.J., Aarons, G.A. et al. Teamwork and implementation of innovations in healthcare and human service settings: a systematic review. Implementation Sci 19 , 49 (2024). https://doi.org/10.1186/s13012-024-01381-9
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Introduction: Chronic Suppurative Otitis Media (CSOM) significantly impacts auditory functions and overall quality of life. Although tympanoplasty is recognized for its auditory benefits, its broader psychological impacts in CSOM patients remain underexplored. Method: In this sequential explanatory mixed-methods study, 100 adult CSOM patients undergoing tympanoplasty were evaluated from January 2022 to December 2023. The study integrated quantitative assessments (Pure-Tone Audiometry, Speech Audiometry, COMOT-15, HADS) and qualitative data from semi-structured interviews. Results: Post-tympanoplasty, patients exhibited a notable improvement in auditory functions, with an average decrease in Pure-Tone Audiometry (PTA) thresholds by 30 dB and a 28% increase in speech recognition scores. Psychological assessments reflected a significant enhancement in quality of life, with an average decrease of 25 points in COMOT-15 scores, and reductions in HADS anxiety and depression scores by an average of 7 and 6 points, respectively. Qualitative interviews reinforced these results, emphasizing improved social interactions and emotional well-being. A strong correlation was observed between the auditory and psychological improvements. Conclusion: The study demonstrates that tympanoplasty in CSOM patients leads to significant auditory and psychological improvements, highlighting the necessity of a comprehensive treatment approach. This underscores the importance of considering both physical and mental health in CSOM management.
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Lailach S, Langanke T, Zahnert T, Garthus-Niegel S, Neudert M (2021) Impact of depressive disorders on quality of life after middle ear surgery in patients with chronic otitis media. Eur Arch Otorhinolaryngol 278:3217–3225
Article PubMed Google Scholar
Bakir S, Kinis V, Bez Y, Gun R, Yorgancilar E, Ozbay M, Meric F (2013) Mental health and quality of life in patients with chronic otitis media. Eur Arch Otorhinolaryngol 270:521–526
Demir UL, Akyildiz MY, Alpay M (2012) The factors which affect disease-specific quality of life in patients with chronic otitis media. J Int Adv Otology 8(3):371
Google Scholar
Gärling T, Gamble A (2017) Life satisfaction and Emotional Well-Being: Psychological, Economic and Social Factors. Economic psychology , 405–420
Ikeda AK, Suarez-Goris D, Reich AJ, Pattisapu P, Raol NP, Randolph GW, Shin JJ (2023) Evidence‐Based Medicine in Otolaryngology Part 16: Qualitative and Quantitative Methods—Contrasting and Complementary Approaches. Otolaryngology–Head and Neck Surgery
Asokan A, Massey CJ, Tietbohl C, Kroenke K, Morris M, Ramakrishnan VR (2023) Physician views of artificial intelligence in otolaryngology and rhinology: a mixed methods study. Laryngoscope Invest Otolaryngol
Homøe, P., Kværner, K., Casey, J. R., Damoiseaux, R. A., van Dongen, T. M., Gunasekera,H., … Weinreich, H. M. (2017). Panel 1: epidemiology and diagnosis. Otolaryngology–Head and Neck Surgery , 156 , S1-S21
Baumann I, Kurpiers B, Plinkert PK, Praetorius M (2009) Development and validation of the chronic Otitis Media Outcome Test 15 (COMOT-15) measurement of health-related quality of life in patients with chronic otitis media. Hno 57:889–895
Article CAS PubMed Google Scholar
Spinhoven PH, Ormel J, Sloekers PPA, Kempen GIJM, Speckens AE, van Hemert AM (1997) A validation study of the hospital anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med 27(2):363–370
Braun V, Clarke V (2006) Using thematic analysis in psychology. Qualitative Res Psychol 3(2):77
Article Google Scholar
Creswell JW, Clark VLP (2017) Designing and conducting mixed methods research. Sage
Baba S, Fujikura T, Pawankar R, Yagi T (2004) Subjective evaluation of post-tympanoplasty hearing in relation to the pure tone threshold. Auris Nasus Larynx 31(4):347–351
Lin YC, Wang WH, Weng HH, Lin YC (2011) Predictors of surgical and hearing long-term results for inlay cartilage tympanoplasty. Archives Otolaryngology–Head Neck Surg 137(3):215–219
Luckett T, Britton B, Clover K, Rankin NM (2011) Evidence for interventions to improve psychological outcomes in people with head and neck cancer: a systematic review of the literature. Support Care Cancer 19:871–881
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We extend our heartfelt appreciation to the ENT-HNS team at Command Hospital Airforce, Bangalore. Our gratitude goes to the participating patients for their trust and involvement. Additionally, our sincere thanks are directed to our peers, reviewers, and families for their unwavering encouragement and insights.
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Department of ENT-HNS, Command Hospital Airforce, Bangalore, Karnataka, India
Sanjay Kumar, Sachin Bhatt & Angshuman Dutta
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Manish Gupta
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Kumar, S., Gupta, M., Bhatt, S. et al. Auditory and Psychological Impacts of Tympanoplasty in Chronic Suppurative Otitis Media Patients: A Mixed-Methods Study. Indian J Otolaryngol Head Neck Surg (2024). https://doi.org/10.1007/s12070-024-04907-1
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DOI : https://doi.org/10.1007/s12070-024-04907-1
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Qualitative case study methodology provides tools for researchers to study complex phenomena within their contexts. When the approach is applied correctly, it becomes a valuable method for health science research to develop theory, evaluate programs, and develop interventions. The purpose of this paper is to guide the novice researcher in identifying the key elements for designing and implementing qualitative case study research projects. An overview of the types of case study designs is provided along with general recommendations for writing the research questions, developing propositions, determining the " case " under study, binding the case and a discussion of data sources and triangulation. To facilitate application of these principles, clear examples of research questions, study propositions and the different types of case study designs are provided. Key Words: Case Study and Qualitative Methods Introduction To graduate students and researchers unfamiliar with case study methodology, there is often misunderstanding about what a case study is and how it, as a form of qualitative research, can inform professional practice or evidence-informed decision making in both clinical and policy realms. In a graduate level introductory qualitative research methods course, we have listened to novice researchers describe their views of case studies and their perceptions of it as a method only to be used to study individuals or specific historical events, or as a teaching strategy to holistically understand exemplary " cases. " It has been a privilege to teach these students that rigorous qualitative case studies afford researchers opportunities to explore or describe a phenomenon in context using a variety of data sources. It allows the researcher to explore individuals or organizations, simple through complex interventions, relationships, communities, or programs (Yin, 2003) and supports the deconstruction and the subsequent reconstruction of various phenomena. This approach is valuable for health science research to develop theory, evaluate programs, and develop interventions because of its flexibility and rigor.
Daphne Watkins
MARIA CRISTINA DI SILVESTRE PARADIZO
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Dianna T Kenny
Corey M. Abramson
The objective of this commentary is to develop a framework for assessing the rigour of qualitative approaches that identifies and distinguishes between the diverse objectives of qualitative health research, guided by a narrative review of the published literature on qualitative guidelines and standards from peer-reviewed journals and national funding organisations that support health services research, patient-centered outcomes research and other applied health research fields. In this framework, we identify and distinguish three objectives of qualitative studies in applied health research: exploratory, descriptive and comparative. For each objective, we propose methodological standards that may be used to assess and improve rigour across all study phases—from design to reporting. Similar to hierarchies of quality of evidence within quantitative studies, we argue that standards for qualitative rigour differ, appropriately, for studies with different objectives and should be evaluate...
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Sabina Faiz Rashid
Qualitative Health Research
Janice Morse
Online Journal of …
Kalaiselvan Ganapathy
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Objective: To provide an overview of qualitative methodologies for health researchers in order to inform better research practices.Approach: Different possible goals in health research are outlined: quantifying relationships between variables, identifying associations, exploring experience, understanding process, distinguishing representations, comprehending social practices and achieving change. Three important issues in understanding qualitative approaches to research are discussed: the partiality of our view of the world, deductive and inductive approaches to research, and the role of the researcher in the research process. The methodologies of phenomenology, grounded theory, discourse analysis, ethnography, ethnomethodology and action research are illustrated.Conclusion: In order to undertake high-quality qualitative research, it is important for researchers to consider their analytic focus and methodological position.
Douglas Ezzy
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Naiya Patel
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Mahmoud F Fathalla
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A case study is one of the most commonly used methodologies of social research. This article attempts to look into the various dimensions of a case study research strategy, the different epistemological strands which determine the particular case study type and approach adopted in the field, discusses the factors which can enhance the effectiveness of a case study research, and the debate ...
McMaster University, West Hamilton, Ontario, Canada. Qualitative case study methodology prov ides tools for researchers to study. complex phenomena within their contexts. When the approach is ...
Qualitative case study methodology enables researchers to conduct an in-depth exploration of intricate phenomena within some specific context. By keeping in mind research students, this article presents a systematic step-by-step guide to conduct a case study in the business discipline. Research students belonging to said discipline face issues ...
Qualitative case study methodology provides tools for researchers to study complex phenomena within their contexts. When the approach is applied correctly, it becomes a valuable method for health science research to develop theory, evaluate programs, and develop interventions. The purpose of this paper is to
Qualitative case study methodology enables researchers to conduct an in-depth exploration of intricate phenomena within some specific context. By keeping in mind research students, this article presents a systematic step-by-step guide to conduct a case study in the business discipline. Research students belonging to said discipline face issues ...
The case study method is particularly useful for researching educational interventions because it provides a rich description of all the interrelated factors. ... Jack S (2008). Qualitative case study methodology: Study design and implementation for novice researchers. The Qualitative Report, 13(4), 544-559. Google Scholar. Converse M. (2012 ...
Definitions of qualitative case study research. Case study research is an investigation and analysis of a single or collective case, intended to capture the complexity of the object of study (Stake, 1995).Qualitative case study research, as described by Stake (), draws together "naturalistic, holistic, ethnographic, phenomenological, and biographic research methods" in a bricoleur design ...
Purpose of case study methodology. Case study methodology is often used to develop an in-depth, holistic understanding of a specific phenomenon within a specified context. 11 It focuses on studying one or multiple cases over time and uses an in-depth analysis of multiple information sources. 16,17 It is ideal for situations including, but not limited to, exploring under-researched and real ...
A case study is a detailed study of a specific subject, such as a person, group, place, event, organization, or phenomenon. Case studies are commonly used in social, educational, clinical, and business research. A case study research design usually involves qualitative methods, but quantitative methods are sometimes also used.
A case study is a qualitative research method that involves the in-depth exploration and analysis of a particular case, which can be an individual, group, organization, event, or community. The primary purpose of a case study is to generate a comprehensive and nuanced understanding of the case, including its history, context, and dynamics. Case ...
An overview of the types of case study designs is provided along with general recommendations for writing the research questions, developing propositions, determining the "case" under study, binding the case and a discussion of data sources and triangulation. Qualitative case study methodology provides tools for researchers to study complex phenomena within their contexts. When the ...
Current qualitative case study approaches are shaped by paradigm, study design, and selection of methods, and, as a result, case studies in the published literature vary. Differences between published case studies can make it difficult for researchers to define and understand case study as a methodology.
Qualitative case study methodology provides tools for researchers to study complex phenomena within their contexts. When the approach is applied correctly, it becomes a valuable method for health science research to develop theory, evaluate programs, and develop interventions. The purpose of this paper is to guide the novice researcher in identifying the key elements for designing and ...
Abstract. This chapter explores case study as a major approach to research and evaluation. After first noting various contexts in which case studies are commonly used, the chapter focuses on case study research directly Strengths and potential problematic issues are outlined and then key phases of the process.
According to the book Understanding Case Study Research, case studies are "small scale research with meaning" that generally involve the following: The study of a particular case, or a number of cases. That the case will be complex and bounded. That it will be studied in its context. That the analysis undertaken will seek to be holistic.
The following key attributes of the case study methodology can be underlined. 1. Case study is a research strategy, and not just a method/technique/process of data collection. 2. A case study involves a detailed study of the concerned unit of analysis within its natural setting. A de-contextualised study has no relevance in a case study ...
9 The authors def ine case study as a method of qualitative research; this is why they compare it to quantitative methods. The case study as a type of qualitative research 37
Qualitative Approaches . Case Study; The case study approach is useful to employ when there is a need to obtain an in-depth appreciation of an issue, event or phenomenon of interest, in its natural real-life context. Ethnography; Ethnographies are an in-depth, holistic type of research used to capture cultural practices, beliefs, traditions ...
Case study. Case studies involve an in-depth examination of a single case or a small number of cases. Peculiarities: Provides detailed, holistic insights. ... This method of qualitative research design aims to gather rich, descriptive information, such as understanding what qualities make a good teacher. Open questionnaire surveys; ...
Additional articles were identified by searches of reference lists and a cited reference search for included articles (completed in February 2023). We selected studies using quantitative, qualitative, or mixed methods to examine associations between team constructs and implementation outcomes in healthcare and human service settings.
Key Words: Case Study and Qualitative Methods Introduction To graduate students and researchers unfamiliar with case study methodology, there is often misunderstanding about what a case study is and how it, as a form of qualitative research, can inform professional practice or evidence-informed decision making in both clinical and policy realms
Methods: In-depth online or telephone interviews and online focus groups. The topic guide explored frailty, acute decision-making and planning for the future. Data were thematically analysed using the Framework Method. Preliminary findings were presented to a sample of study participants for feedback in two online workshops.
Case Study Method: A Step-by-Step Guide for Business Researchers Yasir Rashid1, Ammar Rashid2, Muhammad Akib Warraich1, Sana Sameen Sabir1, and Ansar Waseem1 Abstract Qualitative case study methodology enables researchers to conduct an in-depth exploration of intricate phenomena within some specific context. By keeping in mind research students ...
Differences between published case studies can make it difficult for researchers to define and understand case study as a methodology. Experienced qualitative researchers have identified case study research as a stand-alone qualitative approach (Denzin & Lincoln, 2011b). Case study research has a level of flexibility that is not readily offered ...
The Journal of Child Psychology and Psychiatry's recent editorial perspective argues that incentive structures in mental health research impede field progress, encouraging the production of positive, novel and clean results and thus questionable research practices (QRPs).Baldwin makes the case that Registered Reports (RRs) offer a valuable solution to some of these issues.
Method: In this sequential explanatory mixed-methods study, 100 adult CSOM patients undergoing tympanoplasty were evaluated from January 2022 to December 2023. The study integrated quantitative assessments (Pure-Tone Audiometry, Speech Audiometry, COMOT-15, HADS) and qualitative data from semi-structured interviews.
Qualitative case study methodology (QCSM) is a useful research approach that has grown in popularity within the social sciences; however, it has received less attention in the occupational therapy literature. The current scoping review aims to explore how studies utilizing a QCSM help inform occupational therapy knowledge and practice.
Qualitative case study methodology provides tools for researchers to study complex phenomena within their contexts. When the approach is applied correctly, it becomes a valuable method for health ...
Background and aims: Waterpipe smoking is regarded as a burgeoning public health problem due to its popularity among young adults. This study aims to understand the meaning-imbued reality of waterpipe smoking for young adults in Sweden. Method: Data from 18 individual interviews with ethnically diverse Swedish young adults were analysed using inductive latent-level qualitative content analysis.
Qualitative case study methodology provides tools for researchers to study complex phenomena within their contexts. When the approach is applied correctly, it becomes a valuable method for health science research to develop theory, evaluate programs, and develop interventions. The purpose of this paper is to guide the novice researcher in ...