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

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

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

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

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

Table of contents

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Research bias

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

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Home » Case Study – Methods, Examples and Guide

Case Study – Methods, Examples and Guide

Table of Contents

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

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

Types of Case Study

Types and Methods of Case Study are as follows:

Single-Case Study

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

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

Multiple-Case Study

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

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

Exploratory Case Study

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

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

Descriptive Case Study

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

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

Instrumental Case Study

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

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

Case Study Data Collection Methods

Here are some common data collection methods for case studies:

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

Observations

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

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

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

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

How to conduct Case Study Research

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

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

Examples of Case Study

Here are some examples of case study research:

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

Application of Case Study

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

Business and Management

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

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

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

Social Sciences

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

Law and Ethics

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

Purpose of Case Study

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

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

Case studies can also serve other purposes, including:

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

Advantages of Case Study Research

There are several advantages of case study research, including:

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

Limitations of Case Study Research

There are several limitations of case study research, including:

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

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Researcher, Academic Writer, Web developer

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• Open access
• Published: 27 June 2011

The case study approach

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

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

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

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Introduction

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

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

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

What is a case study?

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

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

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

What are case studies used for?

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

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

How are case studies conducted?

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

Defining the case

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

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

Selecting the case(s)

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

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

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

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

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

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

Collecting the data

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

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

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

Analysing, interpreting and reporting case studies

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

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

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

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

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

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

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

Conclusions

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

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Acknowledgements

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

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

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Methodology or method? A critical review of qualitative case study reports

Despite on-going debate about credibility, and reported limitations in comparison to other approaches, case study is an increasingly popular approach among qualitative researchers. We critically analysed the methodological descriptions of published case studies. Three high-impact qualitative methods journals were searched to locate case studies published in the past 5 years; 34 were selected for analysis. Articles were categorized as health and health services ( n= 12), social sciences and anthropology ( n= 7), or methods ( n= 15) case studies. The articles were reviewed using an adapted version of established criteria to determine whether adequate methodological justification was present, and if study aims, methods, and reported findings were consistent with a qualitative case study approach. Findings were grouped into five themes outlining key methodological issues: case study methodology or method, case of something particular and case selection, contextually bound case study, researcher and case interactions and triangulation, and study design inconsistent with methodology reported. Improved reporting of case studies by qualitative researchers will advance the methodology for the benefit of researchers and practitioners.

Case study research is an increasingly popular approach among qualitative researchers (Thomas, 2011 ). Several prominent authors have contributed to methodological developments, which has increased the popularity of case study approaches across disciplines (Creswell, 2013b ; Denzin & Lincoln, 2011b ; Merriam, 2009 ; Ragin & Becker, 1992 ; Stake, 1995 ; Yin, 2009 ). 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.

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 by other qualitative approaches such as grounded theory or phenomenology. Case studies are designed to suit the case and research question and published case studies demonstrate wide diversity in study design. There are two popular case study approaches in qualitative research. The first, proposed by Stake ( 1995 ) and Merriam ( 2009 ), is situated in a social constructivist paradigm, whereas the second, by Yin ( 2012 ), Flyvbjerg ( 2011 ), and Eisenhardt ( 1989 ), approaches case study from a post-positivist viewpoint. Scholarship from both schools of inquiry has contributed to the popularity of case study and development of theoretical frameworks and principles that characterize the methodology.

The diversity of case studies reported in the published literature, and on-going debates about credibility and the use of case study in qualitative research practice, suggests that differences in perspectives on case study methodology may prevent researchers from developing a mutual understanding of practice and rigour. In addition, discussion about case study limitations has led some authors to query whether case study is indeed a methodology (Luck, Jackson, & Usher, 2006 ; Meyer, 2001 ; Thomas, 2010 ; Tight, 2010 ). Methodological discussion of qualitative case study research is timely, and a review is required to analyse and understand how this methodology is applied in the qualitative research literature. The aims of this study were to review methodological descriptions of published qualitative case studies, to review how the case study methodological approach was applied, and to identify issues that need to be addressed by researchers, editors, and reviewers. An outline of the current definitions of case study and an overview of the issues proposed in the qualitative methodological literature are provided to set the scene for the review.

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 ( 1995 ), draws together “naturalistic, holistic, ethnographic, phenomenological, and biographic research methods” in a bricoleur design, or in his words, “a palette of methods” (Stake, 1995 , pp. xi–xii). Case study methodology maintains deep connections to core values and intentions and is “particularistic, descriptive and heuristic” (Merriam, 2009 , p. 46).

As a study design, case study is defined by interest in individual cases rather than the methods of inquiry used. The selection of methods is informed by researcher and case intuition and makes use of naturally occurring sources of knowledge, such as people or observations of interactions that occur in the physical space (Stake, 1998 ). Thomas ( 2011 ) suggested that “analytical eclecticism” is a defining factor (p. 512). Multiple data collection and analysis methods are adopted to further develop and understand the case, shaped by context and emergent data (Stake, 1995 ). This qualitative approach “explores a real-life, contemporary bounded system (a case ) or multiple bounded systems (cases) over time, through detailed, in-depth data collection involving multiple sources of information … and reports a case description and case themes ” (Creswell, 2013b , p. 97). Case study research has been defined by the unit of analysis, the process of study, and the outcome or end product, all essentially the case (Merriam, 2009 ).

The case is an object to be studied for an identified reason that is peculiar or particular. Classification of the case and case selection procedures informs development of the study design and clarifies the research question. Stake ( 1995 ) proposed three types of cases and study design frameworks. These include the intrinsic case, the instrumental case, and the collective instrumental case. The intrinsic case is used to understand the particulars of a single case, rather than what it represents. An instrumental case study provides insight on an issue or is used to refine theory. The case is selected to advance understanding of the object of interest. A collective refers to an instrumental case which is studied as multiple, nested cases, observed in unison, parallel, or sequential order. More than one case can be simultaneously studied; however, each case study is a concentrated, single inquiry, studied holistically in its own entirety (Stake, 1995 , 1998 ).

Researchers who use case study are urged to seek out what is common and what is particular about the case. This involves careful and in-depth consideration of the nature of the case, historical background, physical setting, and other institutional and political contextual factors (Stake, 1998 ). An interpretive or social constructivist approach to qualitative case study research supports a transactional method of inquiry, where the researcher has a personal interaction with the case. The case is developed in a relationship between the researcher and informants, and presented to engage the reader, inviting them to join in this interaction and in case discovery (Stake, 1995 ). A postpositivist approach to case study involves developing a clear case study protocol with careful consideration of validity and potential bias, which might involve an exploratory or pilot phase, and ensures that all elements of the case are measured and adequately described (Yin, 2009 , 2012 ).

Current methodological issues in qualitative case study research

The future of qualitative research will be influenced and constructed by the way research is conducted, and by what is reviewed and published in academic journals (Morse, 2011 ). If case study research is to further develop as a principal qualitative methodological approach, and make a valued contribution to the field of qualitative inquiry, issues related to methodological credibility must be considered. Researchers are required to demonstrate rigour through adequate descriptions of methodological foundations. Case studies published without sufficient detail for the reader to understand the study design, and without rationale for key methodological decisions, may lead to research being interpreted as lacking in quality or credibility (Hallberg, 2013 ; Morse, 2011 ).

There is a level of artistic license that is embraced by qualitative researchers and distinguishes practice, which nurtures creativity, innovation, and reflexivity (Denzin & Lincoln, 2011b ; Morse, 2009 ). Qualitative research is “inherently multimethod” (Denzin & Lincoln, 2011a , p. 5); however, with this creative freedom, it is important for researchers to provide adequate description for methodological justification (Meyer, 2001 ). This includes paradigm and theoretical perspectives that have influenced study design. Without adequate description, study design might not be understood by the reader, and can appear to be dishonest or inaccurate. Reviewers and readers might be confused by the inconsistent or inappropriate terms used to describe case study research approach and methods, and be distracted from important study findings (Sandelowski, 2000 ). This issue extends beyond case study research, and others have noted inconsistencies in reporting of methodology and method by qualitative researchers. Sandelowski ( 2000 , 2010 ) argued for accurate identification of qualitative description as a research approach. She recommended that the selected methodology should be harmonious with the study design, and be reflected in methods and analysis techniques. Similarly, Webb and Kevern ( 2000 ) uncovered inconsistencies in qualitative nursing research with focus group methods, recommending that methodological procedures must cite seminal authors and be applied with respect to the selected theoretical framework. Incorrect labelling using case study might stem from the flexibility in case study design and non-directional character relative to other approaches (Rosenberg & Yates, 2007 ). Methodological integrity is required in design of qualitative studies, including case study, to ensure study rigour and to enhance credibility of the field (Morse, 2011 ).

Case study has been unnecessarily devalued by comparisons with statistical methods (Eisenhardt, 1989 ; Flyvbjerg, 2006 , 2011 ; Jensen & Rodgers, 2001 ; Piekkari, Welch, & Paavilainen, 2009 ; Tight, 2010 ; Yin, 1999 ). It is reputed to be the “the weak sibling” in comparison to other, more rigorous, approaches (Yin, 2009 , p. xiii). Case study is not an inherently comparative approach to research. The objective is not statistical research, and the aim is not to produce outcomes that are generalizable to all populations (Thomas, 2011 ). Comparisons between case study and statistical research do little to advance this qualitative approach, and fail to recognize its inherent value, which can be better understood from the interpretive or social constructionist viewpoint of other authors (Merriam, 2009 ; Stake, 1995 ). Building on discussions relating to “fuzzy” (Bassey, 2001 ), or naturalistic generalizations (Stake, 1978 ), or transference of concepts and theories (Ayres, Kavanaugh, & Knafl, 2003 ; Morse et al., 2011 ) would have more relevance.

Case study research has been used as a catch-all design to justify or add weight to fundamental qualitative descriptive studies that do not fit with other traditional frameworks (Merriam, 2009 ). A case study has been a “convenient label for our research—when we ‘can't think of anything ‘better”—in an attempt to give it [qualitative methodology] some added respectability” (Tight, 2010 , p. 337). Qualitative case study research is a pliable approach (Merriam, 2009 ; Meyer, 2001 ; Stake, 1995 ), and has been likened to a “curious methodological limbo” (Gerring, 2004 , p. 341) or “paradigmatic bridge” (Luck et al., 2006 , p. 104), that is on the borderline between postpositivist and constructionist interpretations. This has resulted in inconsistency in application, which indicates that flexibility comes with limitations (Meyer, 2001 ), and the open nature of case study research might be off-putting to novice researchers (Thomas, 2011 ). The development of a well-(in)formed theoretical framework to guide a case study should improve consistency, rigour, and trust in studies published in qualitative research journals (Meyer, 2001 ).

Assessment of rigour

The purpose of this study was to analyse the methodological descriptions of case studies published in qualitative methods journals. To do this we needed to develop a suitable framework, which used existing, established criteria for appraising qualitative case study research rigour (Creswell, 2013b ; Merriam, 2009 ; Stake, 1995 ). A number of qualitative authors have developed concepts and criteria that are used to determine whether a study is rigorous (Denzin & Lincoln, 2011b ; Lincoln, 1995 ; Sandelowski & Barroso, 2002 ). The criteria proposed by Stake ( 1995 ) provide a framework for readers and reviewers to make judgements regarding case study quality, and identify key characteristics essential for good methodological rigour. Although each of the factors listed in Stake's criteria could enhance the quality of a qualitative research report, in Table I we present an adapted criteria used in this study, which integrates more recent work by Merriam ( 2009 ) and Creswell ( 2013b ). Stake's ( 1995 ) original criteria were separated into two categories. The first list of general criteria is “relevant for all qualitative research.” The second list, “high relevance to qualitative case study research,” was the criteria that we decided had higher relevance to case study research. This second list was the main criteria used to assess the methodological descriptions of the case studies reviewed. The complete table has been preserved so that the reader can determine how the original criteria were adapted.

Framework for assessing quality in qualitative case study research.

Adapted from Stake ( 1995 , p. 131).

Study design

The critical review method described by Grant and Booth ( 2009 ) was used, which is appropriate for the assessment of research quality, and is used for literature analysis to inform research and practice. This type of review goes beyond the mapping and description of scoping or rapid reviews, to include “analysis and conceptual innovation” (Grant & Booth, 2009 , p. 93). A critical review is used to develop existing, or produce new, hypotheses or models. This is different to systematic reviews that answer clinical questions. It is used to evaluate existing research and competing ideas, to provide a “launch pad” for conceptual development and “subsequent testing” (Grant & Booth, 2009 , p. 93).

Qualitative methods journals were located by a search of the 2011 ISI Journal Citation Reports in Social Science, via the database Web of Knowledge (see m.webofknowledge.com). No “qualitative research methods” category existed in the citation reports; therefore, a search of all categories was performed using the term “qualitative.” In Table II , we present the qualitative methods journals located, ranked by impact factor. The highest ranked journals were selected for searching. We acknowledge that the impact factor ranking system might not be the best measure of journal quality (Cheek, Garnham, & Quan, 2006 ); however, this was the most appropriate and accessible method available.

International Journal of Qualitative Studies on Health and Well-being.

Search strategy

In March 2013, searches of the journals, Qualitative Health Research , Qualitative Research , and Qualitative Inquiry were completed to retrieve studies with “case study” in the abstract field. The search was limited to the past 5 years (1 January 2008 to 1 March 2013). The objective was to locate published qualitative case studies suitable for assessment using the adapted criterion. Viewpoints, commentaries, and other article types were excluded from review. Title and abstracts of the 45 retrieved articles were read by the first author, who identified 34 empirical case studies for review. All authors reviewed the 34 studies to confirm selection and categorization. In Table III , we present the 34 case studies grouped by journal, and categorized by research topic, including health sciences, social sciences and anthropology, and methods research. There was a discrepancy in categorization of one article on pedagogy and a new teaching method published in Qualitative Inquiry (Jorrín-Abellán, Rubia-Avi, Anguita-Martínez, Gómez-Sánchez, & Martínez-Mones, 2008 ). Consensus was to allocate to the methods category.

Outcomes of search of qualitative methods journals.

In Table III , the number of studies located, and final numbers selected for review have been reported. Qualitative Health Research published the most empirical case studies ( n= 16). In the health category, there were 12 case studies of health conditions, health services, and health policy issues, all published in Qualitative Health Research . Seven case studies were categorized as social sciences and anthropology research, which combined case study with biography and ethnography methodologies. All three journals published case studies on methods research to illustrate a data collection or analysis technique, methodological procedure, or related issue.

The methodological descriptions of 34 case studies were critically reviewed using the adapted criteria. All articles reviewed contained a description of study methods; however, the length, amount of detail, and position of the description in the article varied. Few studies provided an accurate description and rationale for using a qualitative case study approach. In the 34 case studies reviewed, three described a theoretical framework informed by Stake ( 1995 ), two by Yin ( 2009 ), and three provided a mixed framework informed by various authors, which might have included both Yin and Stake. Few studies described their case study design, or included a rationale that explained why they excluded or added further procedures, and whether this was to enhance the study design, or to better suit the research question. In 26 of the studies no reference was provided to principal case study authors. From reviewing the description of methods, few authors provided a description or justification of case study methodology that demonstrated how their study was informed by the methodological literature that exists on this approach.

The methodological descriptions of each study were reviewed using the adapted criteria, and the following issues were identified: case study methodology or method; case of something particular and case selection; contextually bound case study; researcher and case interactions and triangulation; and, study design inconsistent with methodology. An outline of how the issues were developed from the critical review is provided, followed by a discussion of how these relate to the current methodological literature.

Case study methodology or method

A third of the case studies reviewed appeared to use a case report method, not case study methodology as described by principal authors (Creswell, 2013b ; Merriam, 2009 ; Stake, 1995 ; Yin, 2009 ). Case studies were identified as a case report because of missing methodological detail and by review of the study aims and purpose. These reports presented data for small samples of no more than three people, places or phenomenon. Four studies, or “case reports” were single cases selected retrospectively from larger studies (Bronken, Kirkevold, Martinsen, & Kvigne, 2012 ; Coltart & Henwood, 2012 ; Hooghe, Neimeyer, & Rober, 2012 ; Roscigno et al., 2012 ). Case reports were not a case of something, instead were a case demonstration or an example presented in a report. These reports presented outcomes, and reported on how the case could be generalized. Descriptions focussed on the phenomena, rather than the case itself, and did not appear to study the case in its entirety.

Case reports had minimal in-text references to case study methodology, and were informed by other qualitative traditions or secondary sources (Adamson & Holloway, 2012 ; Buzzanell & D'Enbeau, 2009 ; Nagar-Ron & Motzafi-Haller, 2011 ). This does not suggest that case study methodology cannot be multimethod, however, methodology should be consistent in design, be clearly described (Meyer, 2001 ; Stake, 1995 ), and maintain focus on the case (Creswell, 2013b ).

To demonstrate how case reports were identified, three examples are provided. The first, Yeh ( 2013 ) described their study as, “the examination of the emergence of vegetarianism in Victorian England serves as a case study to reveal the relationships between boundaries and entities” (p. 306). The findings were a historical case report, which resulted from an ethnographic study of vegetarianism. Cunsolo Willox, Harper, Edge, ‘My Word’: Storytelling and Digital Media Lab, and Rigolet Inuit Community Government (2013) used “a case study that illustrates the usage of digital storytelling within an Inuit community” (p. 130). This case study reported how digital storytelling can be used with indigenous communities as a participatory method to illuminate the benefits of this method for other studies. This “case study was conducted in the Inuit community” but did not include the Inuit community in case analysis (Cunsolo Willox et al., 2013 , p. 130). Bronken et al. ( 2012 ) provided a single case report to demonstrate issues observed in a larger clinical study of aphasia and stroke, without adequate case description or analysis.

Case study of something particular and case selection

Case selection is a precursor to case analysis, which needs to be presented as a convincing argument (Merriam, 2009 ). Descriptions of the case were often not adequate to ascertain why the case was selected, or whether it was a particular exemplar or outlier (Thomas, 2011 ). In a number of case studies in the health and social science categories, it was not explicit whether the case was of something particular, or peculiar to their discipline or field (Adamson & Holloway, 2012 ; Bronken et al., 2012 ; Colón-Emeric et al., 2010 ; Jackson, Botelho, Welch, Joseph, & Tennstedt, 2012 ; Mawn et al., 2010 ; Snyder-Young, 2011 ). There were exceptions in the methods category ( Table III ), where cases were selected by researchers to report on a new or innovative method. The cases emerged through heuristic study, and were reported to be particular, relative to the existing methods literature (Ajodhia-Andrews & Berman, 2009 ; Buckley & Waring, 2013 ; Cunsolo Willox et al., 2013 ; De Haene, Grietens, & Verschueren, 2010 ; Gratton & O'Donnell, 2011 ; Sumsion, 2013 ; Wimpenny & Savin-Baden, 2012 ).

Case selection processes were sometimes insufficient to understand why the case was selected from the global population of cases, or what study of this case would contribute to knowledge as compared with other possible cases (Adamson & Holloway, 2012 ; Bronken et al., 2012 ; Colón-Emeric et al., 2010 ; Jackson et al., 2012 ; Mawn et al., 2010 ). In two studies, local cases were selected (Barone, 2010 ; Fourie & Theron, 2012 ) because the researcher was familiar with and had access to the case. Possible limitations of a convenience sample were not acknowledged. Purposeful sampling was used to recruit participants within the case of one study, but not of the case itself (Gallagher et al., 2013 ). Random sampling was completed for case selection in two studies (Colón-Emeric et al., 2010 ; Jackson et al., 2012 ), which has limited meaning in interpretive qualitative research.

To demonstrate how researchers provided a good justification for the selection of case study approaches, four examples are provided. The first, cases of residential care homes, were selected because of reported occurrences of mistreatment, which included residents being locked in rooms at night (Rytterström, Unosson, & Arman, 2013 ). Roscigno et al. ( 2012 ) selected cases of parents who were admitted for early hospitalization in neonatal intensive care with a threatened preterm delivery before 26 weeks. Hooghe et al. ( 2012 ) used random sampling to select 20 couples that had experienced the death of a child; however, the case study was of one couple and a particular metaphor described only by them. The final example, Coltart and Henwood ( 2012 ), provided a detailed account of how they selected two cases from a sample of 46 fathers based on personal characteristics and beliefs. They described how the analysis of the two cases would contribute to their larger study on first time fathers and parenting.

Contextually bound case study

The limits or boundaries of the case are a defining factor of case study methodology (Merriam, 2009 ; Ragin & Becker, 1992 ; Stake, 1995 ; Yin, 2009 ). Adequate contextual description is required to understand the setting or context in which the case is revealed. In the health category, case studies were used to illustrate a clinical phenomenon or issue such as compliance and health behaviour (Colón-Emeric et al., 2010 ; D'Enbeau, Buzzanell, & Duckworth, 2010 ; Gallagher et al., 2013 ; Hooghe et al., 2012 ; Jackson et al., 2012 ; Roscigno et al., 2012 ). In these case studies, contextual boundaries, such as physical and institutional descriptions, were not sufficient to understand the case as a holistic system, for example, the general practitioner (GP) clinic in Gallagher et al. ( 2013 ), or the nursing home in Colón-Emeric et al. ( 2010 ). Similarly, in the social science and methods categories, attention was paid to some components of the case context, but not others, missing important information required to understand the case as a holistic system (Alexander, Moreira, & Kumar, 2012 ; Buzzanell & D'Enbeau, 2009 ; Nairn & Panelli, 2009 ; Wimpenny & Savin-Baden, 2012 ).

In two studies, vicarious experience or vignettes (Nairn & Panelli, 2009 ) and images (Jorrín-Abellán et al., 2008 ) were effective to support description of context, and might have been a useful addition for other case studies. Missing contextual boundaries suggests that the case might not be adequately defined. Additional information, such as the physical, institutional, political, and community context, would improve understanding of the case (Stake, 1998 ). In Boxes 1 and 2 , we present brief synopses of two studies that were reviewed, which demonstrated a well bounded case. In Box 1 , Ledderer ( 2011 ) used a qualitative case study design informed by Stake's tradition. In Box 2 , Gillard, Witt, and Watts ( 2011 ) were informed by Yin's tradition. By providing a brief outline of the case studies in Boxes 1 and 2 , we demonstrate how effective case boundaries can be constructed and reported, which may be of particular interest to prospective case study researchers.

Article synopsis of case study research using Stake's tradition

Ledderer ( 2011 ) used a qualitative case study research design, informed by modern ethnography. The study is bounded to 10 general practice clinics in Denmark, who had received federal funding to implement preventative care services based on a Motivational Interviewing intervention. The researcher question focussed on “why is it so difficult to create change in medical practice?” (Ledderer, 2011 , p. 27). The study context was adequately described, providing detail on the general practitioner (GP) clinics and relevant political and economic influences. Methodological decisions are described in first person narrative, providing insight on researcher perspectives and interaction with the case. Forty-four interviews were conducted, which focussed on how GPs conducted consultations, and the form, nature and content, rather than asking their opinion or experience (Ledderer, 2011 , p. 30). The duration and intensity of researcher immersion in the case enhanced depth of description and trustworthiness of study findings. Analysis was consistent with Stake's tradition, and the researcher provided examples of inquiry techniques used to challenge assumptions about emerging themes. Several other seminal qualitative works were cited. The themes and typology constructed are rich in narrative data and storytelling by clinic staff, demonstrating individual clinic experiences as well as shared meanings and understandings about changing from a biomedical to psychological approach to preventative health intervention. Conclusions make note of social and cultural meanings and lessons learned, which might not have been uncovered using a different methodology.

Article synopsis of case study research using Yin's tradition

Gillard et al. ( 2011 ) study of camps for adolescents living with HIV/AIDs provided a good example of Yin's interpretive case study approach. The context of the case is bounded by the three summer camps of which the researchers had prior professional involvement. A case study protocol was developed that used multiple methods to gather information at three data collection points coinciding with three youth camps (Teen Forum, Discover Camp, and Camp Strong). Gillard and colleagues followed Yin's ( 2009 ) principles, using a consistent data protocol that enhanced cross-case analysis. Data described the young people, the camp physical environment, camp schedule, objectives and outcomes, and the staff of three youth camps. The findings provided a detailed description of the context, with less detail of individual participants, including insight into researcher's interpretations and methodological decisions throughout the data collection and analysis process. Findings provided the reader with a sense of “being there,” and are discovered through constant comparison of the case with the research issues; the case is the unit of analysis. There is evidence of researcher immersion in the case, and Gillard reports spending significant time in the field in a naturalistic and integrated youth mentor role.

This case study is not intended to have a significant impact on broader health policy, although does have implications for health professionals working with adolescents. Study conclusions will inform future camps for young people with chronic disease, and practitioners are able to compare similarities between this case and their own practice (for knowledge translation). No limitations of this article were reported. Limitations related to publication of this case study were that it was 20 pages long and used three tables to provide sufficient description of the camp and program components, and relationships with the research issue.

Researcher and case interactions and triangulation

Researcher and case interactions and transactions are a defining feature of case study methodology (Stake, 1995 ). Narrative stories, vignettes, and thick description are used to provoke vicarious experience and a sense of being there with the researcher in their interaction with the case. Few of the case studies reviewed provided details of the researcher's relationship with the case, researcher–case interactions, and how these influenced the development of the case study (Buzzanell & D'Enbeau, 2009 ; D'Enbeau et al., 2010 ; Gallagher et al., 2013 ; Gillard et al., 2011 ; Ledderer, 2011 ; Nagar-Ron & Motzafi-Haller, 2011 ). The role and position of the researcher needed to be self-examined and understood by readers, to understand how this influenced interactions with participants, and to determine what triangulation is needed (Merriam, 2009 ; Stake, 1995 ).

Gillard et al. ( 2011 ) provided a good example of triangulation, comparing data sources in a table (p. 1513). Triangulation of sources was used to reveal as much depth as possible in the study by Nagar-Ron and Motzafi-Haller ( 2011 ), while also enhancing confirmation validity. There were several case studies that would have benefited from improved range and use of data sources, and descriptions of researcher–case interactions (Ajodhia-Andrews & Berman, 2009 ; Bronken et al., 2012 ; Fincham, Scourfield, & Langer, 2008 ; Fourie & Theron, 2012 ; Hooghe et al., 2012 ; Snyder-Young, 2011 ; Yeh, 2013 ).

Study design inconsistent with methodology

Good, rigorous case studies require a strong methodological justification (Meyer, 2001 ) and a logical and coherent argument that defines paradigm, methodological position, and selection of study methods (Denzin & Lincoln, 2011b ). Methodological justification was insufficient in several of the studies reviewed (Barone, 2010 ; Bronken et al., 2012 ; Hooghe et al., 2012 ; Mawn et al., 2010 ; Roscigno et al., 2012 ; Yeh, 2013 ). This was judged by the absence, or inadequate or inconsistent reference to case study methodology in-text.

In six studies, the methodological justification provided did not relate to case study. There were common issues identified. Secondary sources were used as primary methodological references indicating that study design might not have been theoretically sound (Colón-Emeric et al., 2010 ; Coltart & Henwood, 2012 ; Roscigno et al., 2012 ; Snyder-Young, 2011 ). Authors and sources cited in methodological descriptions were inconsistent with the actual study design and practices used (Fourie & Theron, 2012 ; Hooghe et al., 2012 ; Jorrín-Abellán et al., 2008 ; Mawn et al., 2010 ; Rytterström et al., 2013 ; Wimpenny & Savin-Baden, 2012 ). This occurred when researchers cited Stake or Yin, or both (Mawn et al., 2010 ; Rytterström et al., 2013 ), although did not follow their paradigmatic or methodological approach. In 26 studies there were no citations for a case study methodological approach.

The findings of this study have highlighted a number of issues for researchers. A considerable number of case studies reviewed were missing key elements that define qualitative case study methodology and the tradition cited. A significant number of studies did not provide a clear methodological description or justification relevant to case study. Case studies in health and social sciences did not provide sufficient information for the reader to understand case selection, and why this case was chosen above others. The context of the cases were not described in adequate detail to understand all relevant elements of the case context, which indicated that cases may have not been contextually bounded. There were inconsistencies between reported methodology, study design, and paradigmatic approach in case studies reviewed, which made it difficult to understand the study methodology and theoretical foundations. These issues have implications for methodological integrity and honesty when reporting study design, which are values of the qualitative research tradition and are ethical requirements (Wager & Kleinert, 2010a ). Poorly described methodological descriptions may lead the reader to misinterpret or discredit study findings, which limits the impact of the study, and, as a collective, hinders advancements in the broader qualitative research field.

The issues highlighted in our review build on current debates in the case study literature, and queries about the value of this methodology. Case study research can be situated within different paradigms or designed with an array of methods. In order to maintain the creativity and flexibility that is valued in this methodology, clearer descriptions of paradigm and theoretical position and methods should be provided so that study findings are not undervalued or discredited. Case study research is an interdisciplinary practice, which means that clear methodological descriptions might be more important for this approach than other methodologies that are predominantly driven by fewer disciplines (Creswell, 2013b ).

Authors frequently omit elements of methodologies and include others to strengthen study design, and we do not propose a rigid or purist ideology in this paper. On the contrary, we encourage new ideas about using case study, together with adequate reporting, which will advance the value and practice of case study. The implications of unclear methodological descriptions in the studies reviewed were that study design appeared to be inconsistent with reported methodology, and key elements required for making judgements of rigour were missing. It was not clear whether the deviations from methodological tradition were made by researchers to strengthen the study design, or because of misinterpretations. Morse ( 2011 ) recommended that innovations and deviations from practice are best made by experienced researchers, and that a novice might be unaware of the issues involved with making these changes. To perpetuate the tradition of case study research, applications in the published literature should have consistencies with traditional methodological constructions, and deviations should be described with a rationale that is inherent in study conduct and findings. Providing methodological descriptions that demonstrate a strong theoretical foundation and coherent study design will add credibility to the study, while ensuring the intrinsic meaning of case study is maintained.

The value of this review is that it contributes to discussion of whether case study is a methodology or method. We propose possible reasons why researchers might make this misinterpretation. Researchers may interchange the terms methods and methodology, and conduct research without adequate attention to epistemology and historical tradition (Carter & Little, 2007 ; Sandelowski, 2010 ). If the rich meaning that naming a qualitative methodology brings to the study is not recognized, a case study might appear to be inconsistent with the traditional approaches described by principal authors (Creswell, 2013a ; Merriam, 2009 ; Stake, 1995 ; Yin, 2009 ). If case studies are not methodologically and theoretically situated, then they might appear to be a case report.

Case reports are promoted by university and medical journals as a method of reporting on medical or scientific cases; guidelines for case reports are publicly available on websites ( http://www.hopkinsmedicine.org/institutional_review_board/guidelines_policies/guidelines/case_report.html ). The various case report guidelines provide a general criteria for case reports, which describes that this form of report does not meet the criteria of research, is used for retrospective analysis of up to three clinical cases, and is primarily illustrative and for educational purposes. Case reports can be published in academic journals, but do not require approval from a human research ethics committee. Traditionally, case reports describe a single case, to explain how and what occurred in a selected setting, for example, to illustrate a new phenomenon that has emerged from a larger study. A case report is not necessarily particular or the study of a case in its entirety, and the larger study would usually be guided by a different research methodology.

This description of a case report is similar to what was provided in some studies reviewed. This form of report lacks methodological grounding and qualities of research rigour. The case report has publication value in demonstrating an example and for dissemination of knowledge (Flanagan, 1999 ). However, case reports have different meaning and purpose to case study, which needs to be distinguished. Findings of our review suggest that the medical understanding of a case report has been confused with qualitative case study approaches.

In this review, a number of case studies did not have methodological descriptions that included key characteristics of case study listed in the adapted criteria, and several issues have been discussed. There have been calls for improvements in publication quality of qualitative research (Morse, 2011 ), and for improvements in peer review of submitted manuscripts (Carter & Little, 2007 ; Jasper, Vaismoradi, Bondas, & Turunen, 2013 ). The challenging nature of editor and reviewers responsibilities are acknowledged in the literature (Hames, 2013 ; Wager & Kleinert, 2010b ); however, review of case study methodology should be prioritized because of disputes on methodological value.

Authors using case study approaches are recommended to describe their theoretical framework and methods clearly, and to seek and follow specialist methodological advice when needed (Wager & Kleinert, 2010a ). Adequate page space for case study description would contribute to better publications (Gillard et al., 2011 ). Capitalizing on the ability to publish complementary resources should be considered.

Limitations of the review

There is a level of subjectivity involved in this type of review and this should be considered when interpreting study findings. Qualitative methods journals were selected because the aims and scope of these journals are to publish studies that contribute to methodological discussion and development of qualitative research. Generalist health and social science journals were excluded that might have contained good quality case studies. Journals in business or education were also excluded, although a review of case studies in international business journals has been published elsewhere (Piekkari et al., 2009 ).

The criteria used to assess the quality of the case studies were a set of qualitative indicators. A numerical or ranking system might have resulted in different results. Stake's ( 1995 ) criteria have been referenced elsewhere, and was deemed the best available (Creswell, 2013b ; Crowe et al., 2011 ). Not all qualitative studies are reported in a consistent way and some authors choose to report findings in a narrative form in comparison to a typical biomedical report style (Sandelowski & Barroso, 2002 ), if misinterpretations were made this may have affected the review.

Case study research is an increasingly popular approach among qualitative researchers, which provides methodological flexibility through the incorporation of different paradigmatic positions, study designs, and methods. However, whereas flexibility can be an advantage, a myriad of different interpretations has resulted in critics questioning the use of case study as a methodology. Using an adaptation of established criteria, we aimed to identify and assess the methodological descriptions of case studies in high impact, qualitative methods journals. Few articles were identified that applied qualitative case study approaches as described by experts in case study design. There were inconsistencies in methodology and study design, which indicated that researchers were confused whether case study was a methodology or a method. Commonly, there appeared to be confusion between case studies and case reports. Without clear understanding and application of the principles and key elements of case study methodology, there is a risk that the flexibility of the approach will result in haphazard reporting, and will limit its global application as a valuable, theoretically supported methodology that can be rigorously applied across disciplines and fields.

Conflict of interest and funding

The authors have not received any funding or benefits from industry or elsewhere to conduct this study.

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Qualitative Research Designs

Case study design, using case study design in the applied doctoral experience (ade), applicability of case study design to applied problem of practice, case study design references.

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The field of qualitative research there are a number of research designs (also referred to as “traditions” or “genres”), including case study, phenomenology, narrative inquiry, action research, ethnography, grounded theory, as well as a number of critical genres including Feminist theory, indigenous research, critical race theory and cultural studies. The choice of research design is directly tied to and must be aligned with your research problem and purpose. As Bloomberg & Volpe (2019) explain:

Choice of research design is directly tied to research problem and purpose. As the researcher, you actively create the link among problem, purpose, and design through a process of reflecting on problem and purpose, focusing on researchable questions, and considering how to best address these questions. Thinking along these lines affords a research study methodological congruence (p. 38).

Case study is an in-depth exploration from multiple perspectives of a bounded social phenomenon, be this a social system such as a program, event, institution, organization, or community (Stake, 1995, 2005; Yin, 2018). Case study is employed across disciplines, including education, health care, social work, sociology, and organizational studies. The purpose is to generate understanding and deep insights to inform professional practice, policy development, and community or social action (Bloomberg 2018).

Yin (2018) and Stake (1995, 2005), two of the key proponents of case study methodology, use different terms to describe case studies. Yin categorizes case studies as exploratory or descriptive . The former is used to explore those situations in which the intervention being evaluated has no clear single set of outcomes. The latter is used to describe an intervention or phenomenon and the real-life context in which it occurred. Stake identifies case studies as intrinsic or instrumental , and he proposes that a primary distinction in designing case studies is between single and multiple (or collective) case study designs. A single case study may be an instrumental case study (research focuses on an issue or concern in one bounded case) or an intrinsic case study (the focus is on the case itself because the case presents a unique situation). A longitudinal case study design is chosen when the researcher seeks to examine the same single case at two or more different points in time or to capture trends over time. A multiple case study design is used when a researcher seeks to determine the prevalence or frequency of a particular phenomenon. This approach is useful when cases are used for purposes of a cross-case analysis in order to compare, contrast, and synthesize perspectives regarding the same issue. The focus is on the analysis of diverse cases to determine how these confirm the findings within or between cases, or call the findings into question.

Case study affords significant interaction with research participants, providing an in-depth picture of the phenomenon (Bloomberg & Volpe, 2019). Research is extensive, drawing on multiple methods of data collection, and involves multiple data sources. Triangulation is critical in attempting to obtain an in-depth understanding of the phenomenon under study and adds rigor, breadth, and depth to the study and provides corroborative evidence of the data obtained. Analysis of data can be holistic or embedded—that is, dealing with the whole or parts of the case (Yin, 2018). With multiple cases the typical analytic strategy is to provide detailed description of themes within each case (within-case analysis), followed by thematic analysis across cases (cross-case analysis), providing insights regarding how individual cases are comparable along important dimensions. Research culminates in the production of a detailed description of a setting and its participants, accompanied by an analysis of the data for themes or patterns (Stake, 1995, 2005; Yin, 2018). In addition to thick, rich description, the researcher’s interpretations, conclusions, and recommendations contribute to the reader’s overall understanding of the case study.

Analysis of findings should show that the researcher has attended to all the data, should address the most significant aspects of the case, and should demonstrate familiarity with the prevailing thinking and discourse about the topic. The goal of case study design (as with all qualitative designs) is not generalizability but rather transferability —that is, how (if at all) and in what ways understanding and knowledge can be applied in similar contexts and settings. The qualitative researcher attempts to address the issue of transferability by way of thick, rich description that will provide the basis for a case or cases to have relevance and potential application across a broader context.

Qualitative research methods ask the questions of "what" and "how" a phenomenon is understood in a real-life context (Bloomberg & Volpe, 2019). In the education field, qualitative research methods uncover educational experiences and practices because qualitative research allows the researcher to reveal new knowledge and understanding. Moreover, qualitative descriptive case studies describe, analyze and interpret events that explain the reasoning behind specific phenomena (Bloomberg, 2018). As such, case study design can be the foundation for a rigorous study within the Applied Doctoral Experience (ADE).

Case study design is an appropriate research design to consider when conceptualizing and conducting a dissertation research study that is based on an applied problem of practice with inherent real-life educational implications. Case study researchers study current, real-life cases that are in progress so that they can gather accurate information that is current. This fits well with the ADE program, as students are typically exploring a problem of practice. Because of the flexibility of the methods used, a descriptive design provides the researcher with the opportunity to choose data collection methods that are best suited to a practice-based research purpose, and can include individual interviews, focus groups, observation, surveys, and critical incident questionnaires. Methods are triangulated to contribute to the study’s trustworthiness. In selecting the set of data collection methods, it is important that the researcher carefully consider the alignment between research questions and the type of data that is needed to address these. Each data source is one piece of the “puzzle,” that contributes to the researcher’s holistic understanding of a phenomenon. The various strands of data are woven together holistically to promote a deeper understanding of the case and its application to an educationally-based problem of practice.

Research studies within the Applied Doctoral Experience (ADE) will be practical in nature and focus on problems and issues that inform educational practice.  Many of the types of studies that fall within the ADE framework are exploratory, and align with case study design. Case study design fits very well with applied problems related to educational practice, as the following set of examples illustrate:

Elementary Bilingual Education Teachers’ Self-Efficacy in Teaching English Language Learners: A Qualitative Case Study

The problem to be addressed in the proposed study is that some elementary bilingual education teachers’ beliefs about their lack of preparedness to teach the English language may negatively impact the language proficiency skills of Hispanic ELLs (Ernst-Slavit & Wenger, 2016; Fuchs et al., 2018; Hoque, 2016). The purpose of the proposed qualitative descriptive case study was to explore the perspectives and experiences of elementary bilingual education teachers regarding their perceived lack of preparedness to teach the English language and how this may impact the language proficiency of Hispanic ELLs.

Exploring Minority Teachers Experiences Pertaining to their Value in Education: A Single Case Study of Teachers in New York City

The problem is that minority K-12 teachers are underrepresented in the United States, with research indicating that school leaders and teachers in schools that are populated mainly by black students, staffed mostly by white teachers who may be unprepared to deal with biases and stereotypes that are ingrained in schools (Egalite, Kisida, & Winters, 2015; Milligan & Howley, 2015). The purpose of this qualitative exploratory single case study was to develop a clearer understanding of minority teachers’ experiences concerning the under-representation of minority K-12 teachers in urban school districts in the United States since there are so few of them.

Exploring the Impact of an Urban Teacher Residency Program on Teachers’ Cultural Intelligence: A Qualitative Case Study

The problem to be addressed by this case study is that teacher candidates often report being unprepared and ill-equipped to effectively educate culturally diverse students (Skepple, 2015; Beutel, 2018). The purpose of this study was to explore and gain an in-depth understanding of the perceived impact of an urban teacher residency program in urban Iowa on teachers’ cultural competence using the cultural intelligence (CQ) framework (Earley & Ang, 2003).

Qualitative Case Study that Explores Self-Efficacy and Mentorship on Women in Academic Administrative Leadership Roles

The problem was that female school-level administrators might be less likely to experience mentorship, thereby potentially decreasing their self-efficacy (Bing & Smith, 2019; Brown, 2020; Grant, 2021). The purpose of this case study was to determine to what extent female school-level administrators in the United States who had a mentor have a sense of self-efficacy and to examine the relationship between mentorship and self-efficacy.

Suburban Teacher and Administrator Perceptions of Culturally Responsive Teaching to Promote Connectedness in Students of Color: A Qualitative Case Study

The problem to be addressed in this study is the racial discrimination experienced by students of color in suburban schools and the resulting negative school experience (Jara & Bloomsbury, 2020; Jones, 2019; Kohli et al., 2017; Wandix-White, 2020). The purpose of this case study is to explore how culturally responsive practices can counteract systemic racism and discrimination in suburban schools thereby meeting the needs of students of color by creating positive learning experiences. 

As you can see, all of these studies were well suited to qualitative case study design. In each of these studies, the applied research problem and research purpose were clearly grounded in educational practice as well as directly aligned with qualitative case study methodology. In the Applied Doctoral Experience (ADE), you will be focused on addressing or resolving an educationally relevant research problem of practice. As such, your case study, with clear boundaries, will be one that centers on a real-life authentic problem in your field of practice that you believe is in need of resolution or improvement, and that the outcome thereof will be educationally valuable.

Bloomberg, L. D. (2018). Case study method. In B. B. Frey (Ed.), The SAGE Encyclopedia of educational research, measurement, and evaluation (pp. 237–239). SAGE. https://go.openathens.net/redirector/nu.edu?url=https%3A%2F%2Fmethods.sagepub.com%2FReference%2Fthe-sage-encyclopedia-of-educational-research-measurement-and-evaluation%2Fi4294.xml

Bloomberg, L. D. & Volpe, M. (2019). Completing your qualitative dissertation: A road map from beginning to end . (4th Ed.). SAGE.

Stake, R. E. (1995). The art of case study research. SAGE.

Stake, R. E. (2005). Qualitative case studies. In N. K. Denzin and Y. S. Lincoln (Eds.), The SAGE handbook of qualitative research (3rd ed., pp. 443–466). SAGE.

Yin, R. (2018). Case study research and applications: Designs and methods. SAGE.

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The Multiple Case Study Design

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

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

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

TABLE OF CONTENTS

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

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• Published: 10 August 2024

How can health systems approach reducing health inequalities? An in-depth qualitative case study in the UK

• Charlotte Parbery-Clark 1 ,
• Lorraine McSweeney 2 ,
• Joanne Lally 3 &
• Sarah Sowden 4  

BMC Public Health volume  24 , Article number:  2168 ( 2024 ) Cite this article

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Addressing socioeconomic inequalities in health and healthcare, and reducing avoidable hospital admissions requires integrated strategy and complex intervention across health systems. However, the understanding of how to create effective systems to reduce socio-economic inequalities in health and healthcare is limited. The aim was to explore and develop a system’s level understanding of how local areas address health inequalities with a focus on avoidable emergency admissions.

In-depth case study using qualitative investigation (documentary analysis and key informant interviews) in an urban UK local authority. Interviewees were identified using snowball sampling. Documents were retrieved via key informants and web searches of relevant organisations. Interviews and documents were analysed independently based on a thematic analysis approach.

Interviews ( n  = 14) with wide representation from local authority ( n  = 8), NHS ( n  = 5) and voluntary, community and social enterprise (VCSE) sector ( n  = 1) with 75 documents (including from NHS, local authority, VCSE) were included. Cross-referenced themes were understanding the local context, facilitators of how to tackle health inequalities: the assets, and emerging risks and concerns. Addressing health inequalities in avoidable admissions per se was not often explicitly linked by either the interviews or documents and is not yet embedded into practice. However, a strong coherent strategic integrated population health management plan with a system’s approach to reducing health inequalities was evident as was collective action and involving people, with links to a “strong third sector”. Challenges reported include structural barriers and threats, the analysis and accessibility of data as well as ongoing pressures on the health and care system.

We provide an in-depth exploration of how a local area is working to address health and care inequalities. Key elements of this system’s working include fostering strategic coherence, cross-agency working, and community-asset based approaches. Areas requiring action included data sharing challenges across organisations and analytical capacity to assist endeavours to reduce health and care inequalities. Other areas were around the resilience of the system including the recruitment and retention of the workforce. More action is required to embed reducing health inequalities in avoidable admissions explicitly in local areas with inaction risking widening the health gap.

Highlights:

• Reducing health inequalities in avoidable hospital admissions is yet to be explicitly linked in practice and is an important area to address.

• Understanding the local context helps to identify existing assets and threats including the leverage points for action.

• Requiring action includes building the resilience of our complex systems by addressing structural barriers and threats as well as supporting the workforce (training and wellbeing with improved retention and recruitment) in addition to the analysis and accessibility of data across the system.

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Introduction

The health of our population is determined by the complex interaction of several factors which are either non-modifiable (such as age, genetics) or modifiable (such as the environment, social, economic conditions in which we live, our behaviours as well as our access to healthcare and its quality) [ 1 ]. Health inequalities are the avoidable and unfair systematic differences in health and healthcare across different population groups explained by the differences in distribution of power, wealth and resources which drive the conditions of daily life [ 2 , 3 ]. Essentially, health inequalities arise due to the systematic differences of the factors that influence our health. To effectively deal with most public health challenges, including reducing health inequalities and improving population health, broader integrated approaches [ 4 ] and an emphasis on systems is required [ 5 , 6 ] . A system is defined as ‘the set of actors, activities, and settings that are directly or indirectly perceived to have influence in or be affected by a given problem situation’ (p.198) [ 7 ]. In this case, the ‘given problem situation' is reducing health inequalities with a focus on avoidable admissions. Therefore, we must consider health systems, which are the organisations, resources and people aiming to improve or maintain health [ 8 , 9 ] of which health services provision is an aspect. In this study, the system considers NHS bodies, Integrated Care Systems, Local Authority departments, and the voluntary and community sector in a UK region.

A plethora of theories [ 10 ], recommended policies [ 3 , 11 , 12 , 13 ], frameworks [ 1 , 14 , 15 ], and tools [ 16 ] exist to help understand the existence of health inequalities as well as provide suggestions for improvement. However, it is reported that healthcare leaders feel under-skilled to reduce health inequalities [ 17 ]. A lack of clarity exists on how to achieve a system’s multi-agency coherence to reduce health inequalities systematically [ 17 , 18 ]. This is despite some countries having legal obligations to have a regard to the need to attend to health and healthcare inequalities. For example, the Health and Social Care Act 2012 [ 19 ], in England, mandated Clinical Commissioning Groups (CCGs), now transferred to Integrated Care Boards (ICBs) [ 20 ], to ‘have a regard to the need to reduce inequalities between patients with respect to their ability to access health services, and reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health services’. The wider determinants of health must also be considered. For example, local areas have a mandatory requirement to have a joint strategic needs assessment (JSNA) and joint health and wellbeing strategy (JHWS) whose purpose is to ‘improve the health and wellbeing of the local community and reduce inequalities for all ages' [ 21 ] This includes addressing the wider determinants of health [ 21 ]. Furthermore, the hospital care costs to the NHS associated with socioeconomic inequalities has been previously reported at £4.8 billion a year due to excess hospitalisations [ 22 ]. Avoidable emergency admissions are admissions into hospital that are considered to be preventable with high-quality ambulatory care [ 23 ]. Both ambulatory care sensitive conditions (where effective personalised care based in the community can aid the prevention of needing an admission) and urgent care sensitive conditions (where a system on the whole should be able to treat and manage without an admission) are considered within this definition [ 24 ] (encompassing more than 100 International Classification of Diseases (ICD) codes). The disease burden sits disproportionately with our most disadvantaged communities, therefore highlighting the importance of addressing inequalities in hospital pressures in a concerted manner [ 25 , 26 ].

Research examining one component of an intervention, or even one part of the system, [ 27 ] or which uses specific research techniques to control for the system’s context [ 28 ] are considered as having limited use for identifying the key ingredients to achieve better population health and wellbeing [ 5 , 28 ]. Instead, systems thinking considers how the system’s components and sub-components interconnect and interrelate within and between each other (and indeed other systems) to gain an understanding of the mechanisms by which things work [ 29 , 30 ]. Complex interventions or work programmes may perform differently in varying contexts and through different mechanisms, and therefore cannot simply be replicated from one context to another to automatically achieve the same outcomes. Ensuring that research into systems and systems thinking considers real-world context, such as where individuals live, where policies are created and interventions are delivered, is vital [ 5 ]. How the context and implementation of complex or even simple interventions interact is viewed as becoming increasingly important [ 31 , 32 ]. Case study research methodology is founded on the ‘in-depth exploration of complex phenomena in their natural, or ‘real-life’, settings’ (p.2) [ 33 ]. Case study approaches can deepen the understanding of complexity addressing the ‘how’, ‘what’ and ‘why’ questions in a real-life context [ 34 ]. Researchers have highlighted the importance of engaging more deeply with case-based study methodology [ 31 , 33 ]. Previous case study research has shown promise [ 35 ] which we build on by exploring a systems lens to consider the local area’s context [ 16 ] within which the work is implemented. By using case-study methodology, our study aimed to explore and develop an in-depth understanding of how a local area addresses health inequalities, with a focus on avoidable hospital admissions. As part of this, systems processes were included.

Study design

This in-depth case study is part of an ongoing larger multiple (collective [ 36 ]) case study approach. An instrumental approach [ 34 ] was taken allowing an in-depth investigation of an issue, event or phenomenon, in its natural real-life context; referred to as a ‘naturalistic’ design [ 34 ]. Ethics approval was obtained by Newcastle University’s Ethics Committee (ref 13633/2020).

Study selection

This case study, alongside the other three cases, was purposively [ 36 ] chosen considering overall deprivation level of the area (Indices of Multiple Deprivation (IMD) [ 37 ]), their urban/rural location, differing geographical spread across the UK (highlighted in patient and public feedback and important for considering the North/South health divide [ 38 ]), and a pragmatic judgement of likely ability to achieve the depth of insight required [ 39 ]. In this paper, we report the findings from one of the case studies, an urban local authority in the Northern region of the UK with high levels of socioeconomic disadvantage. This area was chosen for this in-depth case analysis due to high-level of need, and prior to the COVID-19 pandemic (2009-2018) had experienced a trend towards reducing socioeconomic inequalities in avoidable hospital admission rates between neighbourhoods within the local area [ 40 ]. Thereby this case study represents an ‘unusual’ case [ 41 ] to facilitate learning regarding what is reported and considered to be the key elements required to reduce health inequalities, including inequalities in avoidable admissions, in a local area.

Semi-structured interviews

The key informants were identified iteratively through the documentary analysis and in consultation with the research advisory group. Initially board level committee members (including lay, managerial, and clinical members) within relevant local organisations were purposively identified. These individuals were systems leaders charged with the remit of tackling health inequalities and therefore well placed to identify both key personnel and documents. Snowball sampling [ 42 ] was undertaken thereafter whereby interviewees helped to identify additional key informants within the local system who were working on health inequalities, including avoidable emergency admissions, at a systems level. Interview questions were based on an iteratively developed topic guide (supplementary data 1), informed from previous work’s findings [ 43 ] and the research advisory network’s input. A study information sheet was emailed to perspective interviewees, and participants were asked to complete an e-consent form using Microsoft Forms [ 42 ]. Each interviewee was interviewed by either L.M. or C.P.-C. using the online platforms Zoom or Teams, and lasted up to one hour. Participants were informed of interviewers’ role, workplace as well as purpose of the study. Interviewees were asked a range of questions including any work relating to reducing health inequalities, particularly avoidable emergency admissions, within the last 5 years. Brief notes were taken, and the interviews were recorded, transcribed verbatim and anonymised.

Documentary analysis

The documentary analysis followed the READ approach [ 44 ]. Any documents from the relevant local/regional area with sections addressing health inequalities and/or avoidable emergency admissions, either explicitly stated or implicitly inferred, were included. A list of core documents was chosen, including the local Health and Wellbeing Strategy (Table 1 ). Subsequently, other documents were identified by snowballing from these core documents and identification by the interviewees. All document types were within scope if produced/covered a period within 5 years (2017-2022), including documents in the public domain or not as well as documents pertaining to either a regional, local and neighbourhood level. This 5-year period was a pragmatic decision in line with the interviews and considered to be a balance of legacy and relevance. Attempts were made to include the final version of each document, where possible/applicable, otherwise the most up-to-date version or version available was used.

An Excel spreadsheet data extraction tool was adapted with a priori criteria [ 44 ] to extract the data. This tool included contextual information (such as authors, target area and document’s purpose). Also, information based on previous research on addressing socioeconomic inequalities in avoidable emergency admissions, such as who stands to benefit, was extracted [ 43 ]. Additionally, all documents were summarised according to a template designed according to the research’s aims. Data extraction and summaries were undertaken by L.M. and C.P.-C. A selection was doubled coded to enhance validity and any discrepancies were resolved by discussion.

Interviews and documents were coded and analysed independently based on a thematic analysis approach [ 45 ], managed by NVivo software. A combination of ‘interpretive’ and ‘positivist’ stance [ 34 , 46 ] was taken which involved understanding meanings/contexts and processes as perceived from different perspectives (interviewees and documents). This allowed for an understanding of individual and shared social meanings/reasonings [ 34 , 36 ]. For the documentary analysis, a combination of both content and thematic analysis as described by Bowen [ 47 ] informed by Braun and Clarke’s approach to thematic analysis [ 45 ] was used. This type of content analysis does not include the typical quantification but rather a review of the document for pertinent and meaningful passages of text/other data [ 47 ]. Both an inductive and deductive approach for the documentary analysis’ coding [ 46 , 47 ] was chosen. The inductive approach was developed a posteriori; the deductive codes being informed by the interviews and previous findings from research addressing socioeconomic inequalities in avoidable emergency admissions [ 43 ]. In line with qualitative epistemological approach to enquiry, the interview and documentary findings were viewed as ‘truths’ in themselves with the acceptance that multiple realities can co-exist [ 48 ]. The analysis of each set of themes (with subthemes) from the documentary analysis and interviews were cross-referenced and integrated with each other to provide a cohesive in-depth analysis [ 49 ] by generating thematic maps to explore the relationships between the themes. The codes, themes and thematic maps were peer-reviewed continually with regular meetings between L.M., C.P.-C., J.L. and S.S. Direct quotes are provided from the interviews and documentary analysis. Some quotes from the documents are paraphrased to protect anonymity of the case study after following a set process considering a range of options. This involved searching each quote from the documentary analysis in Google and if the quote was found in the first page of the result, we shortened extracts and repeated the process. Where the shortened extracts were still identifiable, we were required to paraphrase that quote. Each paraphrased quote and original was shared and agreed with all the authors reducing the likelihood of inadvertently misinterpreting or misquoting. Where multiple components over large bodies of text were present in the documents, models were used to evidence the broadness, for example, using Dahlgren’s and Whitehead’s model of health determinants [ 1 ]. Due to the nature of the study, transcripts and findings were not shared with participants for checking but will be shared in a dissemination workshop in 2024.

Patient and public involvement and engagement

Four public contributors from the National Institute for Health and Care Research (NIHR) Research Design Service (RDS) North East and North Cumbria (NENC) Public and Patient Involvement (PPI) panel have been actively engaged in this research from its inception. They have been part of the research advisory group along with professional stakeholders and were involved in the identification of the sampling frame’s key criteria. Furthermore, a diverse group of public contributors has been actively involved in other parts of the project including developing the moral argument around action by producing a public facing resource exploring what health inequalities mean to people and public views of possible solutions [ 50 ].

Semi-structured interviews: description

Sixteen participants working in health or social care, identified through the documentary analysis or snowballing, were contacted for interview; fourteen consented to participate. No further interviews were sought as data sufficiency was reached whereby no new information or themes were being identified. Participant roles were broken down by NHS ( n  = 5), local authority/council ( n  = 8), and voluntary, community and social enterprise (VSCE) ( n  = 1). To protect the participants’ anonymity, their employment titles/status are not disclosed. However, a broad spectrum of interviewees with varying roles from senior health system leadership (including strategic and commissioner roles) to roles within provider organisations and the VSCE sector were included.

Documentary analysis: description

75 documents were reviewed with documents considering regional ( n  = 20), local ( n  = 64) or neighbourhood ( n  = 2) area with some documents covering two or more areas. Table 2 summarises the respective number of each document type which included statutory documents to websites from across the system (NHS, local government and VSCE). 45 documents were named by interviewees and 42 documents were identified as either a core document or through snowballing from other documents. Of these, 12 documents were identified from both. The timescales of the documents varied and where possible to identify, was from 2014 to 2031.

Integrative analysis of the documentary analysis and interviews

The overarching themes encompass:

Understanding the local context

Facilitators to tacking health inequalities: the assets

Emerging risks and concerns

Figure 1 demonstrates the relationships between the main themes identified from the analysis for tackling health inequalities and improving health in this case study.

Diagram of the relationship between the key themes identified regarding tackling health inequalities and improving health in a local area informed by 2 previous work [ 14 , 51 ]. NCDs = non-communicable diseases; HI = health inequalities

Understanding the local context was discussed extensively in both the documents and the interviews. This was informed by local intelligence and data that was routinely collected, monitored, and analysed to help understand the local context and where inequalities lie. More bespoke, in-depth collection and analysis were also described to get a better understanding of the situation. This not only took the form of quantitative but also considered qualitative data with lived experience:

‛So, our data comes from going out to talk to people. I mean, yes, especially the voice of inequalities, those traditional mechanisms, like surveys, don't really work. And it's about going out to communities, linking in with third sector organisations, going out to communities, and just going out to listen…I think the more we can bring out those real stories. I mean, we find quotes really, really powerful in terms of helping people understand what it is that matters.’ (LP16).

However, there were limitations to the available data including the quality as well as having enough time to do the analysis justice. This resulted in difficulties in being able to fully understand the context to help identify and act on the required improvements.

‘A lack of available data means we cannot quantify the total number of vulnerable migrants in [region]’ (Document V).

‛So there’s lots of data. The issue is joining that data up and analysing it, and making sense of it. That’s where we don’t have the capacity.’ (LP15).

Despite the caveats, understanding the context and its data limitations were important to inform local priorities and approaches on tackling health inequalities. This understanding was underpinned by three subthemes which were understanding:

the population’s needs including identification of people at higher risk of worse health and health inequalities

the driving forces of those needs with acknowledgement of the impact of the wider determinants of health

the threats and barriers to physical and mental health, as well as wellbeing

Firstly, the population’s needs, including identification of people at higher risk of worse health and health inequalities, was important. This included considering risk factors, such as smoking, specific groups of people and who was presenting with which conditions. Between the interviews and documents, variation was seen between groups deemed at-risk or high-risk with the documents identifying a wider range. The groups identified across both included marginalised communities, such as ethnic minority groups, gypsy and travellers, refugees and asylum seekers as well as people/children living in disadvantaged area.

‘There are significant health inequalities in children with asthma between deprived and more affluent areas, and this is reflected in A&E admissions.' (Document J).

Secondly, the driving forces of those needs with acknowledgement of the impact of the wider determinants of health were described. These forces mapped onto Dahlgren’s and Whitehead’s model of health determinants [ 1 ] consisting of individual lifestyle factors, social and community networks, living and working conditions (which include access to health care services) as well as general socio-economic, cultural and environmental conditions across the life course.

…. at the centre of our approach considering the requirements to improve the health and wellbeing of our area are the wider determinants of health and wellbeing, acknowledging how factors, such as housing, education, the environment and economy, impact on health outcomes and wellbeing over people’s lifetime and are therefore pivotal to our ambition to ameliorate the health of the poorest the quickest. (Paraphrased Document P).

Thirdly, the threats and barriers to health included environmental risks, communicable diseases and associated challenges, non-communicable conditions and diseases, mental health as well as structural barriers. In terms of communicable diseases, COVID-19 predominated. The environmental risks included climate change and air pollution. Non-communicable diseases were considered as a substantial and increasing threat and encompassed a wide range of chronic conditions such as diabetes, and obesity.

‛Long term conditions are the leading causes of death and disability in [case study] and account for most of our health and care spending. Cases of cancer, diabetes, respiratory disease, dementia and cardiovascular disease will increase as the population of [case study] grows and ages.’ (Document A).

Structural barriers to accessing and using support and/or services for health and wellbeing were identified. These barriers included how the services are set up, such as some GP practices asking for proof of a fixed address or form of identification to register. For example:

Complicated systems (such as having to make multiple calls, the need to speak to many people/gatekeepers or to call at specific time) can be a massive barrier to accessing healthcare and appointments. This is the case particularly for people who have complex mental health needs or chaotic/destabilized circumstances. People who do not have stable housing face difficulties in registering for GP and other services that require an address or rely on post to communicate appointments. (Paraphrased Document R).

A structural threat regarding support and/or services for health and wellbeing was the sustainability of current funding with future uncertainty posing potential threats to the delivery of current services. This also affected the ability to adapt and develop the services, or indeed build new ones.

‛I would say the other thing is I have a beef [sic] [disagreement] with pilot studies or new innovations. Often soft funded, temporary funded, charity funded, partnership work run by enthusiasts. Me, I've done them, or supported people doing many of these. And they're great. They can make a huge impact on the individuals involved on that local area. You can see fantastic work. You get inspired and you want to stand up in a crowd and go, “Wahey, isn't this fantastic?” But actually the sad part of it is on these things, I've seen so many where we then see some good, positive work being done, but we can't make it permanent or we can't spread it because there's no funding behind it.’ (LP8).

Facilitators to tackling health inequalities: the assets

The facilitators for improving health and wellbeing and tackling health inequalities are considered as assets which were underpinned by values and principles.

Values driven supported by four key principles

Being values driven was an important concept and considered as the underpinning attitudes or beliefs that guide decision making [ 52 ]. Particularly, the system’s approach was underpinned by a culture and a system's commitment to tackle health inequalities across the documents and interviews. This was also demonstrated by how passionately and emotively some interviewees spoke about their work.

‛There's a really strong desire and ethos around understanding that we will only ever solve these problems as a system, not by individual organisations or even just part of the system working together. And that feels great.’ (LP3).

Other values driving the approach included accountability, justice, and equity. Reducing health inequalities and improving health were considered to be the right things to do. For example:

We feel strongly about social justice and being inclusive, wishing to reflect the diversity of [case study]. We campaign on subjects that are important to people who are older with respect and kindness. (Paraphrased Document O).

Four key principles were identified that crosscut the assets which were:

Shared vision

Strong partnership

Asset-based approaches

Willingness and ability to act on learning

The mandated strategy, identifying priorities for health and wellbeing for the local population with the required actions, provided the shared vision across each part of the system, and provided the foundations for the work. This shared vision was repeated consistently in the documents and interviews from across the system.

[Case study] will be a place where individuals who have the lowest socioeconomic status will ameliorate their health the quickest. [Case study] will be a place for good health and compassion for all people, regardless of their age. (Paraphrased Document A).

‛One thing that is obviously becoming stronger and stronger is the focus on health inequalities within all of that, and making sure that we are helping people and provide support to people with the poorest health as fast as possible, so that agenda hasn’t shifted.’ (LP7).

This drive to embed the reduction of health inequalities was supported by clear new national guidance encapsulated by the NHS Core20PLUS5 priorities. Core20PLUS5 is the UK's approach to support a system to improve their healthcare inequalities [ 53 ]. Additionally, the system's restructuring from Clinical Commissioning Groups (CCGs) to Integrated Care Boards (ICBs) and formalisation of the now statutory Integrated Care Systems (ICS) in England was also reported to facilitate the driving of further improvement in health inequalities. These changes at a regional and local level helped bring key partners across the system (NHS and local government among others) to build upon their collective responsibility for improving health and reducing health inequalities for their area [ 54 ].

‛I don’t remember the last time we’ve had that so clear, or the last time that health inequalities has had such a prominent place, both in the NHS planning guidance or in the NHS contract. ’ (LP15). ‛The Health and Care Act has now got a, kind of, pillar around health inequalities, the new establishment of ICPs and ICBs, and also the planning guidance this year had a very clear element on health inequalities.’ (LP12)

A strong partnership and collaborative team approach across the system underpinned the work from the documents and included the reoccurrence of the concept that this case study acted as one team: ‘Team [case study]'.

Supporting one another to ensure [case study] is the best it can be: Team [case study]. It involves learning, sharing ideas as well as organisations sharing assets and resources, authentic partnerships, and striving for collective impact (environmental and social) to work towards shared goals . (Paraphrased Document B).

This was corroborated in the interviews as working in partnership to tackle health inequalities was considered by the interviewees as moving in the right direction. There were reports that the relationship between local government, health care and the third sector had improved in recent years which was still an ongoing priority:

‘I think the only improvement I would cite, which is not an improvement in terms of health outcomes, but in terms of how we work across [case study] together has moved on quite a lot, in terms of teams leads and talking across us, and how we join up on things, rather than see ourselves all as separate bodies' (LP15).

‘I think the relationship between local authorities and health and the third sector, actually, has much more parity and esteem than it had before.' (LP11)

The approaches described above were supported by all health and care partners signing up to principles around partnership; it is likely this has helped foster the case study's approach. This also builds on the asset-based approaches that were another key principle building on co-production and co-creation which is described below.

We begin with people : instead of doing things to people or for them, we work with them, augmenting the skills, assets and strength of [case study]’s people, workforce and carers. We achieve : actions are focused on over words and by using intelligence, every action hones in on the actual difference that we will make to ameliorate outcomes, quality and spend [case study]’s money wisely; We are Team [case study ]: having kindness, working as one organisation, taking responsibility collectively and delivering on what we agreed. Problems are discussed with a high challenge and high support attitude. (Paraphrased Document D).

At times, the degree to which the asset-based approaches were embedded differed from the documents compared to the interviews, even when from the same part of the system. For example, the documents often referred to the asset-based approach as having occurred whilst interviewees viewed it more as a work in progress.

‘We have re-designed many of our services to focus on needs-led, asset-based early intervention and prevention, and have given citizens more control over decisions that directly affect them .’ (Document M).

‘But we’re trying to take an asset-based approach, which is looking at the good stuff in communities as well. So the buildings, the green space, the services, but then also the social capital stuff that happens under the radar.’ (LP11).

A willingness to learn and put in action plans to address the learning were present. This enables future proofing by building on what is already in place to build the capacity, capability and flexibility of the system. This was particularly important for developing the workforce as described below.

‘So we’ve got a task and finish group set up, […] So this group shows good practice and is a space for people to discuss some of the challenges or to share what interventions they are doing around the table, and also look at what other opportunities that they have within a region or that we could build upon and share and scale.’ (LP12).

These assets that are considered as facilitators are divided into four key levels which are the system, services and support, communities and individuals, and workforce which are discussed in turn below.

Firstly, the system within this case study was made up of many organisations and partnerships within the NHS, local government, VSCE sector and communities. The interviewees reported the presence of a strong VCSE sector which had been facilitated by the local council's commitment to funding this sector:

‘Within [case study], we have a brilliant third sector, the council has been longstanding funders of infrastructure in [case study], third sector infrastructure, to enable those links [of community engagement] to be made' (LP16).

In both the documents and interviews, a strong coherent strategic integrated population health management plan with a system’s approach to embed the reduction of health inequalities was evident. For example, on a system level regionally:

‘To contribute towards a reduction in health inequalities we will: take a system wide approach for improving outcomes for specific groups known to be affected by health inequalities, starting with those living in our most deprived communities….’ (Document H).

This case study’s approach within the system included using creative solutions and harnessing technology. This included making bold and inventive changes to improve how the city and the system linked up and worked together to improve health. For example, regeneration work within the city to ameliorate and transform healthcare facilities as well as certain neighbourhoods by having new green spaces, better transport links in order to improve city-wide innovation and collaboration (paraphrased Document F) were described. The changes were not only related to physical aspects of the city but also aimed at how the city digitally linked up. Being a leader in digital innovation to optimise the health benefits from technology and information was identified in several documents.

‘ Having the best connected city using digital technology to improve health and wellbeing in innovative ways.’ (Document G).

The digital approaches included ongoing development of a digitalised personalised care record facilitating access to the most up-to-date information to developing as well as having the ‘ latest, cutting edge technologies’ ( Document F) in hospital care. However, the importance of not leaving people behind by embedding digital alternatives was recognised in both the documents and interviews.

‘ We are trying to just embed the culture of doing an equity health impact assessment whenever you are bringing in a digital solution or a digital pathway, and that there is always an alternative there for people who don’t have the capability or capacity to use it. ’ (LP1).

The successful one hundred percent [redacted] programme is targeting some of our most digitally excluded citizens in [case study]. For our city to continue to thrive, we all need the appropriate skills, technology and support to get the most out of being online. (Paraphrased Document Q)

This all links in with the system that functions in a ‘place' which includes the importance of where people are born, grow, work and live. Working towards this place being welcoming and appealing was described both regionally and locally. This included aiming to make the case study the place of choice for people.

‘Making [case study] a centre for good growth becoming the place of choice in the UK to live, to study, for businesses to invest in, for people to come and work.’ (Document G).

Services and support

Secondly, a variety of available services and support were described from the local authority, NHS, and voluntary community sectors. Specific areas of work, such as local initiatives (including targeted work or campaigns for specific groups or specific health conditions) as well as parts of the system working together with communities collaboratively, were identified. This included a wide range of work being done such as avoiding delayed discharges or re-admissions, providing high quality affordable housing as well as services offering peer support.

‘We have a community health development programme called [redacted], that works with particular groups in deprived communities and ethnically diverse communities to work in a very trusted and culturally appropriate way on the things that they want to get involved with to support their health.’ (LP3 ).

It is worth noting that reducing health inequalities in avoidable admissions was not often explicitly specified in the documents or interviews. However, either specified or otherwise inferred, preventing ill health and improving access, experience, and outcomes were vital components to addressing inequalities. This was approached by working with communities to deliver services in communities that worked for all people. Having co-designed, accessible, equitable integrated services and support appeared to be key.

‘Reducing inequalities in unplanned admissions for conditions that could be cared for in the community and access to planned hospital care is key.’ (Document H)

Creating plans with people: understanding the needs of local population and designing joined-up services around these needs. (Paraphrased Document A).

‘ So I think a core element is engagement with your population, so that ownership and that co-production, if you're going to make an intervention, don't do it without because you might miss the mark. ’ (LP8).

Clear, consistent and appropriate communication that was trusted was considered important to improve health and wellbeing as well as to tackle health inequalities. For example, trusted community members being engaged to speak on the behalf of the service providers:

‘The messenger is more important than the message, sometimes.’ (LP11).

This included making sure the processes are in place so that the information is accessible for all, including people who have additional communication needs. This was considered as a work in progress in this case study.

‘I think for me, things do come down to those core things, of health, literacy, that digital exclusion and understanding the wider complexities of people.’ (LP12)

‘ But even more confusing if you've got an additional communication need. And we've done quite a lot of work around the accessible information standard which sounds quite dry, and doesn't sound very- but actually, it's fundamental in accessing health and care. And that is, that all health and care organisations should record your communication preferences. So, if I've got a learning disability, people should know. If I've got a hearing impairment, people should know. But the systems don’t record it, so blind people are getting sent letters for appointments, or if I've got hearing loss, the right provisions are not made for appointments. So, actually, we're putting up barriers before people even come in, or can even get access to services.’ (LP16).

Flexible, empowering, holistic care and support that was person-centric was more apparent in the documents than the interviews.

At the centre of our vision is having more people benefiting from the life chances currently enjoyed by the few to make [case study] a more equal place. Therefore, we accentuate the importance of good health, the requirement to boost resilience, and focus on prevention as a way of enabling higher quality service provision that is person-centred. [Paraphrased Document N).

Through this [work], we will give all children and young people in [case study], particularly if they are vulnerable and/or disadvantaged, a start in life that is empowering and enable them to flourish in a compassionate and lively city. [Paraphrased Document M].

Communities and individuals

Thirdly, having communities and individuals at the heart of the work appeared essential and viewed as crucial to nurture in this case study. The interconnectedness of the place, communities and individuals were considered a key part of the foundations for good health and wellbeing.

In [case study], our belief is that our people are our greatest strength and our most important asset. Wellbeing starts with people: our connections with our friends, family, and colleagues, our behaviour, understanding, and support for one another, as well as the environment we build to live in together . (Paraphrased Document A).

A recognition of the power of communities and individuals with the requirement to support that key principle of a strength-based approach was found. This involved close working with communities to help identify what was important, what was needed and what interventions would work. This could then lead to improved resilience and cohesion.

‛You can't make effective health and care decisions without having the voice of people at the centre of that. It just won't work. You won't make the right decisions.’ (LP16).

‘Build on the strengths in ourselves, our families, carers and our community; working with people, actively listening to what matters most to people, with a focus on what’s strong rather than what’s wrong’ (Document G).

Meaningful engagement with communities as well as strengths and asset-based approaches to ensure self-sufficiency and sustainability of communities can help communities flourish. This includes promoting friendships, building community resilience and capacity, and inspiring residents to find solutions to change the things they feel needs altering in their community . (Paraphrased Document B).

This close community engagement had been reported to foster trust and to lead to improvements in health.

‘But where a system or an area has done a lot of community engagement, worked really closely with the community, gained their trust and built a programme around them rather than just said, “Here it is. You need to come and use it now,” you can tell that has had the impact. ' (LP1).

Finally, workforce was another key asset; the documents raised the concept of one workforce across health and care. The key principles of having a shared vision, asset-based approaches and strong partnership were also present in this example:

By working together, the Health and Care sector makes [case study] the best area to not only work but also train for people of all ages. Opportunities for skills and jobs are provided with recruitment and engagement from our most disadvantaged communities, galvanizing the future’s health and care workforce. By doing this, we have a very skilled and diverse workforce we need to work with our people now as well as in the future. (Paraphrased Document E).

An action identified for the health and care system to address health inequalities in case study 1 was ‘ the importance of having an inclusive workforce trained in person-centred working practices ’ (Document R). Several ways were found to improve and support workforce skills development and embed awareness of health inequalities in practice and training. Various initiatives were available such as an interactive health inequalities toolkit, theme-related fellowships, platforms and networks to share learning and develop skills.

‛We've recently launched a [redacted] Fellowship across [case study’s region], and we've got a number of clinicians and managers on that………. We've got training modules that we've put on across [case study’s region], as well for health inequalities…we've got learning and web resources where we share good practice from across the system, so that is our [redacted] Academy.’ (LP2).

This case study also recognised the importance of considering the welfare of the workforce; being skilled was not enough. This had been recognised pre-pandemic but was seen as even more important post COVID-19 due to the impact that COVID-19 had on staff, particularly in health and social care.

‛The impacts of the pandemic cannot be underestimated; our colleagues and services are fatigued and still dealing with the pressures. This context makes it even more essential that we share the responsibility, learn from each other at least and collaborate with each other at best, and hold each other up to be the best we can.’ (Document U).

Concerns were raised such as the widening of health inequalities since the pandemic and cost of living crisis. Post-pandemic and Brexit, recruiting health, social care and third sector staff was compounding the capacity throughout this already heavily pressurised system.

In [case study], we have seen the stalling of life expectancy and worsening of the health inequality gap, which is expected to be compounded by the effects of the pandemic. (Paraphrased Document T)

‘I think key barriers, just the immense pressure on the system still really […] under a significant workload, catching up on activity, catching up on NHS Health Checks, catching up on long-term condition reviews. There is a significant strain on the system still in terms of catching up. It has been really difficult because of the impact of COVID.’ (LP7).

‘Workforce is a challenge, because the pipelines that we’ve got, we’ve got fewer people coming through many of them. And that’s not just particular to, I don't know, nursing, which is often talking talked [sic] about as a challenged area, isn't it? And of course, it is. But we’ve got similar challenges in social care, in third sector.’ (LP5).

The pandemic was reported to have increased pressures on the NHS and services not only in relation to staff capacity but also regarding increases in referrals to services, such as mental health. Access to healthcare changed during the pandemic increasing barriers for some:

‘I think people are just confused about where they're supposed to go, in terms of accessing health and care at the moment. It's really complex to understand where you're supposed to go, especially, at the moment, coming out of COVID, and the fact that GPs are not the accessible front door. You can't just walk into your GP anymore.’ (LP16).

‘Meeting this increased demand [for work related to reducing ethnic inequalities in mental health] is starting to prove a challenge and necessitates some discussion about future resourcing.’ (Document S)

Several ways were identified to aid effective adaptation and/or mitigation. This included building resilience such as developing the existing capacity, capability and flexibility of the system by learning from previous work, adapting structures and strengthening workforce development. Considerations, such as a commitment to Marmot Principles and how funding could/would contribute, were also discussed.

The funding’s [linked to Core20PLUS5] purpose is to help systems to ensure that health inequalities are not made worse when cost-savings or efficiencies are sought…The available data and insight are clear and [health inequalities are] likely to worsen in the short term, the delays generated by pandemic, the disproportionate effect of that on the most deprived and the worsening food and fuel poverty in all our places. (Paraphrased Document L).

Learning from the pandemic was thought to be useful as some working practices had altered during COVID-19 for the better, such as needing to continue to embed how the system had collaborated and resist old patterns of working:

‘So I think that emphasis between collaboration – extreme collaboration – which is what we did during COVID is great. I suppose the problem is, as we go back into trying to save money, we go back into our old ways of working, about working in silos. And I think we’ve got to be very mindful of that, and continue to work in a different way.’ (LP11).

Another area identified as requiring action, was the collection, analysis, sharing and use of data accessible by the whole system.

‘So I think there is a lot of data out there. It’s just how do we present that in such a way that it’s accessible to everyone as well, because I think sometimes, what happens is that we have one group looking at data in one format, but then how do we cascade that out?’ (LP12)

We aimed to explore a system’s level understanding of how a local area addresses health inequalities with a focus on avoidable emergency admissions using a case study approach. Therefore, the focus of our research was strategic and systematic approaches to inequalities reduction. Gaining an overview of what was occurring within a system is pertinent because local areas are required to have a regard to address health inequalities in their local areas [ 20 , 21 ]. Through this exploration, we also developed an understanding of the system's processes reported to be required. For example, an area requiring action was viewed as the accessibility and analysis of data. The case study described having health inequalities ‘at the heart of its health and wellbeing strategy ’ which was echoed across the documents from multiple sectors across the system. Evidence of a values driven partnership with whole systems working was centred on the importance of place and involving people, with links to a ‘strong third sector ’ . Working together to support and strengthen local assets (the system, services/support, communities/individuals, and the workforce) were vital components. This suggested a system’s committed and integrated approach to improve population health and reduce health inequalities as well as concerted effort to increase system resilience. However, there was juxtaposition at times with what the documents contained versus what interviewees spoke about, for example, the degree to which asset-based approaches were embedded.

Furthermore, despite having a priori codes for the documentary analysis and including specific questions around work being undertaken to reduce health inequalities in avoidable admissions in the interviews with key systems leaders, this explicit link was still very much under-developed for this case study. For example, how to reduce health inequalities in avoidable emergency admissions was not often specified in the documents but could be inferred from existing work. This included work around improving COVID-19 vaccine uptake in groups who were identified as being at high-risk (such as older people and socially excluded populations) by using local intelligence to inform where to offer local outreach targeted pop-up clinics. This limited explicit action linking reduction of health inequalities in avoidable emergency admissions was echoed in the interviews and it became clear as we progressed through the research that a focus on reduction of health inequalities in avoidable hospital admissions at a systems level was not a dominant aspect of people’s work. Health inequalities were viewed as a key part of the work but not necessarily examined together with avoidable admissions. A strengthened will to take action is reported, particularly around reducing health inequalities, but there were limited examples of action to explicitly reduce health inequalities in avoidable admissions. This gap in the systems thinking is important to highlight. When it was explicitly linked, upstream strategies and thinking were acknowledged as requirements to reduce health inequalities in avoidable emergency admissions.

Similar to our findings, other research have also found networks to be considered as the system’s backbone [ 30 ] as well as the recognition that communities need to be central to public health approaches [ 51 , 55 , 56 ]. Furthermore, this study highlighted the importance of understanding the local context by using local routine and bespoke intelligence. It demonstrated that population-based approaches to reduce health inequalities are complex, multi-dimensional and interconnected. It is not about one part of the system but how the whole system interlinks. The interconnectedness and interdependence of the system (and the relevant players/stakeholders) have been reported by other research [ 30 , 57 ], for example without effective exchange of knowledge and information, social networks and systems do not function optimally [ 30 ]. Previous research found that for systems to work effectively, management and transfer of knowledge needs to be collaborative [ 30 ], which was recognised in this case study as requiring action. By understanding the context, including the strengths and challenges, the support or action needed to overcome the barriers can be identified.

There are very limited number of case studies that explore health inequalities with a focus on hospital admissions. Of the existing research, only one part of the health system was considered with interviews looking at data trends [ 35 ]. To our knowledge, this research is the first to build on this evidence by encompassing the wider health system using wider-ranging interviews and documentary analysis. Ford et al. [ 35 ] found that geographical areas typically had plans to reduce total avoidable emergency admissions but not comprehensive plans to reduce health inequalities in avoidable emergency admissions. This approach may indeed widen health inequalities. Health inequalities have considerable health and costs impacts. Pertinently, the hospital care costs associated with socioeconomic inequalities being reported as £4.8 billion a year, mainly due to excess hospitalisations such as avoidable admissions [ 58 ] and the burden of disease lies disproportionately with our most disadvantaged communities, addressing inequalities in hospital pressures is required [ 25 , 26 ].

Implications for research and policy

Improvements to life expectancy have stalled in the UK with a widening of health inequalities [ 12 ]. Health inequalities are not inevitable; it is imperative that the health gap between the deprived and affluent areas is narrowed [ 12 ]. This research demonstrates the complexity and intertwining factors that are perceived to address health inequalities in an area. Despite the evidence of the cost (societal and individual) of avoidable admissions, explicit tackling of inequality in avoidable emergency admissions is not yet embedded into the system, therefore highlights an area for policy and action. This in-depth account and exploration of the characteristics of ‘whole systems’ working to address health inequalities, including where challenges remain, generated in this research will be instrumental for decision makers tasked with addressing health and care inequalities.

This research informs the next step of exploring each identified theme in more detail and moving beyond description to develop tools, using a suite of multidimensional and multidisciplinary methods, to investigate the effects of interventions on systems as previously highlighted by Rutter et al. [ 5 ].

Strengths and limitations

Documentary analysis is often used in health policy research but poorly described [ 44 ]. Furthermore, Yin reports that case study research is often criticised for not adhering to ‘systematic procedures’ p. 18 [ 41 ]. A clear strength of this study was the clearly defined boundary (in time and space) case as well as following a defined systematic approach, with critical thought and rationale provided at each stage [ 34 , 41 ]. A wide range and large number of documents were included as well as interviewees from across the system thereby resulting in a comprehensive case study. Integrating the analysis from two separate methodologies (interviews and documentary analysis), analysed separately before being combined, is also a strength to provide a coherent rich account [ 49 ]. We did not limit the reasons for hospital admission to enable a broad as possible perspective; this is likely to be a strength in this case study as this connection between health inequalities and avoidable hospital admissions was still infrequently made. However, for example, if a specific care pathway for a health condition had been highlighted by key informants this would have been explored.

Due to concerns about identifiability, we took several steps. These included providing a summary of the sectors that the interviewees and document were from but we were not able to specify which sectors each quote pertained. Additionally, some of the document quotes required paraphrasing. However, we followed a set process to ensure this was as rigorous as possible as described in the methods section. For example, where we were required to paraphrase, each paraphrased quote and original was shared and agreed with all the authors to reduce the likelihood to inadvertently misinterpreting or misquoting.

The themes are unlikely to represent an exhaustive list of the key elements requiring attention, but they represent the key themes that were identified using a robust methodological process. The results are from a single urban local authority with high levels of socioeconomic disadvantage in the North of England which may limit generalisability to different contexts. However, the findings are still generalisable to theoretical considerations [ 41 ]. Attempts to integrate a case study with a known framework can result in ‘force-fit’ [ 34 ] which we avoided by developing our own framework (Fig. 1 ) considering other existing models [ 14 , 59 ]. The results are unable to establish causation, strength of association, or direction of influence [ 60 ] and disentangling conclusively what works versus what is thought to work is difficult. The documents’ contents may not represent exactly what occurs in reality, the degree to which plans are implemented or why variation may occur or how variation may affect what is found [ 43 , 61 ]. Further research, such as participatory or non-participatory observation, could address this gap.

Conclusions

This case study provides an in-depth exploration of how local areas are working to address health and care inequalities, with a focus on avoidable hospital admissions. Key elements of this system’s reported approach included fostering strategic coherence, cross-agency working, and community-asset based working. An area requiring action was viewed as the accessibility and analysis of data. Therefore, local areas could consider the challenges of data sharing across organisations as well as the organisational capacity and capability required to generate useful analysis in order to create meaningful insights to assist work to reduce health and care inequalities. This would lead to improved understanding of the context including where the key barriers lie for a local area. Addressing structural barriers and threats as well as supporting the training and wellbeing of the workforce are viewed as key to building resilience within a system to reduce health inequalities. Furthermore, more action is required to embed reducing health inequalities in avoidable admissions explicitly in local areas with inaction risking widening the health gap.

Availability of data and materials

Individual participants’ data that underlie the results reported in this article and a data dictionary defining each field in the set are available to investigators whose proposed use of the data has been approved by an independent review committee for work. Proposals should be directed to [email protected] to gain access, data requestors will need to sign a data access agreement. Such requests are decided on a case by case basis.

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Acknowledgements

Thanks to our Understanding Factors that explain Avoidable hospital admission Inequalities - Research study (UNFAIR) PPI contributors, for their involvement in the project particularly in the identification of the key criteria for the sampling frame. Thanks to the research advisory team as well.

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This research was funded by the National Institute for Health and Care Research (NIHR), grant number (ref CA-CL-2018-04-ST2-010). The funding body was not involved in the study design, collection of data, inter-pretation, write-up, or submission for publication. The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health and Social Care or Newcastle University.

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Conceptualization - J.L. and S.S.; methodology - C.P.-C., J.L. & S.S.; formal analysis - C. P.-C. & L.M.; investigation- C. P.-C. & L.M., resources, writing of draft manuscript - C.P.-C.; review and editing manuscript L.M., J.L., & S.S.; visualization including figures and tables - C.P.-C.; supervision - J.L. & S.S.; project administration - L.M. & S.S.; funding acquisition - S.S. All authors have read and agreed to the published version of the manuscript.

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Parbery-Clark, C., McSweeney, L., Lally, J. et al. How can health systems approach reducing health inequalities? An in-depth qualitative case study in the UK. BMC Public Health 24 , 2168 (2024). https://doi.org/10.1186/s12889-024-19531-5

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ORIGINAL RESEARCH article

Study on the f-u-bvf analytical model for sustainable food design: a case study of tofu.

• Department of Spatial Culture Design, Graduate School of Techno Design, Kookmin University, Seoul, Republic of Korea

The food lifestyle has evolved from the regional differences that were previously shaped by different geographic locations to the pluralistic complexity of food styles that are now influenced by different user consciousnesses. The field of food design has assumed a greater social responsibility, while also facing the challenge of sustainable development. Consequently, it is of paramount importance to devise or refine the methodology of food design innovation. This study makes a significant contribution to the field of sustainable food design by combining design methodology with sociological concepts such as “Field and Habitus” to construct the “F-U-BVF” food lifestyle analysis framework. This study examines the applicability of the F-U-BVF analytical framework, exemplified by tofu, through the refinement and translation of user needs, among other methods. The objective is to guide users toward sustainable lifestyles based on a design methodology, thereby creating multiple values conducive to food sustainability. At the same time, the deconstruction of the structural relationship, process, and methodology of sustainable food design based on the F-U-BVF analytical framework is intended to break through the barriers of traditional design science. This is to provide a new systematic research paradigm for sustainable food design, as well as to provide a new perspective on the experience and interactive relationship between people and food. Finally, it is also to provide effective food design innovation solutions for relevant multi-stakeholders. This is of great significance for the development of sustainable food design.

1 Introduction

The process of socio-economic transition from an agro-pastoral economy to an industrial economy to a service economy ( Liang et al., 2022 ), with the globalization of information, environmental changes and cultural developments, has led to complex problems and challenges in society, resulting in group needs and conflicts between people in the spatial environment. To address the current social problems and challenges of environmental degradation, social inequality and economic instability faced globally, it is necessary to embrace the principles of sustainalism and adopting a sustainalist lifestyle, pave the way toward a more sustainable economy that balances humanity’s and the environment’s needs, benefiting everyone involved ( Hariram et al., 2023 ). In this regard, Governments are setting or have set targets for change and are taking sustainable action, including innovation in policies, services, products, etc., to address the challenges ( Elzen and Wieczorek, 2005 ; Almeida et al., 2013 ; Silvestre and Ţîrcă, 2019 ). This shift in focus not only promotes the development of design solutions for social problems but also expands the scope of design beyond physical objects to include non-object design such as service design, information design, and lifestyle design ( Liang et al., 2022 ). This change is closely linked to the shift in the social characteristics of modern humans, and it gives design the ability and social responsibility to promote change. Design should be utilized as a strategic tool to promote sustainable innovation and play a crucial role in integrating transformative capacity and social responsibility. Sustainable design takes into account the environmental, economic and social impacts that occur throughout a product’s life cycle ( Elkington, 1997 ). It involves rethinking modern society’s way of life and aims to create design changes for products and services that minimize resource consumption and promote recycling. With the development of society and the awakening of people’s sense of social responsibility, today’s ecological environment and social issues have prompted designers to pay attention to the concept of sustainable development and changes in the way of life ( Papanek, 2020 ). As a result, there are numerous initiatives aimed at promoting sustainable behavior and innovation through design. Design innovation has become a key driver of sustainable change ( Chick and Micklethwaite, 2011 ; Keitsch, 2012 ).

Food is a crucial source of energy for human beings in their daily activities and is closely linked to global issues and sustainable development ( Rasul, 2016 ). Modern technologies, such as preservation methods, and the rapid development of the transportation industry have made food a commodity. The focus on profit, rather than health, has become the primary goal of the food industry ( Zhang, 2000 ). But food is much more than a commodity. Food has a significant impact on human and environmental health, and sustainable diets can be a win-win for both human health and environmental sustainability ( Zhang and Chai, 2022 ; Liu et al., 2024 ). The wastage and pollution involved in the life cycle of food, including raw materials, production, sale, consumption, disposal, and recycling, have a direct or indirect impact on ecological and environmental sustainability ( Murphy et al., 2014 ; Nemecek et al., 2016 ; Lekavičius et al., 2023 ). At the same time, the regional cultural variability carried by food also reflects the different social patterns between regions from the side, clearly defining the relationship between the regional system context and its food ( Hinrichs, 2003 ; Kittler et al., 2016 ). Additionally, many consumers hold the belief that plant-based diets are healthier than animal-based diets. This belief has led to changes in dietary behaviors ( Possidónio et al., 2021 ) and has continued to encourage the development of sustainable dietary lifestyles. As a result, the concept of “sustainable diets” has emerged as a paradigm that considers both the ecological aspects of specific environments and human health and nutrition. It also focuses on the affordability and sociocultural acceptability of diets at global, local, and individual levels ( Garnett et al., 2014 ; Johnston et al., 2014 ; del Valle et al., 2022 ).

The Food and Agriculture Organization of the United Nations (FAO) recognizes sustainable diets as dietary patterns that promote an individual’s health and well-being, have low environmental impact, and are accessible, affordable, safe, equitable, and culturally acceptable ( Food and Agriculture Organization of the United Nations, 2020 ). Food involves ecology, society, economy, health, culture, and their interrelationships, which together constitute the macro-organization of sustainable food ( Hajer et al., 2016 ; Mason and Lang, 2017 ). The design intervention in sustainable food development is a balanced optimization of the relationship between these factors. At the same time, consumer food choices are shaped by the food environment, including access to healthy foods ( Turner et al., 2021 ). Therefore, the intervention of design prompts the supply side, processors, and others to rethink the possibility of food sustainability ( Sijtsema and Snoek, 2023 ) and explore how to provide more effective and innovative ideas and strategies for structural changes in food development. This becomes a real challenge for the sustainable design of food. For instance, Grönman et al. used different methods at different stages of food packaging design to improve the sustainability of the packaging, integrating sustainability into the design process at all stages ( Grönman et al., 2013 ). Choi and Blevis investigated the impact of human-computer interaction (HCI) design on promoting individual participation in establishing a sustainable food culture in urban areas ( Choi and Blevis, 2010 ). Clear et al. conducted a detailed microdocumentation of participants to quantify the relationship between potential impacts and their daily food preparation methods, scheduling, and roles in social gatherings. The aim was to inform the sustainable design of at-home cooking and dining ( Clear et al., 2013 ). These studies show that sustainable innovation research and practice in food has expanded beyond its original limitations with the design shift. There is now more consideration given to combining bottom-up consumer social responsibility awareness with top-down design strategy interventions. In other words, sustainable food design emerges from a combination of user awareness of responsibility and producer product innovation ( Nielsen et al., 2016 ). This paper argues that sustainable design is one of the ways to define the connotations and forms of food design and create points of connection between relevant variables such as people and food, thus making design one of the innovative ways to make food sustainable. Therefore, research on “Food” and “User” is one of the requirements for sustainable food design before food innovations can be generated and related issues can be defined. The objective of this study is to cross-fertilize multiple disciplines from the perspectives of “food” and “user,” with the construction of dietary lifestyle research methodology serving as the primary innovation point for sustainable food design. This approach is intended to enhance the multifaceted values conducive to the sustainable development of food and to break through the barriers of traditional design science in order to provide a new systematic research paradigm for sustainable food design.

2 Methods and process

2.1 constructing a methodology for studying dietary lifestyles, 2.1.1 field theory.

The concept of “field (French champ) theory” was put forward by the renowned French sociologist Pierre Bourdieu ( Hilgers and Mangez, 2014 ). This theory provides a crucial theoretical foundation for comprehending and analyzing lifestyles. The term “field” refers to the social space in which individuals are subject to certain rules and norms, as well as the specific social, economic, and cultural relationships that exist within that space. “Habitus” is another core concept in Bourdieu’s sociological theory ( Bourdieu, 2009 ). It refers to the habits of perception, thought, and behavior that are accumulated and solidified through long periods of life practice and taken for granted. The cognitive structure of individuals as the subject of behavior is characterized by a perception mode formed through long-term social practice, known as the “Habitus.” The “Habitus” guides the generation of people’s thoughts and behaviors, and lifestyle is a complete and systematic expression of the products and behaviors of “Habitus” in a specific “field” ( Bourdieu, 2014 , 2020 ). Since the 20th century, behavioral economists have researched the types and components of lifestyle to provide a theoretical basis for understanding the consumption habits of different social groups. Recently, research on lifestyle has focused on the behavioral characteristics and consumption habits of various social groups ( Xin, 2020 ).

2.1.2 Factors affecting modern dietary habits

According to the theory of “Field-Habitus,” the dietary practices of individuals within specific social, economic, and cultural contexts form a “Habitus” that influences their thoughts and behaviors related to food, ultimately shaping their dietary lifestyles.

User: The main factor influencing modern dietary lifestyles is the user. People are the primary agents in food production, selection, distribution, and other related activities. However, their behavior and realize are not fixed. They can change due to various external factors such as social, environmental, and economic conditions, as well as their backgrounds, emotions, and feelings. These factors play a significant role in the emergence and development of dietary lifestyles.

Field space: It is important to recognize that human beings are social creatures and that society often influences their actions. The society serves as a “field space” for actors, encompassing policies, economy, technology, culture, and other social layers that guide the development of dietary lifestyles. All behavioral activities within the field space have their bottom line, and although the development of dietary lifestyles relies on social influences, it is also influenced by “the choices and identities of people in the relevant social activities,” which results in the creation or development of diversified dietary lifestyles.

Behavior: People as a behavioral subject in the field of space generated by the “habitus “determines the dietary lifestyle, which mainly refers to the activities and habits generated by people, the activities determine the behavioral actions and social scope, attributes, etc., habit is the user’s long-term habitual activities generated by the behavioral preferences, which are the user’s physiological and psychological needs for food comprehensive reflection.

Value: The choice of dietary lifestyles among different groups is influenced by various factors, including personal values and their perceived impact on society ( Zhang, 2008 ). This dimension is a key variable in the study of food-related cultural and social contexts, as well as in the psychological and spiritual aspects of food. Values can impact dietary behaviors and lifestyle choices. However, they can also change in response to human experiences. The function of values lies in their ability to encapsulate culturally significant concepts, connotations, sentiments, and convictions, which can then be utilized to motivate actions ( Rokeach, 1973 ).

In summary, the user is central to shaping modern dietary lifestyles. Behavioral patterns, influenced by people’s activities and habits, are key factors in determining dietary lifestyles. Additionally, people’s values play a role in the formation of diverse dietary lifestyles, while the environment in which people live provides the background orientation for their dietary choices. The interplay of these factors creates a diverse and contemporary dietary lifestyle and also provides a benchmark for examining particular food and cultural practices.

2.1.3 Research methods for dietary lifestyles

The primary objective of constructing a research methodology for dietary lifestyles is to treat them as structured objects to be guided. The focus is on describing the state of people’s dietary lifestyles in a specific field environment, using their essential attributes and dimensional analysis as the main content. Currently, scholars typically study lifestyles using ethnography and phenomenological research methods. This involves user observation, interviews, and questionnaires, as well as extracting keywords, categorization, abstraction, and comparison. Researchers validate their findings through a reciprocal cycle of research until they develop a framework that can be applied beyond the limited empirical material and specific objects of observation while remaining relatively stable ( Xin, 2020 ). Based on the analysis of the influencing factors of dietary lifestyle, this study constructs a research method of dietary lifestyle based on “field theory” from the perspective of food and the dimensions of users’ behaviors (habits, activities) and values in a specific field space, i.e., the research framework of “F-U-BVF (Food Food-User User Behavior, Value Values, Field Field)” ( Figure 1 ). The objective is to interpret the eating lifestyle by incorporating the relevant perceptions, conceptual thinking, speculations, doubts, pleasures, pains, hopes, worries, desires, and demands ( Ni, 2007 ) of users of eating activities into the empirical material.

Figure 1 . F-U-BVF dietary lifestyle research framework.

The analysis of dietary lifestyle attributes and dimensions should be an objective evaluation based on the user’s perspective. The F-U-BVF framework’s dynamic research on users is analyzed from three perspectives. The first one is the field space, which includes both objective factors at the social level such as policy background, social culture, spatial environment, and people’s continuous relationship with other people or things in the social space. The second perspective is the value orientation, which consists of the value orientation at the time of the behavior or event and the intensity of the feelings in the heart and its continuous impact, which drives user behavior. Lastly, the third perspective is behavioral habits, which include daily living habits, eating habits, and other specific manifestations of food life. This analysis provides more reference value for multi-dynamic research on users and a more comprehensive approach to research on dietary lifestyles. The F-U-BVF research framework is employed in the field of food design innovation. This framework is utilized to analyze the complex relationship between food and users, the continuous influence on the social environment, and the user’s habits and activities in their dietary life. This analysis allows for the identification of potential design solutions that align with the needs and preferences of users. For instance, the F-U-BVF research framework can be employed to examine the application environments, user behavioral patterns, and prospective development dynamics of a diverse array of foods with sustainability characteristics, including alternative foods (plant proteins, insect proteins, etc.), surplus foods (coffee grounds, fruit peels, etc.), and so forth. Propose innovative possibilities from multiple perspectives, including food itself, related products, visual impressions, space, interactive behaviors, reflective activities, and so forth, with the objective of promoting the innovative development of related sustainable food design. It can be argued that the F-U-BVF research framework reflects the plasticity of the dietary lifestyle itself and, at the same time, interprets the diversity of life itself to guide the researcher to discover the different opportunities for the development of food from different dimensions and to establish the corresponding dietary lifestyle guidelines, to re-comprehend and adapt to different social environments, and to continuously update or adopt new dietary lifestyles.

2.2 Dietary lifestyle study using the example of Chinese tofu

Tofu has become a popular traditional food due to its nutritional value, soft texture, and versatility in preparation. Tofu has its origins in China and has since spread throughout East Asia and beyond as a result of social and cultural movements. The spread of tofu and soy products has provided the world with a resource of high-quality plant proteins, contributing significantly to sustainable food development. Research has demonstrated that the protein digestibility of whole-cooked soybeans, which contain a significant amount of high-quality protein, is only 65.3%. However, the protein digestibility of soy products can be increased to 92–96% through heating and cooking ( Wu et al., 2012 ). Additionally, mixing soy products with cereal food can result in protein absorption levels similar to those of meat protein. Therefore, the emergence of soy products not only makes it possible to fully utilize the nutrients of soy, but also has a significant impact on the insufficient or lack of animal protein intake and even social problems such as food shortages that humans may face. Tofu is currently the most widely used soybean product. Other soybean products are typically derived from the reprocessing of tofu. These soy products have a similar nutritional profile, including high-quality protein, fat, carbohydrates, carotenoids, and various vitamins ( Augustin and Cole, 2022 ). Soybean products have not only enriched people’s dietary structure, style and content, but also created the diversified development of tofu culture under the influence of the differences in humanities and customs in different regions. The culture surrounding tofu has expanded to encompass various categories of soy products, diverse usage scenarios, and multiple processing methods. The tofu culture of today exhibits characteristics of locality, universality, and everydayness.

In a more expansive sense, the culture surrounding tofu encompasses not only the food itself but also the production and consumption of tofu, as well as the related lifestyles, group beliefs, modern science and technology, and other related foods. In other words, tofu culture encompasses not only the historical and cultural connotations associated with it, but also the dietary behaviors, life patterns, and social responsibilities that it carries. By transcending the current linkage between people and food, tofu culture has adapted or altered regional characteristics, group needs, and social developments to meet the needs of consumers in modern lifestyles. This also indicates the potential for further expansion of the boundaries of tofu culture. The development of food innovations related to tofu and soy products is aligned with the sustainability goals of “responsible consumption and production, good health and well-being.” While the related food activities or practices are influenced by social development, the pattern of development of tofu culture is driven by the values of the consumers. Innovation in tofu culture based on modern lifestyles represents a potential avenue for overcoming the limitations of established knowledge and future development. It is also becoming one of the most significant avenues for the sustainable advancement of tofu culture.

This paper analyzes the lifestyle of users who consume tofu using the F-U-BVF framework ( Figure 2 ). Among them, F-Food, i.e., tofu, is used as a specific food research object, and comparative analysis, survey research and other methods are mainly used to explore the categories, production and consumption of tofu-related food. U-User is to take tofu-related stakeholders as research users, the core users are (potential) consumers, but also includes other related parties such as producers, sellers, etc. The aim is to study user types, behaviors, and needs, and to analyze these needs to identify the real internal needs of the users. This information will be used to construct the direction or possibilities for the future development of tofu and provide a research basis for designing future interventions to promote sustainable innovation in tofu. BVF (Behavior, Value, and Felid) is related to both food and users, including their relevant social background, user activities, value orientation, habits, behavioral logic, and many other aspects.

Figure 2 . Study on the lifestyle impact of tofu based on the F-U-BVF research framework.

2.2.1 Analysis of tofu production and consumption

There are two main steps in making tofu: pulping and coagulation molding. The process of making tofu involves soaking and softening soybeans, grinding them, separating the soybean milk and dregs, steaming the soybean milk, and adding a coagulant to create soybean protein gelatinization ( Cai et al., 1997 ). The specifics will vary in different production environments, but most are done in these steps. In addition, various soy products can be produced by intervening in different ways during the tofu-making process. For instance, when heating soy milk, it is important to control whether it boils or not, as this can cause a surface film to form, known as Soy milk film (千张) or dried Beancurd sticks (腐竹); Various coagulants are added after pulping, resulting in different textures of tofu; Derivatives of tofu, such as Fried tofu (油豆腐), Dougan (豆腐干), and Fermented bean curd (腐乳), are produced through deep-frying, red cooking, or fermenting ( Figure 3 ). Tofu and its derivative food products constitute the tofu culture. The diverse tastes, forms, and textures of these soy products provide the foundation for the innovative development of the tofu culture.

Figure 3 . Study of the relationship between tofu and related soy products.

Modern marketing strategies ensure continued consumption of tofu and related foods. As a result of the shift from a subsistence economy to a commercial one, most tofu and related foods have become marketable commodities and have entered the global marketplace. Users have also participated in the globalized marketplace through their consumption behavior ( Chen, 2019 ). Tofu represents 50% of the consumption share of traditional soy foods, making it a significant product category. Furthermore, soybeans (also known as soya beans), the primary ingredient in tofu, have significant health benefits and are environmentally friendly. The Agricultural Outlook 2022–2031 published by the OECD-FAO (Organisation for Economic Co-operation and Development-Food and Agriculture Organisation) mentions pulses as an ingredient in foods such as meat substitutes, which is likely to significantly increase their importance in agricultural commodities given that public demand for these products will continue to grow. Pulses are set to regain their importance in the dietary systems of many regions of the world. The Agricultural Outlook 2022–2031 predicts that this global trend will continue, with global per capita consumption of pulses forecast to grow to 9 kg in 2031 ( OECD/FAO, 2022 ). Such a trend could encourage more profound innovation in tofu and related food products.

In this paper, tofu and related foods are categorized into those that cook food and ready-to-eat food ( Figure 4 ). Foods that require cooking are primarily intended to meet daily dietary needs. They possess the characteristics of versatility, adaptability, and originality, and to a certain extent, reflect traditional production processes and related ways of life. Those that are ready-to-eat foods are mostly derivative products based on modern dietary lifestyles, including regional snacks with traditional cultural characteristics, packaged foods derived from traditional soy products, and creative foods with strong innovations. These foods represent an extension of tofu culture from traditional to modern times. This reflects the ability to adapt traditional foods to meet the needs of the present and explore innovative directions for tofu from multiple perspectives, expanding into new markets for consumption.

Figure 4 . Major categories of tofu and related soy products.

Based on the analysis above, it is evident that soybean products are commonly consumed in daily meals. However, traditional soybean products have already met the requirements for three meals, leaving limited room for innovation. At the same time, there is an increasing demand for ready-to-eat food due to modern lifestyles, social changes, group behavior, and other developments in food consumption. The development of tofu and related foods is driven by the pursuit of the health benefits of soy products. However, the specific approach to promoting their consumption needs to be analyzed and researched from multiple perspectives of relevant consumers. This will help propose the direction of innovation for the materialization of related foods.

2.2.2 User study on tofu and related foods

2.2.2.1 analysis of user stakeholders.

The relevant stakeholders in the dietary lifestyle of a commercial economy mainly include suppliers, producers, and sellers of raw materials involved in the production and life cycle of the food in question, as well as (potential) consumers who are at the heart of the dietary lifestyle ( Figure 5 ). Consumers’ dietary behavior plays a crucial role in food development and the formation of dietary lifestyles, making it a prerequisite for food sustainability. Modern dietary lifestyles can, in turn, enhance and enrich the content of consumers’ diets. Most food ingredients come from the local environment, and their suppliers are one of the key factors in preserving local ecosystems, while at the same time playing a fundamental role in ensuring food quality for the end consumer. The main role of the food producer is to transform raw materials into commodities and to pass on the material and related immaterial content of food. Food sellers’ behavioral activities, such as selling and promotion, are directly linked to the dietary lifestyles of other stakeholders and consumers. These activities can effectively promote and facilitate food innovation, as well as expand the external reach of food.

Figure 5 . Key stakeholders in the food industry in a commodity-based economy.

The tofu and related food industry chain encompasses all aspects of soybean production, from planting and management to harvesting, trading, processing, warehousing, logistics, and retailing of soybean products. Additionally, it includes food consumption and edibility ( Zheng et al., 2020 ). With changing lifestyles, consumers have developed a more diversified demand for soy products, which requires transformative and innovative measures for the development of traditional soy-based foods. This study examines the relationships among stakeholders of soy products ( Figure 6 ). The main interested parties, who are (potential) consumers, consist of both shop and internet users. They together shape the relevant food consumption patterns and are the determining factors for the development of soya products in a commodity economy. Sellers, such as offline stores and online Internet stores, and producers, such as factories and workshops, are the direct stakeholders in tofu and related foods and are mainly involved in production and distribution. Direct stakeholders influence the evolution of modern dietary lifestyles by being involved in the consumption patterns of core consumer users. Indirect stakeholders include government, media, logistics, external capital, etc., and the social policies and publicity involved also play a role in the development of soya products. The quality of soy products produced and sold, and ultimately the consumer’s experience of consumption, are affected by providers of soybean raw materials. The consumption preferences, values, and behavior of core consumer users have a direct impact on other related parties. This influence expands the boundaries of food culture from intrinsic attributes to extrinsic forms, promoting the formation or development of related dietary lifestyles. Understanding consumers is crucial for researching soybean product dietary lifestyles and promoting the formation of stable relationships related to tofu culture.

Figure 6 . Stakeholder analysis of tofu and related soy products.

2.2.2.2 Core consumer user requirements analysis

The Internet’s virtual public space is a crucial component of modern society, providing people with access to external information and consumption opportunities ( Papacharissi, 2002 ). During the COVID-19 outbreak, online information platforms popularized the nutritional benefits of soy products and strongly promoted healthy diets, increasing consumers’ attention and awareness of soy products. The development and innovation of tofu culture is driven by consumers’ growing health awareness. At the same time, the market economy has facilitated the growth of e-commerce platforms, leading to significant changes in the consumption patterns of soybean products. Various online marketing methods have emerged, expanding the market boundaries of soybean products. Consumers of traditional soybean products include people of all ages. However, with the rise of the internet, young people have become the largest group of consumers of modern commercialized soybean products. They are willing to try new things, which has made them the main consumers of innovative food. The diet of young people has changed due to the transformation of modern lifestyles, which has led to diversified consumption scenarios for soybean products. This change has not only altered the traditional marketing model but has also raised consumer expectations for the value of soybean products. As a result, people have begun to explore the various functions of soybean products in multiple scenarios. Thus, the future development trend of tofu culture is determined by the choice preferences of young consumers. This paper aims to enhance the definition of the target users by creating a questionnaire and an in-depth interview framework that considers four dimensions from both the user and food perspectives ( Table 1 ). These dimensions include basic user information (closely related to consumer demand and consumption level), knowledge of soybean products (understanding of the value of food culture, health, low carbon, etc.), consumption of soybean products (consumption categories, reasons for purchase, purchase channels, expenditure, mode of consumption, frequency of consumption, etc.), and expectations for the future development of soybean products (soybean product consumption scenarios, form and flavor, nutritional composition and low carbon and environmental protection, etc.). This study aims to re-examine and analyze changes in consumer needs, as well as explore possibilities for innovative development in tofu culture.

Table 1 . Framework for user questionnaire and in-depth interviews based on modern dietary lifestyles.

Based on the physical and mental health, consumption ability, and other relevant aspects of modern lifestyle users, this study distributes 212 questionnaires to consumers aged 18–44 in mainland China based on Table 1 . Finally, 200 valid questionnaires were returned ( Figure 7 ). The ratio of men and women engaged in this study was approximately 3:7 (27% male, 69% female). Among the users, those aged 18 to 35 account for 95%. The majority of users (82%) are located in cities and counties, with a significant proportion comprising students and business persons. A mere 29% of respondents to this survey were aware of the cultural aspects of soy products. Nevertheless, 68.5% of users are aware of the health benefits of soy products, and over half (55%) are aware of their low-carbon value. The majority (91%) of users purchase soy products, with the majority of these purchases being traditional (68%) and derived (83%). Among them, 66.5% went to supermarkets, 51% bought on e-commerce platforms, and 55.5% went to food markets to make their selections. The data indicates that 41.5% of consumers spent between RMB 11 and RMB 20 per visit, 32.5% spent between RMB 21 and RMB 150, and no individual spent more than RMB 100 on soy products. Furthermore, the results of the consumption method survey indicated that over half (62.5%) of respondents selected soy products for fast food, 63.5% opted to prepare them themselves, and 35.5% patronized restaurants for their consumption. In the survey on the frequency of consumption, 37.5% of respondents indicated that they consumed the soybean product depending on their mood, 39.5% reported consuming it 2–3 times a week, 7.5% reported consuming it once a week, and 15.5% reported consuming it almost every day. The results of the survey on consumers’ expectations for future soybean products revealed that 30% of respondents indicated a preference for the form of the product, 39.5% expressed a desire for a specific taste, and 29.5% indicated a preference for regional characteristics. The proportion of expectations for future consumption scenarios of soy products was essentially comparable, with a range of 31–33%. However, with regard to the anticipated future nutritional value of soy products, 62.5% of respondents indicated a preference for protein supplementation, while 36% expressed a desire to replace meat.

Figure 7 . Soy products related lifestyle survey questionnaire statistics.

Through research and analysis, it was found that the nutrition and variety of tofu-related foods are the main factors influencing consumption. Consumers have high demands for the taste of soybean products, their compatibility with their lifestyles, and their overall experience. In addition, the nutritional benefits of soy products are derived primarily from soybeans. As a result of the public’s growing focus on health and increased awareness of soy nutrition, consumers are gradually incorporating related foods into their daily diets. This trend has also contributed to the development of tofu and other soy-based foods. Meanwhile, due to rapid urbanization, changing lifestyles, and busy work schedules, healthy snacks have become popular among working people. Ready-to-eat soy products are receiving consumer attention due to their healthfulness. In addition, at present, the R&D and deep-processing capabilities of soybean product producers are increasing, the variety of tofu-related foods is enriching, and the added value of the products is improving. The proportion of soybean products in the user’s food consumption is continuing to grow, which provides a new point of opportunity for the development of soybean products. This paper analyzes the innovation strategy of tofu and related foods by taking the basic attributes, consumption preferences, and consumption demands of users as reference targets. A typical user profile ( Figure 8 ) is constructed based on the above research collation to analyze the consumption preferences and demands of consumers for tofu-related foods.

Figure 8 . Constructing a typical user profile for tofu-related foods.

An analysis of typical users’ soybean product consumption preferences and demand shows that the core group’s demand for innovation in tofu-related foods is mainly an expectation for the development of ready-to-eat (instant) foods. After sorting out the user requirements and categorizing the user requirements into three aspects—quality, health, and humanity—and combining the applicable multi-scenario characteristics of soya bean products, we propose possible innovation directions for tofu-related food in Table 2 . These directions include modeling, flavoring, packaging, and interaction, among others. We also explore how to embody the healthiness, culture, and sustainability of soya bean products in ready-to-eat food through innovations in raw materials, visual effects, and user experience.

Table 2 . User demand and translation of ready-to-eat soybean foods.

The F-U-BVF research framework, which examines the modern dietary lifestyle, allows for the design to intervene in the sustainable and innovative practice of tofu culture from multiple perspectives. These include the design, construction, and reorganization of food, which can be approached from various angles, such as the shape, packaging, experience, and eating scene. The preceding analysis identified two fundamental conditions that must be met for the practice of sustainable food design to be effective.

1. A healthy and sustainable dietary lifestyle. In the context of rapid social and economic development and the fast pace of urban life, there has been a shift in people’s dietary aspirations from solving the problem of subsistence to a plant-based, healthy eating lifestyle. The concept of sustainable food design, as exemplified by the tofu culture, places greater emphasis on the nutritional value of the food itself. Soy protein and other nutrients present in tofu fulfill the dietary needs of specific user groups within the context of healthy eating. Design interventions provide a greater opportunity for innovation within the experience of soy products, encompassing categories, flavors, packaging, and scenarios.

2. Dietary activities that do not result in harm to the natural ecology. The current industrialized model of food production, which is dominated by the laws of the market economy, ignores the negative impacts it has on the food system. For instance, the depletion of water resources, ecological degradation, unsustainable use of natural resources, and the large amounts of energy consumption and carbon emissions resulting from long-distance trade have become one of the main obstacles to the sustainable development of food security, natural resources, and the ecological environment. They are also one of the key concerns of sustainable food production and consumption. There are significant telecoupling effects in the global agro-food system, where changes in one region affect global cropland expansion and biodiversity loss ( Chai et al., 2024 ). Foods exemplified by soy products are characterized by eco-friendly sustainability. Therefore, this paper advocates the replacement of red meat with soy-based foods, which will not only benefit the development of China’s local food system, but also have significant telecoupling effects and positive impacts on ecosystems on a global scale. The ecological damage caused by food can be avoided or minimized through the implementation of design interventions in the production of soybean products and consumer dietary activities. The social responsibility of design drives it to meet the needs of consumers while becoming one of the most effective ways to achieve low-carbon development in food-related ecosystems.

3.1 Structural relationships in sustainable food design

The study constructed the F-U-BVF research framework to analyze tofu and its related food culture influenced by modern lifestyles. It was determined that the material properties of tofu and related foods can meet the sustainability goals related to food, which is a necessary component of sustainable food design. In recent years, economic growth has facilitated exchanges between different regions and the movement of internal and external consumers. This has resulted in a constant renewal of food and living cultures within the regions, leading to the coexistence of traditional and modern food cultures, such as tofu. The consumption of tofu and related foods aligns with modern society’s demand for sustainable development. This study examines the demand relationship between “F-Tofu” and “U-User.” It analyzes both traditional and modern food culture to identify sustainable characteristics of the tofu-related industrial chain. The study uses design as the leading role to construct the structural relationship of food design based on the example of the tofu culture ( Figure 9 ). The aim is to provide a methodology for realizing sustainable innovation of traditional food.

Figure 9 . Structural relationship of sustainable food design based on tofu culture.

User needs analysis is essential in the design and innovation process of tofu and related foods. This analysis helps to effectively promote the link and interaction between innovative concepts and consumers, and enhances the interaction between users and foods. Design participation in the development process of tofu culture is a systematic integration of tangible materials (food) and intangible content (culture), providing sustainable added value to tofu-related food innovations. Based on the research and analysis conducted, the development of tofu culture involves three main aspects: studying user needs related to tofu, integrating and excavating tofu culture comprehensively, and balancing and optimizing sustainable development with modern dietary lifestyles. Designers can help users adopt sustainable lifestyles by incorporating design elements that reflect their dietary values. Although designers cannot dictate human values, they can create design outputs, such as product (or food itself) design, experience design, visual or packaging design, and service design, to encourage users to establish sustainable dietary goals and corresponding dietary principles. This, in turn, helps users to re-understand and adapt to sustainable dietary patterns, and develop and promote new dietary behaviors and lifestyles.

3.2 Sustainable food design process exemplified by tofu culture

The design engagement process in sustainable food development, as exemplified by the tofu culture ( Figure 10 ), comprises two stages. The first stage, exploration and discovery phase: (1) Analyze the characteristics of traditional foods related to tofu and modern lifestyles, as well as research the sustainable characteristics of foods; (2) Explore and discover user needs in the process of sustainable development of tofu-related food based on the above research. After identifying and organizing the essential requirements during the exploration phase, we proceeded to the second phase, the design intervention phase. This phase involved the following steps: (1) Identifying sustainable food design opportunities related to tofu through requirement translation; (2) Developing sustainable food design proposals related to tofu based on the identified opportunities; (3) Conducting experiments on different sustainable food design proposals related to tofu. (4) Finalize the marketable output of the effective design proposals obtained through experimentation. Simultaneously, feedback from the design intervention phase will inform an iterative analysis of the research elements in the exploration and discovery phase. Additionally, feedback from the design execution and design experiment will validate the proposal’s validity. The design execution feedback will also validate the validity of the design experiment. A continuous process of design intervention and feedback leads to the creation of a final design output for tofu and related foods that meets user needs and achieves sustainability goals.

Figure 10 . Main process of sustainable food design based on tofu culture.

The sustainable food design process described above focuses on the “social needs” of tofu-related foods, which are related to the culture, lifestyle, and society of the group. Sustainable food design promotes sustainability by considering the needs relations of both F (food) and U (user). It expands the scope of concern to explore the dynamics of society as a whole, as well as the food and way of life of different groups. The goal of sustainable food design is not only to provide a pleasurable eating experience but also to emphasize the interaction between the material and immaterial elements of food. Sustainable food design not only provides food to the user but integrates the user into the sustainability process, becoming a co-producer of design resources.

3.3 A design approach for sustainable food based on tofu culture

The main methodological tools for engaging in sustainable food design come from extensions of design disciplines such as industrial design, interaction design, and service design ( Figure 11 ). However, sustainable food design is not entirely in the same dimension as traditional design, and its methods are more flexible. Additionally, it involves the integration of various fields, including anthropology, psychology, and sociology. For instance, anthropological fieldwork and observation methods are utilized to examine diverse aspects such as the characteristics of food, its sustainability, and its value and significance. This study examines tofu culture using the F-U-BVF framework. The methodology involves conducting desktop and on-site surveys to provide an in-depth analysis of the food. Combining stakeholder maps, quantitative and qualitative user research, and user profiling based on research to identify food sustainability issues. Subsequently, analyze the results to uncover the underlying causes of the problems and prioritize user needs. Analyze and summarize key requirements using visual aids, identify opportunities for sustainable food design by mapping user journeys and translating requirements, and explore new design and business models. In the direct or indirect participation of different players such as stakeholders, consumer users, social enterprises, local institutions, and social organizations, the interactive touchpoints between food and people and society are explored to present sustainable food design outputs. Experiment, test, evaluate, and provide feedback on design results to improve the description and presentation of sustainable food design. And implement the final tangible or intangible sustainable food design solution.

Figure 11 . Main methodological tools for the sustainable food design process.

Based on the analysis above, it is evident that the design approach to promote sustainability in tofu-related food involves deconstructing various aspects of tofu culture, such as its historical characteristics, social life, regional ecology, production, and consumption. This deconstruction provides an opportunity for design innovation, which can then be reorganized from a sustainability perspective. The resulting design should consider both material and immaterial aspects of tofu-related food to promote sustainable design and innovation in tofu culture.

The design methodology for material content outputs includes: (1) The material ontology of tofu-related foods was deconstructed and reorganized. The culture surrounding tofu encompasses a wide variety of food-related topics. To deconstruct and restructure the material ontology of tofu-related foods, it is necessary to separate their material form, color, taste, texture, and other external appearance factors. The design presentation can be productized, materialized, and visualized through a multi-perspective reorganization using design thinking. (2) Derivation of tofu-related foods in multiple directions. Food derivatives related to tofu include eating utensils, packaging, tools, and furniture, among others. The design of derivative products stems from the dismantling of tofu culture-related content and the reorganization, superimposition, mutation, and expansion of different design elements, thus ultimately presenting a design that breaks the established boundaries of existing design.

The design methodology for non-material content outputs includes (1) constructing sustainable dietary concepts through tofu-related food innovations. Design no longer solely exists as a commoditized object, but also plays a guiding role in social life. By deconstructing the content of modern life culture in tofu culture, sorting out modern food-related development trends and social needs, and designing in a restructured way, we can promote the generation and development of sustainable food activities by guiding the change of users’ behavior. (2) Tofu-related food service experience activities. Tofu culture encompasses a wealth of intangible experiences, including not only the enjoyment of tofu as a food but also the production of tofu-related food, social culture, customs, and habits. The use of various design methods allows the tofu to transcend its material properties and create emotional and sensory design outputs, such as cultural heritage, low-carbon impact, and environmental protection.

The design methodology for sustainable food innovation aims primarily at problem-solving. It is used to analyze and summarize scenarios related to sustainable food, as well as the final output results. Essentially, design methodology guides the innovation of sustainable practices in food practices and proposes more rational models of food design innovation. The sustainable food design methodology described above, which is based on the F-U-BVF framework, offers distinct advantages in addressing the issues that arise among the food product, the consumer, and sustainable development. In modern society, people and the environment are in a state of interdependent interaction, and sustainable food design is a discussion of people in modern diets, as well as the state of interaction between people and food-related social, environmental and cultural conditions, as an object of design. The sustainable food design approach expands the scope of the design object and shifts the purpose of the design from addressing food consumption needs to exploring solutions for complex social problems.

4 Conclusions and discussion

The paper proposes the F-U-BVF Framework realizes the design value of a closed loop of “Innovation-Experience-Reassessment” ( Figure 12 ). This framework reflects a globalized and systematic thinking mode in the development process of food culture and provides an innovative methodological tool for understanding the complex relationship related to food. It aims to achieve the commercial value sought by food producers under the demand of economic growth, to satisfy users’ multi-scenario dietary needs in a healthy and sustainable living model. Applying this framework to sustainable food innovation activities can effectively address sustainability issues in food development from the perspective of multi-stakeholders, including producers and consumers. It can also provide new ways of experiencing and interacting with food while creating sustainable solutions. This text explores the value of design thinking for sustainable food innovation through the closed-loop relationship of “Innovation-Experience-Reassessment.”

Figure 12 . The value of “innovation-experience-reflection” in sustainable food design.

4.1 Innovation value: solving complex problems in food sustainability

Factors such as social background, lifestyle, human customs, industrial structure, etc. related to the process of sustainable food development may influence and change the direction of food development. Consumers may also have different problems in the process of basic food needs, information awareness, and experience and interaction. Traditional Design Thinking solves problems primarily by designing tangible objects such as food, utensils, tools, and spaces, focusing on creating functional and practical solutions. However, given the shift in design and the diverse range of methods and tools available, producers should seek sustainable innovation paths for food from multiple perspectives. To achieve this, the “F-U-BVF Framework” provides a systematic approach to addressing the complex and diverse issues related to food sustainability. It offers ideas and solutions for identifying and solving problems, ultimately promoting sustainable development in the food industry. This framework aims to facilitate innovative sustainable food design with the producer as the leader.

4.2 Experiential value: enhancing the interactive experience related to sustainable food

One purpose of design is to create experiential value for the user. Designers should aim to engage users at an emotional level, which can be achieved through the user’s mood and feelings during experience and interaction. Sustainable food design explores the relationship between people, social culture, and food. The design focus shifts to the non-material needs of people related to food, taking the guidance of values and interactive experience as the core goal. This approach aligns with the touchpoints of food design to create more positive interactions between people and food. Integrating tangible resources and intangible values can enhance the user experience, form a stable and positive emotional connection with users, and continuously develop and update food-related lifestyles to create value for users.

4.3 Reassessment value: effectively connecting the multiple stakeholders involved in food culture

Food culture is a prerequisite for design innovation for producers and user experience for consumers. Moving from the innovation and experience layer to the r reassessment layer of food design requires a reassessment of the social values inherent in food culture, particularly about sustainability. The reassessment activities on designing sustainable content can provide feedback to both users and producers. This feedback can promote the development of sustainable lifestyles for users and help producers update and iterate their final design outputs. The closed-loop process involves service providers, government, technology, media, and other parties to provide sustainable food design reassessment value, including related policy development, publicity activities, and technical support. The involvement of multiple food stakeholders in the context of sustainable design increases the relevance of the production side to the user side and creates an effective feedback mechanism for food evaluation to receive timely feedback from users and stakeholders. Based on the feedback, the design output can be continuously updated and improved, and sustainable food solutions can be tested and innovated from various perspectives.

The development of society and technology in the information age has influenced the transformation of food-based design in the context of globalization. In addition, the need for a sustainable global diet based on plant-based lifestyles has led to food sustainability has brought about new breakthroughs in the exploration of design methods. This paper posits that the structural relationship, design process, main design tools, and related design methods of sustainable food design based on the F-U-BVF research framework can serve as a guide for future research and practice in food design. This will enable relevant users to implement a sustainable dietary lifestyle and, in turn, promote the sustainable development of plant-based dietary lifestyles, and ultimately effectively enhance the social responsibility of sustainable food design under the commercialization mode, such as the exploration of food and ecology, food and culture, and food and society in the context of globalization and other related sustainable development directions. In conclusion, the F-U-BVF framework offers insights into the field of sustainable food innovation. It provides a novel vision, guiding methodology, and theoretical framework for sustainable food design related to plant-based diets and more. In addition, the F-U-BVF framework can be employed not only in the investigation of sustainable food design, but also in the cross-fertilization of other multidisciplinary disciplines. Furthermore, this paper also expects to provide certain possibilities for food-related research in other disciplines.

Nevertheless, it should be noted that this study is not without its limitations. Firstly, the “F-U-BVF Research Framework” proposed in this paper is based on field theory to analyze the influencing factors of dietary lifestyle, with the objective of conducting systematic research on food and its related contents. However, it should be noted that the framework constructed through theoretical and qualitative research will inevitably be affected by the research perspectives and personal subjective perceptions. Secondly, the structural relationships, processes, and methods of sustainable food design derived in this paper are primarily based on case studies. Therefore, the design processes, methods, etc. emphasized here still need to be verified in more design practice activities, and accordingly, design strategies that can meet specific practice activities should be adapted and applied. It is anticipated that in the future, more pertinent researchers and practitioners will be able to corroborate the framework of this study in a continuous cycle, thereby prompting us to continuously update the research framework paradigm of sustainable food design in a more rational manner.

Data availability statement

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

Ethics statement

Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. Written informed consent from the patients/participants or patients/participants legal guardian/next of kin was not required to participate in this study in accordance with the national legislation and the institutional requirements.

Author contributions

YL: Conceptualization, Methodology, Visualization, Writing – original draft. YH: Writing – original draft, Writing – review & editing.

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.

Acknowledgments

The authors would like to express their gratitude to the professors of Kookmin University, Korea, and Beijing Institute of Fashion Technology, China, for providing help and resources for this study.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: sustainable, food design, lifestyle, research framework, tofu culture

Citation: Liang Y and Han Y (2024) Study on the F-U-BVF analytical model for sustainable food design: a case study of tofu. Front. Sustain. Food Syst . 8:1365638. doi: 10.3389/fsufs.2024.1365638

Received: 04 January 2024; Accepted: 05 August 2024; Published: 15 August 2024.

Reviewed by:

Copyright © 2024 Liang and Han. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Yuehui Liang, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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Optimizing urban form to enhance dispersion of carbon emissions: a case study of hangzhou, 1. introduction, 2. literature review, 3. materials and methods, 3.1. study area, 3.2. data sources and processing, 3.3. methodology, 3.3.1. calculation of urban carbon emissions, 3.3.2. simulating carbon emission dispersion trajectories, 4.1. spatial distribution of urban carbon emissions, 4.2. spatial distribution of carbon emission diffusion trajectories, 4.3. experimental simulation design, 4.4. impact of building location and height on carbon emission diffusion, 5. discussion, 5.1. optimizing building locations, 5.2. optimizing building heights, 5.3. implications for future building design, 6. conclusions, 6.1. findings, 6.2. limitations and future research directions, author contributions, data availability statement, conflicts of interest.

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Sun, S.; Xu, L. Optimizing Urban Form to Enhance Dispersion of Carbon Emissions: A Case Study of Hangzhou. Buildings 2024 , 14 , 2478. https://doi.org/10.3390/buildings14082478

Sun S, Xu L. Optimizing Urban Form to Enhance Dispersion of Carbon Emissions: A Case Study of Hangzhou. Buildings . 2024; 14(8):2478. https://doi.org/10.3390/buildings14082478

Sun, Shaoxin, and Lihua Xu. 2024. "Optimizing Urban Form to Enhance Dispersion of Carbon Emissions: A Case Study of Hangzhou" Buildings 14, no. 8: 2478. https://doi.org/10.3390/buildings14082478

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Designing for neurodiversity and inclusion, the landlord’s impact on return to office, data centers: coming to a neighborhood near you, web 2.0’s impact on the modern workplace, chair of the month.

While at the Circularity 24 conference in Chicago, WDM’s Cynthia Milota sat down with Jessica Heiges to discuss what it takes to design and operate a zero waste building. 

A net zero waste building is operated to reduce, reuse, recycle, compost or recover solid waste streams thereby resulting in no waste disposal to landfills or incinerators.

Federal Energy Management Program

Chou Hall – UC Berkeley Haas School

As a true zero waste advisor for the chou hall project team, jessica’s focus is sustainable and just transitions to waste-free systems..

Chou Hall was the first a TRUE Zero Waste academic building, certified in 2019. TRUE is a “zero waste certification program that guides facilities, portfolios, events and construction sites to design waste out of their system,” (Byrne, 2023).  Today there are over 300 facilities in 28 countries that have received the TRUE certification. 

TRUE projects have diverted over 5.6 million tons from the world’s waste streams.

USGBC, 2023

Cynthia Milota (CM): What is Chou Hall’s story? How did the project come to be and how were you involved.

Jessica Heiges (JH): The Chou Hall zero waste building initiative was the result of a perfect alignment of forces. The project had buy-in from all necessary stakeholders across campus – leadership, facilities and the student body – who were motivated to support innovative sustainability solutions. The Haas School of Business wanted to be a “living laboratory” where sustainability solutions could be tested, applied and learned, moving beyond just theory taught in the classroom.

The Haas Dean and COO at the time were also highly supportive of this initiative – and had the initial funds to back it. Chou Hall was newly built, slated to open in October of 2017. The building was already on track to receive LEED and WELL certification, so Haas aimed for the “trifecta” by also obtaining TRUE certification. Additionally, the primary donor for Chou Hall deeply believed in and advocated for innovation and sustainability.

I started my master’s program in zero waste + circularity in August 2017. A classmate of mine was already involved in the project; and once he learned of my interest in and capacity to support the certification program, he brought me onto the team. 

CM: What are the goals of a TRUE certification, and what is the process?  

JH:   To receive the GBCI TRUE certification , a facility must have 12 consecutive months of a 90%+ diversion-from-landfill (diversion) rate. It is important to note that incineration, including waste-to-energy, is not considered a diversion method. Facilities also need to demonstrate a documented baseline year of waste diversion data and maintain a contamination rate below 10% for all outgoing waste streams.

The TRUE certification process involves earning credits across 15 categories, including innovation, upstream waste management practices, staff training and reporting. Unlike other certification programs, TRUE takes a holistic approach, aiming to influence not just on-site waste management, but also upstream and downstream practices within the supply chain. To keep their certification current, facilities must maintain a diversion rate above 90% and submit annual reports.

CM: What are the operations of Chou Hall? How can others apply those lessons in their facilities? 

JH: Since its certification, Chou Hall continues to excel. It remains a shining example of a successful zero waste implementation, serving as a key differentiator between Haas and other sustainability-minded MBA programs. It has become a north star for other buildings on campus and is now expanding to include other buildings in the Haas ecosystem.

Throughout the two years of working toward zero waste at Chou Hall, our team learned a great deal. Some of the most significant learnings and recommendations that resulted from our experience include:

• Early stakeholder engagement: Get key decision-makers on board early. Clearly define their roles in the initiative and keep them informed to generate buy-in throughout the process.
• Comprehensive education: Develop a multi-channel education campaign tailored to your specific audience and deliver it persistently. Effective communication is crucial for success.
• Strong program management: Assemble a passionate and dedicated team to manage the program. Setbacks are inevitable, so a methodical approach and strong stakeholder relationships are essential.
• Funding matters: Verbal support isn’t enough. Secure dedicated, recurring and sufficient funding to support the initiative’s infrastructure and ongoing operations.
• Planning for events: Events often generate far more waste than anticipated, and managing waste during events requires careful planning to navigate competing priorities and resource limitations.
• Waste audits are powerful: Conduct waste audits (also known as waste characterization studies) to gain valuable insights into the types and volumes of waste generated. This will help you target your efforts and refine your program. Waste audits can also be a great engagement tool: getting community members involved by having them sort trash while wearing hazmat suits!

CM: You mentioned that the success of zero waste facilities is largely due to a partnership between the site facilities team, the owner and the various consultants. Can you elaborate on this partnership and why its so crucial?

JH:   Facility staff are the backbone of zero waste implementation and maintenance. They implement the infrastructure changes needed to promote zero waste, such as installing compost and recycling bins and dishwashers. Custodial and janitorial staff are essential as they ultimately ensure proper waste sorting, placing waste in the designated bins for collection and preventing contamination.

Building owners play a key role in approving components within a facility as well, such as installing dishwashers, which is vital for reducing waste. Their support is essential for unlocking zero waste initiatives. And lastly, the success of any zero waste program hinges on the cooperation of building occupants. This means properly sorting waste and avoiding unnecessary printing. 

CM: How does the familiar camping phrase “pack-in, pack out” apply to Zero Waste buildings?  

JH : The “pack-in, pack-out” mentality is essential for zero waste practices. The core idea is two-fold:

• It is based on an understanding that we should not bring and leave our waste elsewhere, and
• It creates a “nudge of inconvenience.” By making it less convenient to throw away waste, individuals may be less inclined to engage in waste-generating practices.

That said, it is not a solution for every situation, and it is important to recognize accessibility concerns. Not all individuals have equal access to reusable versus single-use consumption items. Accessibility can vary based on a variety of factors, and there are financial and time constraints to choosing less convenient consumption practices. Physical constraints can be a barrier as well for those with disabilities who may not have the option to choose reusable consumption (e.g. drinking a beverage without a straw).

Yet ultimately, the “pack-in, pack-out” mentality aims to view all locations like the wilderness and make a conscious effort to monitor and minimize our negative impact. It is one tactic to promote behavioral change toward reducing our current unsustainable rate of waste generation.

Chou Hall does not have any landfill bins. You heard it right! Their pack-in, pack-out policy for trash helps students and staff be aware of the waste they generate. 

Northern California Recycling Association

CM: How has Chou Hall influenced the operation of other buildings on the Berkeley campus? Do you see overall student behavior changing regarding waste generation?   

JH: UC Berkeley has developed its own zero waste program embodying many principles from the TRUE certification, which is being implemented in buildings across campus. Though not certified by TRUE, all new buildings at UC Berkeley are designed to be zero waste. There is a clear change in student behavior – they are taking more ownership and pride in the sustainability of their campus. Across campus there are student-generated signs, programs, clubs and policies in support of waste reduction education and infrastructural and programmatic change. It is powerful and energizing. Having that kind of student engagement is not unique but makes an impact toward achieving such ambitious sustainability goals.

Getting Started in your Workplace

To get started on a Zero Waste journey at your office, Dr. Nick Becker provides “18 Zero-Waste Tips to Implement in the Workplace,” (Becker, 2024).  Here are some concepts to get started.

More strategic zero waste strategies include encouraging employee and customer ideas on sustainability, going beyond pilots to create long-term initiatives for zero office waste. Partner with the facilities team, building management and your community to highlight zero waste initiatives. 

Chou Hall is a stand-out example of a zero waste building, holding the TRUE certification and positively influencing zero waste around the entire UC Berkeley campus. Functioning as a zero waste facility for 6 years, the success of the Chou Hall project in planning and on-going operation is dependent on effective collaboration between the facility staff, building owners, building users and consultants. Eliminating waste can be accomplished by reducing, reusing, recycling and composting to divert waste from landfills or incinerators. 

For the complete list visit ClimateSort/zero-waste-tips.

Photos courtesy of UC Berkeley Haas School of Business.

• building community
• circular economy
• Cynthia Milota
• Jessica Heiges
• sustainability
• TRUE certification
• UC Berkeley Haas School

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Analysing Complete Street Design Principles Using Space Syntax Methodology in a Case of Haft-e-Tir Square, Tehran

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• Azadeh Mohajer Milani   ORCID: orcid.org/0000-0002-0912-4347 1  

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Research on urban fabric has long been a focus of interest for researchers and planners. In response to the automobile-centric design of cities, approaches such as Complete Streets have emerged to create accessible, people-centric environments by integrating various transportation modes. The study is to understand how complete street design strategies influence the connectivity and integration of the urban fabric, focusing on Haft-e-Tir Square in Tehran as a case study. Employing space syntax methodology, the current layout and a design proposal based on Complete Street strategies for the square had analysed to reveal the impact of this planning and design principle on the city’s urban fabric. The result uncovers how Complete Street hold promise in improving urban functionality and elevating the life quality. The design proposal’s interventions proved that by prioritizing pedestrians, cyclists, motorists, and transit riders, the level of safety, walkability, liveability, and environmental sustainability of the area can improve. Moreover, the findings showed a considerable reduction in the pedestrian and traffic congestion, resulting in supports for local businesses and improved urban functionalities. By contributing to the ongoing discourse on Complete Streets and its impact on shaping urban environments, this research is paving the way for future studies in this area.

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Mohajer Milani, A. Analysing Complete Street Design Principles Using Space Syntax Methodology in a Case of Haft-e-Tir Square, Tehran. Int J Environ Res 18 , 97 (2024). https://doi.org/10.1007/s41742-024-00646-x

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Received : 06 March 2024

Revised : 13 July 2024

Accepted : 15 July 2024

Published : 13 August 2024

DOI : https://doi.org/10.1007/s41742-024-00646-x

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