Research Methods Literature ReviewPrior to beginning work on this assignment, review the qualitative and quantitative research designs encountered so far in this course.For your literature review, you

International Journal of Qualitative Methods 2 (2) Spring 2003

Design and Control Issues in Qualitative Case Study Research

Gaynor Lloyd-Jones

Gaynor Lloyd-Jones, Ph.D., CSPPD Coordinator, Medical Teaching Organization, University of

Edinburgh, Scotland

Abstract: Some methodologists have pointed to similarities between experimental method and

case study research in terms of design, theory testing and development. However, little is known

about how these debates inform qualitative research rationales. The use of a sequential dual

case study provided an opportunity to examine these issues and their impact on the unfolding

research process. The interplay of inductive and deductive approaches was evident throughout

in decisions determining the nature of the research enquiry.

Keywords: Qualitative case study research; experimental method; qualitative research design

Acknowledgements: The author gratefully acknowledges the support of the following: Dr. Tony

Hak who supervised the research, PH Holt Trust for funding the research, and Dr. Roger Gomm

for his constructive comments on earlier versions of this article.

Citation Information:

Lloyd-Jones, G. (2003). Design and control issues in qualitative case study research.

International Journal of Qualitative Methods, 2(2). Article 4. Retrieved [INSERT

DATE] from http://www.ualberta.ca/~iiqm/backissues/2_2/pdf/lloydjones.pdf Lloyd-Jones DESIGN AND CONTROL ISSUES 2

International Journal of Qualitative Methods 2 (2) Spring 2003

Introduction

Much is sometimes made of the distinctions between qualitative and quantitative research design

and the development of the enquiry process. Quantitative research honours the logic of

experimental or correlational method in adhering to agreed rules and predetermined sequences,

irrespective of emerging data and analysis. The role of researcher is detached from the field of

enquiry. By contrast, qualitative design displays an interactive, dynamic, and emergent character

in which the aims, strategies, data, analysis, and validity are woven together in the process of the

study (Hammersley & Atkinson, 1995; Maxwell, 1996; Becker, 1996). The qualitative researcher

is the key instrument in the design process, continually deploying reflexivity and evaluative

skills to data analysis and to the decisions concerning the direction of the next step in the study.

The design of each qualitative research study might therefore be considered unique.

Yet dissenting opinions point to greater complexity beneath the surface of this polarized

perspective. Hammersley (1992) argues that the qualitative-quantitative divide is artificially

polarized, disguising both methodological similarity and diversity in consequence. In an analysis

that emphasizes the trade-offs and overlaps between experimental, survey, and qualitative

research, he concludes that no single approach is necessarily ideal and that selection inevitably

involves loss as well as gain. This raises the possibility that the underlying logic between

approaches may be shared, and also that different approaches may be strategically deployed to

offset their particular disadvantages and advantages. Hammersley is not alone in seeing

relationships between qualitative research and experimental method. Yin (1994) draws attention

to similarities at the design level, seeing the single case study as analogous to a single Lloyd-Jones DESIGN AND CONTROL ISSUES 3

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experiment in terms of theory testing and development. What is shared between qualitative and

quantitative research may therefore be more real than apparent (Becker, 1996).

Although these arguments are well delineated in the literature, their impact on methodological

decisions in research practice is less well documented. Whether they can be used in qualitative

case study research, what implications ensue from their adoption, and how they might influence

the ongoing design, conduct, and study outcomes remain largely unanswered questions.

Qualitative research and experimental method

In order to place the discussion in context, three interrelated features of research methodology

will be used to compare qualitative research and experimental method: theory testing, the nature

and use of control, and the induction-deduction dimension. This is not intended as a

comprehensive review but serves to highlight those aspects of research design that have practical

implications for the present study.

The ultimate aim of experimental method is to develop theory through repeated testing of related

hypotheses. However, the outcomes of experiments are not generalizable per se but by reference

to the related theory. In practice, much replication is required under similar and differing

conditions before a theory may be upheld, rejected, or modified, and the point at which this

occurs requires the exercise of judgement (Campbell & Stanley, 1963). Yin (1994) employs

similar replication logic in his description of case study method, notably in his treatment of

multiple case study design. He stresses the careful selection of cases that will either replicate

(literal replication) or produce contrasting findings (theoretical replication) in line with the Lloyd-Jones DESIGN AND CONTROL ISSUES 4

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prevailing theory. Similar findings uphold the theory whereas contradictory findings either

demand theory modification or refutation thus mimicking experimental method. Though not all

qualitative studies are intended, by any means, either to develop or test theory, theoretical

inference has been proposed as a means of combating the problem of local to global

generalization inherent in qualitative case study research (Gomm, Hammersley, & Foster, 2000;

Yin, 1994).

There is a small, but significant, point to be made concerning theory testing and threats to

validity in experimental method. In general, an experiment tests only a single theory, although it

may be designed to differentiate between two rival hypotheses. Therefore, valid inference from

experimental method is prey to threats from unforeseen, conflicting theories or hypotheses

despite the use of control measures (Cook & Campbell, 1979). Bem’s (1967) alternative reading

of Festinger’s (1957) cognitive dissonance theory is a case in point. Qualitative researchers could

argue that inductive approaches might be less prone to the problem but this is true in terms of

potential only. As in all research, omissions pose potential threats to validity similar to

misinterpretations, treatment artefacts, or measurement error (Popper, 1972).

In essence, experimental method relies on the logic of comparison, contrasting the outcomes of

two conditions that vary by a single assigned variable. Validity threats from rival hypotheses are

excluded by controlling extraneous, but not necessarily identified, influences on the outcome. It

is important to differentiate between the use of comparison and control measures for the former

is no stranger to qualitative researchers. It is central to the analysis of grounded theory, implicit

in natural experimental settings and widely used in historical and political research where Lloyd-Jones DESIGN AND CONTROL ISSUES 5

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multiple cases are available for analysis (Ragin, 1994; Gomm et al., 2000). In the latter instances,

the comparisons relate to naturally occurring examples, avoiding the artificial contrivance of

control. Experimental control is essentially a means to an end. It is the technique that allows the

creation of different manufactured conditions that permit comparison and valid inference.

The approach to control, and the degree to which it is pursued, differentiate between case study

and experimental method (Hammersley, 1992). Experimental control measures act as a filter

against generic validity threats, relieving the researcher of the need to identify rival hypotheses

(Maxwell, 1996) although occasionally threats are specified (Campbell & Stanley, 1963).

Experimental control encompasses a range of strategies such as pre- or post-testing, matched

groups and contexts, randomization, and treatment equivalence all devoted to close matching of

the control and treatment groups. The absence of rigorous control measures is one reason for the

pluralistic, diverse character of qualitative research design, as the researcher must seek out

alternative explanations and hypotheses throughout the research process design, data collection,

and analysis (Maxwell, 1996). The success with which such threats are kept at bay will depend

on the researcher’s analytical and imaginative insights that inform methodological rationales and

decisions. Control, as conceived in quantitative research terms, conflicts with the respect paid to

context and naturalism in qualitative research. In practice however, qualitative researchers do

operate with lesser degrees of control (Hammersley, 1992). Data collection methods such as

structured interviewing and focus groups inhabit a ‘no man’s land’ between naturalism and

control. In such situations, the choice of greater control may influence the data in ways that

compromise the representativity of the subsequent analysis. Lloyd-Jones DESIGN AND CONTROL ISSUES 6

International Journal of Qualitative Methods 2 (2) Spring 2003

A similar, and often cited, distinction between the inductive approach of case study and the

deduction of experimental method also blurs under scrutiny. Though hypothesis raising and

testing are claimed as definitive of deductive reasoning they are neither the exclusive preserve of

quantitative research nor the only ways that deductive reasoning can be employed (Hammersley,

1992). Qualitative researchers employ both cognitive processes informally in the development of

the enquiry process (Becker, 1993). Yet the deductive principles of experimental research do

lead to a restrictive focus when control is relied on to exclude invalid inference. By contrast,

qualitative researchers must remain open and alert to possible alternatives and it is this quality

that marks qualitative research as primarily inductive. It seems likely that the qualitative

researcher will encounter choices that reflect some of these considerations during the research

enquiry.

Few qualitative researchers have utilized sequential case studies to develop and test theory in a

manner similar to experimental method. Though practical considerations of time, scale, and

feasibility discourage such endeavours, the assumption that the complex pluralistic nature of

social life does not rest on universal laws constitutes the greater obstacle (Lincoln & Guba,

1985). Yet the ethnographic studies of Hargreaves (1967), Lacey (1970), and Ball (1981) offer a

striking example from the qualitative case study literature of the development of differentiation-

polarization theory. The theory proposes that streaming secondary school pupils, according to

academic ability, results in polarization of their attitudes toward the school. The streaming

practices varied in the different schools studied and the relationship between these practices and

the degree of polarization found represented a test of theory through the medium of qualitative

research (Hammersley, 1992). In this article, a similar strategy of theory development and testing Lloyd-Jones DESIGN AND CONTROL ISSUES 7

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is described, but within a single research study. The methodological rationales that directed the

enquiry process are highlighted to explore the conceptual territory between qualitative design

and experimental method.

Background to the study

The background to the study was a wave of curricular revision in medical undergraduate

education in the United Kingdom, instigated by the General Medical Council (1993). The

medical school at the University of Liverpool responded by developing a subject integrated,

problem-based learning (PBL) course. Small group, enquiry-led learning replaced the former

heavy diet of lectures and discrete, discipline-based courses were combined in a curriculum that

integrated natural, clinical, and social sciences throughout. The course was launched in 1996

with a pioneer intake of 200 students, while senior students continued on the traditional course

that was gradually phased out. PBL had already established a foothold in US/Canadian medical

education but, despite this, there were few successful examples of institutions negotiating

curriculum change of the scale contemplated by Liverpool.

Design of the study

The double case design employed in the research (see Table 1) was not predetermined at the start

of data collection but emerged gradually in response to literature reviews, collected data, and

analysis. This section describes the rationales and possibilities entertained at the start of the

study.

As a medically qualified curriculum facilitator working in the medical school, the researcher was

familiar with experimental research method and was attracted to the possibility of theory Lloyd-Jones DESIGN AND CONTROL ISSUES 8

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development and testing within Yin’s (1994) model of multiple case study design. As a two-year

period of qualitative data collection was planned, it was feasible to look at two separate academic

sessions, each representing a single case study. The choice of cohorts and course years was not

made at the outset, other than a decision to start data collection with the launch of the course. By

default, the pioneer year thus became the first case study.

First case study Second case study

1996/7 academic session (pioneer entry) 1997/8 academic session

Peer social reference group – senior medical

studentsPeer social reference group – senior medical

students

No peer educational reference group Peer educational reference group – pioneer

entry group

Table 1. Multiple case study design of the Liverpool study

The choice of the second case study was left open, although three possibilities were considered.

The one ultimately adopted was to study the next student entry on the PBL course, in effect

comparing the experiences of two first-year cohorts in two case studies (Table 1). Alternatively

the pioneer cohort studied in the first case study could be followed into the second course year,

thereby comparing the experience of different course years from the viewpoint of a single cohort.

A third plan combined the two, researching the second first-year student entry plus the pioneer

cohort experience in the second year of the course. The latter idea proved too ambitious for the

resources of a single part-time researcher and was discarded early on.

Reviewing the literature revealed three areas of relevance for study design development. First,

there was a series of ethnographic case studies of the medical student experience (Fox, 1957;

Becker, Geer, Hughes, & Strauss, 1977; Haas & Shaffir, 1991), which could provide comparison

with the present study. In two of these student experience was characterized by insecurity Lloyd-Jones DESIGN AND CONTROL ISSUES 9

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attributed to impending professional responsibilities (Fox, 1957; Haas & Shaffir, 1991) but in the

third, educational cueing

1 to faculty, tutors, and assessment was prominent and uncertainty was

not in evidence (Becker et al., 1977).

A separate review of the PBL literature showed that little was known about the nature of PBL

student experience. This was highly significant because PBL proponents claim that the actions of

the typical PBL student differ from more conventional students. PBL students are self-directed

learners who recognize their own individual knowledge deficiencies and take responsibility for

satisfying their learning needs (Barrows & Tamblyn, 1980; Schmidt, 1983). Neither cueing to

teachers, nor to peers is compatible with PBL student action, for PBL is an emphatically

individualistic educational approach. The outcomes of both literature reviews therefore justified

a focus on the student perspective, which in essence became the case at the heart of each case

study.

A study of reference groups at a women’s college in the United States during the depression

years also fed into design development (Newcomb, Koenig, Flacks, & Warwick, 1967). In that

study, Bennington College (now co-ed) students adopted contrasting political allegiances to

those of family (Democrat) and background (Republican), attitudes that were retained 20 years

later. Yet it was not the findings of the American study that were of interest to the Liverpool

setting, but the application of the concept of reference groups. On reflection, it was apparent that

incoming students could employ senior students as reference groups for advice about social and

educational matters. A closer analysis revealed potential distinctions between the experiences of

the pioneer entry students and the following year entry in this respect. Clearly, both cohorts Lloyd-Jones DESIGN AND CONTROL ISSUES 10

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would have access to advice about social affairs but this would not be true for education. The

pioneer entry would lack a senior student reference group, as they were experiencing a quite

different curriculum. The following year would revert to normative circumstances, as the pioneer

entry became the senior educational reference group. At this stage, the analysis was speculative

and clearly did not preclude other contextual differences between pioneer and later cohorts but it

tended to favour the study of different cohorts. However, the final decision was not taken until

completion of the first case study analysis.

Methods

Details of the rationales underlying the unfolding enquiry process in relation to methods of data

collection are described in full elsewhere (Lloyd-Jones, 2002; Lloyd-Jones & Hak, in press), but

are only outlined in this article concentrate on the aspect of theory development within the

design. Participant observation and direct observational methods formed the mainstay of data

collection methods and were supplemented with interviews, focus groups, analysis of course

documents and resources, and a survey derived from a nominal group analysis. Consent for the

study was gained at the start from the Dean and all course directors. Every student received a

copy of the research guidelines assuring them of their rights to confidentiality and of their right

to decline participation. Staff tutors were approached individually on a similar basis.

First case study

Insecurity characterized the student experience during the first term. Study practices contradicted

the PBL model as students were observed cueing to staff, the given resources, and references.

Interview data triangulated the observational data, and inspection of student notes also confirmed Lloyd-Jones DESIGN AND CONTROL ISSUES 11

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students’ reliance on course resources. The insecurity proved problematical for research

development as its causes could not be attributed with certainty. Though the students blamed

uncertainty on the lack of an explicit, shared syllabus, the unfamiliarity and organizational

teething problems of a novel course could not be excluded as contributory. Nor was it possible to

assess how the absence of an educational reference group affected the pioneer students. During

the spring term, insecurity gradually declined as peer interaction and social comparison increased

among the cohort. Students compared workloads, notes, and PBL study, and modified private

study accordingly if they deviated from the consensus. However, insecurity resurfaced in the

summer with approaching assessment as students worried that the exclusive pursuit of PBL

learning might risk examination failure by omitting unseen elements of the faculty agenda. For

the first time, students articulated concern about their pioneer status, speculating about their

knowledge and competence in comparison with students at other medical schools.

The main points to emerge from an analysis of the first case study were insecurity, students’

rejection of self-directed study practices in favour of faculty-directed learning and the gradual

development of collective identity and action among the cohort. These findings favoured the

design in Table 1 for three reasons. First, the study practice findings were novel and unexpected.

The assumption that PBL students acted according to PBL claims had not previously been

challenged, although there was little supporting evidence for it. The first case study findings

could therefore be dismissed as atypical because of the peculiarities of context unless additional

evidence could be found. Evidence of similar practices in a different student cohort in a more

normative context would give greater robustness to the first case study findings. Second,

studying a new cohort experience under more normative circumstances might test the speculation Lloyd-Jones DESIGN AND CONTROL ISSUES 12

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relating to reference groups and, third, help to illuminate the cause of insecurity in the first case

study. Based on the logic of the study design and the first case study analysis, hypotheses were

raised for the second case study, which predicted recurrences of all three phenomena in the

second case study. However, the presence of the pioneer group as a source of educational advice

was anticipated to reduce, but not eradicate, uncertainty. How this effect might be mediated was

regarded as an emergent research question to be answered by data collection and analysis.

Second case study

The hypothesis on study practices was strongly upheld from the start of term as students were

observed openly cueing to resources, tutors, and faculty, similar to their predecessors. Collective

identity and action developed rapidly but, on the other hand, insecurity was striking by its

absence. The refutation of the related hypothesis required explanation and the answer was

sought, and found, in interactions between the pioneer student entry and the new group first year

students. Acting backstage of formal educational settings, the pioneer year had conveyed advice

on a specific textbook, which had been adopted, almost without exception. The effects of this

were not only to standardize content knowledge and reduce insecurity, but also to undermine the

individualistic aims of PBL learning. However, uncertainty reappeared in focus group data in the

spring term, prompted by a recent changeover of PBL tutorial groups and tutors. Students’

former cues of tutor direction were rendered unreliable as they encountered unexpected variation

in tutor and group practice.

In neither case study had students’ study practices conformed to those claimed by advocates for

PBL. Though the timing and degree of insecurity in the two case studies was strikingly different, Lloyd-Jones DESIGN AND CONTROL ISSUES 13

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in both groups a consistent relationship was found between the existence of collective social

groupings and the diminution of uncertainty. Group consensus and conformity appeared to allay

insecurity in both case studies. Conversely, uncertainty was maximal when group consensus was

either undeveloped, as at the start of the first case study, or when challenged by group and tutor

changes in the second case study.

Multiple case study design and the natural experiment

The dual case study design capitalized on the natural experimental features of the setting by

comparing the experience of two successive student cohorts in naturally occurring, but different,

contexts. The various contextual similarities and differences thus constituted a naturally

occurring control structure. The institution, the curriculum and medical student social culture

could be regarded as consistent features across both case studies. On the other hand, initial

problems of implementation in the first case study and growing staff familiarity with the course

in the second were potential differences. However, the most striking distinction that emerged

fully during data collection arose from the different relationships between first year and senior

students as a consequence of curriculum. The initial speculation on senior student role and action

in the early stages of the study proved justified in the findings of the second case study, where

their advice on textbook use and workload at registration was universally adopted, immediately

promoting educational conformity and undermining PBL process.

The design shares some features with Yin’s (1994) model of multiple case study design, notably

in his treatment of each case study as separate entities that permit replication and in the testing of

theory in the second case study. These are principles shared in common with experimental Lloyd-Jones DESIGN AND CONTROL ISSUES 14

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method, although in the natural world replication is too precise a term. The testing in the second

case study occurs under some conditions that are shared with the first, but also under

circumstances that uniquely differentiate between the case studies. The findings that appeared in

both case studies therefore acquire greater robustness as they have withstood the influence of

contextual variation. For instance, the relationship between insecurity, educational cueing, and

collective identity held good in the second case study despite the educational referent action, the

different triggers to uncertainty and the temporal variations in the appearance of phenomena

when compared to the first case study (Lloyd-Jones, 2002). The second case study data also

served as a source, and means, of refining and developing theory. As an example, the low level

of initial student insecurity in the second case study confounded expectations and triggered a

search for explanations that ultimately led back to second-year student action.

However the design differs from Yin (1994) in at least two respects. First, the approach taken

with the first case study was exploratory and inductive, for the uncertainty of outcomes and the

novelty of the situation militated against a deductive strategy so early in the study. This meant

that theory emerged from data analysis of the first case study rather than, as Yin suggests, being

developed deductively before any data are collected. Here, a more qualitative approach to study

design was necessary to run neither the risk of prejudging events nor of being deaf to alternative

hypotheses too early in the research. The first case study therefore, served as an exploratory

vehicle for theory development from which hypotheses or predictions were raised for testing in

the second case study. Lloyd-Jones DESIGN AND CONTROL ISSUES 15

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The second contrast lies in the coexistence of literal and theoretical replications within the

second case study, which again imposes a more open and emergent stance on the researcher.

Since the second case study was contingent on the first in terms both of data and design, it was

not possible to identify at the start of the research what might constitute literal, and what

theoretical, replications in Yin’s (1994) terms. That could only be achieved following an analysis

of the first case study data, and then only in the form of provisional hypotheses. The hypotheses,

founded on literal replications and for testing in the second case study, predicted that educational

cueing and the influence of collective action on study practices would recur. These were upheld

in the data. Another hypothesis, based on theoretical replication, anticipated diminished initial

uncertainty, lessened by the presence and actions of the senior second year students. However,

exactly how the educational reference group action might be mediated was less certain and had

to await further data collection. Here the research reverted to the emergent, inductive approach of

the first case study.

The case study posits an alternative explanation for PBL student action and behaviour to the one

outlined by educationalists (Barrows & Tamblyn, 1980; Schmidt, 1983). The model is derived

from empirically grounded data that respect those social and contextual influences neglected in

the educational theory. In terms of theory testing in experimental method, this constitutes an

alternative hypothesis to the existing claims of PBL. That the qualitatively derived model is

congruent with PBL research derived from a variety of methodologies suggests the findings of

the present study might not be unique (Lloyd-Jones, 2002). Yet caution should be exercised in

generalizing to other PBL curricula on two grounds. The first is because the study represents the Lloyd-Jones DESIGN AND CONTROL ISSUES 16

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equivalent of two experiments only, and second reason is because of the general acceptance of

probabilistic rather than deterministic laws governing social action amongst social researchers.

The discussion has been primarily concerned with maximizing research opportunities to deploy

theory construction and testing but there are limitations to the approach. Significant

methodological implications flow from the design since the logic of the multiple case study rests

on comparing like with like. This is problematical for qualitative research where depth is valued

more highly than breadth, for there is the danger that the research may concentrate on non-

equivalent elements for comparison. Furthermore, without knowledge of the relationship

between the whole case and the constituent parts, as represented by the collected data, claims to

generalization within the case study may be tenuous. Gomm et al. (2000) have pointed to the

lack of attention paid by qualitative researchers to generalization within the case study and of the

cautions necessary in making assertions about the case on the basis of partial knowledge. In the

present study attempts to combat the problem were made through rigorous attention to sampling

of respondents, time and events and the use of a survey instrument (Lloyd-Jones, 2002) but the

issue remains a potential validity threat.

Conclusion

Recent interest in qualitative research methodology has created opportunities to explore

conceptual relationships between qualitative and quantitative design and methods. Though it is

accepted by some researchers that theory development may be achieved by qualitative case study

research, these examples are rare. A qualitative case study, which blended notions of

experimental method with qualitative research, has been described and the design rationale Lloyd-Jones DESIGN AND CONTROL ISSUES 17

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examined. By rendering more explicit the arguments and decision making processes that

contribute to qualitative case study design, it is possible to gain a clearer assessment of a study’s

strengths and limitations, as well as contribute to our understanding of qualitative case study

design and methodology.

Notes

1. The term cueing or educational cueing refers to the way students seek clues or “cues” from the

educational environment as to what the faculty or school wishes them to know and learn. In its

most common form students try to find out about assessment, particularly examination content,

from their teachers. It was particularly obvious in the study quoted in the article because PBL

curricula do not specify curricular content, leaving it up to the student to define what they think

they should learn. This was a cause of insecurity to them. The students’ problem became acute

when they faced examinations as there is no formal curriculum to refer to. Consequently, they try

to ‘read’ tutor's behaviour and search the resources for clues as to what might be included in the

assessment. The term ‘curriculum hunting’ can sometimes be used as a substitute.

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