How to write a case study in public health

How to write a case study in public health Guidelines and template

March 2016

How to write a case study in public health: Guidelines and template UK Health Forum March 2016

Acknowledgements This document is supported and funded by Public Health England.

About the UK Health Forum The UK Health Forum (UKHF) is both a UK forum and an international centre for the prevention of noncommunicable diseases (NCDs), including coronary heart disease, stroke, cancer, diabetes, chronic kidney disease and dementia through a focus on up-stream measures targeted at the four shared modifiable risk factors of poor nutrition, physical inactivity, tobacco use and alcohol misuse. The UKHF recognises that tackling the risk factors for NCDs demands action to address the wider economic, social and environmental determinants of disease, and that doing so will have potential co-benefits for health inequalities, sustainable development, climate change and social justice. www.ukhealthforum.org.uk

How to write a case study in public health: guidelines and template

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Contents About the UK Health Forum.............................................................................................................................................. 2 Short introduction into case studies ................................................................................................................................. 4 Advantages and limitations of case studies ...................................................................................................................... 4 Writing up your case study ............................................................................................................................................... 5 Good tips for writing a case study – what to include ................................................................................................... 5 Getting started checklist ............................................................................................................................................... 6 Descriptive case studies – using the template.............................................................................................................. 7 Appendix A: Case study template .................................................................................................................................. 10 Appendix B: Useful References ....................................................................................................................................... 11


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Short introduction into case studies Research undertaken by UKHF in 2014/15 aimed to understand the value of case studies as evidence in public health. This is a summary of our findings.    

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Case studies are robust, useful and replicable pieces of evidence of ‘a story’. Usually case studies are output from a project, or service, which summarise what took place and describe an event or an intervention. Case studies can be structured or unstructured, and be of different length but ideally no more than 4 pages. They can be prospective, where criteria are established and cases fitting the criteria are included as they become available, or retrospective, where criteria are established for selecting cases from historical records for inclusion in the study. Case studies have many names, and in building this template and guideline 22 different terms associated with case studies were identified, e.g. practice based information, best practice, case report, anecdotes etc. They are observational in nature, sometimes derived from opinion, experience and expertise, and they are difficult to evaluate. They provide real life context. These ‘stories’ can support the advancement, assessment and translation of public health initiatives that can be shared with policy makers and funders. If descriptive enough they can be very useful as evidence in public health and rated quite highly where there is a lack of evidence of a formal nature, e.g. RCTs. There are limitations to case studies, they can be ‘undigestible’, in length and in content.

Advantages and limitations of case studies As found in our research but also confirmed in other studies, e.g. Pathfinders reporta, case studies: .

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Provides much more detailed information than what is available through other methods, such as surveys.

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Can present data collected from multiple methods (i.e., surveys, interviews, document review, and observation).

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They can showcase results of something that may not have been successful in a peer-review process due to methodology, but could be relevant to work in public health

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Sometimes too long, they should be digestible

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Lack rigour: Case studies have been viewed in the evaluation and research fields as less rigorous than other research methods. As qualitative research it can be considered unscientific, and the author may not have been systematic in data collection or allow bias in their findings.

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Not generalisable/replicable: Usually quite small or very specific studies, not typical or representative of a population or area. You can draw on theories to make your case study more evidence-based. It may be difficult for your audience to replicate your study locally, so the more rigorous your project, the more likely it is to have an impact. a

http://www.pathfinder.org/publications-tools/pdfs/Preparing-a-Case-Study-A-Guide-for-Designing-and-Conducting-a-CaseStudy-for-Evaluation-Input.pdf How to write a case study in public health: guidelines and template Page: 4

Writing up your case study Good tips for writing a case study – what to include Integrity    

Provide context (why was this case study written) Strive to be accurate, objective, balanced in your writing Reference published papers & related work that are relevant (if any) Ensure honest attribution of authorship/contribution of others

Completeness    

Describe the research hypotheses Present facts in an unbiased way Describe research methodology (if applicable) Make public all results regardless of outcome

Transparency     

Set out sources of funding & research sponsors Disclose potential conflicts of interest Provide logos and organisation names Take steps to make data accessible Include an honest discussion of the limitations

Responsibility   

Give dates of when the project took place Try to arrange for peer-review and/or evaluation of project and report Consider what recommendations you can make as a result of your case study

Format checks       

Aim your content to your audience in a suitable format Use clear headings: Introduction, Methodology, Results, Discussion, Conclusion Be short in length and to the point (preferably less than 4 pages) Provide details of year/date for when your case study took place and include a publication date on your case study write up Think about evaluation for your case study. Consider how the results could be translated into practice: include detailed information about your population, geography, intervention and results Provide links to where further information can be found, where data might be available and if content is accessible in other formats Provide an author’s name and contact details


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Getting started checklist In order to get started, we suggest you follow this step-by-step checklist. Print it off or copy into Excel and tick off items to keep track of your progress. A case study can be many things and can be different types of reportsb:      

linear (business or scientific research), comparative (looks at the same issue several times from different points of view), chronological (presenting the evidence chronologically), theory-building (presenting new parts of the theory in each new section of the report), suspense (presenting the outcome first followed by explanation) unsequenced (small sections, many studies presented, pulling it all together).

Investigating and writing up a case study will require the completion of specific stages. Allow sufficient time to complete each stage, but also be aware that some stages are revisited while you are analysing the case and writing the report. Thinking and writing becomes a cyclical process. 1. Download the case study template & guidelines 2. Define the task: It helps to think of a problem statement. What ‘problem’ was there which made you want to try a solution (your project)? Writing this statement helps frame the case study. You might find tools such as PICO and SPIDERc a good way to help you define the ‘problem’ 3. Use the template to guide you in writing your case study. 4. If retrospective: Look back at your project to see what content fit into what headings and highlight the areas you need to include to fit the headings of ‘Integrity’, ‘Completeness’, ‘Transparency’ and ‘Responsibility’. 5. If prospective: You can design your case study around the headings in the template to ensure you cover those areas, they may not all be relevant (e.g. results) 6. Establish author(s), sponsor(s)/funder(s), get logos/images, seek permission from these to include in your case study. What can/can’t you include? 7. Do you have any internal design/comms standards that need to be used? If comms people need to be involved, agree ground rules. 8. The template is a structure to help you format your case study and decide on content. This could be the final product or you may wish to style it in a corporate style or in other creative ways. If you are using the template as a final product, you could replace the template headings with more meaningful headings and subheadings, e.g. ‘About the project’ becomes ‘Information needs of the Caribbean public health community’. 9. Any copyright or data protection issues or other ethical declarations required? 10. Can you make your data available? Seek permission or state why not. 11. Do you or any other authors need to declare conflict of interest? Ask everyone to sign a form or email you declarations. 12. Was the project evaluated formally/informally? If not, are your recommendations based on true findings? Do you need to cover a lack of evaluation in a discussion on the limitations of your case study? 13. Establish all the URLs you need for references, to point people to full data or further information if applicable. 14. Set aside several days to write up, review and establish peer-review. In this instance, peerreview could be as simple as asking a colleague or similar organisation to read it over. b

To read more about this see http://www.uefap.com/writing/genre/casestud.htm [Accessed 16 Nov 2015] Read more about PICO and SPIDER tools here http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4310146/ [Accessed 17 March 2016] How to write a case study in public health: guidelines and template Page: 6 c

Descriptive case studies – using the template This section is intended to support the case study template. It gives a further description of content requirements for each section of the template. Remember, if made publically available, this project may be read by various audiences including researchers, funders and policy makers so it is important that your case study is written in a way that can be understood by all. Also remember that it’s likely your audience will critically appraise your case study, possibly utilising a toold. This could be to include your case study as a piece of evidence in policy work, or to translate your findings in order to change local practice. It is important that they have all the information that they need in order to carry our an appraisal, and can contact the author if more information is needed. This list is not intended to be exhaustive. Whilst an ideal case study may include all of this information, it is not always possible or applicable

Note: This document uses the term ‘project’ in reference to the research/intervention/event/protocol (etc.), that you are writing the case study about Construct your case study in a logical order. This will most likely be chronological from the start of your project (hypothesis/aims) to the finish and next steps for the future. Although other styles/formats of case studies exist that you may want to look ate. Title and subtitle This could be the story’s title. But at the least, the reader should be able to get a vague idea of what the story is about from the title. It’s worth being descriptive, e.g.   

Taking the plunge: swimming classes to address obesity in Lancashire Information needs of the Caribbean public health community. A prospective case study Developing a knowledge and information service to support the prevention of non-communicable disease agenda

Logo/organisation names provided The inclusion of logos is nice for easy identification of the authorship and contributors to a case study, but not essential. Remember that you should always seek permission to use organisational logos. You should provide the name of the institution that is considered the owner of the project. Year/date It is really important to include the year or full date that the case study was published so that future readers can assess the currency of the project and it’s relevancy to their work. It’s also important for anyone who may wish to reference it in their work.

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To read more about critical appraisal tools see this: http://www.ukhealthforum.org.uk/prevention/public-health-elearningtoolkit-phelt/ [accessed 22 March 2016] e To read more about this see http://www.uefap.com/writing/genre/casestud.htm [Accessed 16 Nov 2015] How to write a case study in public health: guidelines and template

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Document history If applicable, this section could include dates that the case study was drafted, reviewed or edited. Attribution of authorship/contribution It is important to list everyone involved in this project in order for the case study to be as transparent as possible. This should include anyone involved in background research, research assistance or proof reading the case study etc. If a larger group was involved, provide at least one contact person. Project timescales described Including the date span of the project will help people to appraise your findings for currency and relevancy. About the project This is one of the most important sections of your case study. It should clearly describe the five Ws of your project: Who, What, Why, When, Where, as well as the How. This section ‘sets the scene’ for why the project started, how it was carried out, who was involved and where it happened. At the end of this section the reader should have a clear understanding of the purpose of your project, who was involved and how it was performed, what was found and how it was assessed. Who: Give a description of the population, individuals or groups who took part or who were the focus of your project? How many were there? Were they from a particular region or community? What: What are the aims of the project? Why: Describe why the project was undertaken? Was there an intervention you wanted to test? A service that might fulfil a group need? Were you providing information to a certain population in a certain way? To meet local regional or national drivers? When: What period of time did this happen (date/month/year). Is case study prospective or retrospective? Where: Describe the geographical location of the project. How: What methods were used to carry out this project? How did you deliver the service? Is there a particular research method that you used and why did you use that method? How did you deliver the intervention? How did you promote the event? Analysis/evaluation: If the project is complete at the point of writing the case study, describe any evaluation of the project. What analysis methods did you use? If the project is not complete, describe how it will be evaluated. You could also discuss the expected outcomes. Limitations: If there are any known limitations to your project at this point, they should be listed. Were there any limitations to the methods chosen? Was there bias in participant selection? Challenges: Did you encounter any challenges in your project? How did you overcome these? Readers who want to conduct a similar project may be interested in this.

Results How to write a case study in public health: guidelines and template

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Describe the results of your project as briefly and succinctly as possible. Provide data, figures, charts if applicable or link to them if appropriate. If the project is reported somewhere else i.e. on a website or published paper, you could link to the full results. It is important that you include both positive and negative results. This will help with transparency and replicability. If you are able to make the full data set available you should note how the reader can access this. If you conducted interviews, you should seek permission to publish quotes from each participant and clarify any participant requirements for confidentiality. Conclusion Discuss the results and key lessons learnt. Were the results as expected? If the project was repeated, is there anything you would change? Were there any limitations that may have affected the outcome(s) of the project? Next steps/Recommendations Next steps describe what should happen if the project were to continue. You can also provide recommendations from the project outcomes regardless of if the project continues or not. It could suggest changes if the project were to be repeated or recommendations for change in local, national, regional strategies as a result of your project. Impact/benefit in practice/Return on Investment Here you can talk about the impact of your project. It may be that it had an impact for your organisation, a particular population group or service you provide. Perhaps there are cost savings implications to your project that may be of interest to decision-makers. Disclosure of conflicts of interest Potential conflicts of interest, such as affiliations with industry, should be listed for transparency. Source of funding/sponsors The names of funders or sponsors of individuals, the organisation or project should be listed for transparency. Contact details for more information This is important for transparency and if the reader wishes to contact you for further information. The contact details should be for the lead author. Include organisation URL, address, email address and phone number if appropriate. Keywords For indexing purposes, listing at least four keywords will help with future retrieval of the document if it is published on a website. The U.S National Library of Medicine provides a list of health and medical key word terms called MeSH (Medical Subject Headings) which you may find helpful in deciding on appropriate keywords: https://www.nlm.nih.gov/mesh/ References If you have referenced any other work in the case study make sure it is fully cited. If you need help with referencing, you might find UK Health Forum’s Public Health eLearning Toolkit (PHeLT) useful: http://bit.ly/1dBhVV4


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Appendix A: Case study template CASE STUDY TEMPLATE This is the logical order of fields to complete your case study but the format/layout can be your organisation’s own design. Field sections to be included Titles and subheadings Logo/organisation names provided Year/date Document history Attribution of authorship/contribution of others (incl. peer reviewers) Project timescales described About the project (Who, What, When, Why and How and who is this case study aimed at?) Results and key findings summarised Conclusion Next steps/recommendations Impact/benefit in practice/RoI Disclosure of potential conflicts of interest(s) Sources of funding/sponsors Contact details for more information Keywords References


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Appendix B: Useful References You may find these references useful when thinking of writing your case study: Writing the Case Study, UNSW Australia https://student.unsw.edu.au/writing-case-study Using English for Academic Purposes: A Guide for Students in Higher Education http://www.uefap.com/writing/genre/genre.htm Budgell, B., Guidelines to the writing of case studies http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2597880/ PREPARING A CASE STUDY: A Guide for Designing and Conducting a Case Study for Evaluation Input http://www.pathfinder.org/publications-tools/pdfs/Preparing-a-Case-Study-A-Guide-for-Designing-and-Conductinga-Case-Study-for-Evaluation-Input.pdf


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