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Making Learning Relevant With Case Studies

The open-ended problems presented in case studies give students work that feels connected to their lives.

To prepare students for jobs that haven’t been created yet, we need to teach them how to be great problem solvers so that they’ll be ready for anything. One way to do this is by teaching content and skills using real-world case studies, a learning model that’s focused on reflection during the problem-solving process. It’s similar to project-based learning, but PBL is more focused on students creating a product.

Case studies have been used for years by businesses, law and medical schools, physicians on rounds, and artists critiquing work. Like other forms of problem-based learning, case studies can be accessible for every age group, both in one subject and in interdisciplinary work.

You can get started with case studies by tackling relatable questions like these with your students:

• How can we limit food waste in the cafeteria?
• How can we get our school to recycle and compost waste? (Or, if you want to be more complex, how can our school reduce its carbon footprint?)
• How can we improve school attendance?
• How can we reduce the number of people who get sick at school during cold and flu season?

Addressing questions like these leads students to identify topics they need to learn more about. In researching the first question, for example, students may see that they need to research food chains and nutrition. Students often ask, reasonably, why they need to learn something, or when they’ll use their knowledge in the future. Learning is most successful for students when the content and skills they’re studying are relevant, and case studies offer one way to create that sense of relevance.

Teaching With Case Studies

Ultimately, a case study is simply an interesting problem with many correct answers. What does case study work look like in classrooms? Teachers generally start by having students read the case or watch a video that summarizes the case. Students then work in small groups or individually to solve the case study. Teachers set milestones defining what students should accomplish to help them manage their time.

During the case study learning process, student assessment of learning should be focused on reflection. Arthur L. Costa and Bena Kallick’s Learning and Leading With Habits of Mind gives several examples of what this reflection can look like in a classroom: 

Journaling: At the end of each work period, have students write an entry summarizing what they worked on, what worked well, what didn’t, and why. Sentence starters and clear rubrics or guidelines will help students be successful. At the end of a case study project, as Costa and Kallick write, it’s helpful to have students “select significant learnings, envision how they could apply these learnings to future situations, and commit to an action plan to consciously modify their behaviors.”

Interviews: While working on a case study, students can interview each other about their progress and learning. Teachers can interview students individually or in small groups to assess their learning process and their progress.

Student discussion: Discussions can be unstructured—students can talk about what they worked on that day in a think-pair-share or as a full class—or structured, using Socratic seminars or fishbowl discussions. If your class is tackling a case study in small groups, create a second set of small groups with a representative from each of the case study groups so that the groups can share their learning.

4 Tips for Setting Up a Case Study

1. Identify a problem to investigate: This should be something accessible and relevant to students’ lives. The problem should also be challenging and complex enough to yield multiple solutions with many layers.

2. Give context: Think of this step as a movie preview or book summary. Hook the learners to help them understand just enough about the problem to want to learn more.

3. Have a clear rubric: Giving structure to your definition of quality group work and products will lead to stronger end products. You may be able to have your learners help build these definitions.

4. Provide structures for presenting solutions: The amount of scaffolding you build in depends on your students’ skill level and development. A case study product can be something like several pieces of evidence of students collaborating to solve the case study, and ultimately presenting their solution with a detailed slide deck or an essay—you can scaffold this by providing specified headings for the sections of the essay.

Problem-Based Teaching Resources

There are many high-quality, peer-reviewed resources that are open source and easily accessible online.

• The National Center for Case Study Teaching in Science at the University at Buffalo built an online collection of more than 800 cases that cover topics ranging from biochemistry to economics. There are resources for middle and high school students.
• Models of Excellence , a project maintained by EL Education and the Harvard Graduate School of Education, has examples of great problem- and project-based tasks—and corresponding exemplary student work—for grades pre-K to 12.
• The Interdisciplinary Journal of Problem-Based Learning at Purdue University is an open-source journal that publishes examples of problem-based learning in K–12 and post-secondary classrooms.
• The Tech Edvocate has a list of websites and tools related to problem-based learning.

In their book Problems as Possibilities , Linda Torp and Sara Sage write that at the elementary school level, students particularly appreciate how they feel that they are taken seriously when solving case studies. At the middle school level, “researchers stress the importance of relating middle school curriculum to issues of student concern and interest.” And high schoolers, they write, find the case study method “beneficial in preparing them for their future.”

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Case studies.

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Case studies are stories that are used as a teaching tool to show the application of a theory or concept to real situations. Dependent on the goal they are meant to fulfill, cases can be fact-driven and deductive where there is a correct answer, or they can be context driven where multiple solutions are possible. Various disciplines have employed case studies, including humanities, social sciences, sciences, engineering, law, business, and medicine. Good cases generally have the following features: they tell a good story, are recent, include dialogue, create empathy with the main characters, are relevant to the reader, serve a teaching function, require a dilemma to be solved, and have generality.

Instructors can create their own cases or can find cases that already exist. The following are some things to keep in mind when creating a case:

• What do you want students to learn from the discussion of the case?
• What do they already know that applies to the case?
• What are the issues that may be raised in discussion?
• How will the case and discussion be introduced?
• What preparation is expected of students? (Do they need to read the case ahead of time? Do research? Write anything?)
• What directions do you need to provide students regarding what they are supposed to do and accomplish?
• Do you need to divide students into groups or will they discuss as the whole class?
• Are you going to use role-playing or facilitators or record keepers? If so, how?
• What are the opening questions?
• How much time is needed for students to discuss the case?
• What concepts are to be applied/extracted during the discussion?
• How will you evaluate students?

To find other cases that already exist, try the following websites:

• The National Center for Case Study Teaching in Science , University of Buffalo. SUNY-Buffalo maintains this set of links to other case studies on the web in disciplines ranging from engineering and ethics to sociology and business
• A Journal of Teaching Cases in Public Administration and Public Policy , University of Washington

For more information:

• World Association for Case Method Research and Application

Book Review :  Teaching and the Case Method , 3rd ed., vols. 1 and 2, by Louis Barnes, C. Roland (Chris) Christensen, and Abby Hansen. Harvard Business School Press, 1994; 333 pp. (vol 1), 412 pp. (vol 2).

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Using Case Studies to Teach

Why Use Cases?

Many students are more inductive than deductive reasoners, which means that they learn better from examples than from logical development starting with basic principles. The use of case studies can therefore be a very effective classroom technique.

Case studies are have long been used in business schools, law schools, medical schools and the social sciences, but they can be used in any discipline when instructors want students to explore how what they have learned applies to real world situations. Cases come in many formats, from a simple “What would you do in this situation?” question to a detailed description of a situation with accompanying data to analyze. Whether to use a simple scenario-type case or a complex detailed one depends on your course objectives.

Most case assignments require students to answer an open-ended question or develop a solution to an open-ended problem with multiple potential solutions. Requirements can range from a one-paragraph answer to a fully developed group action plan, proposal or decision.

Common Case Elements

Most “full-blown” cases have these common elements:

• A decision-maker who is grappling with some question or problem that needs to be solved.
• A description of the problem’s context (a law, an industry, a family).
• Supporting data, which can range from data tables to links to URLs, quoted statements or testimony, supporting documents, images, video, or audio.

Case assignments can be done individually or in teams so that the students can brainstorm solutions and share the work load.

The following discussion of this topic incorporates material presented by Robb Dixon of the School of Management and Rob Schadt of the School of Public Health at CEIT workshops. Professor Dixon also provided some written comments that the discussion incorporates.

Advantages to the use of case studies in class

A major advantage of teaching with case studies is that the students are actively engaged in figuring out the principles by abstracting from the examples. This develops their skills in:

• Problem solving
• Analytical tools, quantitative and/or qualitative, depending on the case
• Decision making in complex situations
• Coping with ambiguities

Guidelines for using case studies in class

In the most straightforward application, the presentation of the case study establishes a framework for analysis. It is helpful if the statement of the case provides enough information for the students to figure out solutions and then to identify how to apply those solutions in other similar situations. Instructors may choose to use several cases so that students can identify both the similarities and differences among the cases.

Depending on the course objectives, the instructor may encourage students to follow a systematic approach to their analysis.  For example:

• What is the issue?
• What is the goal of the analysis?
• What is the context of the problem?
• What key facts should be considered?
• What alternatives are available to the decision-maker?
• What would you recommend — and why?

An innovative approach to case analysis might be to have students  role-play the part of the people involved in the case. This not only actively engages students, but forces them to really understand the perspectives of the case characters. Videos or even field trips showing the venue in which the case is situated can help students to visualize the situation that they need to analyze.

Accompanying Readings

Case studies can be especially effective if they are paired with a reading assignment that introduces or explains a concept or analytical method that applies to the case. The amount of emphasis placed on the use of the reading during the case discussion depends on the complexity of the concept or method. If it is straightforward, the focus of the discussion can be placed on the use of the analytical results. If the method is more complex, the instructor may need to walk students through its application and the interpretation of the results.

Leading the Case Discussion and Evaluating Performance

Decision cases are more interesting than descriptive ones. In order to start the discussion in class, the instructor can start with an easy, noncontroversial question that all the students should be able to answer readily. However, some of the best case discussions start by forcing the students to take a stand. Some instructors will ask a student to do a formal “open” of the case, outlining his or her entire analysis.  Others may choose to guide discussion with questions that move students from problem identification to solutions.  A skilled instructor steers questions and discussion to keep the class on track and moving at a reasonable pace.

In order to motivate the students to complete the assignment before class as well as to stimulate attentiveness during the class, the instructor should grade the participation—quantity and especially quality—during the discussion of the case. This might be a simple check, check-plus, check-minus or zero. The instructor should involve as many students as possible. In order to engage all the students, the instructor can divide them into groups, give each group several minutes to discuss how to answer a question related to the case, and then ask a randomly selected person in each group to present the group’s answer and reasoning. Random selection can be accomplished through rolling of dice, shuffled index cards, each with one student’s name, a spinning wheel, etc.

Tips on the Penn State U. website: http://tlt.its.psu.edu/suggestions/cases/

If you are interested in using this technique in a science course, there is a good website on use of case studies in the sciences at the University of Buffalo.

Dunne, D. and Brooks, K. (2004) Teaching with Cases (Halifax, NS: Society for Teaching and Learning in Higher Education), ISBN 0-7703-8924-4 (Can be ordered at http://www.bookstore.uwo.ca/ at a cost of $15.00)

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In This Article Expand or collapse the "in this article" section Case Study in Education Research

Introduction, general overview and foundational texts of the late 20th century.

• Conceptualisations and Definitions of Case Study
• Case Study and Theoretical Grounding
• Choosing Cases
• Methodology, Method, Genre, or Approach
• Case Study: Quality and Generalizability
• Multiple Case Studies
• Exemplary Case Studies and Example Case Studies
• Criticism, Defense, and Debate around Case Study

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Case Study in Education Research by Lorna Hamilton LAST REVIEWED: 27 June 2018 LAST MODIFIED: 27 June 2018 DOI: 10.1093/obo/9780199756810-0201

It is important to distinguish between case study as a teaching methodology and case study as an approach, genre, or method in educational research. The use of case study as teaching method highlights the ways in which the essential qualities of the case—richness of real-world data and lived experiences—can help learners gain insights into a different world and can bring learning to life. The use of case study in this way has been around for about a hundred years or more. Case study use in educational research, meanwhile, emerged particularly strongly in the 1970s and 1980s in the United Kingdom and the United States as a means of harnessing the richness and depth of understanding of individuals, groups, and institutions; their beliefs and perceptions; their interactions; and their challenges and issues. Writers, such as Lawrence Stenhouse, advocated the use of case study as a form that teacher-researchers could use as they focused on the richness and intensity of their own practices. In addition, academic writers and postgraduate students embraced case study as a means of providing structure and depth to educational projects. However, as educational research has developed, so has debate on the quality and usefulness of case study as well as the problems surrounding the lack of generalizability when dealing with single or even multiple cases. The question of how to define and support case study work has formed the basis for innumerable books and discursive articles, starting with Robert Yin’s original book on case study ( Yin 1984 , cited under General Overview and Foundational Texts of the Late 20th Century ) to the myriad authors who attempt to bring something new to the realm of case study in educational research in the 21st century.

This section briefly considers the ways in which case study research has developed over the last forty to fifty years in educational research usage and reflects on whether the field has finally come of age, respected by creators and consumers of research. Case study has its roots in anthropological studies in which a strong ethnographic approach to the study of peoples and culture encouraged researchers to identify and investigate key individuals and groups by trying to understand the lived world of such people from their points of view. Although ethnography has emphasized the role of researcher as immersive and engaged with the lived world of participants via participant observation, evolving approaches to case study in education has been about the richness and depth of understanding that can be gained through involvement in the case by drawing on diverse perspectives and diverse forms of data collection. Embracing case study as a means of entering these lived worlds in educational research projects, was encouraged in the 1970s and 1980s by researchers, such as Lawrence Stenhouse, who provided a helpful impetus for case study work in education ( Stenhouse 1980 ). Stenhouse wrestled with the use of case study as ethnography because ethnographers traditionally had been unfamiliar with the peoples they were investigating, whereas educational researchers often worked in situations that were inherently familiar. Stenhouse also emphasized the need for evidence of rigorous processes and decisions in order to encourage robust practice and accountability to the wider field by allowing others to judge the quality of work through transparency of processes. Yin 1984 , the first book focused wholly on case study in research, gave a brief and basic outline of case study and associated practices. Various authors followed this approach, striving to engage more deeply in the significance of case study in the social sciences. Key among these are Merriam 1988 and Stake 1995 , along with Yin 1984 , who established powerful groundings for case study work. Additionally, evidence of the increasing popularity of case study can be found in a broad range of generic research methods texts, but these often do not have much scope for the extensive discussion of case study found in case study–specific books. Yin’s books and numerous editions provide a developing or evolving notion of case study with more detailed accounts of the possible purposes of case study, followed by Merriam 1988 and Stake 1995 who wrestled with alternative ways of looking at purposes and the positioning of case study within potential disciplinary modes. The authors referenced in this section are often characterized as the foundational authors on this subject and may have published various editions of their work, cited elsewhere in this article, based on their shifting ideas or emphases.

Merriam, S. B. 1988. Case study research in education: A qualitative approach . San Francisco: Jossey-Bass.

This is Merriam’s initial text on case study and is eminently accessible. The author establishes and reinforces various key features of case study; demonstrates support for positioning the case within a subject domain, e.g., psychology, sociology, etc.; and further shapes the case according to its purpose or intent.

Stake, R. E. 1995. The art of case study research . Thousand Oaks, CA: SAGE.

Stake is a very readable author, accessible and yet engaging with complex topics. The author establishes his key forms of case study: intrinsic, instrumental, and collective. Stake brings the reader through the process of conceptualizing the case, carrying it out, and analyzing the data. The author uses authentic examples to help readers understand and appreciate the nuances of an interpretive approach to case study.

Stenhouse, L. 1980. The study of samples and the study of cases. British Educational Research Journal 6:1–6.

DOI: 10.1080/0141192800060101

A key article in which Stenhouse sets out his stand on case study work. Those interested in the evolution of case study use in educational research should consider this article and the insights given.

Yin, R. K. 1984. Case Study Research: Design and Methods . Beverley Hills, CA: SAGE.

This preliminary text from Yin was very basic. However, it may be of interest in comparison with later books because Yin shows the ways in which case study as an approach or method in research has evolved in relation to detailed discussions of purpose, as well as the practicalities of working through the research process.

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Case-based learning.

Case-based learning (CBL) is an established approach used across disciplines where students apply their knowledge to real-world scenarios, promoting higher levels of cognition (see Bloom’s Taxonomy ). In CBL classrooms, students typically work in groups on case studies, stories involving one or more characters and/or scenarios.  The cases present a disciplinary problem or problems for which students devise solutions under the guidance of the instructor. CBL has a strong history of successful implementation in medical, law, and business schools, and is increasingly used within undergraduate education, particularly within pre-professional majors and the sciences (Herreid, 1994). This method involves guided inquiry and is grounded in constructivism whereby students form new meanings by interacting with their knowledge and the environment (Lee, 2012).

There are a number of benefits to using CBL in the classroom. In a review of the literature, Williams (2005) describes how CBL: utilizes collaborative learning, facilitates the integration of learning, develops students’ intrinsic and extrinsic motivation to learn, encourages learner self-reflection and critical reflection, allows for scientific inquiry, integrates knowledge and practice, and supports the development of a variety of learning skills.

CBL has several defining characteristics, including versatility, storytelling power, and efficient self-guided learning.  In a systematic analysis of 104 articles in health professions education, CBL was found to be utilized in courses with less than 50 to over 1000 students (Thistlethwaite et al., 2012). In these classrooms, group sizes ranged from 1 to 30, with most consisting of 2 to 15 students.  Instructors varied in the proportion of time they implemented CBL in the classroom, ranging from one case spanning two hours of classroom time, to year-long case-based courses. These findings demonstrate that instructors use CBL in a variety of ways in their classrooms.

The stories that comprise the framework of case studies are also a key component to CBL’s effectiveness. Jonassen and Hernandez-Serrano (2002, p.66) describe how storytelling:

Is a method of negotiating and renegotiating meanings that allows us to enter into other’s realms of meaning through messages they utter in their stories,

Helps us find our place in a culture,

Allows us to explicate and to interpret, and

Facilitates the attainment of vicarious experience by helping us to distinguish the positive models to emulate from the negative model.

Neurochemically, listening to stories can activate oxytocin, a hormone that increases one’s sensitivity to social cues, resulting in more empathy, generosity, compassion and trustworthiness (Zak, 2013; Kosfeld et al., 2005). The stories within case studies serve as a means by which learners form new understandings through characters and/or scenarios.

CBL is often described in conjunction or in comparison with problem-based learning (PBL). While the lines are often confusingly blurred within the literature, in the most conservative of definitions, the features distinguishing the two approaches include that PBL involves open rather than guided inquiry, is less structured, and the instructor plays a more passive role. In PBL multiple solutions to the problem may exit, but the problem is often initially not well-defined. PBL also has a stronger emphasis on developing self-directed learning. The choice between implementing CBL versus PBL is highly dependent on the goals and context of the instruction.  For example, in a comparison of PBL and CBL approaches during a curricular shift at two medical schools, students and faculty preferred CBL to PBL (Srinivasan et al., 2007). Students perceived CBL to be a more efficient process and more clinically applicable. However, in another context, PBL might be the favored approach.

In a review of the effectiveness of CBL in health profession education, Thistlethwaite et al. (2012), found several benefits:

Students enjoyed the method and thought it enhanced their learning,

Instructors liked how CBL engaged students in learning,

CBL seemed to facilitate small group learning, but the authors could not distinguish between whether it was the case itself or the small group learning that occurred as facilitated by the case.

Other studies have also reported on the effectiveness of CBL in achieving learning outcomes (Bonney, 2015; Breslin, 2008; Herreid, 2013; Krain, 2016). These findings suggest that CBL is a vehicle of engagement for instruction, and facilitates an environment whereby students can construct knowledge.

Science – Students are given a scenario to which they apply their basic science knowledge and problem-solving skills to help them solve the case. One example within the biological sciences is two brothers who have a family history of a genetic illness. They each have mutations within a particular sequence in their DNA. Students work through the case and draw conclusions about the biological impacts of these mutations using basic science. Sample cases: You are Not the Mother of Your Children ; Organic Chemisty and Your Cellphone: Organic Light-Emitting Diodes ;   A Light on Physics: F-Number and Exposure Time

Medicine – Medical or pre-health students read about a patient presenting with specific symptoms. Students decide which questions are important to ask the patient in their medical history, how long they have experienced such symptoms, etc. The case unfolds and students use clinical reasoning, propose relevant tests, develop a differential diagnoses and a plan of treatment. Sample cases: The Case of the Crying Baby: Surgical vs. Medical Management ; The Plan: Ethics and Physician Assisted Suicide ; The Haemophilus Vaccine: A Victory for Immunologic Engineering

Public Health – A case study describes a pandemic of a deadly infectious disease. Students work through the case to identify Patient Zero, the person who was the first to spread the disease, and how that individual became infected.  Sample cases: The Protective Parent ; The Elusive Tuberculosis Case: The CDC and Andrew Speaker ; Credible Voice: WHO-Beijing and the SARS Crisis

Law – A case study presents a legal dilemma for which students use problem solving to decide the best way to advise and defend a client. Students are presented information that changes during the case.  Sample cases: Mortgage Crisis Call (abstract) ; The Case of the Unpaid Interns (abstract) ; Police-Community Dialogue (abstract)

Business – Students work on a case study that presents the history of a business success or failure. They apply business principles learned in the classroom and assess why the venture was successful or not. Sample cases: SELCO-Determining a path forward ; Project Masiluleke: Texting and Testing to Fight HIV/AIDS in South Africa ; Mayo Clinic: Design Thinking in Healthcare

Humanities - Students consider a case that presents a theater facing financial and management difficulties. They apply business and theater principles learned in the classroom to the case, working together to create solutions for the theater. Sample cases: David Geffen School of Drama

Recommendations

Finding and Writing Cases

Consider utilizing or adapting open access cases - The availability of open resources and databases containing cases that instructors can download makes this approach even more accessible in the classroom. Two examples of open databases are the Case Center on Public Leadership and Harvard Kennedy School (HKS) Case Program , which focus on government, leadership and public policy case studies.

• Consider writing original cases - In the event that an instructor is unable to find open access cases relevant to their course learning objectives, they may choose to write their own. See the following resources on case writing: Cooking with Betty Crocker: A Recipe for Case Writing ; The Way of Flesch: The Art of Writing Readable Cases ;   Twixt Fact and Fiction: A Case Writer’s Dilemma ; And All That Jazz: An Essay Extolling the Virtues of Writing Case Teaching Notes .

Implementing Cases

Take baby steps if new to CBL - While entire courses and curricula may involve case-based learning, instructors who desire to implement on a smaller-scale can integrate a single case into their class, and increase the number of cases utilized over time as desired.

Use cases in classes that are small, medium or large - Cases can be scaled to any course size. In large classes with stadium seating, students can work with peers nearby, while in small classes with more flexible seating arrangements, teams can move their chairs closer together. CBL can introduce more noise (and energy) in the classroom to which an instructor often quickly becomes accustomed. Further, students can be asked to work on cases outside of class, and wrap up discussion during the next class meeting.

Encourage collaborative work - Cases present an opportunity for students to work together to solve cases which the historical literature supports as beneficial to student learning (Bruffee, 1993). Allow students to work in groups to answer case questions.

Form diverse teams as feasible - When students work within diverse teams they can be exposed to a variety of perspectives that can help them solve the case. Depending on the context of the course, priorities, and the background information gathered about the students enrolled in the class, instructors may choose to organize student groups to allow for diversity in factors such as current course grades, gender, race/ethnicity, personality, among other items.  

Use stable teams as appropriate - If CBL is a large component of the course, a research-supported practice is to keep teams together long enough to go through the stages of group development: forming, storming, norming, performing and adjourning (Tuckman, 1965).

Walk around to guide groups - In CBL instructors serve as facilitators of student learning. Walking around allows the instructor to monitor student progress as well as identify and support any groups that may be struggling. Teaching assistants can also play a valuable role in supporting groups.

Interrupt strategically - Only every so often, for conversation in large group discussion of the case, especially when students appear confused on key concepts. An effective practice to help students meet case learning goals is to guide them as a whole group when the class is ready. This may include selecting a few student groups to present answers to discussion questions to the entire class, asking the class a question relevant to the case using polling software, and/or performing a mini-lesson on an area that appears to be confusing among students.  

Assess student learning in multiple ways - Students can be assessed informally by asking groups to report back answers to various case questions. This practice also helps students stay on task, and keeps them accountable. Cases can also be included on exams using related scenarios where students are asked to apply their knowledge.

Barrows HS. (1996). Problem-based learning in medicine and beyond: a brief overview. New Directions for Teaching and Learning, 68, 3-12.  

Bonney KM. (2015). Case Study Teaching Method Improves Student Performance and Perceptions of Learning Gains. Journal of Microbiology and Biology Education, 16(1): 21-28.

Breslin M, Buchanan, R. (2008) On the Case Study Method of Research and Teaching in Design.  Design Issues, 24(1), 36-40.

Bruffee KS. (1993). Collaborative learning: Higher education, interdependence, and authority of knowledge. Johns Hopkins University Press, Baltimore, MD.

Herreid CF. (2013). Start with a Story: The Case Study Method of Teaching College Science, edited by Clyde Freeman Herreid. Originally published in 2006 by the National Science Teachers Association (NSTA); reprinted by the National Center for Case Study Teaching in Science (NCCSTS) in 2013.

Herreid CH. (1994). Case studies in science: A novel method of science education. Journal of Research in Science Teaching, 23(4), 221–229.

Jonassen DH and Hernandez-Serrano J. (2002). Case-based reasoning and instructional design: Using stories to support problem solving. Educational Technology, Research and Development, 50(2), 65-77.  

Kosfeld M, Heinrichs M, Zak PJ, Fischbacher U, Fehr E. (2005). Oxytocin increases trust in humans. Nature, 435, 673-676.

Krain M. (2016) Putting the learning in case learning? The effects of case-based approaches on student knowledge, attitudes, and engagement. Journal on Excellence in College Teaching, 27(2), 131-153.

Lee V. (2012). What is Inquiry-Guided Learning?  New Directions for Learning, 129:5-14.

Nkhoma M, Sriratanaviriyakul N. (2017). Using case method to enrich students’ learning outcomes. Active Learning in Higher Education, 18(1):37-50.

Srinivasan et al. (2007). Comparing problem-based learning with case-based learning: Effects of a major curricular shift at two institutions. Academic Medicine, 82(1): 74-82.

Thistlethwaite JE et al. (2012). The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23.  Medical Teacher, 34, e421-e444.

Tuckman B. (1965). Development sequence in small groups. Psychological Bulletin, 63(6), 384-99.

Williams B. (2005). Case-based learning - a review of the literature: is there scope for this educational paradigm in prehospital education? Emerg Med, 22, 577-581.

Zak, PJ (2013). How Stories Change the Brain. Retrieved from: https://greatergood.berkeley.edu/article/item/how_stories_change_brain

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Case Study Compilation

The SEL Integration Approach  Case Study Compilation  was developed with and for educators who work in a K-12 school setting, including teachers, paraprofessionals, counselors, SEL Directors, teacher leaders, & school principals, to provide examples of practice related to three questions:

• What does it mean to focus on social-emotional development and the creation of positive learning environments?
• How can educators integrate their approaches to social, emotional, and academic development?
• What does it look, sound, and feel like when SEL is effectively embedded into all elements of the school day?

When read one at a time, the case studies offer snapshots of social-emotional learning in action; they describe daily routines, activities, and teachable moments within short vignettes. When read together, the case studies provide a unique picture of what it takes for a school to integrate social, emotional, and academic learning across grade levels, content areas, and other unique contexts.

The Case Study Compilation includes:

• Eleven case studies:  Each case study highlights educator ‘moves’ and strategies to embed social-emotional skills, mindsets, and competencies throughout the school day and within academics. They each  conclude with a reflection prompt that challenges readers to examine their own practice. The case studies are written from several different perspectives, including teachers in the classroom and in distance learning environments, a school counselor, and district leaders.
• Reflection Guide for Professional Learning:  The Reflection Guide offers an entry point for educators to think critically about their work with youth in order to strengthen their practice. School leaders or other partners may choose to use this Reflection Guide in a variety of contexts, including coaching conversations and staff professional development sessions.

View our accompanying Quick Reference Guide , Companion Guides , and Educator & School Leader Self-Reflection Tools .

“We must resist thinking in siloed terms when it comes to social-emotional learning (SEL), academics, and equity. Rather, these elements of our work as educators and partners go hand in hand.”

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Case Studies

Case studies can be used to help students understand simple and complex issues. They typically are presented to the students as a situation or scenario which is guided by questions such as “What would you do in this situation?” or “How would you solve this problem?” Successful case studies focus on problem situations relevant to course content and which are relevant “both to the interests and experience level of learners” (Illinois Online Network, 2007).

Case studies can be simple problems where students “work out” a solution to more complex scenarios which require role playing and elaborate planning. Case studies typically involve teams although cases can be undertaken individually. Because case studies often are proposed to not have “one right answer” (Kowalski, Weaver, Henson, 1998, p. 4), some students may be challenged to think alternatively than their peers. However, when properly planned, case studies can effectively engage students in problem solving and deriving creative solutions.

The Penn State University’s Teaching and Learning with Technology unit suggests the following elements when planning case studies for use in the classroom.

Case studies actively involve students as they work on issues found in “real-life” situations and, with careful planning, can be used in all academic disciplines.

• Real-World Scenario. Cases are generally based on real world situations, although some facts may be changed to simplify the scenario or “protect the innocent.”
• Supporting Data and Documents. Effective case assignments typically provide real world situations for student to analyze. These can be simple data tables, links to URLs, quoted statements or testimony, supporting documents, images, video, audio, or any appropriate material.
• Open-Ended Problem. Most case assignments require students to answer an open-ended question or develop a solution to an open-ended problem with multiple potential solutions. Requirements can range from a one-paragraph answer to a fully developed team action plan, proposal or decision. (Penn State University, 2006, para. 2).

Most case assignments require students to answer an open-ended question or develop a solution to an open-ended problem with multiple potential solutions.

Instructor Tasks

To help you get started using case studies in the classroom, a number of tasks should be considered. Following this list are tasks to help you prepare students as they participate in the case study.

• Identify a topic that is based on real-world situations
• Develop the case that will challenge students’ current knowledge of the topic
• Link the case to one (or more) of the course goals or objectives
• Provide students with case study basic information before asking them to work on the case
• Prepare necessary data, information, that will help students come up with a solution
• Discuss how this case would relate to real life and career situations
• Place students in teams in which participants have differing views and opinions to better challenge them in discussing possible solutions to the case
• Review team dynamics with the students (prepare an outline of team rules and roles)
• Inform students that they are to find a solution to the case based on their personal experiences, the knowledge gained in class, and challenge one another to solve the problem

Student Tasks

• Determine team member roles and identify a strategic plan to solve the case
• Brainstorm and prepare questions to further explore the case
• Read and critically analyze any data provided by the instructor, discuss the facts related to the case, identify and discuss the relationship of further problems within the case
• Listen to and be open to viewpoints expressed by each member of the team
• Assess, refine, and condense solutions that are presented
• Prepare findings as required by the instructor

Case studies provide students with scenarios in which they can begin to think about their understanding and solutions to problems found in real-world situations. When carefully planned, case studies will challenge students’ critical thinking and problem solving skills in a safe and open learning environment. Case studies can help students analyze and find solutions to complex problems with foresight and confidence.

Illinois Online Network (2007). ION research: Case studies. https://www.ion.uillinois.edu/resources/casestudies/

Kowalski, T. J., Weaver, R. A., & Henson, K. T. (1998). Case studies of beginning teachers. New York, NY: Longman.

Penn State University (2006). Office of Teaching and Learning with Technology. Using cases in teaching. http://tlt.its.psu.edu/suggestions/cases/casewhat.html

Selected Resources

Study Guides and Strategies (2007). Case studies. https://www.studygs.net/casestudy.htm

Suggested citation

Northern Illinois University Center for Innovative Teaching and Learning. (2012). Case studies. In Instructional guide for university faculty and teaching assistants. Retrieved from https://www.niu.edu/citl/resources/guides/instructional-guide

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Enrich your students’ educational experience with case-based teaching

The NCCSTS Case Collection, created and curated by the National Center for Case Study Teaching in Science, on behalf of the University at Buffalo, contains over a thousand peer-reviewed case studies on a variety of topics in all areas of science.

Cases (only) are freely accessible; subscription is required for access to teaching notes and answer keys.

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Case Studies: Bringing Learning to Life and Making Knowledge Stick

Learning by doing is a highly effective and proven strategy for knowledge retention. But sometimes, learning about others who have “done”—using case studies, for example—can be an excellent addition to or replacement for hands-on learning. Case studies―a vital tool in the problem-based learning toolkit—can turbocharge lessons in any subject, but they are particularly useful teaching aids in subjects like Medicine, Law or Forensic Science , where hands-on experiences may not initially be possible.

Here’s a look at how this type of problem-based learning functions to make learning stick and how any faculty member can use them to facilitate deeper, richer learning experiences:

Case studies complement theoretical information 

Reading about scientific principles in a textbook challenges students to think deductively and use their imagination to apply what they’re learning to real-world scenarios. It’s an important skill set. Not all information can or should be packaged up and handed to students, pre-formed; we want students to become critical thinkers and smart decision-makers who are capable of forming their own insights and opinions. 

However, the strategic use of case studies, as a companion to required reading, can help students see theoretical information in a new light, and often for the first time. In short, a case study can bring to life what is often dry and difficult material, transforming it into something powerful, and inspiring students to keep learning. Furthermore, the ability to select or create case studies can give students greater agency in their learning experiences, helping them steer their educational experiences towards topics they find interesting and meaningful. 

What does the research show about using case studies in educational settings? For one, when used in group settings, the use of case studies is proven to promote collaboration while promoting the application of theory. Furthermore, case studies are proven to promote the consideration of diverse cultures, perspectives, and ideas. Beyond that? They help students to broaden their professional acumen —a vitally necessary part of the higher education experience. 

Case studies can be what you want them to be, but they should follow a formula  

Faculty may choose to use case studies in any number of ways, including asking students to read existing case studies, or even challenging them to build their own case studies based on real or hypothetical situations. This can be done individually or in a group. It may be done in the classroom, at home, or in a professional setting. Case studies can take on a wide variety of formats. They may be just a few paragraphs or 30 pages long. They may be prescriptive and challenge readers to create a takeaway or propose a different way of doing things. Or, they may simply ask readers to understand how things were done in a specific case. Beyond written case studies, videos or slide decks can be equally compelling formats. One faculty member even asks students to get theatrical and act out a solution in their sociology class.  

Regardless of format, a case study works best when it roughly follows an arc of problem, solution and results. All case studies must present a problem that doesn’t have an immediately clear solution or result. For example, a medical student may read a case study detailing the hospital admission of a 42-year-old woman who presents to the emergency room with persistent and severe calf pain, but has normal blood tests and ultrasound imaging. What should the physician consider next? A law student might read a case study about an elderly man involved in a car accident who denies any memory of the event. What legal angles should be considered?

Case studies – get started

Are you eager to use case studies with your students? Cengage higher education titles typically contain case studies and real-world examples that bring learning to life and help knowledge stick. Below are some learning materials, spanning a range of subjects, that can help your students reap the proven benefits of case study learning:

Accounting, 29e

Award-winning authors Carl Warren, Jefferson P. Jones and William B. Tayler offer students the opportunity to analyze real-world business decisions and show how accounting is used by real companies.

Guide to Computer Forensics and Investigations, 7e

“Guide to Computer Forensics and Investigations” by Bill Nelson, Amelia Phillips, Christopher Steuart and Robert S. Wilson includes case projects aimed at providing practical implementation experience, as well as practice in applying critical thinking skills.

Business Ethics: Case Studies and Selected Readings, 10e

Marianne M. Jennings’ best-selling “Business Ethics: Case Studies and Selected Readings, 10e” explores a proven process for analyzing ethical dilemmas and creating stronger values.

Anatomy & Physiology, 1e

Author Dr. Liz Co includes a chapter composed entirely of case studies to give students additional practice in critical thinking. The cases can be assigned at the end of the semester or at intervals as the instructor chooses.

Psychopathology and Life: A Dimensional Approach, 11e

Christopher Kearney offers a concise, contemporary and science-based view of psychopathology that emphasizes the individual first. Geared toward cases to which most college students can relate, helping them understand that symptoms of psychological problems occur in many people in different ways.

Understanding Psychological Disorders Enhanced, 12e

In “Understanding Psychological Disorders Enhanced” by David Sue, Derald Sue, Diane M. Sue and Stanley Sue, students can explore current events, real-world case studies and the latest developments from the field.

Policing in the US: Past, Present, and Future, 1e

This comprehensive and timely text by Lorenzo M. Boyd, Melissa S. Morabito and Larry J. Siegel examines the current state of American policing, offering a fresh and balanced look at contemporary issues in law enforcement. Each chapter opens with a real-life case or incident.

Public Speaking: The Evolving Art, 5e

With a student-centered approach, “Public Speaking: The Evolving Art” by Stephanie J. Coopman and James Lull includes innovative solutions to current issues, including critically assessing the credibility of information sources. A diverse collection of sample student and professional presentations encourage students to consider chapter concepts in the context of real speeches.

Theory and Practice of Counseling and Psychotherapies, 11e

Dr. Gerald Corey’s best-selling text helps readers compare and contrast the therapeutic models expressed in counseling theories.

Related articles

22 Cases and Articles to Help Bring Diversity Issues into Class Discussions

Explore more.

• Course Materials
• Diversity, Equity, and Inclusion

T he recent civic unrest in the United States following the death of George Floyd has elevated the urgency to recognize and study issues of diversity and the needs of underrepresented groups in all aspects of public life.

Business schools—and educational institutions across the spectrum—are no exception. It’s vital that educators facilitate safe and productive dialogue with students about issues of inclusion and diversity. To help, we’ve gathered a collection of case studies (all with teaching notes) and articles that can encourage and support these critical discussions.

These materials are listed across three broad topic areas: leadership and inclusion, cases featuring protagonists from historically underrepresented groups, and women and leadership around the world. This list is hardly exhaustive, but we hope it provides ways to think creatively and constructively about how educators can integrate these important topics in their classes. HBP will continue to curate and share content that addresses these equity issues and that features diverse protagonists.

Editors’ note: To access the full text of these articles, cases, and accompanying teaching notes, you must be registered with HBP Education. We invite you to sign up for a free educator account here . Verification may take a day; in the meantime, you can read all of our Inspiring Minds content .

Leadership and Inclusion

John Rogers, Jr.—Ariel Investments Co.

—by Steven S. Rogers and Greg White

Gender and Free Speech at Google (A)

—by Nien-hê Hsieh, Martha J. Crawford, and Sarah Mehta

The Massport Model: Integrating Diversity and Inclusion into Public-Private Partnerships

—by Laura Winig and Robert Livingston

“Numbers Take Us Only So Far”

—by Maxine Williams

For Women and Minorities to Get Ahead, Managers Must Assign Work Fairly

—by Joan C. Williams and Marina Multhaup

How Organizations Are Failing Black Workers—and How to Do Better

—by Adia Harvey Wingfield

To Retain Employees, Focus on Inclusion—Not Just Diversity

—by Karen Brown

From HBR 's The Big Idea:

Toward a Racially Just Workplace: Diversity efforts are failing black employees. Here’s a better approach.

—by Laura Morgan Roberts and Anthony J. Mayo

Cases with Protagonists from Historically Underrepresented Groups

Arlan Hamilton and Backstage Capital

—by Laura Huang and Sarah Mehta

United Housing—Otis Gates

—by Steven Rogers and Mercer Cook

Eve Hall: The African American Investment Fund in Milwaukee

—by Steven Rogers and Alterrell Mills

Dylan Pierce at Peninsula Industries

—by Karthik Ramanna

Maggie Lena Walker and the Independent Order of St. Luke

—by Anthony J. Mayo and Shandi O. Smith

Multimedia Cases:

Enterprise Risk Management at Hydro One, Multimedia Case

—by Anette Mikes

Women and Leadership Around the World

Monique Leroux: Leading Change at Desjardins

—by Rosabeth Moss Kanter and Ai-Ling Jamila Malone

Kaweyan: Female Entrepreneurship and the Past and Future of Afghanistan

—by Geoffrey G. Jones and Gayle Tzemach Lemmon

Womenomics in Japan

—by Boris Groysberg, Mayuka Yamazaki, Nobuo Sato, and David Lane

Women MBAs at Harvard Business School: 1962-2012

—by Boris Groysberg, Kerry Herman, and Annelena Lobb

Beating the Odds

—by Laura Morgan Roberts, Anthony J. Mayo, Robin J. Ely, and David A. Thomas

Rethink What You “Know” About High-Achieving Women

—by Robin J. Ely, Pamela Stone, and Colleen Ammerman

“I Try to Spark New Ideas”

—by Christine Lagarde and Adi Ignatius

How Women Manage the Gendered Norms of Leadership

—by Wei Zheng, Ronit Kark, and Alyson Meister

Is this list helpful to you? What other topics or materials would you like to see featured in our next curated list? Let us know .

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• Departments and Institutes
• Research centres and groups
• Chair's Blog: Summer Term 2022
• Staff wellbeing

Case Studies on Education at LSE

Here you can explore examples of excellent teaching and learning practice across the School.

If you would like to contribute a case study, please send us this completed form .

For various snapshots and good practice examples on current online teaching at LSE, visit our regularly updated gallery page here .

US Centre - Online Career Masterclasses: preparing students for life after graduation  

US Centre’s Master´s to PhD and Graduate to Professional online masterclasses are designed to support LSE master's students in planning and starting their careers. During the interactive online sessions, students get the exclusive opportunity to learn from LSE PhD Students who are conducting research on US-focused topics or to gain career advice from successful LSE Alumni based in the US. 

19 February 2021

Government - Simulating the production of Social Research for Policy Advice

A new learning activity on GV4F4 (Policy Advice in Theory and Practice) - a simulation of a social research organisation preparing a bid for a local transport policy tender. The activity adds a practical component to GV4F4, a module that introduces MSc students to theory of evidence-based policy making, the science-policy nexus, and policy advice and evaluation tools. 

13 August 2020

Geography and Environment - Political Ecology Field Guide Assessment

Students in GY328 Political Ecology of Development created “Political Ecology Field Guides”, which allowed them to apply the analytical tools developed throughout the course to create an original research product. 

3 August 2020

Health Policy - Vaca Virus simulation on HP412 Global Health Security

This was a one-day simulation activity on the course HP412 ( Global Health Security ), which recreated the governance decisions of an outbreak of ‘Vaca Virus’ in the country of ‘Esperanza’. The activity unfolded over the course of the day with new information, such as the development of vaccines, civil unrest and community resistance, which each actor had to react to in real time. 

10 June 2020

LSE Faith Centre - Faith and Climate Action Leadership Programme

In 2019 the LSE Faith Centre launched a new leadership programme: ‘Faith and Climate Action’. The team looked at how religious perspectives and faith communities are contributing to climate action, both in terms of the theological inspiration they bring to the conversation and the social capital they can harness to affect change amongst the 80% of the global population who hold a faith. 

7 April 2020

Law - Self-assessment cover sheet for formative work

Encouraging students on LL104 - Law Of Obligations to think for themselves about how marking criteria apply to their work, and to stimulate more active engagement with the formative feedback process.

4 February 2020

Methodology - Developing post-graduate research skills

Combining a blog-post, a project outline and peer-feedback in the formative assignment has equipped students with key graduate attributes focusing on communication, structure, coherence, and self-assessment, as well as creates a feeling of community in Methodology's post-graduate courses.

6 December 2019

Anthropology - Developing undergraduate assessment

The Department of Anthropology recently streamlined the assessment on its undergraduate programme(s). The overall amount of summative assessment has been reduced, and the bottleneck of coursework essays during vacations removed. This streamlining has introduced diversity of assessment formats, but aimed to reduce student stress and build familiarity with the formats by mirroring assessment formats across the years. 

19 November 2019

LSE Library - Feedback activities

The Library team set up a feedback board to ask students how they felt they could support them during exam season. They also set up creative feedback activities, inviting students to create ‘eggmojis’ to express how they felt about using the Library and to create and display poems about the Library with magnetic poetry.

18 November 2019

Economics - The First Year Challenge - creating greater sense of community

The First Year Challenge is an innovative way of creating greater sense of community among first year students and introducing them to the field of economics and LSE heritage. Small groups of students explore London together and, given sets of clues, produce a short video at the end of the project with a prize for the best video.

4 July 2019

European Institute - The diversity of Muslim communities in London

Esra Ozyurek enabled her students to discover the diversity of Muslim communities in London in her Religious Diversity and Conflict in Europe course ( EU475 ).

31 May 2019

Language Centre - En un Lugar en Londres

En un lugar de Loñdres (In a certain place in London) is a research-based project which aims at developing language learning and increasing sociolinguistic awareness through the observation and contextualization of London’s Spanish linguistic landscapes on-land and online. Learners are encouraged to wander the city and to engage with the people behind those linguistic landscapes.

This is an update to an initial case study posted in September 2017.

2 April 2019

Language Centre - Interviewing London's French speakers

Students must find and interview a French speaker in London, then write up the interview and create a piece of ‘digital storytelling’ from it. The activity develops multiple student skills: interviewing, writing an article (similar to a magazine or newspaper), and editing video and/or audio with a student voiceover and other visual/audio elements – a deliberately creative assessment.

18 March 2019

Methodology - GitHub

We introduced the free online repository and version control service GitHub to share course materials, submit summative assessment, and provide feedback for most of the computational methods courses at the Department of Methodology. This innovation enables learning-by-doing and facilitates collaboration.

5 March 2019

Statistics - Research Internships

During 2017 and 2018 I carried out two research projects in collaboration with two 3 rd year undergraduate students. Both projects were aimed at supervising and developing an undergraduate student’s interest in research. 

19 February 2019

Mathematics - Exam feedback through script viewing

We gave undergraduate students examination feedback by allowing them to view their marked unseen written examination scripts, with full solutions available in advance and with the examiners present at the sessions.

Statistics - MSc Data Science capstone project

We introduced a capstone project module in our MSc in Data Science programme, which enables our students to apply the knowledge gained in our programme to real-world data science projects, by working in collaboration with capstone project partners. 

Mathematics - Oral Examination

We implemented a high-stake oral examination.  100% of the final grade for two year 3 financial mathematics modules was determined by oral assessment.

18 February 2019

Statistics - Industry Practitioners Challenge

We organise the LSE Statistics Practitioners’ Challenge for BSc and MSc students. During this event, we collaborate with leading industry partners to initiate competitive projects focusing on real issues faced by companies. Students, who take on the challenge, use their personal and professional skills developed through their program at LSE. 

Mathematics - Professional and Personal Development Seminars

This case study is about the PPD Seminar Series which the Department of Mathematics runs for its first-year students.

Statistics - Diversifying assessment and transferable skills

Combining diversified assessment with development of communication and other transferable skills through a market research "pitch".

Language Centre - Mandarin video chatshow

In this teaching and assessment activity, students work in pairs to create a filmed interview in the style of a TV chat-show. This requires them to research, listen, speak and present ideas and arguments in Mandarin Chinese, based on current affairs subjects of their choosing. Over the five years of the project, students have stated that the activity improves both their language abilities and their transferrable skills.

14 February 2019

Social Policy - Research Diary

The Department of Social Policy, along with guidance from TLC, has developed a research diary for our second year research methods students. The diary includes: guided questions related to the research project each week; a detailed timeline for project completion; and space to write down questions as they arise.

13 February 2019

LSE LIFE - Quant4Qual

Quant4Qual brings together students from across departments in a space that has a (1) facilitatory teaching style (2) peer-to-peer learning (3) grounded-learning in case-study analysis. The aim of the project is to establish an entry point for students to gain confidence working with empirical research methods in the social science.

12 February 2019  

US Centre - Research Assistantships: inviting students into the scholarly community

The US Centre’s Undergraduate Research Assistantship is an opportunity for students to involve themselves in internationally-oriented scholarship on America’s changing role in the world. Collaborating over the course of a year, students are paired with academics who require assistance in processing new data, gathering archival resources, writing-up a blog article, or conducting library searches.

8 February 2019

There are two former types of teaching case studies at the LSE. They are:

LSE Learning technology case studies  and

Lse academic development case studies (below) , teaching and learning case studies 2017-18.

Employing case studies on Master's courses in LSE Finance

Prof. Daniel Ferreira discusses the long-term use of the case study method in the Department of Finance, and its more recent introduction to undergraduate teaching.

9 November 2018

Researching London

Dr Ioanna Gouseti illustrates how vital experiential learning and research in London is to her 2nd year BSc students on 'Researching London: Methods for Social Research (SO211).

15 March 2018

The MPA Online Pre-Arrival Course

Dr Babken Babajanian explains the aid to student integration provided by the IPA since 2016 by its online pre-arrival course for the Masters of Public Administration  .

14 December 2017

Gender Studies student research conference

Dr Jacob Breslow and his students describe why their conference was a challenging yet rewarding learning and assessment experience.

19 October 2017

Developing real-world experience

Dr James Abdey explains the benefits to students of 'real-world' learning on ST327 Market Research: An Integrated Approach.

22 September 2017

Building a research community: involving academics, PhD students and MSc students in Conflict Research Group seminars

Dr Denisa Kostovicova details the CRG lunchtime research seminars, organised during term times since 2011.

19 September 2017

Video production for  En un lugar de Loñdres

Lourdes Hernández-Martín, project designer and course coordinator, LN122, explains her students' project to research the lives and language of 300,000+ members of London’s Spanish-speaking communities.

4 September 2017

Designing and presenting posters

Dr Jennifer Jackson-Preece details the use of student research and poster creation in her course on Ethnic Diversity and International Society (EU457) in this case study.

10 August 2017

Accounting case-based groupwork

Dr Tommaso Palermo used a case-based approach to groupwork with his second year undergraduate class. 

14 July 2017

Graduate Teaching Assistant Away Day 

Alex Marcoci and Diana Popescu discuss how they organised a shared Away Day for graduate teaching assistants for the Departments of Philosophy, Logic & Scientific Method and Government.

26 June 2017

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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.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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Student Case Study

Delving into student case studies offers invaluable insights into educational methodologies and student behaviors. This guide, complete with detailed case study examples , is designed to help educators, researchers, and students understand the nuances of creating and analyzing case studies in an educational context. By exploring various case study examples, you will gain the tools and knowledge necessary to effectively interpret and apply these studies, enhancing both teaching and learning experiences in diverse academic settings.

What is a Student Case Study? – Meaning A student case study is an in-depth analysis of a student or a group of students to understand various educational, psychological, or social aspects. It involves collecting detailed information through observations, interviews, and reviewing records, to form a comprehensive picture. The goal of a case study analysis is to unravel the complexities of real-life situations that students encounter, making it a valuable tool in educational research. In a case study summary, key findings are presented, often leading to actionable insights. Educators and researchers use these studies to develop strategies for improving learning environments. Additionally, a case study essay allows students to demonstrate their understanding by discussing the analysis and implications of the case study, fostering critical thinking and analytical skills.

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Schools especially those that offers degree in medicine, law, public policy and public health teaches students to learn how to conduct a case study. Some students say they love case studies . For what reason? Case studies offer real world challenges. They help in preparing the students how to deal with their future careers. They are considered to be the vehicle for theories and concepts that enables you to be good at giving detailed discussions and even debates. Case studies are useful not just in the field of education, but also in adhering to the arising issues in business, politics and other organizations.

Student Case Study Format

Case Study Title : Clear and descriptive title reflecting the focus of the case study. Student’s Name : Name of the student the case study is about. Prepared by : Name of the person or group preparing the case study. School Name : Name of the school or educational institution. Date : Date of completion or submission.

Introduction

Background Information : Briefly describe the student’s background, including age, grade level, and relevant personal or academic history. Purpose of the Case Study : State the reason for conducting this case study, such as understanding a particular behavior, learning difficulty, or achievement.

Case Description

Situation or Challenge : Detail the specific situation, challenge, or condition that the student is facing. Observations and Evidence : Include observations from teachers, parents, or the students themselves, along with any relevant academic or behavioral records.

Problem Analysis : Analyze the situation or challenge, identifying potential causes or contributing factors. Impact on Learning : Discuss how the situation affects the student’s learning or behavior in school.

Intervention Strategies

Action Taken : Describe any interventions or strategies implemented to address the situation. This could include educational plans, counseling, or specific teaching strategies. Results of Intervention : Detail the outcome of these interventions, including any changes in the student’s behavior or academic performance.

Conclusion and Recommendations

Summary of Findings : Summarize the key insights gained from the case study. Recommendations : Offer suggestions for future actions or strategies to further support the student. This might include recommendations for teachers, parents, or the student themselves.

Best Example of Student Case Study

Overcoming Reading Challenges: A Case Study of Emily Clark, Grade 3 Prepared by: Laura Simmons, Special Education Teacher Sunset Elementary School Date: May 12, 2024   Emily Clark, an 8-year-old student in the third grade at Sunset Elementary School, has been facing significant challenges with reading and comprehension since the first grade. Known for her enthusiasm and creativity, Emily’s struggles with reading tasks have been persistent and noticeable. The primary purpose of this case study is to analyze Emily’s reading difficulties, implement targeted interventions, and assess their effectiveness.   Emily exhibits difficulty in decoding words, reading fluently, and understanding text, as observed by her teachers since first grade. Her reluctance to read aloud and frustration with reading tasks have been consistently noted. Assessments indicate that her reading level is significantly below the expected standard for her grade. Parental feedback has also highlighted Emily’s struggles with reading-related homework.   Analysis of Emily’s situation suggests a potential learning disability in reading, possibly dyslexia. This is evidenced by her consistent difficulty with word recognition and comprehension. These challenges have impacted not only her reading skills but also her confidence and participation in class activities, especially those involving reading.   To address these challenges, an individualized education plan (IEP) was developed. This included specialized reading instruction focusing on phonemic awareness and decoding skills, multisensory learning approaches, and regular sessions with a reading specialist. Over a period of six months, Emily demonstrated significant improvements. She engaged more confidently in reading activities, and her reading assessment scores showed notable progress.   In conclusion, the intervention strategies implemented for Emily have been effective. Her case highlights the importance of early identification and the implementation of tailored educational strategies for students with similar challenges. It is recommended that Emily continues to receive specialized instruction and regular monitoring. Adjustments to her IEP should be made as necessary to ensure ongoing progress. Additionally, fostering a positive reading environment at home is also recommended.

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Case Study Definition

A case study is defined as a research methodology that allows you to conduct an intensive study about a particular person, group of people, community, or some unit in which the researcher could provide an in-depth data in relation to the variables. Case studies can examine a phenomena in the natural setting. This increases your ability to understand why the subjects act such. You may be able to describe how this method allows every researcher to take a specific topic to narrow it down making it into a manageable research question. The researcher gain an in-depth understanding about the subject matter through collecting qualitative research and quantitative research datasets about the phenomenon.

Benefits and Limitations of Case Studies

If a researcher is interested to study about a phenomenon, he or she will be assigned to a single-case study that will allow him or her to gain an understanding about the phenomenon. Multiple-case study would allow a researcher to understand the case as a group through comparing them based on the embedded similarities and differences. However, the volume of data in case studies will be difficult to organize and the process of analysis and strategies needs to be carefully decided upon. Reporting of findings could also be challenging at times especially when you are ought to follow for word limits.

Example of Case Study

Nurses’ pediatric pain management practices.

One of the authors of this paper (AT) has used a case study approach to explore nurses’ pediatric pain management practices. This involved collecting several datasets:

Observational data to gain a picture about actual pain management practices.

Questionnaire data about nurses’ knowledge about pediatric pain management practices and how well they felt they managed pain in children.

Questionnaire data about how critical nurses perceived pain management tasks to be.

These datasets were analyzed separately and then compared and demonstrated that nurses’ level of theoretical did not impact on the quality of their pain management practices. Nor did individual nurse’s perceptions of how critical a task was effect the likelihood of them carrying out this task in practice. There was also a difference in self-reported and observed practices; actual (observed) practices did not confirm to best practice guidelines, whereas self-reported practices tended to.

How do you Write a Case Study for Students?

1. choose an interesting and relevant topic:.

Select a topic that is relevant to your course and interesting to your audience. It should be specific and focused, allowing for in-depth analysis.

2. Conduct Thorough Research :

Gather information from reputable sources such as books, scholarly articles, interviews, and reliable websites. Ensure you have a good understanding of the topic before proceeding.

3. Identify the Problem or Research Question:

Clearly define the problem or research question your case study aims to address. Be specific about the issues you want to explore and analyze.

4. Introduce the Case:

Provide background information about the subject, including relevant historical, social, or organizational context. Explain why the case is important and what makes it unique.

5. Describe the Methods Used:

Explain the methods you used to collect data. This could include interviews, surveys, observations, or analysis of existing documents. Justify your choice of methods.

6. Present the Findings:

Present the data and findings in a clear and organized manner. Use charts, graphs, and tables if applicable. Include direct quotes from interviews or other sources to support your points.

7. Analytical Interpretation:

Analyze the data and discuss the patterns, trends, or relationships you observed. Relate your findings back to the research question. Use relevant theories or concepts to support your analysis.

8. Discuss Limitations:

Acknowledge any limitations in your study, such as constraints in data collection or research methods. Addressing limitations shows a critical awareness of your study’s scope.

9. Propose Solutions or Recommendations:

If your case study revolves around a problem, propose practical solutions or recommendations based on your analysis. Support your suggestions with evidence from your findings.

10. Write a Conclusion:

Summarize the key points of your case study. Restate the importance of the topic and your findings. Discuss the implications of your study for the broader field.

What are the objectives of a Student Case Study?

1. learning and understanding:.

• To deepen students’ understanding of a particular concept, theory, or topic within their field of study.
• To provide real-world context and practical applications for theoretical knowledge.

2. Problem-Solving Skills:

• To enhance students’ critical thinking and problem-solving abilities by analyzing complex issues or scenarios.
• To encourage students to apply their knowledge to real-life situations and develop solutions.

3. Research and Analysis:

• To develop research skills, including data collection, data analysis , and the ability to draw meaningful conclusions from information.
• To improve analytical skills in interpreting data and making evidence-based decisions.

4. Communication Skills:

• To improve written and oral communication skills by requiring students to present their findings in a clear, organized, and coherent manner.
• To enhance the ability to communicate complex ideas effectively to both academic and non-academic audiences.

5. Ethical Considerations:

To promote awareness of ethical issues related to research and decision-making, such as participant rights, privacy, and responsible conduct.

6. Interdisciplinary Learning:

To encourage cross-disciplinary or interdisciplinary thinking, allowing students to apply knowledge from multiple areas to address a problem or issue.

7. Professional Development:

• To prepare students for future careers by exposing them to real-world situations and challenges they may encounter in their chosen profession.
• To develop professional skills, such as teamwork, time management, and project management.

8. Reflection and Self-Assessment:

• To prompt students to reflect on their learning and evaluate their strengths and weaknesses in research and analysis.
• To foster self-assessment and a commitment to ongoing improvement.

9. Promoting Innovation:

• To inspire creativity and innovation in finding solutions to complex problems or challenges.
• To encourage students to think outside the box and explore new approaches.

10. Building a Portfolio:

To provide students with tangible evidence of their academic and problem-solving abilities that can be included in their academic or professional portfolios.

What are the Elements of a Case Study?

A case study typically includes an introduction, background information, presentation of the main issue or problem, analysis, solutions or interventions, and a conclusion. It often incorporates supporting data and references.

How Long is a Case Study?

The length of a case study can vary, but it generally ranges from 500 to 1500 words. This length allows for a detailed examination of the subject while maintaining conciseness and focus.

How Big Should a Case Study Be?

The size of a case study should be sufficient to comprehensively cover the topic, typically around 2 to 5 pages. This size allows for depth in analysis while remaining concise and readable.

What Makes a Good Case Study?

A good case study is clear, concise, and well-structured, focusing on a relevant and interesting issue. It should offer insightful analysis, practical solutions, and demonstrate real-world applications or implications.

Case studies bring people into the real world to allow themselves engage in different fields such as in business examples, politics, health related aspect where each individuals could find an avenue to make difficult decisions. It serves to provide framework for analysis and evaluation of the different societal issues. This is one of the best way to focus on what really matters, to discuss about issues and to know what can we do about it.

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Top 40 Most Popular Case Studies of 2021

Two cases about Hertz claimed top spots in 2021's Top 40 Most Popular Case Studies

Two cases on the uses of debt and equity at Hertz claimed top spots in the CRDT’s (Case Research and Development Team) 2021 top 40 review of cases.

Hertz (A) took the top spot. The case details the financial structure of the rental car company through the end of 2019. Hertz (B), which ranked third in CRDT’s list, describes the company’s struggles during the early part of the COVID pandemic and its eventual need to enter Chapter 11 bankruptcy. 

The success of the Hertz cases was unprecedented for the top 40 list. Usually, cases take a number of years to gain popularity, but the Hertz cases claimed top spots in their first year of release. Hertz (A) also became the first ‘cooked’ case to top the annual review, as all of the other winners had been web-based ‘raw’ cases.

Besides introducing students to the complicated financing required to maintain an enormous fleet of cars, the Hertz cases also expanded the diversity of case protagonists. Kathyrn Marinello was the CEO of Hertz during this period and the CFO, Jamere Jackson is black.

Sandwiched between the two Hertz cases, Coffee 2016, a perennial best seller, finished second. “Glory, Glory, Man United!” a case about an English football team’s IPO made a surprise move to number four.  Cases on search fund boards, the future of malls,  Norway’s Sovereign Wealth fund, Prodigy Finance, the Mayo Clinic, and Cadbury rounded out the top ten.

Other year-end data for 2021 showed:

• Online “raw” case usage remained steady as compared to 2020 with over 35K users from 170 countries and all 50 U.S. states interacting with 196 cases.
• Fifty four percent of raw case users came from outside the U.S..
• The Yale School of Management (SOM) case study directory pages received over 160K page views from 177 countries with approximately a third originating in India followed by the U.S. and the Philippines.
• Twenty-six of the cases in the list are raw cases.
• A third of the cases feature a woman protagonist.
• Orders for Yale SOM case studies increased by almost 50% compared to 2020.
• The top 40 cases were supervised by 19 different Yale SOM faculty members, several supervising multiple cases.

CRDT compiled the Top 40 list by combining data from its case store, Google Analytics, and other measures of interest and adoption.

All of this year’s Top 40 cases are available for purchase from the Yale Management Media store .

And the Top 40 cases studies of 2021 are:

1.   Hertz Global Holdings (A): Uses of Debt and Equity

2.   Coffee 2016

3.   Hertz Global Holdings (B): Uses of Debt and Equity 2020

4.   Glory, Glory Man United!

5.   Search Fund Company Boards: How CEOs Can Build Boards to Help Them Thrive

6.   The Future of Malls: Was Decline Inevitable?

7.   Strategy for Norway's Pension Fund Global

8.   Prodigy Finance

9.   Design at Mayo

10. Cadbury

11. City Hospital Emergency Room

13. Volkswagen

14. Marina Bay Sands

15. Shake Shack IPO

16. Mastercard

17. Netflix

18. Ant Financial

19. AXA: Creating the New CR Metrics

20. IBM Corporate Service Corps

21. Business Leadership in South Africa's 1994 Reforms

22. Alternative Meat Industry

23. Children's Premier

24. Khalil Tawil and Umi (A)

25. Palm Oil 2016

26. Teach For All: Designing a Global Network

27. What's Next? Search Fund Entrepreneurs Reflect on Life After Exit

28. Searching for a Search Fund Structure: A Student Takes a Tour of Various Options

30. Project Sammaan

31. Commonfund ESG

32. Polaroid

33. Connecticut Green Bank 2018: After the Raid

34. FieldFresh Foods

35. The Alibaba Group

36. 360 State Street: Real Options

37. Herman Miller

38. AgBiome

39. Nathan Cummings Foundation

40. Toyota 2010

This article is free to read if you register or sign in.

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Questions or problems? Email [email protected] or call 0711 046 000 .

Case study on schools needed as learning resumes – Knut

Knut secretary general collins oyuu said some schools were damaged by floods..

Knut secretary general Colins Oyuu said schools are not the same as some are in worse and pathetic condition after being ravaged by floods.

He said matters of hygene are also a concern as latrines in most schools sank following heavy flooding.

The Kenya National Union of Teachers wants a case study on schools conducted even as schools reopen for Second Term.

"A case-to-case study of these schools must be put into consideration. Like here for example, the learners cannot come here to this school," he said at Nyamasao Primary School in Kisumu county.

While supporting the directive to reopen schools, Oyuu added that the Ministry of Education and by extension, the government should see to it that proper consideration is done on the case-to-case analysis of the schools.

He further noted that the government should draw funds from the Ministry of Education Infrastructure fund to rebuild the affected schools.

The SG noted that it's not only the National Government Constituency Development Funds (NG-CDF) that can come to the rescue of the particular schools.

"We must also get into the Ministry of Education Infrastructure Funding," he said.

"If we have donors to come in, then the government should open its arms very wide to allow proper assistance," he added.

Oyuu was in Nyando subcounty in Kisumu county to asses the situation of schools impacted by floods.

He noted that some of the schools acted as rescue camps hosting families affected by floods across the area and this was a matter that needed to be looked into critically.

"As we are here, the school next to this one is an IDP camp. What will happen to the community in that camp? Over 380 families are in the school compound where will they go?" Oyuu questioned and added that people's safety must also be looked into as they leave the schools in readiness for reopening for Second Term.

Oyuu also noted that matters of hygene are also a concern even as learners go back and must be looked at too.

He said latrines in most schools sank following heavy flooding.

"I have gone to four schools that the latrines have literally sank, the grounds are totally wet, what does that mean? Hygene is compromised so we have so many issues to look into but all in all, we support that learning must resume," he said.

The secretary general also disclosed that they did a crossection analysis across their 110 branches and found that 90 per cent of schools are in good shape for resumption of studies.

"We support opening of schools but with measures to be put in place properly to safeguard the health of the community living around and the learners and also to bring us back to resume syllabus coverage as required."

Oyuu took the opportunity to call for reconsideration of proper funding in good time as schools prepare to reopen on Monday.

He noted that as a union, they had raised issues on capitation to schools and this is when it should come in handy.

"Term Two is going to start, but do we have funding? I think the CS should get back to the drawing board and make sure that Treasury is pushed as required," he said.

"Already we have calamities, infrastructure, learning materials, this should be catered for," the union boss said.

Education CS Ezekiel Machogu announced that a section of schools in seven counties among them Tana River, Homa Bay and Kisumu may not reopen on Monday. 

He said the ministry will explore other learning options such as relocation of learners to safer centres.

[PHOTOS] Destruction, vehicles submerged in Ahero as River Nyando breaks banks

[photos] flooding situation at ahero police station, chopper, speed boats evacuate flood victims in nyando, most popular, 31 busia mcas sent home as azimio takes control assembly, latest videos, we’ve moved over 181,000 people from nairobi rivers corridor – kindiki, climate change categorised as national security threat – kindiki, sign up for the free star email newsletter and receive the latest kenya news daily..

Effect of high-risk pregnancy on prenatal stress level: a prospective case-control study

• Open access
• Published: 11 May 2024

Cite this article

You have full access to this open access article

• Hülya Türkmen   ORCID: orcid.org/0000-0001-6187-9352 1 ,
• Bihter Akın   ORCID: orcid.org/0000-0002-3591-3630 2 &
• Yasemin Erkal Aksoy   ORCID: orcid.org/0000-0002-7453-1205 2  

The study aimed to determine the effects of high-risk pregnancy on prenatal stress levels. The study was conducted with a case-control design in Turkey in September-December 2019. The sample included pregnant women diagnosed with high-risk pregnancy and were at their 36th or later gestational weeks as the case group ( n  = 121) and healthy pregnant women as the control group ( n  = 245). The Antenatal Perceived Stress Inventory (APSI) and the Revised Prenatal Distress Questionnaire (NUPDQ-17 Item Version) were used to assess the stress levels of the participants in the study. It was determined that high-risk pregnancy was associated with higher rates of prenatal stress (APSI: p  < 0.001, effect size = 0.388; NUPDQ: p  = 0.002, effect size = 0.272) compared to the control group. The results of the linear regression analysis showed that high-risk pregnancy affected APSI (R 2  = 0.043, p  < 0.001) and NUPDQ (R 2  = 0.033, p  = 0.009) scores, but education levels, number of pregnancies, and number of abortions did not affect APSI and NUPDQ scores. According to the results of this study, high-risk pregnant women are in a risk group for stress. It is of great importance for the course of a pregnancy that healthcare professionals assess the stress levels of pregnant women in the high-risk pregnancy category and provide psychological support to pregnant women who have high stress levels or are hospitalized.

Avoid common mistakes on your manuscript.

Introduction

A high-risk pregnancy is a significant health problem that threatens the health of the pregnant woman, the health of her fetus, and ultimately the health of her newborn, increases the risk of morbidity and mortality, and has physiological, psychological, social, and economic aspects (Cincioğlu et al., 2020 ; Gözüyeşil & Düzgün, 2021 ; Sinaci et al., 2020 ). Chronic diseases existing before pregnancy and problems that arise during pregnancy can make a pregnancy risky. Pregnant women with gestational diabetes mellitus, preeclampsia/eclampsia, potential threat of preterm labor, cervical insufficiency, premature rupture of membranes, vaginal bleeding, Rh incompatibility, intrauterine growth retardation, and infections are in the high-risk category (Gözüyeşil & Düzgün, 2021 ; Sinaci et al., 2020 ; ACOG, 2019 ; Soğukpınar et al., 2018 ; Üzar-Özçetin & Erkan, 2019 ; ACOG, 2018 ).

Approximately 10% of all pregnancies in the world are considered to be in the high-risk category (Cincioğlu et al., 2020 ; Gourounti et al., 2015a , b ; Göüyeşil & Düzgün, 2021 ; Sinaci et al., 2020 ; Soğukpınar et al., 2018 ; Üzar-Özçetin & Erkan, 2019 ). According to Turkey Demographic and Health Survey (TNSA) 2018 data, 35% of pregnancies in Turkey are in the high-risk category (Hacettepe University Institute of Population Studies, 2019 ).

Good mental health during pregnancy is important for the health of both the pregnant woman and her fetus (Gümüşdaş et al., 2014 ). In a high-risk pregnancy, the normal outcome of the pregnancy and the birth of a healthy baby are threatened. These pregnant women have a variety of health needs that must be met. If these needs are not met, the mother may experience extreme stress and anxiety (Ölçer & Oskay, 2015 ). In the case of intense stress caused by the risks of pregnancy, the elevation of catecholamines such as cortisol and epinephrine may increase the possibility of pregnancy complications (e.g., preeclampsia) and adversely affect pregnancy outcomes (e.g., intrauterine growth retardation) (Atasever & Çelik, 2018 ; Cetin et al., 2017 ; Deshpande, 2016 ; Gözüyeşil & Düzgün, 2021 ; Riggin, 2020 ; Traylor et al., 2020 ; Yüksel et al., 2013 ). Moreover, newborns exposed to extreme stress during the intrauterine period may have permanent health problems later in their lives (Graignic-Philippe et al., 2014 ; MacKinnon et al., 2018 ; Van De Loo et al., 2016 ).

It is seen that distress in pregnancy has a high prevalence ranging between 11.9% and 63.5% in studies conducted in Turkey (Yüksel et al., 2013 ; Çapık et al., 2015 ; Gözüyeşil & Düzgün, 2021 ). It is very important that health professionals identify pregnant women at risk of stress to ensure a healthy pregnancy process and protect the fetus and newborn from the harmful effects of stress. This way, more careful monitoring of pregnant women at risk of stress can be ensured, and the negative consequences of stress can be prevented with appropriate interventions (Williamson et al., 2023 ; Atasever & Çelik, 2018 ; Pinar et al., 2022 ). It is reported in the international literature that mental problems such as anxiety and stress are more common in high-risk pregnancies than in healthy pregnancies (Byatt et al., 2014 ; Abedian et al., 2015 ; Gourounti et al., 2015a , b ). In Turkey, there are few studies examining the prenatal stress levels of high-risk pregnant women. However, in these studies, the prenatal stress levels of women with healthy and high-risk pregnancies were not compared, and only the stress levels of high-risk pregnancies were determined (Gözüyeşil & Düzgün, 2021 ; Üzar-Özçetin & Erkan, 2019 ). Current evidence indicates that studies describing the concept of prenatal stress in high-risk pregnancies with different diagnoses are needed to learn more about the complex aspects of prenatal stress and identify the sociodemographic and obstetric factors that may lead to high-risk pregnancies for early diagnosis (Pinar et al., 2022 ; Hung et al., 2021 ; Gözüyeşil & Düzgün, 2021 ; Mete et al., 2020 ; Üzar-Özçetin & Erkan, 2019 ; Atasever & Çelik, 2018 ). For this reason, it is thought that this study will guide healthcare professionals who provide care for women with high-risk pregnancies about the services they will provide.

This study aims to prospectively determine the effects of high-risk pregnancies on prenatal stress levels compared to healthy pregnant women, using two different measurement instruments.

Materials and methods

Research questions.

Does high-risk pregnancy have an impact on prenatal stress?

What are the factors affecting the prenatal distress levels of women diagnosed with high-risk pregnancy?

Is there a difference in prenatal stress levels among different high-risk pregnancy diagnoses?

Design and settings

This case-control study was conducted to determine the difference between the stress levels of women with healthy and high-risk pregnancies. In other words, it was aimed to determine the suspected causal effect of high-risk pregnancy on prenatal stress levels. This case-control study was carried out between September and December 2019 at the Obstetrics and Gynecology Inpatient and Outpatient Clinics of Atatürk City Hospital in the Balıkesir province of Turkey. The case and control groups included women who were selected from the same hospital.

The hospital where the study was conducted hosted a total of 4,152 deliveries in 2018. Approximately 10% of all pregnancies are considered to be in the high-risk category (Sinaci et al., 2020 ). The sample size required to conduct the study was calculated as 134 high-risk pregnant women using the Epi Info StatCalc program based on an assumed population size of 4152, prevalence of 10%, margin of error of 5%, and in a 95% confidence interval. The study was completed with a total of 384 pregnant women, including 134 high-risk pregnant women and 250 healthy pregnant women, who accepted to participate in the study and filled out the consent form. However, the data of 13 pregnant women in the case group and 5 pregnant women in the control group were excluded from the study because they filled out the data collection forms incompletely. For the case group ( n  = 121), the post hoc power analysis (G*Power 3.1) revealed a medium effect size and a power of 0.421.

The inclusion criteria of the study were being in a gestational week further than 36 weeks, not having a psychiatric diagnosis, and being 18 years old or order. Pregnant women who were hospitalized in the Obstetrics and Gynecology Inpatient Clinic, were diagnosed with high-risk pregnancy by a physician, and met the inclusion criteria were included in the high-risk pregnancy group. In the control group, pregnant women who were healthy, were at or above their 36th gestational week, and visited the Outpatient Clinics were included. Women who wanted to leave the study or responded incompletely to the data collection forms were excluded. After those who met the inclusion criteria were included, no pregnant women withdrew from the study by their own accord. However, 18 pregnant women were excluded from the study because they filled out the forms incompletely.

High-risk pregnancies were defined as the presence of one or more of the following: pre-existing chronic diseases, preeclampsia, gestational diabetes mellitus (GDM), vaginal bleeding, placenta previa, threat of preterm labor, premature rupture of membranes, intrauterine growth retardation (IUGR), fetal anomaly/distress, multiple pregnancy, polyhydramnios/oligohydramnios, Rh incompatibility, and infectious diseases (Cincioğlu et al., 2020 ; Gözüyeşil & Düzgün, 2021 ; Sinaci et al., 2020 ; Üzar-Özçetin & Erkan, 2019 ).

Data collection

A Personal Information Form, the Antenatal Perceived Stress Inventory, and the Prenatal Distress Questionnaire were administered to the participants. The participants were informed about the study, the purpose of the study was explained to them, and their written consent was obtained. The data collection forms were administered to the participants by the first author. The data were collected based on the self-reports of the participants. The data collection period was between September and December 2019. The interviews lasted about 15 min for each participant.

Personal information form

The form which was prepared by the researchers in line with the literature consisted of a total of 20 questions on some characteristics of the participants, including their sociodemographic characteristics and obstetric history (Gözüyeşil & Düzgün, 2021 ; Mete et al., 2020 ; Üzar-Özçetin & Erkan, 2019 ; Atasever & Çelik, 2018 ).

Antenatal perceived stress inventory (APSI)

The Turkish validity and reliability study of the inventory developed by Razurel et al. ( 2014 ) to assess perceived stress in the prenatal period was performed by Atasever and Çelik ( 2018 ). The inventory is applied to pregnant women at the 36th -39th gestational weeks. It is a 5-point Likert-type scale (very much = 5 points, much = 4 points, quite = 3 points, a little = 2 points, none = 1 point) and consists of 12 items and 3 dimensions. Its dimensions are Medical and Obstetric Risks/Fetal Health, Psychosocial Changes during Pregnancy, and Prospect of Childbirth. The minimum and maximum scores that can be obtained from the inventory are 12 and 60. High scores indicate high levels of stress perceived by pregnant women. In the study conducted by Atasever and Çelik, Cronbach’s alpha internal consistency coefficient for APSI was found to be 0.70, while this coefficient was found as 0.81 in this study.

Revised prenatal distress questionnaire ((NUPDQ)-17 Item Version)

The questionnaire developed by Yali and Lobel ( 1999 ) to determine the levels of stress experienced by women regarding pregnancy-related issues was revised by Lobel ( 2008 ). The Turkish validity and reliability study of the questionnaire was performed by Yüksel et al. ( 2011 ). The questionnaire is in the form of a 3-point Likert-type scale (very much = 2 points, a little = 1 point, none = 0 point) and consists of 17 items. The questionnaire is unidimensional. The minimum and maximum scores that can be obtained from the questionnaire are 0 and 34. High scores indicate that pregnant women have high levels of prenatal distress. Cronbach’s alpha internal consistency coefficient for NUPDQ was found to be 0.85 in the study performed by Yüksel et al., while it was found as 0.82 in this study.

Statistical analysis

Frequency, percentage, mean, and standard deviation values were used in the data analyses. Whether the data had normal distribution was tested using the Kolmogorov-Smirnov test. The Chi-squared test and independent-samples t-test methods were used to identify the differences between groups in terms of the sociodemographic and obstetric information of the participants. The Mann-Whitney U Test was used to determine the differences between the case and control groups in terms of their total APSI, APSI subscale, and total NUPDQ scores. The Type I error level was accepted as p  < 0.05. A Cohen’s d value of 0.20 is considered to indicate a small effect size, a value of 0.50 is considered to show a medium effect size, and a value of 0.80 or greater is interpreted as a large effect size (Özsoy & Özsoy, 2013 ). Since education, number of pregnancies, and number of miscarriages, which are thought to have an impact on stress levels, may be confounding factors, the linear regression analysis in this study was carried out to determine whether these factors or high-risk pregnancy affected the stress levels of the participants (Models 1 and 2). As a result of the Mann-Whitney U Test, a significant difference was found between high-risk pregnancies and healthy pregnancies in terms of “psychosocial changes during pregnancy” and “prospect of childbirth”. For this reason, APSI dimensions were collected in a single model, and a linear regression analysis was performed for the further analysis of the relationship between high-risk pregnancy and the APSI dimension scores of the participants (Model 3). The variable with the highest β coefficient was considered the relatively most significant independent variable. Multicollinearity was ignored in case of Tolerance > 0.20 and variance inflation factors (VIF) < 10. R 2 shows what percentage of the dependent variable is explained by the independent variables. According to Cohen, R 2 values of 0.0196, 0.1300, and 0.2600 are the lower thresholds for small, medium, and large effect sizes, respectively (Özsoy & Özsoy, 2013 ). One-Way MANOVA was also conducted to see whether there was a difference in stress levels during pregnancy between the case and control groups. The comparison of the stress levels of the participants in the case group based on their diagnoses was conducted with the Kruskal-Wallis test.

Ethical considerations

For the study to be carried out, approval was obtained from the Clinical Research Ethics Committee of the Faculty of Medicine of the University, and written permission was obtained from the institution where the study would be conducted (2019/123). The purpose of the study was explained to the pregnant women who agreed to participate, and they were informed that their identifying information would be kept confidential. The written consent of the participants was obtained with the Volunteer Information Form. The participants in both the case and control groups who were thought to need counseling were referred to a specialist for psychological support.

Table  1 shows the sociodemographic and obstetric characteristics of the participants. There was no significant difference between the women in the case and control groups in terms of age, whether they had an income-generating job, income status, place of residence, parity, number of living children, status of having a planned pregnancy, and smoking status ( p  > 0.05). It was determined that the participants in the case group had significantly lower education levels than those in the control group ( p  < 0.001). Moreover, the number of pregnancies ( p  = 0.036) and the number of abortions ( p  = 0.012) in the case group were found significantly higher than those in the control group. These results supported the hypothesis that some sociodemographic and obstetric characteristics of women are associated with high-risk pregnancies.

According to the Kolmogorov-Smirnov test results, the total APSI and NUPDQ scores of the participants were not normally distributed ( p  < 0.001). Table  2 shows the stress levels of the participants compared based on their scale scores. The total APSI ( p  < 0.001, Cohen’s d = 0.388) and total NUPDQ ( p  = 0.002, Cohen’s d = 0.272) scores of the participants in the case group were significantly higher than those of the participants in the control group. The APSI Psychosocial Changes during Pregnancy ( p  < 0.001, Cohen’s d = 0.473) and Prospect of Childbirth ( p  < 0.001, Cohen’s d = 0.314) dimension scores of the participants in the case group were also significantly higher than those of the participants in the control group. These results supported the hypothesis that prenatal stress levels are higher in high-risk pregnancies than in healthy pregnancies.

Table  3 shows the stress levels of the participants with different diagnoses in the case group. In terms of risky pregnancies, the most frequently observed diagnoses were the threat of preterm labor in 37.2% of the participants in the case group, vaginal bleeding/placenta previa in 20.7%, and gestational diabetes mellitus in 10.7%. No statistically significant correlation was found between the diagnoses of the participants in the case group and their total APSI or NUPDQ scores ( p  > 0.05). This result did not support the hypothesis that there is a difference in prenatal stress levels based on differences in high-risk pregnancy diagnoses.

In the linear regression analysis, Model 1 included APSI on education, gravidity, number of abortions, and high-risk pregnancy, and it was determined that there was a significant relationship between APSI and high-risk pregnancies, where the former explained 4.3% of the total variance in the latter (R 2  = 0.043) ( p  < 0.001). Model 2 included NUPDQ on education, gravidity, number of abortions, and high-risk pregnancy, and it was determined that there was a significant relationship between NUPDQ and high-risk pregnancies, where the former explained 3.3% of the total variance in the latter (R 2  = 0.033) ( p  = 0.009). Model 3 included APSI dimensions, and it was determined that there was a significant relationship between psychosocial changes during pregnancy and high-risk pregnancy, where the former explained 5.7% of the total variance in the latter ( R  = 0.057) ( p  < 0.001) (Table  4 ).

As a result of the MANOVA, it was determined that having a high-risk or a pregnancy was associated with significant differences in the combined set of dependent variables (APSI and NUPDQ total scores), F = 6.231, p  = 0.002, Wilk’s Lambda = 0.967. There were significant differences between the case and control groups in terms of their APSI psychosocial changes during pregnancy and prospect of childbirth dimension scores, F = 7.258, p  < 0.001, Pillai’s Trace = 0.057. (Table  5 ).

This study determined the stress levels of pregnant women with high-risk and healthy pregnancies. Stress experienced in high-risk pregnancies can have negative effects in terms of the pregnancy process and maternal and fetal health (Atasever & Çelik, 2018 ; Gözüyeşil & Düzgün, 2021 ; Riggin, 2020 ; Traylor et al., 2020 ; Yüksel et al., 2011 ). Therefore, it is thought that the results of this study will contribute to the literature.

It was determined in this study that the education levels of the high-risk pregnant women, who constituted the case group, were lower compared to the healthy pregnant women in the control group. Other studies in the literature have shown that risk factors in pregnancy are at higher rates in women with low educational levels (Annagür et al., 2014 ; Soğukpınar et al., 2018 ; Topalahmetoğlu et al., 2017 ; Türkmen, 2019 ). It is thought that as education levels increase, the knowledge levels of pregnant women about the management of risk factors in pregnancy increase, and these situations are intervened with in the early period. Moreover, high education levels can also prevent factors that may cause a high-risk pregnancy such as malnutrition, ill-advised exercise practices, and lack of antenatal care. For this reason, considering the results of our study, it is recommended that health professionals provide education to pregnant women with low education levels about prenatal care, proper nutrition, exercise, and antenatal follow-ups.

The numbers of pregnancies and abortions among the participants in the case group in this study were significantly higher compared to those in the control group. In the study by Orbay et al. ( 2017 ), the number of pregnancies among pregnant women with GDM was lower than the number of pregnancies among those without GDM. Cincioğlu et al. ( 2020 ) found the mean number of abortions among pregnant women with risky pregnancies to be 1.31 ± 0.71. As the number of pregnancies increases, the potential risks of pregnancy also increase. More frequent monitoring of pregnant women with a high number of abortions by health professionals and providing information about family planning methods to women with a high number of pregnancies will prevent high-risk pregnancies.

High-risk pregnancies consist of many obstetric pathologies including maternal chronic diseases. Every pathologic condition experienced during pregnancy can affect the women’s stress levels (Sinaci et al., 2020 ). In this study, two different scales were used to measure the stress levels of the participants, and the stress levels of the participants in the case group were found to be higher than the stress levels of those in the control group. Gözübebek and Düzgün (2021) stated that 63.5% of pregnant women diagnosed with risky pregnancies experienced distress. Üzar-Özçetin and Erkan ( 2019 ) reported high perceived stress levels in high-risk pregnant women. In their meta-analysis study, Amiri and Behnezhad ( 2019 ) revealed that diabetes during pregnancy was a risk factor for anxiety symptoms, and diabetes increased the risk of anxiety by up to 48%. Other studies in the literature have shown that high-risk pregnant women also have high anxiety levels (Byatt et al., 2014 ; Denis et al., 2012 ; Gourounti et al., 2015a , b ; McDonald et al., 2021 ; Orbay et al., 2017 ; Sinaci et al., 2020 ; Hung et al., 2021 ).

It was reported that low education levels, having a history of abortion, and a high number of pregnancies may cause prenatal stress (Atasever & Çelik, 2018 ). In this study, lower education levels and higher numbers of pregnancies and abortions were found in the case group than in the healthy control group. Since low education levels and high numbers of pregnancies and abortions were thought to be potential confounding factors in terms of prenatal stress, further analyses tests were performed, and it was determined that these factors did not affect stress levels to a significant extent. The research in this field may benefit from a more in-depth exploration of potential implications and confounding factors related to education.

In the studies performed by Üzar-Özçetin and Erkan ( 2019 ) and Yüksel et al. ( 2013 ), it was found that the stress levels of pregnant women who had experienced hospitalization due to any risk during pregnancy were high. It is considered that diagnosis methods, treatment methods, symptoms, complications, and their effects on the fetus for high-risk pregnancies cause great stress in pregnant women, and the fact that some pregnant women spend this process in the hospital increases their stress levels even further. For this reason, considering the results of our study, it is recommended that healthcare professionals inform the pregnant woman about her diagnosis and symptoms and explain each procedure to be performed, and that healthcare institutions provide more comfortable hospital rooms.

In this study, it was seen that the prenatal stress levels of the participants were high in terms of psychosocial changes during pregnancy. Intense stress can cause a sense of helplessness and hopelessness by depleting the energy of individuals, as well as negatively affecting their physical and mental health (Sharma & Rush, 2014 ). For this reason, healthcare professionals have an important role in the care of pregnant women with high-risk pregnancies. They should take an active role in the early diagnosis of at-risk pregnant women through qualified home visits and by initiating and continuing treatment. Advanced clinical guidelines and case management models should be developed for women having high-risk pregnancies.

In the study by Pinar et al. ( 2022 ), women with high-risk pregnancies were given training on stress management. After the training program, it was determined that 51.4% of the women in the intervention group and 75.7% in the control group experienced stress. Based on these results, it is recommended that healthcare professionals provide training, to ensure the active participation of the pregnant woman and her partner, on stress management to reduce the perceived stress, anxiety, and hopelessness levels of women in high-risk pregnancy cases. Additionally, these pregnant women should be provided with methods to cope with stress such as breathing exercises, relaxation exercises, appropriate physical exercises, visualization/yoga, massage therapy, music therapy, explanations about social support factors, and practices strengthening their spirituality (Ölçer & Oskay, 2015 ).

In this study, no significant difference was found in the prenatal stress levels of the participants in the case group based on their obstetric diagnoses of high-risk pregnancy. In the study by Byatt et al. ( 2014 ), no significant difference was identified between obstetric diagnoses in terms of anxiety levels in pregnant women. A high-risk pregnancy causes high stress levels in pregnant women due to similar diagnostic tests, treatment methods, hospitalization, complications, and fetal outcomes (Kent et al., 2015 ).

It is thought that high stress levels are not associated with obstetric diagnoses, and similar stress levels are experienced by all pregnant women aware of any risky situation during their pregnancies. Nevertheless, an increase in stress levels in risky pregnancies such as cases of preeclampsia may cause a further aggravation in the clinical status of women. Healthcare professionals should be aware of the higher stress levels of these pregnant women, they should help the pregnant woman express her feelings and thoughts by providing a reassuring communication environment, and plan appropriate consultancy, intervention, and care routines to help reduce their stress levels. These professionals can also coach high-risk pregnant women in terms of stress reduction and coping mechanisms. Pregnant women with high stress levels should be referred to a specialist for psychological support and therapy.

Strengths and limitations

The strength of this study was its prospective design with a control group. In this study, the use of two similar scales in terms of measuring the stress levels of pregnant women provided rigor and transparency compared to data obtained in previous studies. Since these scales were included in studies in Turkey only in the context of testing their validity and reliability in Turkish, it was decided to use them in the study as they measure stress levels in the prenatal period. A limitation of the study was that the pre-pregnancy stress levels of the participants, which would affect their present condition, were not measured in the study. Women with high stress levels before pregnancy have a higher risk of high-risk pregnancy. In other words, instead of high-risk pregnancy increasing stress levels, high stress levels may have affected the high-risk pregnancy statuses of the women. The results of the study also revealed a significant difference in education levels between the case and control groups. However, as a result of further analyses, it was determined that education did not affect prenatal stress levels.

In this study, it was determined that high-risk pregnancy affected prenatal stress. Moreover, it was found that the participants in the case group who had high-risk pregnancies had lower education levels and higher numbers of pregnancies and abortions compared to the participants in the control group with healthy pregnancies. This is why healthcare professionals are recommended to bear in mind that pregnant women with low education levels and a high number of pregnancies and abortions are at risk of high-risk pregnancies and monitor these pregnant women more frequently and carefully.

It is of great importance for the course of a pregnancy that healthcare professionals assess the stress levels of pregnant women in the high-risk pregnancy category, provide psychological support to pregnant women who have high stress levels or are hospitalized, offer them counseling and training opportunities (e.g., relaxation exercises, breathing exercises, practices strengthening their spirituality, music therapy), take appropriate precautions, and refer these pregnant women to specialists if needed. Moreover, since the stress levels of these pregnant women will increase even more during childbirth, alternative methods to reduce the fear of childbirth and childbirth pain should be explained.

It is recommended to organize educational programs such as trainings, seminars, and conferences on stress management during pregnancy for health professionals working in family health centers, community health centers, and gynecology departments.

Consequently, more studies with larger sample sizes are needed to compare diagnostic stress levels in high-risk pregnancies. In addition to prenatal stress and childbirth fear levels, future studies should also determine the stress levels of women before pregnancy for similar comparisons between high-risk and healthy pregnancies.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors express thanks to the mothers for participation in the study.

Open access funding provided by the Scientific and Technological Research Council of Türkiye (TÜBİTAK). No funding was received to conduct the study.

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Study conception and design: Hülya TÜRKMEN.  Data collection:  Hülya TÜRKMEN.  Data analysis and interpretation:  Hülya TÜRKMEN.  Drafting of the article:  Hülya TÜRKMEN, Bihter AKIN, Yasemin ERKAL AKSOY.  Critical revision of the article:  Hülya TÜRKMEN, Bihter AKIN, Yasemin ERKAL AKSOY.

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Türkmen, H., Akın, B. & Erkal Aksoy, Y. Effect of high-risk pregnancy on prenatal stress level: a prospective case-control study. Curr Psychol (2024). https://doi.org/10.1007/s12144-024-05956-z

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DOI : https://doi.org/10.1007/s12144-024-05956-z

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