critical review of theory and research

• Methodology
• Open access
• Published: 13 October 2014

Considering methodological options for reviews of theory: illustrated by a review of theories linking income and health

• Mhairi Campbell 1 ,
• Matt Egan 2 ,
• Theo Lorenc 3 ,
• Lyndal Bond 4 ,
• Frank Popham 1 ,
• Candida Fenton 1 &
• Michaela Benzeval 1 , 5  

Systematic Reviews volume  3 , Article number:  114 ( 2014 ) Cite this article

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Review of theory is an area of growing methodological advancement. Theoretical reviews are particularly useful where the literature is complex, multi-discipline, or contested. It has been suggested that adopting methods from systematic reviews may help address these challenges. However, the methodological approaches to reviews of theory, including the degree to which systematic review methods can be incorporated, have received little discussion in the literature. We recently employed systematic review methods in a review of theories about the causal relationship between income and health.

This article discusses some of the methodological issues we considered in developing the review and offers lessons learnt from our experiences. It examines the stages of a systematic review in relation to how they could be adapted for a review of theory. The issues arising and the approaches taken in the review of theories in income and health are considered, drawing on the approaches of other reviews of theory.

Different approaches to searching were required, including electronic and manual searches, and electronic citation tracking to follow the development of theories. Determining inclusion criteria was an iterative process to ensure that inclusion criteria were specific enough to make the review practical and focused, but not so narrow that key literature was excluded. Involving subject specialists was valuable in the literature searches to ensure principal papers were identified and during the inductive approaches used in synthesis of theories to provide detailed understanding of how theories related to another. Reviews of theory are likely to involve iterations and inductive processes throughout, and some of the concepts and techniques that have been developed for qualitative evidence synthesis can be usefully translated to theoretical reviews of this kind.

Conclusions

It may be useful at the outset of a review of theory to consider whether the key aim of the review is to scope out theories relating to a particular issue; to conduct in-depth analysis of key theoretical works with the aim of developing new, overarching theories and interpretations; or to combine both these processes in the review. This can help decide the most appropriate methodological approach to take at particular stages of the review.

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Theory is fundamental to research and rational thought. The term ‘theory’ has been variously defined, and is frequently used without definition, but often refers to an explanatory framework for observations. In science, theories generally purport to explain empirical observations and form the basis on which testable hypotheses are generated to provide support for, or challenge, the theory. Gorelick defines theory as ‘the creative, inductive, and synthetic discipline of forming hypotheses’ [ 1 ], p. 7. Popper defined a scientific theory as one that is experimentally falsifiable [ 2 ]. Merton has contrasted ‘grand’ social theories such as Marxism, functionalism, and post-modernism with ‘middle-range theories’ that start with an empirical phenomenon and abstract from it to create general statements that can be verified by data [ 3 ]. Mid-range theories are dominant within empirical and scientific approaches to research. Gough usefully categorises such research as aiming to generate, explore, or test theories. Of particular importance in health literature are studies which include theories about cause and effect; such studies may test these theories in a ‘black box’ way or attempt to generate, explore, and test more clearly articulated causal-pathway frameworks, such as those presented in logic models [ 4 ]. For this discussion, the terms ‘causal pathway’, ‘causal maps’, and ‘logic model’ refer to qualitative models used to identify key concepts and the links between them [ 5 ].

Within the health sciences, it is widely understood that individual and population health are influenced by a wide array of interconnecting factors, so theoretical models can be complex and, at times, contested [ 6 ]. However, different disciplines approach such research in different ways and are not always well connected. Reviews of theory may aid our attempts to navigate a diverse literature and potentially lead to insights into how factors relate to one another [ 6 – 9 ]. Theory reviews could have one or more of the following aims: identifying and mapping a comprehensive range of relevant theories; assessing which theories have become influential and which have been, or have become over time, largely overlooked; and integrating complementary theories and facilitating the analysis and synthesis of theories into more generalised or abstract ‘meta-theories’. By focusing on theory, rather than diverse empirical studies, reviews can be useful devices to describe complex topics across different disciplines and inform policy debates.

The purpose of this article is to consider the ways in which theoretical reviews might be conducted and in particular the role of systematic approaches within this. It illustrates the discussion by drawing on the approach of a recent theoretical review the authors undertook of income and health [ 10 ]. It discusses some of the methodological challenges and options that reviewers may face when planning and conducting reviews that focus on theoretical literature. We think the discussion will be particularly relevant to reviewers considering the degree to which they might attempt to use and adapt methods commonly associated with systematic reviews, which tend to have been developed around reviews of empirical research and thus not specifically designed to assess descriptions of theories underpinning research. We will discuss the extent to which methods developed and used for reviews of empirical research may, or indeed may not, be usefully adapted to meet the challenges posed when reviewing theories on the phenomena of interest. In particular, we will discuss some of the methods we (the authors) employed when conducting our own recent review of theories of income and health [ 10 ]. Reviews of theory are part of a growing methodological advancement, and we think this would be an opportune time to contribute lessons learnt from our project and others and discuss some of the methodological considerations that inform such a review. Some of our reflections are based on the methods we employed in our review; others result from critical thinking and discussions that took place following the review’s completion.

Below, we outline general approaches in the literature to conducting reviews of theories. We then describe the broad principles of our approach before providing a detailed summary of each stage of the review and the way in which we incorporated systematic approaches into them. We examine how this contributed to our understanding of the literature on income and health and reflect on the value of this approach.

Existing approaches to reviews of theory

There is often substantial variation in the methodologies of reviews that consider theory. Some take the form of traditional literature reviews, often reliant on expert knowledge in the relevant field. Such expert knowledge allows in-depth understanding of theories and links between them. However, it can be limited to the disciplinary perspective of the reviewer, not necessarily identifying less popular or emerging theories, and cannot provide a sense of the extent to which different theories are employed in the literature. Given these limitations, some reviewers of theory have employed methodologies associated with systematic reviews such as comprehensive searches and clear criteria for including, appraising, and synthesising the literature to provide a more comprehensive picture [ 11 , 12 ]. Reviews of theory are thus rather different to reviews of empirical data. In particular, the primary goal of using systematic methods in the latter case is to minimise bias. In theory reviews—where it is not even clear that the concept of ‘bias’ is substantively meaningful—their main contribution may be more in ‘opening up’ reviewers’ thinking about the research topic and widening the potential space of hypothesis generation.

Often reviews of theory are conducted to assist reviewers involved in carrying out systematic reviews of intervention effectiveness. Realist review [ 13 , 14 ] is currently a key area of methodological development around the integration of theory into reviews of interventions. Realist reviews aim to draw out and test ‘programme theories’ about the causal pathways through which interventions work, in order to bring together evidence on effectiveness with data on implementation and context. In some cases, theory reviews may have relatively narrow inclusion criteria tied to theories about a specific intervention. However, narrow criteria do not necessarily lead to small-scale review. Two systematic reviews of theory conducted in relation to larger reviews are Baxter and Allmark’s [ 12 ] review of chest pain and medical assistance and Bonell et al.’s [ 11 ] review of theories on school environment and health: the former has a narrower research question with a search result of around 100 papers, but the latter entailed screening more than 62,000 papers.

A recent systematic review of interventions on crime, fear of crime, health, and the environment was preceded by a mapping broad review of theories that attempted to explain associations between these factors [ 5 ]. The crime review used a pragmatic approach to searching and selecting literature and did not attempt to provide a comprehensive systematic review of all theories related to the topic. Rather, the theory review aimed to construct a coherent framework for integrating relevant theories, in order to contextualise and better understand the empirical data.

The income and health review of theory

We conducted a review of theories about causal relationships between income and health (see Additional file 1 for brief description). Given the wide-ranging literatures across disciplines, and the contested nature of many debates, we felt that a systematic approach to the review would help shed light on the range of casual paths that had been posited. Our intention was to gain some of the benefits of applying systematic review methods to a review of theory, such as clarity, comprehensiveness, and transparency. By making the literature search as systematic and transparent as possible, a review can extend beyond researcher knowledge and disciplinary background [ 15 ]. Developing inclusion criteria and devising methods to uniformly capture data across included papers strengthens objectivity [ 15 ]. By the time the included papers have been assessed, it is hoped that the explicit methods used reduce subjectivity. Once the theories are gathered through the systematic searching, screening, and extracting, the interpretation of their content at the synthesis stage may be still be at risk of subjectivity.

Reviews of theory may be particularly valuable in seeking to develop a synoptic understanding of questions where a number of different disciplines overlap. In our recent review of theories describing pathways linking individual and family income to health [ 10 ], we included theories from public health, psychology, social policy, sociology, and economics, all of which have distinct traditions and vocabularies. In addition, many of the causal pathways between income and health described by these theories are long and complex. In cases such as these, syntheses of theory can help to produce new insights about complex fields by drawing together different paradigms and translating concepts between disciplines.

The techniques developed in the crime theory review were adapted by the authors of the present article for a review of theories linking income to health across the lifecourse [ 10 ]. In the income and health review, an attempt was made to incorporate more techniques from systematic reviews, including a priori inclusion criteria, comprehensive electronic searching, and standardised data extraction. These methods were employed to capture theories from literature in disciplines with which we may have been less familiar. The methods used for our review are indebted to those developed by realist reviewers. However, our review focused less specifically on evaluating mid-range theories of the mechanisms and contexts of interventions and more on mapping and synthesising the whole landscape of theories around income, health, and the lifecourse. The resulting review was a methodological hybrid including elements of the earlier crime review, drawing on seminal literature to create a framework, and more standard systematic reviews. Below, we outline key review stages, illustrated by the methods used in the income and health review of theory. Challenges faced and tactics to address, these are described. The aim was to generate guidance and discussion of methods that may be useful when planning and conducting a review of theory.

Results and discussion

Developing the research question.

An explicitly stated research question is a characteristic of systematic reviews that can be adopted for reviews of theory. The question should be designed following consideration of what the end users will find useful, so consultations with potential end users may be part of the process [ 15 ]. As stated above, review questions can be broad or narrow in scope. A broad question may reflect the reviewers’ aim to scope out and map a wide range of theories within a subject area. The purpose of this income and health review was to use theory as a tool to support a larger programme of work exploring the importance of income and other aspects of family resources in determining a wide range of health and social outcomes. In contrast, if the aim is to identify theories relating to a specific phenomenon or intervention, then a narrow question may be more appropriate. For example, the review of theories of behaviour change in limiting gestational weight gain [ 16 ]; and in another review, Sherman et al. [ 17 ] used self regulatory theory to examine psychological adjustment among male partners in response to women’s cancer. Both these reviews of theory have a narrow topic, distinct from the broad scope of the income and health review.

Assembling the team

Guidance for conducting a systematic review recommends gathering a team that includes an experienced reviewer, a subject specialist, and an information scientist with advanced knowledge of bibliographic search strategies [ 15 ], p. 85; [ 18 ]. For theory reviews, the role of the subject specialists and the stages at which their contribution is valuable may become particularly crucial. Besides helping to ensure that key papers within the field are identified for inclusion in the review, specialists can provide a detailed understanding of how different theories came to be developed, how one theory relates to another, and where the points of controversy lie. It may be useful to have input from more than one specialist if the scope of the review is multi-disciplinary or covers a subject area that is divided by rival theoretical ‘camps’. Conducting the income and health review was aided by the team including members with experience of systematic reviews, theory reviews, and information science, as well as reviewers with backgrounds in lifecourse epidemiology, social policy, and economics. We also worked with an advisory group that included end users and researchers with a range of experience in social science research.

The degree of specialist input required will be influenced by the depth of analysis required. Reviews that aim to provide in-depth synthesis, including attempts to develop meta-theories, are likely to require greater specialist input than reviews that aim to scope the various theories in the literature. This echoes guidance for other types of review. For example, Cochrane’s Qualitative and Implementation Methods group states that greater subject expertise is required to appraise the theoretical contributions made by qualitative research compared to that required simply to include or exclude relevant evidence [ 19 ]. Hence, the most appropriate team for any particular review will depend not only on the subject matter being reviewed, but also on the degree to which the review is intended primarily to be a scoping exercise or a more specialist theoretical analysis.

Inclusion and exclusion

A priori inclusion and exclusion criteria are a mainstay of systematic reviews, helping to guide the literature search and ensure clear focus and transparency in the selection of studies. Frameworks for developing such criteria have been developed. For example, Cochrane advocates the use of criteria that specifies population, intervention, comparison, outcome, and study (PICOS) design. Qualitative reviewers have an alternative framework: sample, phenomenon of interest, design, evaluation, and research type (SPIDER) [ 20 ]. No comparable frameworks currently exist for theory reviews. When conducting reviews of theory, the task of creating inclusion/exclusion criteria can present challenges. First, the term ‘theory’ needs to be defined with enough precision to enable reviewers to consistently filter out papers that are insufficiently theoretical. Generic definitions, such as those highlighted at the beginning of this article, are conceptually helpful, but in practice, reviewers may find themselves struggling to decide whether a text is describing a theory or a hypothesis or speculation (and wondering how crucial these distinctions might be for the review). They may also struggle to find a consistent way of distinguishing a general discussion of issues from a more fully expounded theory. The decisions that were taken of includable theory during the income and health review were guided by screening for substantial hypothesis of exposure—mechanism—outcome and study design. We found considering papers in relation to these criteria a useful tool to clarify the theory content of papers, although we would emphasise that in this particular example it is theories of cause and effect that is being examined. Reviews of alternative types of theory would require alternative criteria.

A second challenge relates to the tension between having inclusion criteria that are specific enough to make the review practical and focused, but not so specific that key literature is excluded. Although this issue is not exclusive to reviews of theory, we found that a particular problem with the income and health theory review was that some of the most widely recognised theoretical texts did not originate from literature that focused on income, health, or lifecourse (i.e. not all three of these elements simultaneously) specifically. The Black Report [ 21 ], for instance, continues to exert a huge influence on how researchers think about the causes of health inequalities, and its theoretical framework can be seen to underpin some of the literature that was relevant to our review. However, the Black Report itself generally refers to the broader concept of socio-economic status rather than more specifically to the issue of income. We did not want to exclude the theoretical framework outlined in the Black Report nor did we want to open up our inclusion criteria so that it included all theories of socio-economic status and health (to do so would have been an enormous undertaking).

One potential solution to both these challenges is to acknowledge that overly rigid a priori inclusion criteria may be less useful for theory reviews, whilst more subjective methods of selecting relevant studies may be more useful; what may be required is a careful balance between these approaches. In the income and health review we developed inclusion criteria in advance of the review but acknowledged that there could be some papers key to explaining relevant theories that might be missed and therefore we allowed reviewers some leeway to include papers that did not quite fit the criteria if deemed sufficiently relevant. Subjective appraisals for relevance should ideally be conducted independently by more than one reviewer reading each text and, if necessary, resolving disagreements through discussion and/or an additional reviewer’s input. However, this process can be time consuming and resource intensive if a literature search has identified large numbers of potentially relevant papers. Another solution could be to use a second reviewer to independently check a random sample of included papers to verify that the criteria are being met consistently. Reviewers may also choose to modify inclusion criteria as the review progresses so that apparent gaps can be redressed and points of interest can be pursued in more detail [ 18 ]. Whilst potentially useful, these ‘solutions’ all carry possible risks of their own related to subjective bias, transparency, size, scope, and manageability of the review.

Our own ‘solution’ to the challenge of determining inclusion criteria was a pragmatic combination of approaches. Two of the review authors (MB, FP) with expert knowledge of socio-economics and income-health literature were able to identify ‘seminal’ papers (key texts, widely regarded as theoretically influential within the field) which are often cited as making important advances in the understanding of how socio-economic factors and health are related. The number of papers included at that stage was small, but the inclusion criteria were broad in the sense that we included theories that considered socio-economic status broadly rather than the narrow definition of income alone. From this review, we created a conceptual framework within which to structure a more in-depth review. A second stage of the review sought out wide-ranging literatures from different disciplines with theories that related specifically to income, health, and lifecourse (or life stages). For this second stage, we developed a priori criteria which were modified slightly as the review progressed. In addition for this stage, we developed criteria for identifying theory based broadly on Pawson and Tilley’s [ 22 ] concepts of context, mechanism, and outcome; although as noted above, the aim of our review was broader than most realist reviews and not focused on evaluation. To be included, a theory had to describe a causal association connecting income to health through a specific pathway or mechanism. More complex theories (e.g. those that involve multiple and multi-staged pathways and outcomes, feedback loops, contextual factors) were included if they involved the three core components of income, causal pathway or mechanism, and health outcome. Papers were excluded if they did not discuss theories at all or if they did not present theories containing all three of the core components. Papers were also excluded if the theoretical discussion was judged (subjectively) by reviewers to be cursory, for example, where a hypothesis or existing theory was briefly referred to or implied as part of a general discussion.

Literature searches for systematic reviews often incorporate formal electronic searches of subject-relevant research databases such as MEDLINE, EconLit, and PsycINFO. It is also good practice to include so-called ‘hand searching’ (a misnomer, as much of this searching is also electronic) techniques. Hand searching may include expert consultations, trawls through specific journals, checking the references of included studies, and seeing where included studies have themselves been cited (some databases such as Web of Knowledge and Scopus allow for this type of forward citation tracking) [ 15 ], p. 104.

In our review of income and health, the aim of the electronic searches was to identify papers outwith our personal collections. The intentionally broad focus of the review question, combined with the vast amount of literature relating to income and health, resulted in our development of a two part electronic search strategy (see Additional file 2 ). One focused on ‘highly cited literature’ and the other aimed to capture ‘recent literature’, although both employed the same search terms. The highly cited search was an attempt to identify the most influential theoretical work. This used electronic databases, SCOPUS and Web of Knowledge, which focus on high impact journals and may be used for citation tracking. The top 2,000 papers, ordered by number of citations, were taken from each database, on the assumption that the most highly cited papers were most likely to have been particularly influential. This search was repeated twice as we refined our search terms. Given the focus on highly cited papers, these searches tended to identify older papers. The ‘recent literature’ search was designed to be more specifically focused on identifying emerging theories from different disciplines. It focused on subject-specific databases from the fields of health sciences (such as epidemiology, medical sociology, health economics, health psychology, health geography, clinical sciences, public health), economics, political sciences, geography, and sociology. This search was limited to papers published within the past 10 years to identify more recent theories and those that have current application.There are no well-tested search strategies for identifying theoretical literature. Our approach identified 5,021 papers; of these, 272 were employed in the review. Several of the authors had extensive collections of papers relevant to this study, referred to here as ‘personal collection’. To satisfy our curiosity of the final contribution of the electronic and hand searching to the income and health review, we compared original search results prior to de-duplication. For this exercise, we included personal collections and citation tracking as hand searching and the ‘highly cited’ and ‘recent literature’ electronic searches as electronic. The final proportions of these groups are shown in Figure  1 . Of the papers finally included in the income and health review, 76% were identified solely through hand searching: of these, 64% were in the personal collections of subject specialists and 12% came from either forward or backwards citation tracking. The citation searching included tracking references from papers found through the electronic searches. The electronic bibliographic searches identified 12% of final inclusion papers (along with a further 12% of included papers that were found both through the electronic and hand-searching methods). Therefore, for the income and health review, we found that electronic bibliographic literature searches had limitations, with a large amount of effort yielding a relatively small proportion of the final included papers. However, those papers were not identified by any of the other search strategies and hence were important to the aim of including multi-discipline literature. Citation tracking, both backwards and forwards, also resulted in useful literature being found, particularly for compiling our theoretical framework of how mechanisms interact to impact on health.

Source of included papers for the income and health review of theory.

Whilst piloting our electronic search strategy, we developed and tested search terms to help us identify theoretical papers. We found that the string of terms ‘theory or pathway or model or mechanism or review’ (with truncations appropriate to specific databases) were useful for identifying papers that discussed theories. Nonetheless, when the terms for ‘income’, ‘theory’, and ‘health’ were checked separately and then combined, we also found that 17% of papers that we wanted to retrieve from our initial (and intentionally broad) electronic search did not include all of the terms in the title or abstract—and therefore would have been missed from any literature search that used that term as a filter; 8% had no term to identify theory in the title or abstract.

In other reviews, the searching process for relevant theory has been dependent on the search strategy for empirical evidence on the same topic. The theory-based review by Baxter and Allmark on chest pain and medical assistance was conducted on literature identified from a previous systematic review of empirical evidence. Hence, the reviewers focused on literature already searched and filtered [ 12 ]. The review of theory on school environment and health combined searching for theory with the searches for relevant empirical studies [ 23 ]. Therefore, papers containing relevant theory were identified during the screening process of papers reporting empirical studies. A potential limitation of this approach is that it could omit publications that provided detailed theoretical discussions without presenting empirical data. Optimising the balance between search specificity and selectivity is a perennial problem for systematic reviewers. The challenges described here underline the need for multiple approaches, including formal electronic searches and hand searches, so that the strengths of one approach can help to compensate for the deficiencies of another whilst ensuring the reviewers’ task is manageable. A consequence of the initial broad electronic searching for the income and health review was the time it took to screen over 5,000 papers. This was amplified by the fact that frequently the title and abstract gave no indication of whether there was any theoretical content and the full text had to be retrieved and screened. This is likely to be a feature of many reviews of theory and perhaps consideration has to be given to the following: achieving a balance between including search terms to limit the focus to papers including theory, with the risk of missing important texts; acknowledging a realistic timescale required for thorough searching and screening for relevant papers, with the possibility of a low ‘hit’ rate; or reconsider the objectives to establish whether a tighter focus is preferable.

Data extraction

Reviewers have a number of options regarding how they select and extract data from included papers in such a way as to manage often substantial amounts of information and to aid synthesis. One option is to produce standardised extraction forms to help ensure that similar types of data are taken from each paper to facilitate cross-comparison. If the included documents are too heterogeneous to fit a standardised approach, or if the reviewers are looking to conduct more detailed qualitative analysis, an alternative approach is more useful. In systematic reviews of qualitative research, reviewers may work with whole texts rather than selected extracts, using ethnographic or other techniques to code and then analyse the data. Textual analysis software such as NVivo can be used to aid this process. If the reviewers feel they have a thorough knowledge of the papers, they may feel that formal data extraction and coding are unnecessary.

Reviewers of theory have a similar range of standardised and qualitative approaches to extracting data, and their choice may be determined on the purpose of the review (e.g. the extent of scoping or in-depth analysis) and their degree of familiarity with the material. As the income and health review combined an in-depth analysis of seminal literature with a broader scope of relevant theories, a combination of approaches was used. The analysis of the small number of key papers was conducted by subject specialists without a formal data extraction process. In contrast, the scoping part of the review led to the inclusion of 147 papers that were summarised using a data extraction form that we created in Microsoft Access specifically for the review (see Additional file 3 for fields included). The extracted data were then coded into broader categories of theory relating to causal mechanisms from the review of seminal papers. Data were extracted by one reviewer, and a second reviewer independently extracted a sample of studies; results were compared and differences discussed to develop a common consistent approach.

Quality appraisal

For most systematic reviews, appraisals of the methodological quality of included evidence are a crucial stage that then enables reviewers to determine the strength of evidence and potential for bias relating to specific findings. Within evidence synthesis, in particular qualitative synthesis, there is discussion of whether it is appropriate to appraise the quality of studies and what form such appraisals might take [ 4 , 24 ]. Similarly, theoretical evidence cannot be appraised using the kinds of tools which have been developed for more conventional systematic reviews, most of which tend to focus on internal validity and study design. Some reviews have emphasised theories identified in empirical papers that were judged to be of high methodological quality [ 12 ]. However, study methodology and theoretical development are different areas of research demanding different skills and so it does not necessarily follow that high quality empirical methods necessarily occur alongside good or influential theories [ 24 ]. It may be that the appraisal process helps to distinguish between papers presenting a theory based on flawed empirical study and papers presenting a comprehensively argued theory which fail to clearly report research methods.

Detailed appraisal of theories is likely to involve an inductive and subjective approach by researchers with a thorough knowledge of the field, rather than the use of standardised checklists (although one exception to this is the checklist devised by Bonell et al. [ 23 ]). Our income and health review did not include a standardised critical appraisal of the theories we included. In retrospect, it may have been useful to have attempted to grade theories by relevance to the review question and, possibly, by level of detail or originality, to help exclude studies that included relatively minor theoretical discussions or simply referred to the work of other theorists.

Approaches to data synthesis will differ depending on the different aims of a review. Gough helpfully distinguishes between aggregative and configurative reviews—the former generally focus on synthesising empirical papers and ‘add up’ their findings, whilst the latter aim to interpret and configure findings from existing literature to develop new understandings of existing research [ 4 ]. Theoretical reviews often lean more to configurative approaches but may also contain some aspects of aggregation depending on the aim. This results in different approaches to synthesis. Some reviews (e.g. Bonell et al. [ 11 ]) have treated the individual theory as the unit of analysis, with a focus on constructing a typology of theories within an overarching picture of causal determinants. Others have an in-depth or configurative approach, for example, Lorenc et al. [ 25 ] aimed to analytically isolate specific causal or interpretive assertions from diverse theories and then to develop a causal ‘map’ of the interrelations between different factors.

However, there remain a number of unanswered questions around synthesis of theories, particularly whether diverse, complex, and potentially incommensurable conceptual vocabularies can be effectively integrated. A review of theory that attempted a more in-depth analysis could incorporate techniques developed for qualitative reviews, for example, from thematic synthesis [ 26 ] or meta-ethnography [ 27 ]. The reviewers could attempt to distinguish between different orders of theory: those framed directly around specific data, those that result from an author’s attempts to juxtapose pre-existing theories and/or ideological positions with empirical observations, and those resulting from the reviewers own reflections based on comparisons of the included literature. Broadly following the meta-ethnographical approach, reviewers could explore whether the relationship between different theories is reciprocal (i.e. the theories are mutually supportive) or refutational (i.e. the theories appear to contradict one another) or whether the theories can potentially form part of the same line of argument (e.g. by representing different stages along the same causal pathway) [ 27 ].

As has been noted, the income and health review was a hybrid that combined an expert review of key literature with a wider scope of relevant theoretical literature drawn from systematic searches. The seminal texts in the expert review were synthesised through a subjective process of induction by specialists who had immersed themselves in the literature. A key synthesising stage of the systematic searches was the interpretative collating of findings which was used to create a causal map and review the key concepts and relations that were believed to be important. Through an iterative process of checking between this mapping process and the themes we had developed from the systematic scoping literature, a framework of theoretical pathways between income and health was constructed.

The synthesis process used in the income and health review combined standardised and iterative elements. Guided by Baxter et al.’s [ 6 ] method of developing a conceptual framework, papers were scanned to extract descriptions of specific pathways/theories linking income to health. The extracted literature was organised by a coding framework: a typology of theories, developed iteratively in conjunction with the analysis of seminal texts. The extracted texts were then organised by themes emerging from the data within each theory type, drawing together similar theoretical pathways from differing disciplines including sociology, economics, public health, and psychology. Narrative synthesis techniques were used to scope, compare, and contrast the key theories that were identified and focused on: the definition of key concepts, hypothesised pathways, the range of contextual factors included in the model/theory, and the time sequencing of hypothesised influences and outcomes within the lifecourse. These methods are similar to the processes involved in thematic synthesis described by Thomas and Harden [ 26 ]. In retrospect, awareness that the synthesis process we undertook would concentrate entirely on qualitative techniques would have enabled us to adopt qualitative software and analysis methods at an early stage of the review. This may have made the data collection quicker and the synthesis more intuitive.

In this article, we have discussed some of the methodological issues involved when conducting a review of theory, using examples from a recently conducted theoretical review of income and health. The article should be read as a discussion of what we learnt rather than an attempt at formal guidance. The aim has been to help provide a starting point for anyone considering their own review of theory to think about the possible purpose of their review and the methods that are most appropriate for that purpose. We suggest that there are a spectra of methods for conducting theory reviews that stretch from scoping out theories relating to a particular issue to in-depth analysis of key theoretical works with the aim of developing new, overarching theories and interpretations. The two types of approach are not mutually exclusive; the income and health review included elements of both. We think it may be useful at the outset of a review of theory to spend time considering whether the key aim of the review is to scope, to conduct in-depth analysis, or to combine both these aspects in the review. Identifying the type of review can clarify the most appropriate approach. Scoping reviews are more likely to require a more standardised approach to searching, inclusion and exclusion, and data extraction to help manage the potentially large numbers of studies that may be identified. However, in our experience, scoping reviews of theory also benefit from the flexibility and nuance that can come from more subjective and inductive processes. In-depth reviews of theory are likely to involve iterations and inductive processes throughout, and we have suggested that some of the concepts and techniques that have been developed for qualitative evidence synthesis can be usefully translated to theory reviews of this kind.

Reflecting on our experience of conducting the review of theories on income and health, we feel that there were positive and negative aspects to the process. Table  1 summarises the main challenges we faced. Taking the time to grapple with defining and applying inclusion criteria was a process which helped clarify what we were looking for and how we wanted to use it. The systematic searching was extensive and laborious, and we found that it contributed only a small amount to the review in comparison with that found through personal libraries. However, those papers would have been omitted without the systematic search methods, probably reducing the scope of the review.

Our team of authors included members with substantial knowledge of the income and health topic; it is possible that conducting the review without access to this knowledge would make the systematic searching of far greater relevance. The team also included members with considerable experience in conducting systematic reviews. Although this had some advantages in terms of methodological expertise, we have tried to show here that systematic review methods are not always appropriate or may need to be adapted for theory reviews—and the reviewers need the confidence and flexibility to do this.

We suggested in the background above that systematic methods may be valuable in reviews of theory for two reasons: to complement the review team’s existing expertise as a framework for hypothesis generation and to increase reliability in the synthesis. Our experience suggests that these benefits are real, in that the systematic approach helps to distance reviewers from commitments to particular perspectives. Nonetheless, reviewer expertise continued to define the interpretation of the theories and was also indispensable in searching.

Reviewers wondering which approach and methods would best suit them should consider the purpose of the review in terms of what would be most useful to end users. Furthermore, if reviews of theory are to be more common, their general utility requires greater consideration. At this stage in their development, there is an opportunity to pose searching questions about the uses and usefulness of such reviews. How would the focus and content alter depending on whether their main function was as an academic resource, as a support for decision makers, or as a combination of the two? Do their findings genuinely advance our understanding of theory (e.g. by identifying overlooked theories, by showing how apparently rival theories relate to one another, or by aiding the generation of meta-theories)? Conversely, do they tend to reiterate theoretical viewpoints that are already well established (including, for example, the view that social phenomena are frequently ‘complex’)? Future work on this kind of synthesis will doubtless lead to a refinement of methods and can shed more light on the added value that can be obtained by reviewing theory.

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Acknowledgements

MC was funded on the income and health review of theory by the Joseph Rowntree Foundation. At the time of the review, LB, ME and CF were funded by the UK Medical Research Council/Chief Scientist Office Evaluating the Health Effects of Social Interventions programme (MC_UU_12017/4), and MC is currently funded by this programme; MB and FP were funded by the Social Patterning of Health over the Lifecourse programme (MC_UU_12017/7) at the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow. Mark Petticrew, London School of Hygiene and Tropical Medicine, was a co-author of the income and health review of theory and provided helpful comments on an earlier draft of this article.

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MC and ME wrote the first draft of this article, with MB and TL contributing to drafting. All authors contributed to revising the manuscript and approved the final draft. All authors were involved in developing and conducting the income health review of theory.

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Additional file 1: Purpose and methods for the income and health review [ [ 21 ] , [ 28 ] - [ 30 ] ]. The review is on theories about causal relationships between income and health. (DOC 48 KB)

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Additional file 2: Further details of income and health electronic literature searches. Details show development of a two part electronic search strategy. (DOC 48 KB)

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Additional file 3: Data extraction for the income and health review [ [ 30 ] - [ 41 ] ]. List shows the details collected from the papers included in the systematic search. (DOC 48 KB)

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Campbell, M., Egan, M., Lorenc, T. et al. Considering methodological options for reviews of theory: illustrated by a review of theories linking income and health. Syst Rev 3 , 114 (2014). https://doi.org/10.1186/2046-4053-3-114

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

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

Case study research is an increasingly popular approach among qualitative researchers (Thomas, 2011 ). Several prominent authors have contributed to methodological developments, which has increased the popularity of case study approaches across disciplines (Creswell, 2013b ; Denzin & Lincoln, 2011b ; Merriam, 2009 ; Ragin & Becker, 1992 ; Stake, 1995 ; Yin, 2009 ). Current qualitative case study approaches are shaped by paradigm, study design, and selection of methods, and, as a result, case studies in the published literature vary. Differences between published case studies can make it difficult for researchers to define and understand case study as a methodology.

Experienced qualitative researchers have identified case study research as a stand-alone qualitative approach (Denzin & Lincoln, 2011b ). Case study research has a level of flexibility that is not readily offered by other qualitative approaches such as grounded theory or phenomenology. Case studies are designed to suit the case and research question and published case studies demonstrate wide diversity in study design. There are two popular case study approaches in qualitative research. The first, proposed by Stake ( 1995 ) and Merriam ( 2009 ), is situated in a social constructivist paradigm, whereas the second, by Yin ( 2012 ), Flyvbjerg ( 2011 ), and Eisenhardt ( 1989 ), approaches case study from a post-positivist viewpoint. Scholarship from both schools of inquiry has contributed to the popularity of case study and development of theoretical frameworks and principles that characterize the methodology.

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

Definitions of qualitative case study research

Case study research is an investigation and analysis of a single or collective case, intended to capture the complexity of the object of study (Stake, 1995 ). Qualitative case study research, as described by Stake ( 1995 ), draws together “naturalistic, holistic, ethnographic, phenomenological, and biographic research methods” in a bricoleur design, or in his words, “a palette of methods” (Stake, 1995 , pp. xi–xii). Case study methodology maintains deep connections to core values and intentions and is “particularistic, descriptive and heuristic” (Merriam, 2009 , p. 46).

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

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

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

Current methodological issues in qualitative case study research

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

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

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

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

Assessment of rigour

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

Framework for assessing quality in qualitative case study research.

Adapted from Stake ( 1995 , p. 131).

Study design

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

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

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

Search strategy

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

Outcomes of search of qualitative methods journals.

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

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

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

Case study methodology or method

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

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

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

Case study of something particular and case selection

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

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

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

Contextually bound case study

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

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

Article synopsis of case study research using Stake's tradition

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

Article synopsis of case study research using Yin's tradition

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

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

Researcher and case interactions and triangulation

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

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

Study design inconsistent with methodology

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

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

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

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

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

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

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

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

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

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

Limitations of the review

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

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

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

Conflict of interest and funding

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

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Theory and Research in Social Movements: A Critical Review

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Aldon Morris

There has been an expolosion of theoretical and empirical writings on social movements and collective action within the last decade. These writings have triggered debates, a new school of thought, defenses of old schools of thought and advances. Moreover, important research on social movements is being conducted in various disciplines including sociology, political science, history, economics and communications. For example, The Central States Speech Journal (1980) recently devoted an entire volume to social movement articles. Studies of movements and protest transcend national boundaries as epitomized by the Conflict Research Group of the European Consortium for Political Research. This group (Webb et al., 1983) is developing New European perspectives based on a six-nation study of 180 protest groups over a 20-year period (1960-1980) using a resource mobilization perspective. The field of social movements is thriving and contributions are being made from diverse camps. The purpose ...

Pp. 213-244 in Research in Political Sociology. Political Sociology for the 21st Century, vol. 12, edited by B. A. Dobratz, T. Buzzell, and L. K. Waldner. Greenwich: Elsevier Science.

Jorge Cadena-Roa , Pamela Oliver

The Consequences of Social Movements

Ondrej Cisar

lorenzo bosi , Katrin Uba

Jacquelien van Stekelenburg

Katerina Vrablikova

The chapter maps current research on social movements and protest in political science with a special focus on studies that do not fall under “social movement literature.” It examines topics and puzzles, theoretical and analytical approaches, and methods and data that appear in political science scholarship on movements and protest using content analysis of abstracts presented at two political science conferences (APSA 2015 and ECPR 2015). It shows that the two fields—political science and social movement literature developed mainly in sociology—could considerably contribute to each other by (1) combining methodological diversity and flexibility of social movement literature with political science focus on individual-level surveys and (2) by expansion of social movement literature’s focus on political actors and repertoires other than social movements and protest.

The European Experience: A Multi-Perspective History of Modern Europe, 1500–2000

Andrew S . Tompkins

Over the course of the twentieth century, protest and social movements changed dramatically. In the first half of the century, much of the European continent was embroiled in conflict between right- and left-wing movements that sought to take power through revolutionary upheaval. By the end of the Second World War this central conflict had led to very different outcomes, which reconfigured the possibilities and aims of protest according to where it took place. In Southern Europe, right-wing dictatorships ruthlessly persecuted their leftist opponents for decades, but protests around 1968 proved formative for the democratic revolutions that would eventually take place once these regimes were weakened. In the liberal democracies of Western Europe, there was decidedly more scope for protest than there was under dictatorship and, in the 1960s, young people in particular questioned the limits that authorities imposed on both protest and on democracy itself. In Eastern Europe, uprisings against Soviet-style communist dictatorships were violently repressed, but they eventually gave way to forms of dissent and ultimately open protests that called for democracy. Developments across the continent differed greatly by region, but by the end of the twentieth century, there was a general trend that culminated in the fragmentation of political movements, blurring the lines between left and right and simultaneously leading to intense—and inconclusive—contestation over what ‘democracy’ could and should mean.

Jai Kwan Jung

The theory of protest cycles has informed us that the external political environment and the internal competition among social movement organizations are distinct elements leading to the emergence, development, and decline of popular protest. This theory, however, has not been examined systematically. I conduct an event-history analysis to test and refine the theory of protest cycles using a well-known new social movement event dataset. While proposing a general way of operationalizing the core concepts in social movement studies, I show that political opportunity only matters during the initial phase of social movement mobilization, rather than throughout the movement’s lifespan. What explains declining frequencies of protest occurrence during the demobilization phase is the joint effect of two internal factors: the institutionalization of social movements and the growing violence during protests.

International Journal of Politics, Culture and Society

margit mayer

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