Highlights of case study prototypes in relation to this study

Stake (1995) categorised the case study approach into three main types:

intrinsic, instrumental and collective case studies.

The intrinsic case study deals with peculiar, atypical or unique phenomena.

This does not necessarily follow any particular trend; rather, it is selected on its own merit and is a source of interest to the researcher for examination. This could be exemplified by a study that examines ‘couplehood’ in dementia (Hellstrom et al. 2005; Anandan et al. 2010). Following this example, the current research cannot be said to be an intrinsic case study for several reasons. For example, the MDGs and workplace health promotion programmes are global and contemporary phenomena in which all stakeholders are expected to participate. As a result, the study did not follow an atypical trend.

The instrumental case study serves as a steppingstone to gain a better understanding of an event, situation or phenomenon. The case is not the primary reason for the study but helps to explain other events, issues or phenomena or offers an explanation of a theory. An example is a study (Luck et al. 2007) conducted on potential violence by patients in an emergency department, which explored its possible cause(s). The current study is a form of instrumental case study, which explored the contributions of the organisations studied to the realisation of the MDGs (MDGs) in Nigeria. Assessment of the contributions of participating industries to the realisation of the MDGs was the primary reason for the study, but not the exploration of disease prevention efforts and identification of workplace health promotion programmes at the institutions of study.

Specifically, exploring disease prevention efforts and identifying workplace health promotion programmes were instrumental in the identification of contributions made by the organisations studied to the achievement of the MDGs.

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The collective case study involves multiple cases with opportunity for a wider and varied understanding of a particular issue or event – for example, the study in which Scheib (2003) examined the role of stress in the professional life of the school music teacher, and one that examined the effect of the introduction of electronic health records instead of paper-based records into NHS systems in the UK (Robertson et al. 2012). The latter (for instance) involved five NHS acute and mental health trusts. Thus, it allowed varied analysis of the implementation of the new technique (electronic health records) in record systems in the UK.

The present research could also be described as a collective case study that allowed the opportunity to examine the variation in efforts directed at combating the predominantly reported diseases in the corporate, non-health institutions studied. Consequently, this was intended to explore their contributions to the attainment of the MDGs in Nigeria. In addition, it granted the opportunity to examine the morbidity and mortality differences between genders at the two non-health, corporate ‘healthy organisations’.

Another classification was provided by Flyvberg (2006), who categorised case studies as extreme, maximum variation, critical and paradigmatic. Each of these is outlined below.

An extreme or deviant case study is reported to be useful in investigating unusual or peculiar situations, events or phenomena. These could be extremely good or bad cases. It is similar to the intrinsic case study described in the previous paragraphs. This research does not share this attribute. Maximum variation cases are used to obtain information about various dimensions of the case, process and outcome. For instance, information from five or six different cases could be sought with reference to a particular issue such as location and budget. This study is designed to explore maximum variation. All the secretaries and their line managers were approached to take part in the study and were from different geopolitical zones in Nigeria. The Nigerian government has federal character policies for work appointments. However, as a backup plan, convenience sampling existed to recruit participants in a situation where there is a clear lack of representation from a given geopolitical zones during the fieldwork. Hence, an arrangement was put in place to ensure maximum variation in such circumstances. However, there was no need for it as participants

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represented the varied geopolitical zones in the country. Critical cases involve logical deduction and are confirmatory of a given phenomenon event or situation. The research shares this attribute by exploring the contributions of healthy organisations to the realisation of the MDGs in Nigeria. The importance of HWs and healthy employees to productivity and organisational performance has been well researched and documented in the literature. The researcher sought approval of case organisations deemed to have the necessary and sustainable structure (Occupational Health and policy) to ensure health protection and maintenance among the workforce. They were ‘HWs’, contributing to preventing, reducing and combating disease at their institutions.

Paradigmatic cases allow the establishment of a school of thought within the domain of study and thus require the setting of standards. This study does not share these characteristics. It did not set out to form a standard or form any school of thought. Findings from these studies are within the context of and are peculiar to the two studied case organisations.

Robson (2011) classified case studies into two broad categories – holistic (single) and multiple. In multiple case studies, theory suggests the same or a predictable different result. Moreover, Robson further classified single case studies into seven categories: individual, organisational and institutional, set of individual case studies, cross-national, social groups, community, and events, roles and relationships. These categorisations are as explained below.

An individual case study is a holistic picture of a person, event or process with a linkage to cause and effect. This study partly shares this attribute. It was intended to describe the WHPPs at each of the two organisations within their contextual environment and the resultant effects on the achievement of MDGs 3 and 6. Organisational and institutional case studies involve places such as workplaces and schools. They are similar to individual case studies, described above, but encompass multiple versions of individual case studies.

This type examines best practice or evaluates policies, change processes or adaptations to new procedures. This study explored the ways in which the two participating organisations prevented and combated disease in their workplace.

Consequently, the study assessed best practice in disease prevention and the

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resultant effects on the achievement of goals 3 and 6 of the MDGs. Hence, this study could be grouped under this category. Sets of individual case studies deal with more than one similar trait studied. The study shares this attribute because it examined the morbidity and mortality patterns of some selected health problems–diabetes, hypertension, malaria and morbid obesity (among others). This is in addition to the common health problems identified at each of the two participant institutions. The aim was to describe the two organisations individually within their contextual environment. Multiple variables were studied.

For instance, the different types of workplace health promotion programmes targeted at the commonly reported health problems (including diabetes, hypertension, malaria and morbid obesity) were examined. The WHPPs included fitness programmes, counselling services, health information and health education services as provided by the occupational health services at the organisations studied. A cross-national case study involves a comparative study of national governments and their policies. This study is defined within the national context of Nigeria, although using an international guideline – the UN-MDGs–as a benchmark to determine the performances of the two case institutions. This study partly shares the features of this prototype. A social group case study deals with a family or a particular case, as demonstrated in Anandan et al. (2010), which determined reasons for differences in recruitment rates of minority ethnic people in asthma research. This research is multi-professional and not specific to a particular familial trait or social group.

Additionally, the study involved transnational establishments, and, as such, could not be classified as a social group case study. A community case study is usually descriptive and sometimes exploratory. It focuses on patterns of and relationships between major aspects of the studied community–for example, family and work. This study shares some attributes of this. Case organisations are subsets of the community studied. Events, roles and relationships case studies are exemplified by studies undertaken to examine the doctor–patient relationship (Robson 2011). This research is not a role-relationship study. The research determined the achievement by two corporate institutions in disease prevention and in ensuring gender equality in health matters at work. Also, Yin (2009) outlined types of single case study as holistic, critical and extreme.

Holistic: involves a single study but one representing a global picture. This

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study cannot be said to be holistic. The study is in the context of the Nigerian environment. It only described the activities and disease prevention efforts of the two organisations studied. Extreme case: this is a rare form of study emerging from simple and holistic cases. It provides the basis for subsequent possibilities. This study does not share this attribute, as highlighted in the above paragraph. Critical case: the expected outcome supports the known theory, in this prototype. It is a type of case study that accepts or rejects a known theory – for instance, a study that sets out to investigate the effect of organic solvents on workers as a cause of brain damage, and examines an enterprise that follows strictly all the health, safety and environmental guidance on air quality management. Such a studied enterprise is referred to as a critical case enterprise (Flyvberg 2006). This study shares a feature of a critical case in the choice of industries with occupational health services. In addition, these workplaces involved in both proactive and reactive measures to curtail disease and thus sustain or maintain workers’ health. As a result, the study, sharing feature of critical case study was used to confirm the effects of implementing proactive and reactive workplace health measures on curtailing diseases at work.

Merriam (2002) categorised case studies as particularistic, descriptive and heuristic. These are as highlighted below.

A particularistic case study concentrates on specifics. It concentrates on a given concept or idea, examining multiple variables and units of analysis. This study shares some of these features as it was designed to focus on efforts by participant organisations to combat diseases (including diabetes, hypertension, morbid obesity and malaria as a unit of analysis). A descriptive case study has the features of an in-depth explanation of event(s). This is exemplified in a study (Tolson et al. 2002) that dealt with coping mechanisms during menstruation by women with Parkinson’s disease. Participants from the two corporate institutions in this study gave accounts of their experiences and knowledge of disease prevention efforts in the workplace. Additionally, the respondents were able to give these accounts in relation to their gender needs. A heuristic case study leads to the production of new meaning and understanding. This study does not have this attribute.

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Yin (2003) also described various types of case study: explanatory, exploratory, descriptive and multiple (collective).

The explanatory case study describes a programme and its effects. It is useful for complex life phenomena that cannot be addressed by survey and experimental study. This is exemplified in a study by Joia (2002) that analysed the effects of web-based learning in a community in Brazil. The present study shares this attribute. The exploratory case study is used to examine interventions with uncertain and varied output or results, as seen in a study by Lotzkar and Bottorff (2001) on the development of the relationship between nurse and patient. Multiple (collective) case studies allow the researcher to examine phenomena or interventions from various and diverse perspectives with comparison within and between cases. The predicted, observed or contrasted trends are usually theory based. The current study shares this feature by involving more than one organisation, with the opportunity to look within and across the two cases of study.

From the foregoing, this study can be explained as following the eclectic case study categorisation. For instance, it can be referred to as an instrumental case study, because the phenomena studied (disease prevention and practice of gender equality in health matters) served as a stepping stone to gain better understanding of another phenomenon (contributions of case organisations to MDGs’ success). The study explored the contributions of organisations to the achievements of the MDGs (MDGs) in Nigeria. The influences of participating industries on the achievement of the MDGs were the primary reasons for the study, but not the exploration of disease prevention efforts or identification of workplace health promotion programmes. Specifically, exploring the disease prevention efforts and identifying workplace health promotion programmes were instrumental in the identification of contributions made by the case organisations to the realisation of the MDGs. Also, the study is exploratory because it examined interventions (workplace health promotion programmes in preventing and combating disease at work) with varied outputs. Furthermore, this study can be referred to as organisational because it involved workplaces. It is multiple because of the opportunity for comparison within and across cases. Also, it is an occupational health case study because it was conducted within this field of

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In summary, the study utilised eclectic categorisation with attributes related to nearly all the highlighted prototypes, as demonstrated in the previous paragraphs. So, this study can be classified as an instrumental, exploratory, organisational, multiple occupational health case study of two healthy organisations in Nigeria.