Qualitative research design using case studies

Barker et al. (2002:72) write about the foundations of qualitative research:

 Qualitative research uses language as its raw material.

 It aims to study people’s thoughts, experiences, feelings, or use of language in depth and detail.

 The main advantage of qualitative methods is that they enable thick description.

As a new researcher with a small number of participants, I wanted to use my training in psychoanalytic psychotherapy as one way of understanding the detail and processes of the sibling donors’ thoughts and feelings. I looked for a

research method that might allow this. I wanted to use a qualitative rather than a quantitative method in order to obtain this detail and nuance regarding the individual experiences of the sibling donors, as expressed in their narrated accounts using their own language. I work full-time in a busy teenage and young adult oncology department, so I therefore chose to interview sibling donors from that site only. There are approximately 20 bone marrow transplants a year in this unit, and of these up to eight may involve bone marrow donated by a sibling. I was therefore aware that the number of available participants would be limited.

Hollway (2004) and Hollway and Jefferson (2000) have used psychoanalytic techniques in interpretivist research as one way of gathering data sensitive to both external circumstance and internal emotion. Hollway (2004:29) points to the limitations of conventional methods of qualitative enquiry, where ‘the idea of a socially constructed individual… is intolerant of the idea of internal mental states, conscious and unconscious, that are partially independent of language.’

Hollway is writing here of the ‘defended subject’: whilst many participants may not always say what they feel, Hollway is noting the complexity and meaning of conscious and unconscious defences. It may be important to note what such participants do not say, which links to Barker et al.’s (2002) idea of language as

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‘raw material’ to be looked at and studied in detail. To achieve this degree of depth, it is necessary to limit the number of participants. Midgley (2004) points out that although qualitative methods offer rich detail, they lead by their very nature to smaller studies, sometimes involving only a few participants – as with mine. This can leave such studies open to criticism. Vickers (1965) makes a similar argument, saying that whilst generalisation is not possible in case studies, ‘thick description’ is, and from this we gain a rich picture of the subject.

Midgley (2004:106) finds that in recent years criticism of the value of case studies has changed:

Quantitative studies can only show a statistical correlation between two variables (when X happens Y usually happens too), while qualitative approaches can actually help us to understand the causal links by going beyond sheer association to identify causal mechanisms (Y tends to follow X because...).

3.4.1 Multiple and single case studies

Weaver et al. (2015:1) present a powerful reason for more in-depth studies such as case studies:

A shadow represents a dark image or a faint semblance, such as a

trailing presence. In order to prevent sibling donors of hematopoietic cells from feeling that their generous role is cast in shadow, care teams have a meaningful opportunity to bring the experience of sibling donors into the light.

These researchers are describing how sibling donors may have felt – and indeed even been – hidden from view because of the greater interest in the complex medical procedure for recipients. Weaver et al. (2015) encourage further study of and attention to this somewhat hidden group.

In this research design, therefore, in order to look in a more detailed way at this group, I decided to use a number of case studies. Rustin (2001:104–105) addresses the justification for researching single case studies:

Case examples have always been important sources of discovery in sociology… It is because it is through single cases that self-reflection,

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decision and action in human lives can best be explored and represented that the single case study is essential to human understanding.

Rustin refers to the ‘luminosity’ provided through the single case. Other researchers have also referred to the particular power of the case study to

‘illuminate’: ‘the essence of a case study, the central tendency among all types of case study, is that it tries to illuminate a decision or set of decisions: why they were taken, how they were implemented, and with what result’ (Schramm

1971:6). Thomas (2009:115) also uses the analogy of a research study shining a light on or illuminating a particular subject. He states that an interpretive study can also be illuminative: ‘The aim is gain rich, detailed understanding of the case by examining aspects of its detail.’ Thus the small case study would seem to suit the topic of investigating the intimate feelings and emotions felt by sibling bone marrow donors, because it aims to capture the unique qualities of the individual.

Thomas (2009) explains that if one chooses to research a small number of cases, one cannot then generalise one’s findings to the broader population.

Therefore he advises that the participants in such intimate research should be carefully selected on the basis of age and gender, to get as wide a range of participants as possible. I have learnt from my medical colleagues that

adolescent sibling bone marrow donors are relatively few in number; this is due to the fact that adolescents diagnosed with cancer are few in comparison with the adult population. As stated before, a sibling has a one in four chance of being a match, so from the outset the number of participants in the study was likely to be small. The study was therefore designed as a small number of discrete single case studies.

Whilst the case study enables ‘rich, detailed understanding’ (Thomas

2009:115), the understanding can only be of the specific group of participants, and any application of the findings beyond that needs to be made with great caution. James Patrick (1973), a sociologist, wrote a study of a Glasgow gang by actually joining the gang and learning about it from the inside. Geertz (1975:42) criticises the notion of the ‘inside’ researcher, arguing that for the anthropologist, understanding comes not from ‘extraordinary empathy but readily observable symbolic forms… to grasp the unarticulated concepts that

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inform the lives and cultures of other peoples’. Whilst Patrick (1973) could only describe and write about his understanding of one gang, as each gang has its own character, he could hypothesise as to the possible nature of the other gangs he met during that study.

Barker et al. (2002:162) describe small studies using cases as a way of

‘combining research and practice’ which allows clinicians to undertake research within their working practice. They also describe clinicians using a narrative approach, like Freud, or more ‘structured studies using systemic measurement of process and outcome’ (Barker et al. 2002:162). Like Thomas, they note that small studies allow for ‘individual uniqueness and complexity’ (Barker et al.

2002:162), but not generalisation.

Willig (2013:103) makes the distinction between descriptive case studies and explanatory case studies. The first is concerned with ‘providing a detailed description of the phenomenon within its context’, whilst explanatory case studies ‘aim to generate explanations for the occurrences with which they are concerned’. This provides a helpful distinction, and allows the researcher to find a way of investigating particular phenomena or particular and restricted groups such as adolescent sibling bone marrow donors. Willig also describes how because case studies often involve complex human interactions, they can result in the generation of new theories, as with Freud’s descriptions of his

psychoanalytic work.