Multiple-Case Designs - SAGE Research Methods


multiple case study design

A case study is a methodological approach that involves the in-depth exploration of a specific bounded system, utilizing multiple forms of data collection to systemically gather information on how the system operates or functions. May 16,  · A multiple case study design was conducted that included four Family Health Team sites within the province of Ontario, Canada. Case study research seeks to investigate real life experiences within the context in which it occurs and involves the collection of detailed information using a variety of data collection methods []. As there are Cited by: The choice of the case study design depends on the object and subject of the research. For this, you may refer to Thomas and Myers (Thomas, G. and Myers, K., The anatomy of the case study.

Multiple case studies research design | Business OSHW

For over two decades occupational therapists have been encouraged to enhance their roles within primary care and focus on health promotion and prevention activities.

While there is a clear fit between occupational therapy and primary care, there have been few practice examples, despite a growing body of evidence to support the role. Inthe province of Ontario, Canada provided funding to include occupational therapists as members of Family Health Teams, an interprofessional model of primary care.

The integration of occupational therapists into this model of primary care is one of the first large scale initiatives of its kind in North America. The objective of the study was to examine how occupational therapy services are being integrated into primary care teams and understand the structures supporting the integration. A multiple case study design was used to provide an in-depth description of the integration of occupational therapy.

Four Family Health Teams with occupational therapists as part of the team were identified. Data collection included in-depth interviews, document analyses, multiple case study design, and questionnaires. Each Family Health Team had a unique organizational structure that contributed to the integration of occupational therapy. Communication, trust and understanding of occupational therapy were key elements in the integration of occupational therapy into Family Health Teams, and were supported by a number of strategies including co-location, multiple case study design, electronic medical records and team multiple case study design. An understanding of occupational therapy was critical for integration into the team and physicians were less likely to understand the occupational therapy role than other health providers.

With an increased emphasis on interprofessional primary care, new professions will be integrated into primary healthcare teams. The study found that explicit strategies and structures are required to facilitate the integration of a new professional group. An understanding of professional roles, trust and communication are foundations for interprofessional collaborative practice.

Multiple case study design is multiple case study design clear fit between occupational therapy OT and primary care. Both view health in a holistic manner and seek to support individuals and communities in achieving and maintaining a healthy lifestyle [ 12 ]. While there is evidence to support the role of occupational therapy in health promotion and prevention, multiple case study design, there have been few practice examples of occupational therapy within primary care settings [ 34 ].

The lack of an occupational therapy presence in primary care can be attributed to a number of factors [ 5 ]. First and foremost, there has not been funding for occupational therapy in primary care, both in Canada and internationally [ 5 ]. Second, primary care has traditionally been delivered in solo practitioner models [ 6 ]. Finally, the occupational therapy profession has traditionally focused on the rehabilitation or remediation of function versus health promotion [ 7 ].

Inthe First Ministers of Canada committed to ensuring that half of Canadians would have access to multidisciplinary primary care teams by [ 8 ], multiple case study design.

Each Family Health Team is interprofessional in nature; however there is considerable variability in structure, size and organizational dimensions. A Family Health Team may consist of a single site or may be comprised of multiple offices that have common programs or structures such as an electronic medical record EMRprograms and management. The complement of interdisciplinary health professionals also varies according to the specific needs of the community. While the initial list of funded interdisciplinary health providers did not include occupational therapists, in March the Ontario government committed funds to include occupational therapy services in Family Health Teams [ 10 ].

At the initiation of the study, 20 teams had occupational therapists within their team complement. A growing number of national and international studies have documented the structures and processes to support interprofessional primary care teams [ 1112 ].

However, few of these studies have included occupational therapy within the team complement and no study has exclusively examined the implementation of occupational therapy into a new or existing primary care team.

A handful of articles have examined the integration of other professionals into primary care teams [ 13 - 15 ]. While these findings might provide insights for occupational therapy, each profession entering primary care will have unique features and support the team through unique roles. Occupational therapists have a long history in working in team- based environments and therefore the implementation of occupational therapy services may be experienced differently than professions that have been primarily consultative.

Interprofessional teams are poised to play a greater role in the delivery of primary care in Canada and abroad [ 1617 ]. It is anticipated that more disciplines will continue to enter primary care, making it critical to understand how professionals are being introduced into primary care teams. The purpose of the paper is to examine how occupational therapy is being integrated into primary care teams and understand the structures and processes supporting the integration.

The study aimed to explore the primary guiding question: What structures and processes support the integration of occupational therapy in Family Health Teams? A multiple case study design [ 18 ] was conducted that included four Family Health Team sites within the province of Ontario, Canada.

Case study research seeks to investigate real life experiences within the context in which it occurs and involves the collection of detailed information using a variety of multiple case study design collection methods [ 18 - 20 ].

As there are few documented examples of occupational therapists in primary care, a case study design enabled an in-depth exploration of how occupational therapy was being integrated into interprofessional primary care teams. As per case study methodology as outlined by Yin [ 18 ], each case provided an opportunity for the replication of the outlined questions and methods.

Four cases Family Health Teams were identified from the approximately 20 that employed occupational therapists at the time of the study. The sites were chosen to reflect different dimensions of service provision that may influence the role and integration of occupational therapy. The literature on interprofessional collaborative practice has identified certain elements that support interprofessional collaborative care, including: 1 EMR, 2 team size, and 3 co-location of health professionals [ 613 ].

Each dimension was considered in the identification of the cases. Two further dimensions were considered in the case selection; multiple case study design versus community and rural versus urban. While there is little evidence examining the role of occupational therapist in primary care, the literature has described occupational therapy working with a wide range of client populations and conditions [ 4 ].

Therefore the nature and duration of clinical experience of occupational therapist as well as the full-time equivalency FTE were also thought to be important elements to consider in the identification of cases.

Purposeful sampling of sites was used with the intent to sample breadth of communities, teams, and occupational therapists. Information letters were sent to the Executive Director at each site describing the study and seeking approval for participation. All occupational therapists working at the Family Health Teams were asked to participate. The Executive Director and the lead physician were also invited due to their leadership and decision making roles on the team.

In addition, any member of the team that provided collaborative patient care with the occupational therapist was also considered to be eligible for the study. The occupational therapist s at each Family Health Team acted as the main contact for liaising and coordinating interviews multiple case study design the staff. Data collection drew on multiple forms of evidence including semi-structured interviews, document analyses and questionnaires.

The principal investigator CD visited each Family Health Team to retrieve documents for analyses, distribute questionnaires and conduct interviews with key informants. All interviews were conducted between the February-May using a semi-structured interview guide. Questions were developed by the research team and were informed by the literature on interprofessional collaborative primary care [ 1112 ].

Questions fell under five broad categories including; roles how would you describe your role, how did you establish your rolephysical space i.

Additional questions regarding funding for occupational therapy were included in the interview guide for the Executive Director and questions related to clinical practice were removed. Program documents included job descriptions, occupational therapy assessments, team mission and vision.

The web pages of each Family Health Team were viewed to obtain further information about team collaboration, and sites were contacted if further questions about the nature of occupational therapy services were identified. Two sites were contacted to clarify demographic information number of sites and number of physicians and the occupational therapist s at each site was contacted to provide further details on the referral process to occupational therapy, multiple case study design.

A Family Health Team Profile was completed by each Executive Director to obtain descriptive information about multiple case study design Family Health Team demographics, including the type of electronic medical record system, multiple case study design, number of rostered patients and health professional make-up.

An Occupational Therapy Profile was completed by each occupational therapist to obtain information about their educational background and work experiences, multiple case study design. Both within-case and cross-case analyses were conducted [ 18multiple case study design, 19 multiple case study design. Pattern matching was then used as the overall analytic strategy.

Propositions for this study were derived from the literature on interprofessional collaborative practice. A number of factors have been found to support interprofesional practice.

This was felt to be particularly relevant for the study as occupational therapists were new professionals within the teams. Studies have also identified the nature of team processes and organizational structures to be important influences on collaboration, and the nature of team processes was anticipated to influence the integration of occupational therapy [ 21 ].

The use of electronic medical records EMR have become standard in Family Health Teams in Ontario, Canada [ 22 ] and have already been found to support internal communication. Therefore, the two study propositions were:. Integration of occupational therapy into the Family Health Team will depend on the understanding of the occupational therapy role by team members, and structures to support interprofessional collaborative practice.

Each case was first analyzed individually, multiple case study design, followed by cross-site analyses to determine common themes [ 19 ]. Data obtained from documents were extracted using apriori document analysis forms. Tables and matrixes were used to visually examine the data for each case and across cases.

Qualitative interview data were digitally recorded and transcribed verbatim by a research assistant, multiple case study design.

Atlas ti, a qualitative data analysis and research software program, was used to code data and identify themes both within and across cases. All transcripts were read and re-read by the primary author and preliminary codes were established. A number of strategies were used to establish trustworthiness [ 2324 ]. Four transcripts were read and independently coded by a second investigator LL using the preliminary coding structure.

Transcripts were selected from four different health professions to ensure the coding structure could be applied across transcripts. Any discrepancies in multiple case study design were noted and discussed until consensus was reached. Two revisions to the coding structure were made; the first involved collapsing two codes into one code, the second revision involved renaming a code to better reflect the essence of the statements being captured.

A second strategy to establish trustworthiness involved member checking. Occupational therapists were provided with a preliminary summary of their site and asked to contact the primary author if any errors were noted, or if additional information should multiple case study design included. None of the participants reported any errors or provided further information. A third strategy involved triangulation of data methods, sources and investigators. The study included a number of data methods including interviews, multiple case study design, questionnaires and document analyses.

Each contributed to the understanding of how occupational therapists are integrated into primary care and structures to support the integration. Participants included members from a range of disciplines across four sites in order to provide different perspectives and experiences on the integration of occupational therapists. Finally, the investigation team was made up four occupational therapists; two multiple case study design CD, LLone administrative CB and one clinician working in primary care CC.

The diversity of the team brought unique perspectives to the design, implementation and analyses and grounded the study in both research and practice. Patient rosters ranged from 7, to 42, multiple case study design, patients and sites were located in both rural and urban centres.

Three sites were community sites and one was an academic site. Occupational therapists in two sites had less than five years experience, while two sites had occupational therapists with 15 and more years of experience. Each site had multiple case study design unique complement of health providers, which included: chiropodists, psychologists, social workers, dieticians, physician assistants, multiple case study design, pharmacists, patient educators, mental health workers, health promoters, respiratory therapists, case managers, nurses, nurse practitioners, and physicians.

In case one the occupational therapists along with the interdisciplinary multiple case study design providers and administrative staff were located in two buildings in the largest regional town, while the physicians worked in distributed clinics across the region. Despite the lack of co-location each key informant reported a strong sense of collaboration and connection.



multiple case study design


The choice of the case study design depends on the object and subject of the research. For this, you may refer to Thomas and Myers (Thomas, G. and Myers, K., The anatomy of the case study. case study report ♦ do pattern matching ♦ do explanation building ♦ address rival explanations ♦ use logic models ♦ use theory in single-case studies ♦ use replication logic in multiple-case studies ♦ use case study protocol ♦ develop case study database Phase of research in which tactic occurs data collection data collection. May 16,  · A multiple case study design was conducted that included four Family Health Team sites within the province of Ontario, Canada. Case study research seeks to investigate real life experiences within the context in which it occurs and involves the collection of detailed information using a variety of data collection methods []. As there are Cited by: