Shaping Health PolicyCase Study Methods and Analysis

Macfarlane, Fraser; Exworthy, Mark; Willmott, Micky

doi:10.1332/policypress/9781847427588.001.0001

Cited by 12 publications

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“…Case study methods are a recognised and well-established approach to conducting research in a variety of 'real life' settings including health care. 117 Yin defines case study research as 'an empirical study that investigates contemporary phenomena within a real-life context, when the boundaries between the phenomena and context are not clearly evident and which multiple sources of evidence are used' (p. 18). 118 This approach allowed us to employ a range of social science research techniques and designs, mainly qualitative, to gain some in-depth understanding of the nature of engagement between service users, the public and local NHS organisations within their specific organisations.…”

Section: Methodsmentioning

confidence: 99%

Commissioning for long-term conditions: hearing the voice of and engaging users – a qualitative multiple case study

Peckham

Wilson

Williams

et al. 2014

Health Services and Delivery Research

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BackgroundSome 15 million people in England have a long-term condition (LTC) but there is concern about whether or not the NHS meets their needs. To address this, consecutive governments have developed policies aimed at improving service delivery and patient and public engagement and involvement (PPEI). There has been little research that examines the impact or benefit of PPEI in commissioning. This project explored the role and impact of PPEI in commissioning for people with LTCs. The research was undertaken during a period of substantial change in the English NHS, which enabled us to observe how the NHS reforms in England impacted on approaches to PPEI.AimThe aim was to examine how commissioners enable voice and engagement of people with LTCs and identify what impact this has on the commissioning process and pattern of services. Our specific objectives were to (1) critically analyse the relationship between the public/patient voice and the impact on the commissioning process; (2) determine how changes in the commissioning process reshape local services; (3) explore whether or not any such changes in services impact on the patient experience; (4) identify if and how commissioners enable the voice and engagement of people with LTCs; and (5) identify how patient groups/patient representatives get their voice heard and what mechanisms and processes patients and the public use to make their voice heard.MethodsWe used a case study design examining the experience of PPEI in three LTC groups – diabetes, rheumatoid arthritis and neurological conditions – through three in-depth case studies. Our approach involved reviewing practice across the UK and then focusing on three geographical areas to examine practices of commissioning health care for people with LTCs, approaches to PPEI, patterns of services for people with LTCs and the activities of local patient and voluntary organisations for people with LTCs. The research had five phases and involved participatory and interactive methods of data collection and analysis.FindingsWe identified two key areas where improvements to practice in relation to PPEI can be made. The first relates to the framework or infrastructure arrangements for PPEI and how PPEI can be supported in the NHS and other organisations. To combat short-termism and the fragility of PPEI activities, sufficient resources need to be invested in developing shared understandings and sustaining relationships and infrastructures. The second area of action relates to the process for PPEI and how it should be undertaken.ConclusionAction needs to be taken by organisations at both national and local levels. PPEI is a circular process and, in itself, extremely fragile. This circular process can be ‘virtuous’– successful engagement leads to improved involvement and outcomes. However, where involvement is tokenistic or ends, patients and the public become disengaged and less involved and can be described as a ‘vicious circle’. In addition, we identified a number of key methodological issues and areas for further research that should be considered by research funders and researchers undertaking research in the area of PPEI, including a need for research on PPEI with young people.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Methodsmentioning

confidence: 99%

Commissioning for long-term conditions: hearing the voice of and engaging users – a qualitative multiple case study

Peckham

Wilson

Williams

et al. 2014

Health Services and Delivery Research

Self Cite

View full text Add to dashboard Cite

show abstract

“…145 Yin 146 defines case study research as 'an empirical study that investigates contemporary phenomena within a real life context, when the boundaries between the phenomena and context are not clearly evident and which multiple sources of evidence are used' (p. 18). This approach allowed us to employ a range of social science research techniques and designs, mainly qualitative, to gain in-depth understanding of the nature of engagement between service users, the public and local NHS organisations within their specific organisations.…”

Section: Stage 3: Case Studiesmentioning

confidence: 99%

ReseArch with Patient and Public invOlvement: a RealisT evaluation – the RAPPORT study

Wilson

Mathie

Keenan

et al. 2015

Health Serv Deliv Res

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226

281

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BackgroundPatient and public involvement (PPI) is a prerequisite for many funding bodies and NHS research ethics approval. PPI in research is defined as research carried out with or by the public rather than to, about or for them. While the benefits of PPI have been widely discussed, there is a lack of evidence on the impact and outcomes of PPI in research.ObjectivesTo determine the types of PPI in funded research, describe key processes, analyse the contextual and temporal dynamics of PPI and explore the experience of PPI in research for all those involved. Mechanisms contributing to the routine incorporation of PPI in the research process were assessed, the impact of PPI on research processes and outcomes evaluated, and barriers and enablers to effective PPI identified.DesignA three-staged realist evaluation drawing on Normalisation Process Theory to understand how far PPI was embedded within health-care research in six areas: diabetes mellitus, arthritis, cystic fibrosis, dementia, public health and learning disabilities. The first two stages comprised a scoping exercise and online survey to chief investigators to assess current PPI activity. The third stage consisted of case studies tracked over 18 months through interviews and document analysis. The research was conducted in four regions of England.ParticipantsNon-commercial studies currently running or completed within the previous 2 years eligible for adoption on the UK Clinical Research Network portfolio. A total of 129 case study participants included researchers and PPI representatives from 22 research studies, and representatives from funding bodies and PPI networks.ResultsIn the scoping 51% (n = 92) of studies had evidence of PPI and in the survey 79% (n = 80), with funder requirements and study design the strongest influence on the extent of PPI. There was little transparency about PPI in publicly accessible information. In case studies, context–mechanism–outcome configurations suggested that six salient actions were required for effective PPI. These were a clear purpose, role and structure for PPI; ensuring diversity; whole research team engagement with PPI; mutual understanding and trust between the researchers and lay representatives; ensuring opportunities for PPI throughout the research process; and reflecting on, appraising and evaluating PPI within a research study. PPI models included a ‘one-off’ model with limited PPI, a fully intertwined model in which PPI was fully embedded and an outreach model with lay representatives linking to broader communities. Enabling contexts included funder, topic/design, resources, research host, organisation of PPI and, most importantly, relationships. In some case studies, lack of coherence in defining PPI persisted, with evidence of a dual role of PPI representative/study participant. Evidence of PPI outcomes included changes to study design, improvements to recruitment materials and rates, and dissemination.ConclusionsSix salient actions were required for effective PPI and were characterised by a shared understanding of moral and methodological purposes of PPI, a key individual co-ordinating PPI, ensuring diversity, a research team positive about PPI input and fully engaged with it, based on relationships that were established and maintained over time, and PPI being evaluated in a proactive and systematic approach. Future work recommendations include exploring the impact of virtual PPI, cost analysis and economic evaluation of the different models of PPI, and a longer-term follow-up study of the outcomes of PPI on research findings and impact on services and clinical practice.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…This study adopted methods appropriate to case study research on a programme oriented to strategic change [21]. In the initial stage of the research, we asked leads from the staff delivery team to develop a programme logic model [22] setting out how activity components and processes were intended to lead to impacts.…”

Section: Methodsmentioning

confidence: 99%

Every City a Food Growing City? What Food Growing Schools London Reveals about City Strategies for Food System Sustainability

2018

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Cities have emerged as leaders in food system innovation and transformation, but their potential can be limited by the absence of supportive governance arrangements. This study examined the value of Food Growing Schools London (FGSL) as a programme seeking city-wide change through focusing on one dimension of the food system. Mixed methods case study research sought to identify high-level success factors and challenges. Findings demonstrate FGSL’s success in promoting food growing by connecting and amplifying formerly isolated activities. Schools valued the programme’s expertise and networking opportunities, whilst strategic engagement facilitated new partnerships linking food growing to other policy priorities. Challenges included food growing’s marginality amongst priorities that direct school and borough activity. Progress depended on support from individual local actors so varied across the city. London-wide progress was limited by the absence of policy levers at the city level. Experience from FGSL highlights how city food strategies remain constrained by national policy contexts, but suggests they may gain traction through focusing on well-delineated, straightforward activities that hold public appeal. Sustainability outcomes might then be extended through a staged approach using this as a platform from which to address other food issues.

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Shaping Health PolicyCase Study Methods and Analysis

Cited by 12 publications

References 0 publications

Commissioning for long-term conditions: hearing the voice of and engaging users – a qualitative multiple case study

Commissioning for long-term conditions: hearing the voice of and engaging users – a qualitative multiple case study

ReseArch with Patient and Public invOlvement: a RealisT evaluation – the RAPPORT study

Every City a Food Growing City? What Food Growing Schools London Reveals about City Strategies for Food System Sustainability

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