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Blog Business How to Present a Case Study like a Pro (With Examples)

How to Present a Case Study like a Pro (With Examples)

Written by: Danesh Ramuthi Sep 07, 2023

Okay, let’s get real: case studies can be kinda snooze-worthy. But guess what? They don’t have to be!

In this article, I will cover every element that transforms a mere report into a compelling case study, from selecting the right metrics to using persuasive narrative techniques.

And if you’re feeling a little lost, don’t worry! There are cool tools like Venngage’s Case Study Creator to help you whip up something awesome, even if you’re short on time. Plus, the pre-designed case study templates are like instant polish because let’s be honest, everyone loves a shortcut.

Click to jump ahead: 

What is a case study presentation?

What is the purpose of presenting a case study, how to structure a case study presentation, how long should a case study presentation be, 5 case study presentation examples with templates, 6 tips for delivering an effective case study presentation, 5 common mistakes to avoid in a case study presentation, how to present a case study faqs.

A case study presentation involves a comprehensive examination of a specific subject, which could range from an individual, group, location, event, organization or phenomenon.

They’re like puzzles you get to solve with the audience, all while making you think outside the box.

Unlike a basic report or whitepaper, the purpose of a case study presentation is to stimulate critical thinking among the viewers. 

The primary objective of a case study is to provide an extensive and profound comprehension of the chosen topic. You don’t just throw numbers at your audience. You use examples and real-life cases to make you think and see things from different angles.

The primary purpose of presenting a case study is to offer a comprehensive, evidence-based argument that informs, persuades and engages your audience.

Here’s the juicy part: presenting that case study can be your secret weapon. Whether you’re pitching a groundbreaking idea to a room full of suits or trying to impress your professor with your A-game, a well-crafted case study can be the magic dust that sprinkles brilliance over your words.

Think of it like digging into a puzzle you can’t quite crack . A case study lets you explore every piece, turn it over and see how it fits together. This close-up look helps you understand the whole picture, not just a blurry snapshot.

It’s also your chance to showcase how you analyze things, step by step, until you reach a conclusion. It’s all about being open and honest about how you got there.

Besides, presenting a case study gives you an opportunity to connect data and real-world scenarios in a compelling narrative. It helps to make your argument more relatable and accessible, increasing its impact on your audience.

One of the contexts where case studies can be very helpful is during the job interview. In some job interviews, you as candidates may be asked to present a case study as part of the selection process.

Having a case study presentation prepared allows the candidate to demonstrate their ability to understand complex issues, formulate strategies and communicate their ideas effectively.

The way you present a case study can make all the difference in how it’s received. A well-structured presentation not only holds the attention of your audience but also ensures that your key points are communicated clearly and effectively.

In this section, let’s go through the key steps that’ll help you structure your case study presentation for maximum impact.

Let’s get into it. 

Open with an introductory overview 

Start by introducing the subject of your case study and its relevance. Explain why this case study is important and who would benefit from the insights gained. This is your opportunity to grab your audience’s attention.

Explain the problem in question

Dive into the problem or challenge that the case study focuses on. Provide enough background information for the audience to understand the issue. If possible, quantify the problem using data or metrics to show the magnitude or severity.

Detail the solutions to solve the problem

After outlining the problem, describe the steps taken to find a solution. This could include the methodology, any experiments or tests performed and the options that were considered. Make sure to elaborate on why the final solution was chosen over the others.

Key stakeholders Involved

Talk about the individuals, groups or organizations that were directly impacted by or involved in the problem and its solution. 

Stakeholders may experience a range of outcomes—some may benefit, while others could face setbacks.

For example, in a business transformation case study, employees could face job relocations or changes in work culture, while shareholders might be looking at potential gains or losses.

Discuss the key results & outcomes

Discuss the results of implementing the solution. Use data and metrics to back up your statements. Did the solution meet its objectives? What impact did it have on the stakeholders? Be honest about any setbacks or areas for improvement as well.

Include visuals to support your analysis

Visual aids can be incredibly effective in helping your audience grasp complex issues. Utilize charts, graphs, images or video clips to supplement your points. Make sure to explain each visual and how it contributes to your overall argument.

Pie charts illustrate the proportion of different components within a whole, useful for visualizing market share, budget allocation or user demographics.

This is particularly useful especially if you’re displaying survey results in your case study presentation.

Stacked charts on the other hand are perfect for visualizing composition and trends. This is great for analyzing things like customer demographics, product breakdowns or budget allocation in your case study.

Consider this example of a stacked bar chart template. It provides a straightforward summary of the top-selling cake flavors across various locations, offering a quick and comprehensive view of the data.

Not the chart you’re looking for? Browse Venngage’s gallery of chart templates to find the perfect one that’ll captivate your audience and level up your data storytelling.

Recommendations and next steps

Wrap up by providing recommendations based on the case study findings. Outline the next steps that stakeholders should take to either expand on the success of the project or address any remaining challenges.

Acknowledgments and references

Thank the people who contributed to the case study and helped in the problem-solving process. Cite any external resources, reports or data sets that contributed to your analysis.

Feedback & Q&A session

Open the floor for questions and feedback from your audience. This allows for further discussion and can provide additional insights that may not have been considered previously.

Closing remarks

Conclude the presentation by summarizing the key points and emphasizing the takeaways. Thank your audience for their time and participation and express your willingness to engage in further discussions or collaborations on the subject.

Well, the length of a case study presentation can vary depending on the complexity of the topic and the needs of your audience. However, a typical business or academic presentation often lasts between 15 to 30 minutes. 

This time frame usually allows for a thorough explanation of the case while maintaining audience engagement. However, always consider leaving a few minutes at the end for a Q&A session to address any questions or clarify points made during the presentation.

When it comes to presenting a compelling case study, having a well-structured template can be a game-changer. 

It helps you organize your thoughts, data and findings in a coherent and visually pleasing manner. 

Not all case studies are created equal and different scenarios require distinct approaches for maximum impact. 

To save you time and effort, I have curated a list of 5 versatile case study presentation templates, each designed for specific needs and audiences. 

Here are some best case study presentation examples that showcase effective strategies for engaging your audience and conveying complex information clearly.

1 . Lab report case study template

Ever feel like your research gets lost in a world of endless numbers and jargon? Lab case studies are your way out!

Think of it as building a bridge between your cool experiment and everyone else. It’s more than just reporting results – it’s explaining the “why” and “how” in a way that grabs attention and makes sense.

This lap report template acts as a blueprint for your report, guiding you through each essential section (introduction, methods, results, etc.) in a logical order.

Want to present your research like a pro? Browse our research presentation template gallery for creative inspiration!

2. Product case study template

It’s time you ditch those boring slideshows and bullet points because I’ve got a better way to win over clients: product case study templates.

Instead of just listing features and benefits, you get to create a clear and concise story that shows potential clients exactly what your product can do for them. It’s like painting a picture they can easily visualize, helping them understand the value your product brings to the table.

Grab the template below, fill in the details, and watch as your product’s impact comes to life!

3. Content marketing case study template

In digital marketing, showcasing your accomplishments is as vital as achieving them. 

A well-crafted case study not only acts as a testament to your successes but can also serve as an instructional tool for others. 

With this coral content marketing case study template—a perfect blend of vibrant design and structured documentation, you can narrate your marketing triumphs effectively.

4. Case study psychology template

Understanding how people tick is one of psychology’s biggest quests and case studies are like magnifying glasses for the mind. They offer in-depth looks at real-life behaviors, emotions and thought processes, revealing fascinating insights into what makes us human.

Writing a top-notch case study, though, can be a challenge. It requires careful organization, clear presentation and meticulous attention to detail. That’s where a good case study psychology template comes in handy.

Think of it as a helpful guide, taking care of formatting and structure while you focus on the juicy content. No more wrestling with layouts or margins – just pour your research magic into crafting a compelling narrative.

5. Lead generation case study template

Lead generation can be a real head-scratcher. But here’s a little help: a lead generation case study.

Think of it like a friendly handshake and a confident resume all rolled into one. It’s your chance to showcase your expertise, share real-world successes and offer valuable insights. Potential clients get to see your track record, understand your approach and decide if you’re the right fit.

No need to start from scratch, though. This lead generation case study template guides you step-by-step through crafting a clear, compelling narrative that highlights your wins and offers actionable tips for others. Fill in the gaps with your specific data and strategies, and voilà! You’ve got a powerful tool to attract new customers.

Related: 15+ Professional Case Study Examples [Design Tips + Templates]

So, you’ve spent hours crafting the perfect case study and are now tasked with presenting it. Crafting the case study is only half the battle; delivering it effectively is equally important. 

Whether you’re facing a room of executives, academics or potential clients, how you present your findings can make a significant difference in how your work is received. 

Forget boring reports and snooze-inducing presentations! Let’s make your case study sing. Here are some key pointers to turn information into an engaging and persuasive performance:

• Know your audience : Tailor your presentation to the knowledge level and interests of your audience. Remember to use language and examples that resonate with them.
• Rehearse : Rehearsing your case study presentation is the key to a smooth delivery and for ensuring that you stay within the allotted time. Practice helps you fine-tune your pacing, hone your speaking skills with good word pronunciations and become comfortable with the material, leading to a more confident, conversational and effective presentation.
• Start strong : Open with a compelling introduction that grabs your audience’s attention. You might want to use an interesting statistic, a provocative question or a brief story that sets the stage for your case study.
• Be clear and concise : Avoid jargon and overly complex sentences. Get to the point quickly and stay focused on your objectives.
• Use visual aids : Incorporate slides with graphics, charts or videos to supplement your verbal presentation. Make sure they are easy to read and understand.
• Tell a story : Use storytelling techniques to make the case study more engaging. A well-told narrative can help you make complex data more relatable and easier to digest.

Ditching the dry reports and slide decks? Venngage’s case study templates let you wow customers with your solutions and gain insights to improve your business plan. Pre-built templates, visual magic and customer captivation – all just a click away. Go tell your story and watch them say “wow!”

Nailed your case study, but want to make your presentation even stronger? Avoid these common mistakes to ensure your audience gets the most out of it:

Overloading with information

A case study is not an encyclopedia. Overloading your presentation with excessive data, text or jargon can make it cumbersome and difficult for the audience to digest the key points. Stick to what’s essential and impactful. Need help making your data clear and impactful? Our data presentation templates can help! Find clear and engaging visuals to showcase your findings.

Lack of structure

Jumping haphazardly between points or topics can confuse your audience. A well-structured presentation, with a logical flow from introduction to conclusion, is crucial for effective communication.

Ignoring the audience

Different audiences have different needs and levels of understanding. Failing to adapt your presentation to your audience can result in a disconnect and a less impactful presentation.

Poor visual elements

While content is king, poor design or lack of visual elements can make your case study dull or hard to follow. Make sure you use high-quality images, graphs and other visual aids to support your narrative.

Not focusing on results

A case study aims to showcase a problem and its solution, but what most people care about are the results. Failing to highlight or adequately explain the outcomes can make your presentation fall flat.

How to start a case study presentation?

Starting a case study presentation effectively involves a few key steps:

• Grab attention : Open with a hook—an intriguing statistic, a provocative question or a compelling visual—to engage your audience from the get-go.
• Set the stage : Briefly introduce the subject, context and relevance of the case study to give your audience an idea of what to expect.
• Outline objectives : Clearly state what the case study aims to achieve. Are you solving a problem, proving a point or showcasing a success?
• Agenda : Give a quick outline of the key sections or topics you’ll cover to help the audience follow along.
• Set expectations : Let your audience know what you want them to take away from the presentation, whether it’s knowledge, inspiration or a call to action.

How to present a case study on PowerPoint and on Google Slides?

Presenting a case study on PowerPoint and Google Slides involves a structured approach for clarity and impact using presentation slides :

• Title slide : Start with a title slide that includes the name of the case study, your name and any relevant institutional affiliations.
• Introduction : Follow with a slide that outlines the problem or situation your case study addresses. Include a hook to engage the audience.
• Objectives : Clearly state the goals of the case study in a dedicated slide.
• Findings : Use charts, graphs and bullet points to present your findings succinctly.
• Analysis : Discuss what the findings mean, drawing on supporting data or secondary research as necessary.
• Conclusion : Summarize key takeaways and results.
• Q&A : End with a slide inviting questions from the audience.

What’s the role of analysis in a case study presentation?

The role of analysis in a case study presentation is to interpret the data and findings, providing context and meaning to them. 

It helps your audience understand the implications of the case study, connects the dots between the problem and the solution and may offer recommendations for future action.

Is it important to include real data and results in the presentation?

Yes, including real data and results in a case study presentation is crucial to show experience,  credibility and impact. Authentic data lends weight to your findings and conclusions, enabling the audience to trust your analysis and take your recommendations more seriously

How do I conclude a case study presentation effectively?

To conclude a case study presentation effectively, summarize the key findings, insights and recommendations in a clear and concise manner. 

End with a strong call-to-action or a thought-provoking question to leave a lasting impression on your audience.

What’s the best way to showcase data in a case study presentation ?

The best way to showcase data in a case study presentation is through visual aids like charts, graphs and infographics which make complex information easily digestible, engaging and creative. 

Don’t just report results, visualize them! This template for example lets you transform your social media case study into a captivating infographic that sparks conversation.

Choose the type of visual that best represents the data you’re showing; for example, use bar charts for comparisons or pie charts for parts of a whole. 

Ensure that the visuals are high-quality and clearly labeled, so the audience can quickly grasp the key points. 

Keep the design consistent and simple, avoiding clutter or overly complex visuals that could distract from the message.

Choose a template that perfectly suits your case study where you can utilize different visual aids for maximum impact. 

Need more inspiration on how to turn numbers into impact with the help of infographics? Our ready-to-use infographic templates take the guesswork out of creating visual impact for your case studies with just a few clicks.

Related: 10+ Case Study Infographic Templates That Convert

Congrats on mastering the art of compelling case study presentations! This guide has equipped you with all the essentials, from structure and nuances to avoiding common pitfalls. You’re ready to impress any audience, whether in the boardroom, the classroom or beyond.

And remember, you’re not alone in this journey. Venngage’s Case Study Creator is your trusty companion, ready to elevate your presentations from ordinary to extraordinary. So, let your confidence shine, leverage your newly acquired skills and prepare to deliver presentations that truly resonate.

Go forth and make a lasting impact!

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9 Creative Case Study Presentation Examples & Templates

Learn from proven case study presentation examples and best practices how to get creative, stand out, engage your audience, excite action, and drive results.

9 minute read

helped business professionals at:

Short answer

What makes a good case study presentation?

A good case study presentation has an engaging story, a clear structure, real data, visual aids, client testimonials, and a strong call to action. It informs and inspires, making the audience believe they can achieve similar results.

Dull case studies can cost you clients.

A boring case study presentation doesn't just risk putting your audience to sleep—it can actuallyl ead to lost sales and missed opportunities.

When your case study fails to inspire, it's your bottom line that suffers.

Interactive elements are the secret sauce for successful case study presentations.

They not only increase reader engagement by 22% but also lead to a whopping 41% more decks being read fully , proving that the winning deck is not a monologue but a conversation that involves the reader.

Let me show you shape your case studies into compelling narratives that hook your audience and drive revenue.

Let’s go!

How to create a case study presentation that drives results?

Crafting a case study presentation that truly drives results is about more than just data—it's about storytelling, engagement, and leading your audience down the sales funnel.

Here's how you can do it:

Tell a story: Each case study should follow a narrative arc. Start with the problem, introduce your solution, and showcase the results. Make it compelling and relatable.

Leverage data: Hard numbers build credibility. Use them to highlight your successes and reinforce your points.

Use visuals: Images, infographics, and videos can enhance engagement, making complex information more digestible and memorable.

Add interactive elements: Make your presentation a two-way journey. Tools like tabs and live data calculators can increase time spent on your deck by 22% and the number of full reads by 41% .

Finish with a strong call-to-action: Every good story needs a conclusion. Encourage your audience to take the next step in their buyer journey with a clear, persuasive call-to-action.

Visual representation of what a case study presentation should do:

How to write an engaging case study presentation?

Creating an engaging case study presentation involves strategic storytelling, understanding your audience, and sparking action.

In this guide, I'll cover the essentials to help you write a compelling narrative that drives results.

What is the best format for a business case study presentation?

4 best format types for a business case study presentation:

• Problem-solution case study
• Before-and-after case study
• Success story case study
• Interview style case study

Each style has unique strengths, so pick one that aligns best with your story and audience. For a deeper dive into these formats, check out our detailed blog post on case study format types .

What to include in a case study presentation?

An effective case study presentation contains 7 key elements:

• Introduction
• Company overview
• The problem/challenge
• Your solution
• Customer quotes/testimonials

To learn more about what should go in each of these sections, check out our post on what is a case study .

How to motivate readers to take action?

Based on BJ Fogg's behavior model , successful motivation involves 3 components:

This is all about highlighting the benefits. Paint a vivid picture of the transformative results achieved using your solution.

Use compelling data and emotive testimonials to amplify the desire for similar outcomes, therefore boosting your audience's motivation.

This refers to making the desired action easy to perform. Show how straightforward it is to implement your solution.

Use clear language, break down complex ideas, and reinforce the message that success is not just possible, but also readily achievable with your offering.

This is your powerful call-to-action (CTA), the spark that nudges your audience to take the next step. Ensure your CTA is clear, direct, and tied into the compelling narrative you've built.

It should leave your audience with no doubt about what to do next and why they should do it.

Here’s how you can do it with Storydoc:

How to adapt your presentation for your specific audience?

Every audience is different, and a successful case study presentation speaks directly to its audience's needs, concerns, and desires.

Understanding your audience is crucial. This involves researching their pain points, their industry jargon, their ambitions, and their fears.

Then, tailor your presentation accordingly. Highlight how your solution addresses their specific problems. Use language and examples they're familiar with. Show them how your product or service can help them reach their goals.

A case study presentation that's tailor-made for its audience is not just a presentation—it's a conversation that resonates, engages, and convinces.

How to design a great case study presentation?

A powerful case study presentation is not only about the story you weave—it's about the visual journey you create.

Let's navigate through the design strategies that can transform your case study presentation into a gripping narrative.

Add interactive elements

Static design has long been the traditional route for case study presentations—linear, unchanging, a one-size-fits-all solution.

However, this has been a losing approach for a while now. Static content is killing engagement, but interactive design will bring it back to life.

It invites your audience into an evolving, immersive experience, transforming them from passive onlookers into active participants.

Which of these presentations would you prefer to read?

Use narrated content design (scrollytelling)

Scrollytelling combines the best of scrolling and storytelling. This innovative approach offers an interactive narrated journey controlled with a simple scroll.

It lets you break down complex content into manageable chunks and empowers your audience to control their reading pace.

To make this content experience available to everyone, our founder, Itai Amoza, collaborated with visualization scientist Prof. Steven Franconeri to incorporate scrollytelling into Storydoc.

This collaboration led to specialized storytelling slides that simplify content and enhance engagement (which you can find and use in Storydoc).

Here’s an example of Storydoc scrollytelling:

Bring your case study to life with multimedia

Multimedia brings a dynamic dimension to your presentation. Video testimonials lend authenticity and human connection. Podcast interviews add depth and diversity, while live graphs offer a visually captivating way to represent data.

Each media type contributes to a richer, more immersive narrative that keeps your audience engaged from beginning to end. You can upload your own interactive elements or check stock image sites like Shutterstock, Adobe Stock, iStock, and many more. For example, Icons8, one of the largest hubs for icons, illustrations, and photos, offers both static and animated options for almost all its graphics, whether you need profile icons to represent different user personas or data report illustrations to show your findings.

Prioritize mobile-friendly design

In an increasingly mobile world, design must adapt. Avoid traditional, non-responsive formats like PPT, PDF, and Word.

Opt for a mobile-optimized design that guarantees your presentation is always at its best, regardless of the device.

As a significant chunk of case studies are opened on mobile, this ensures wider accessibility and improved user experience , demonstrating respect for your audience's viewing preferences.

Here’s what a traditional static presentation looks like as opposed to a responsive deck:

Streamline the design process

Creating a case study presentation usually involves wrestling with an AI website builder .

It's a dance that often needs several partners - designers to make it look good, developers to make it work smoothly, and plenty of time to bring it all together.

Building, changing, and personalizing your case study can feel like you're climbing a mountain when all you need is to cross a hill.

By switching to Storydoc’s interactive case study creator , you won’t need a tech guru or a design whizz, just your own creativity.

You’ll be able to create a customized, interactive presentation for tailored use in sales prospecting or wherever you need it without the headache of mobilizing your entire team.

Storydoc will automatically adjust any change to your presentation layout, so you can’t break the design even if you tried.

Case study presentation examples that engage readers

Let’s take a deep dive into some standout case studies.

These examples go beyond just sharing information – they're all about captivating and inspiring readers. So, let’s jump in and uncover the secret behind what makes them so effective.

What makes this deck great:

• A video on the cover slide will cause 32% more people to interact with your case study .
• The running numbers slide allows you to present the key results your solution delivered in an easily digestible way.
• The ability to include 2 smart CTAs gives readers the choice between learning more about your solution and booking a meeting with you directly.

Light mode case study

• The ‘read more’ button is perfect if you want to present a longer case without overloading readers with walls of text.
• The timeline slide lets you present your solution in the form of a compelling narrative.
• A combination of text-based and visual slides allows you to add context to the main insights.

Marketing case study

• Tiered slides are perfect for presenting multiple features of your solution, particularly if they’re relevant to several use cases.
• Easily customizable slides allow you to personalize your case study to specific prospects’ needs and pain points.
• The ability to embed videos makes it possible to show your solution in action instead of trying to describe it purely with words.

UX case study

• Various data visualization components let you present hard data in a way that’s easier to understand and follow.
• The option to hide text under a 'Read more' button is great if you want to include research findings or present a longer case study.
• Content segmented using tabs , which is perfect if you want to describe different user research methodologies without overwhelming your audience.

Business case study

• Library of data visualization elements to choose from comes in handy for more data-heavy case studies.
• Ready-to-use graphics and images which can easily be replaced using our AI assistant or your own files.
• Information on the average reading time in the cover reduces bounce rate by 24% .

Modern case study

• Dynamic variables let you personalize your deck at scale in just a few clicks.
• Logo placeholder that can easily be replaced with your prospect's logo for an added personal touch.
• Several text placeholders that can be tweaked to perfection with the help of our AI assistant to truly drive your message home.

Real estate case study

• Plenty of image placeholders that can be easily edited in a couple of clicks to let you show photos of your most important listings.
• Data visualization components can be used to present real estate comps or the value of your listings for a specific time period.
• Interactive slides guide your readers through a captivating storyline, which is key in a highly-visual industry like real estate .

Medical case study

• Image and video placeholders are perfect for presenting your solution without relying on complex medical terminology.
• The ability to hide text under an accordion allows you to include research or clinical trial findings without overwhelming prospects with too much information.
• Clean interactive design stands out in a sea of old-school medical case studies, making your deck more memorable for prospective clients.

Dark mode case study

• The timeline slide is ideal for guiding readers through an attention-grabbing storyline or explaining complex processes.
• Dynamic layout with multiple image and video placeholders that can be replaced in a few clicks to best reflect the nature of your business.
• Testimonial slides that can easily be customized with quotes by your past customers to legitimize your solution in the eyes of prospects.

Grab a case study presentation template

Creating an effective case study presentation is not just about gathering data and organizing it in a document. You need to weave a narrative, create an impact, and most importantly, engage your reader.

So, why start from zero when interactive case study templates can take you halfway up?

Instead of wrestling with words and designs, pick a template that best suits your needs, and watch your data transform into an engaging and inspiring story.

Hi, I'm Dominika, Content Specialist at Storydoc. As a creative professional with experience in fashion, I'm here to show you how to amplify your brand message through the power of storytelling and eye-catching visuals.

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10-Step Guide To Crafting A Successful Case Study Presentation

• By Judhajit Sen
• May 2, 2024

Key Takeaways

• An effective case study is a blueprint for convincing an audience and explaining a solution’s rationale and potential impact.   
• The ideal time for a business case study is when you have to make your presentation to persuade clients, solve internal problems, back up arguments with real examples, or discuss an idea’s viability for a firm.   
• Case study template presentations aren’t just about presenting solutions; they’re powerful storytelling tools that engage audiences with real-world examples and provoke critical thinking.
• Key elements of an effective case study presentation template include an executive summary, problem statement, solution, execution details, key results, inclusion of quotes and testimonials, acknowledgment of contributors, call to action, conclusion, and Q&A session.

A case study is like your argument’s blueprint, explaining the why, how, where, and who to persuade your audience. It’s your solution to a clear question, like expanding in a market or launching a product. Case studies help convince clients, analyze internal issues, and provide real-life use cases.

So, when should you make your case study like a pro? When you need to:

– Persuade clients about your services.

– Solve internal problems for a company.

– Back up arguments with real examples.

– Discuss an idea’s viability for a firm.

It’s not just about finding a solution—it’s about influencing your audience with your findings. Case study formats organize a lot of information in a clear, engaging way for clients and stakeholders, often using templates.

In simpler terms, a professional case study is an in-depth look at a specific topic, often tackling real-world problems. It showcases your expertise and how your solutions can solve actual issues.

In social sciences, it’s both a method and a research design to examine problems and generalize findings. Essentially, it’s investigative research aimed at presenting solutions to analyzed issues.

In business, case study examples delve into market conditions, main problems, methods used, and outcomes gained. It’s a powerful tool for understanding and addressing complex business challenges.

Case Study Presentation

Good case study PowerPoint templates explore a specific subject, whether it’s an individual, group, event, or organization. It’s like solving a puzzle with your audience, pushing you to think creatively.

Unlike a standard report, the goal here is to stimulate critical thinking. You’re not just throwing numbers around; you’re using real-life examples to provoke thought and offer different perspectives.

In marketing, case studies showcase your solutions’ effectiveness and success in solving client problems. These research presentations use written content, visuals, and other tools to tell compelling stories. They’re perfect for sales pitches, trade shows, conferences, and more—whether in-person or virtual.

But the best case study presentation slides aren’t just reports; they’re powerful and persuasive storytelling tools. Whether you’re a marketer or salesperson, knowing how to present a case study can be a game-changer for your business. It’s all about engaging your audience and sharing insights in a clear and compelling way.

Looking to make a compelling presentation? Check out our blog on persuasive presentations.

Importance of a Case Study Presentation

To write a compelling case study presentation is more than just sharing information—it’s about convincing your audience that your product or service is the solution they need. Case study presentations help in – 

Generating leads and driving sales: Case studies showcase your product’s success, turning potential customers into paying clients.

Building credibility and social proof: They establish your authority and value through real-life examples, earning trust from clients and prospects.

Educating and informing your target audience: Case studies teach potential clients about your product’s benefits, positioning you as an industry leader.

Increasing brand awareness: Case studies promote your brand, boost your visibility, and attract new customers.

Stats back up the power of case studies: 

– 13% of marketers rely on them in their content strategy.

– They help boost conversions by 23% and nurture leads by 9%.

– 80% of tech content marketers include case studies in their strategy.

But case studies aren’t just marketing fluff; they’re about solving problems and showcasing accurate results. They’re valuable in various scenarios, from business cases to analyzing internal issues.

To create a compelling case study presentation effectively is your chance to offer a comprehensive, evidence-based argument that informs and persuades your audience. It’s like solving a puzzle, exploring every piece until you reach a clear conclusion. It’s about connecting data with real-world scenarios in a compelling narrative.

Whether in sales pitches, job interviews, or content marketing, case study presentation examples are your secret weapon for success. They provide tangible proof of your product’s value, helping you stand out in a cluttered marketplace.

Following are ten essential steps to crafting a successful case study presentation.

Begin With The Executive Summary

Leaders often seek a quick snapshot of important information, and that’s where the executive summary plays a vital role. Begin with a short introduction, laying out the purpose and goals of the case study in a straightforward manner. Capture your audience’s attention and provide a clear path for what follows.

Follow the introduction with a brief of the entire case study, allowing the audience to grasp the main points swiftly. Delve into the subject’s relevance and significance, explaining why the case study is essential and who benefits from its insights. This establishes the tone for the rest of the study, encouraging the audience to explore further.

Check out our expert tips and techniques to master creating an executive summary for presentations.

Define the Problem Statement

Focus on the problem or challenge central to the case study. Provide background for the audience to grasp the issue, backing it up with data, graph or metrics to highlight its seriousness.

Need help visualizing your data? Check out our guide on mastering data visualizations.

Outline the goals and purpose of the case study and the questions it seeks to answer. This entails outlining the main issues from the customer’s viewpoint, making it understandable to the audience.

Start with a brief recap of the problem, clarifying the purpose of the study and the expected audience learnings. Explain the situation, shedding light on the hurdles faced. Present the key issues and findings without delving into specific details.

Highlight the importance of the problem using data and evidence to emphasize its real-world impact. Encapsulate the analysis’s purpose, aligning the issues identified with the study’s objectives.

Propose The Solution

At the heart of a presentation lies its solution. Reveal the steps taken to address the identified problem, including the methodology, experiments, or tests carried out and the considerations of various options. Clarify why the final solution was chosen over others.

Illustrates the shift from the problem-filled “before” to the successful “after.” 

Detail the proposed solution, recommendations, or action plan based on analyses. This includes explaining its reasoning and outlining implementation steps, timelines, and potential challenges.

Describe the analytical methods and approach used, demonstrating the thoroughness of the analysis, including research processes, data collection tools, and frameworks employed.

Present the essential findings and insights, utilizing data, charts, and visuals to enhance comprehension and engagement. Thoroughly discuss the analyses and the implications of the findings.

Show How the Solution was Executed

The execution slide of a case study presentation describes careful planning, consideration of risks, and measurement of metrics crucial for implementing the solution. 

Delve into the steps taken to attain desired client results, including identifying project key performance indicators (KPIs), addressing issues, and implementing risk mitigation strategies.

Detail the journey towards helping the client achieve results. Outline the planning, processes, risks, metrics, and KPIs essential for maximizing outcomes. This includes discussing any challenges encountered during execution and the strategies to overcome them, ensuring a seamless implementation process. 

Highlight the practical steps taken to turn the proposed solution into tangible results for the client.

Present the Key Results

Cover the outcomes achieved through the implementation of the solution. Leverage data and metrics to evaluate whether the solution successfully met its objectives and the extent of its impact on stakeholders. Acknowledge any setbacks or areas for improvement.

Outline the solution’s positive impact on the client’s project or business, highlighting aspects such as financial results, growth, and productivity enhancements. Reinforce these assertions with supporting evidence, including images, videos, and statistical data.

Emphasize the remarkable outcomes resulting from the solution, substantiating tangible success with relevant data and metrics. Illustrate the effectiveness of your recommendations through before-and-after comparisons and success metrics, highlighting their real-world impact.

This solidifies the rationale behind your proposal, showcasing its substantial impact on the business or project, particularly in terms of financial benefits for clients.

Include Quotes and Testimonials

Incorporate quotes and testimonials directly from customers who have experienced the transformation firsthand, adding authenticity and credibility to your case study. These voices of customers (VoC) provide firsthand accounts of the benefits and effectiveness of your solution, offering extra social proof to support your claims.

To gather compelling testimonials, plan and schedule interviews with your subjects. Design case study interview questions that allow you to obtain quantifiable results to capture valuable insights into the customer experience and the impact of your solution.

Include testimonials from satisfied customers to bolster the credibility of your case study and provide potential clients with real-life examples of success. These quotes serve as powerful endorsements of your offerings, helping to build trust and confidence among your target audience.

Acknowledge your Contributors with References and Citations

Express gratitude to those who played a vital role in shaping your case study’s outcomes. Extend heartfelt thanks to individuals whose insights and collaboration were essential in problem-solving.

Acknowledges the valuable contributions of external resources, reports, and data sets. Citing these sources maintains transparency and credibility, ensuring due credit is given and providing a solid foundation for further investigation.

Incorporate a comprehensive list of references, citations, and supplementary materials in the appendices supporting the case study’s findings and conclusions. These additional resources demonstrate the thoroughness of the research and offer interested parties the opportunity to delve deeper into the topic.

Thank those who contributed, and encourage the audience to explore the provided references to better understand the insights presented in the case study.

Give a Call to Action (CTA)

As the well-crafted case study presentation slides near their end, it’s crucial to outline actionable steps for stakeholders going forward. Recommend the following strategies to the audience to build upon the success achieved.

Ask stakeholders to integrate the proven solutions highlighted in the case study into existing processes or projects. These strategies have shown effectiveness and can be valuable tools in driving further success.

Encourage audience members to participate in a detailed consultation or product demonstration. Leveraging expertise and solutions can expedite goal achievement and overcome any remaining challenges.

Recommend further research and analysis to explore additional opportunities for improvement or innovation. Continuous learning and adaptation are essential in today’s dynamic business environment, with support available every step of the way.

Proactive steps based on insights from the case study will position organizations for continued growth and success. Urge the stakeholders to take action and seize the opportunities ahead.

Check out our blog on framing an effective call to action to learn more about crafting presentation CTAs. 

Conclude your Case Study Presentation

Conclude the presentation by recapping the main points and highlighting their importance. Show that the solution presented effectively tackled the identified problem, delivering concrete results and benefits for the clients.

Summarize the key takeaways, underscoring how the findings can be applied in similar situations and showcasing the solution’s relevance across various contexts. This demonstrates not only its effectiveness but also its potential to yield positive outcomes in diverse scenarios.

Reiterate the power of strategic problem-solving and innovative solutions in driving success, and end by thanking the audience for their attention and participation.

To know more about concluding a presentation, check out our blog on helpful tips to end a presentation successfully.

Open the Floor for Q&A, Feedback and Discussion

After your presentation ends, conduct a Q&A session. Encourage the audience to share their thoughts, ask questions for clarification, and engage in a constructive dialogue about the case study presented.

Feedback is valuable, so ask everyone to share their perspectives and insights. Also, encourage questions or comments, as they can provide further depth to the understanding of the subject matter.

This is an opportunity for mutual learning and exploring different viewpoints. Urge everyone to speak up and contribute to the conversation. The aim is to listen and exchange ideas to enrich the understanding of the topic.

Unlocking Success: Mastering the Art of Case Study Presentations

Case study presentations are not just reports; they’re dynamic storytelling tools that help sway clients, dissect internal issues, and provide real-world illustrations. 

These presentations aren’t just about offering solutions; they’re about influencing audiences with findings. Organizing vast amounts of data in an engaging way, often using templates and case studies, provides a clear path for clients and stakeholders.

Case study presentations delve deep into subjects, pushing presenters to think creatively. Unlike standard reports, they aim to provoke thought and offer varied perspectives. They’re powerful tools for showcasing success in solving client problems and using written content, visuals, and other elements to tell compelling stories.

Mastering case study presentations can be a game-changer, whether you’re a marketer, salesperson, or educator. It’s about engaging your audience and clearly and persuasively sharing insights into success stories.

Frequently Asked Questions (FAQs)

1. When should I consider doing a case study?

Case studies are beneficial when you need to persuade clients about your services, solve internal problems for a company, back up arguments with real examples, or discuss the viability of an idea for a firm.

2. What is the primary purpose of a case study presentation?

The primary goal of a case study presentation is to offer a comprehensive and evidence-based argument that informs and persuades the audience. It’s about presenting solutions to analyzed issues in a compelling narrative format.

3. What makes a case study presentation different from a standard report?

Unlike a standard report, a case study presentation aims to stimulate critical thinking by using real-life examples to provoke thought and offer different perspectives. It’s not just about presenting data; it’s about engaging the audience with compelling stories.

4. Where can case study presentations be effectively used?

Case study presentations are perfect for sales pitches, trade shows, conferences, and more—whether in-person or virtual. They are valuable storytelling tools that showcase the effectiveness of solutions and success in solving client problems.

Transform Your Business with Prezentium’s Case Study Presentations

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Free PowerPoint Case Study Presentation Templates

By Joe Weller | January 23, 2024

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We’ve collected the top free PowerPoint case study presentation templates with or without sample text. Marketing and product managers, sales execs, and strategists can use them to arrange and present their success stories, strategies, and results.

On this page, you'll find six PowerPoint case study presentation templates, including a  marketing case study template , a  problem-solution-impact case study , and a  customer journey case study template , among others. Plus, discover the  key components of successful case study presentations , find out the  different types of case study presentations , and get  expert tips .

PowerPoint Single-Slide Case Study Presentation Template

Download the Sample Single-Slide Case Study Presentation Template for PowerPoint Download the Blank Single-Slide Case Study Presentation Template for PowerPoint

When to Use This Template:  Use this single-slide case study presentation template when you need to give a quick but effective overview of a case study. This template is perfect for presenting a case study when time is limited and you need to convey key points swiftly.

Notable Template Features: You can fit everything you need on one slide. Download the version with sample text to see how easy it is to complete the template. Unlike more detailed templates, it focuses on the main points, such as the problem, solution, approach, and results, all in a compact format. It's great for keeping your audience focused on the key aspects of your case study without overwhelming them with information.

PowerPoint Marketing Case Study Template

Download the Sample Marketing Case Study Template for PowerPoint

Download the Blank Marketing Case Study Template for PowerPoint

When to Use This Template: Choose this marketing case study template when you need to dive deep into your marketing strategies and results. It's perfect for marketing managers and content marketers who want to showcase the detailed process and successes of their campaigns. 

Notable Template Features: This template focuses on the detailed aspects of marketing strategies and outcomes. It includes specific sections to outline business needs, results, and strategic approaches.

PowerPoint Problem-Solution-Impact Case Study Template

Download the Sample Problem-Solution-Impact Case Study Template for PowerPoint

Download the Blank Problem-Solution-Impact Case Study Template for PowerPoint

When to Use This Template:  This problem-solution-impact case study template is useful for focusing on how a challenge was solved and the results. Project managers and strategy teams that want to clearly portray the effectiveness of their solutions can take advantage of this template. 

Notable Template Features: This template stands out with its clear structure that breaks down the case into problem, solution, and impact. Use the template — available with or without sample data — to help you tell a complete story, from the issue faced to the solution and its results, making it perfect for presentations that need to show a clear cause-and-effect relationship.

PowerPoint Comparative Study Template

Download the Sample Comparative Study Template for PowerPoint  

Download the Blank Comparative Study Template for PowerPoint  

When to Use This Template:  Choose this comparative study template — available with or without sample data — to illuminate how different products, strategies, or periods stack up against each other. It's great for product managers and research teams who want to do side-by-side comparisons. 

Notable Template Features: This template lets you put things next to each other to see their differences and similarities, with a focus on direct comparisons. Use the columns and split slides to make the content easy to understand and visually appealing, perfect for highlighting changes or different approaches.

PowerPoint Customer Journey Case Study Template

Download the Sample Customer Journey Case Study Template for PowerPoint

Download the Blank Customer Journey Case Study Template for PowerPoint

When to Use This Template: This template is useful for customer experience managers and UX designers who need to understand and improve how customers interact with what they offer. Use the customer journey case study template with sample data to see how to show every step of a customer's experience with your product or service. 

Notable Template Features:  This template focuses on the whole path a customer takes with a product or service. It follows them, from first learning about the offering to after they buy it.

PowerPoint Case Study Storyboard Template

Download the Sample Case Study Storyboard Template for PowerPoint   Download the Blank Case Study Storyboard Template for PowerPoint  

When to Use This Template:  Creative teams and ad agencies should use this case study storyboard template — with or without sample data — to tell a story using more images than text.

Notable Template Features: This template transforms a case study into a visual story. Effectively communicate the journey of a business case, from the challenges faced to the solutions implemented and the results achieved.

Key Components of Successful Case Study Presentations

The key components of successful case study presentations include clear goals, engaging introductions, detailed customer profiles, and well-explained solutions and results. Together they help you present how your strategies succeed in real-world scenarios. 

The following components are fundamental to crafting a compelling and effective marketing case study presentation:   

• Clear Objective:  Define the goal of your case study, ensuring it addresses specific questions or goals. 
• Engaging Introduction:  Start with an overview of the company, product, or service, as well as the context to provide necessary background information. 
• Customer Profile:  Detail your target customer demographics and their needs to help the audience understand who the marketing efforts are aimed at and their relevance. 
• The Challenge:  Clearly articulate the primary problem or issue to overcome to establish the context for the solution and strategy, highlighting the need for action. 
• Solution and Strategy:  Describe the specific strategies and creative approaches used to address the challenge. These details should demonstrate your approach to problem-solving and the thought process behind your decisions. 
• Implementation:  Explain how the solution was put into action to show the practical application. This description should bring your strategy to life, allowing the audience to see how you executed plans. 
• Results and Impact:  Present measurable outcomes and impacts of the strategy to validate and show its effectiveness in real-world scenarios. 
• Visual Elements:  Use charts, images, and infographics to make complex information more accessible and engaging, aiding audience understanding. 
• Testimonials and Quotes:  Include customer feedback or expert opinions to add credibility and a real-world perspective, reinforcing your strategy’s success. 
• Lessons Learned and Conclusions:  Summarize key takeaways and insights gained to show what the audience can learn from the case study. 
• Call to Action (CTA):  End with an action you want the audience to take to encourage engagement and further interaction.

Different Types of Case Study Presentations

The types of case study presentations include those that compare products, showcase customer journeys, or tell a story visually, among others. Each is tailored to different storytelling methods and presentation goals.

The following list outlines various types of case study presentations:   

• Problem-Solution-Impact Case Study:  This type focuses on a clear narrative structure, outlining the problem, solution implemented, and final impact. It's straightforward and effective for linear stories. 
• Comparative Case Study:  Ideal for showcasing before-and-after scenarios or comparisons between different strategies or time periods. This option often uses parallel columns or split slides for comparison. 
• Customer Journey Case Study:  Centered on the customer's experience, this option maps out their journey from recognizing a need to using the product or service, and the benefits they gained. It's a narrative-driven and customer-focused case study format. 
• Data-Driven Case Study:  Emphasizing quantitative results and data, this format is full of charts, graphs, and statistics. This option is perfect for cases where numerical evidence is the main selling point. 
• Storyboard Case Study:  Use this type to lay out the case study in a storytelling format. This option often relies on more visuals and less text. Think of it as a visual story, engaging and easy to follow. 
• Interactive Case Study:  Designed with clickable elements for an interactive presentation, this type allows the presenter to dive into different sections based on audience interest, making it flexible and engaging.
• Testimonial-Focused Case Study:  This format is best for highlighting customer testimonials and reviews. It leverages the power of word of mouth and is highly effective in building trust.

Expert Tips for Case Study Presentations

Expert tips for case study presentations include knowing your audience, telling a clear story, and focusing on the problem and solution. They can also benefit from using visuals and highlighting results.

“Case studies are one of the most powerful tools in an organization’s marketing arsenal,” says Gayle Kalvert, Founder and CEO of  Creo Collective, Inc. , a full-service marketing agency. “Done correctly, case studies provide prospective buyers with proof that your product or service solves their business problem and shortens the sales cycle.”   

“Presentations are probably the most powerful marketing asset, whether for a webinar, a first meeting deck, an investor pitch, or an internal alignment/planning tool,” says marketing expert  Cari Jaquet . “Remember, the goal of a case study presentation is not just to inform, but also to persuade and engage your audience.” 

Use these tips to make your presentation engaging and effective so that it resonates with your audience:   

• Know Your Audience:  Tailor the presentation to the interests and knowledge level of your audience. Understanding what resonates with them helps make your case study more relevant and engaging. “Presentations can also be a forcing function to define your audience, tighten up your mission and message, and create a crisp call to action,” explains Jaquet.
• Tell a Story:  Structure your case study like a story, with a clear beginning (the problem), middle (the solution), and end (the results). A narrative approach keeps the audience engaged. 
• Focus on the Problem and Solution:  Clearly articulate the problem you addressed and how your solution was unique or effective. This section is the core of a case study and should be given ample attention. 
• Use Data Wisely:  Incorporate relevant data to support your points, but avoid overwhelming the audience with numbers. Use charts and graphs for visual representation of data to make it more digestible. 
• Highlight Key Results:  Emphasize the impact of your solution with clear and quantifiable results. This could include increased revenue, cost savings, improved customer satisfaction, and similar benefits.
• Incorporate Visuals:  Use high-quality visuals to break up text and explain complex concepts. Consider using photos, infographics, diagrams, or short videos.  “I put together the graphics that tell the story visually. Speakers often just need a big image or charts and graphs to help guide their talk track. Of course, if the audience expects details (for example, a board deck), the graphic helps reinforce the narrative,” shares Jaquet.
• Include Testimonials:  Adding quotes or testimonials from clients or stakeholders adds credibility and a real-world perspective to your presentation. 
• Practice Storytelling:  A well-delivered presentation is as important as its content. Practice your delivery to ensure you are clear, concise, and engaging. At this point, it also makes sense to solicit feedback from stakeholders. Jaquet concurs: “Once my outline and graphics are in place, I typically circulate the presentation draft for review. The feedback step usually surfaces nuances in the story or key points that need to show up on the slides. There is no point in building out tons of slides without alignment from the speaker or subject matter experts.”
• End with a Strong Conclusion:  Summarize the key takeaways and leave your audience with a final thought or call to action. 
• Seek Feedback:  After your presentation, request feedback to understand what worked well and what could be improved for future presentations. 

“Don't underestimate the power of a great presentation. And don't wait until the last minute or try to invent the wheel on your own,” advises Jaquet. “Many times, getting the next meeting, winning the deal, or getting the project kicked off well, requires your audience to understand and believe your story.”

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Business Case Study PowerPoint Template

Business Case Study PowerPoint Template is a professional presentation created to describe Business Case Studies.

A Case Study is a research method consisting of a close and detailed examination of a subject of study (a.k.a “the case”) as well as its related contextual conditions. “The Case” studied can be an individual, an organization, an action or even an event taking place in a specific place and time frame.

The Case Method   is a teaching approach that uses real scenario cases to situate students in the role of the people (generally top management) who faced the decision making process in the specific timeframe, place and environmental condition. This method has become widespread across Business Schools as the standard learning path for the new generation of managers.

Ideal for MBA Students and Candidates that require simple and quick business PowerPoint Templates to complete their analysis for the Case Study, and present it to the class. It is created with high definition background pictures that represent the business metaphor of each section. Also it uses high quality PowerPoint Icons, to represent business ideas and be able to describe conclusions and findings with high visual impact. Business Consultants and Analysts can take advantage of this case study template to present their overall analysis and findings to the executive board or top management.

The structure of our Business Case Study PowerPoint Template consists of the following sections, each of them created through the Harvard Business School Business Case Study Guidelines.

• Problem and Solution
• Executive Summary
• Brief History
• Business Key Points
• Key Challenges
• Industry Analysis
• Environmental Analysis
• Financial Performance
• Company Analysis
• Key Success Factors
• Alternative Options
• Pros & Cons
• Solution Analysis and Comparison
• Recommendations

This sections will guide each presenter in to the full description of the Case Study Analysis , engaging the audience with powerful visual components.

Every Shape, Icon and Clipart is 100% editable, allowing the user to customize the complete appearance of the presentation, changing size, color, effects, position, etc. Also, every shape can be reused in existing presentations in the case the presentar desires to decorate existing Business Case Analysis with new high quality PowerPoint Shapes.

Impress your audience with our outstanding  Business Case Studies PowerPoint Template . Create professional PowerPoint presentations that appeal to Global audiences.

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Case Study Research Method

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What Is a Case Study?

Weighing the pros and cons of this method of research

Verywell / Colleen Tighe

• Pros and Cons

What Types of Case Studies Are Out There?

Where do you find data for a case study, how do i write a psychology case study.

A case study is an in-depth study of one person, group, or event. In a case study, nearly every aspect of the subject's life and history is analyzed to seek patterns and causes of behavior. Case studies can be used in many different fields, including psychology, medicine, education, anthropology, political science, and social work.

The point of a case study is to learn as much as possible about an individual or group so that the information can be generalized to many others. Unfortunately, case studies tend to be highly subjective, and it is sometimes difficult to generalize results to a larger population.

While case studies focus on a single individual or group, they follow a format similar to other types of psychology writing. If you are writing a case study, we got you—here are some rules of APA format to reference.  

At a Glance

A case study, or an in-depth study of a person, group, or event, can be a useful research tool when used wisely. In many cases, case studies are best used in situations where it would be difficult or impossible for you to conduct an experiment. They are helpful for looking at unique situations and allow researchers to gather a lot of˜ information about a specific individual or group of people. However, it's important to be cautious of any bias we draw from them as they are highly subjective.

What Are the Benefits and Limitations of Case Studies?

A case study can have its strengths and weaknesses. Researchers must consider these pros and cons before deciding if this type of study is appropriate for their needs.

One of the greatest advantages of a case study is that it allows researchers to investigate things that are often difficult or impossible to replicate in a lab. Some other benefits of a case study:

• Allows researchers to capture information on the 'how,' 'what,' and 'why,' of something that's implemented
• Gives researchers the chance to collect information on why one strategy might be chosen over another
• Permits researchers to develop hypotheses that can be explored in experimental research

On the other hand, a case study can have some drawbacks:

• It cannot necessarily be generalized to the larger population
• Cannot demonstrate cause and effect
• It may not be scientifically rigorous
• It can lead to bias

Researchers may choose to perform a case study if they want to explore a unique or recently discovered phenomenon. Through their insights, researchers develop additional ideas and study questions that might be explored in future studies.

It's important to remember that the insights from case studies cannot be used to determine cause-and-effect relationships between variables. However, case studies may be used to develop hypotheses that can then be addressed in experimental research.

Case Study Examples

There have been a number of notable case studies in the history of psychology. Much of  Freud's work and theories were developed through individual case studies. Some great examples of case studies in psychology include:

• Anna O : Anna O. was a pseudonym of a woman named Bertha Pappenheim, a patient of a physician named Josef Breuer. While she was never a patient of Freud's, Freud and Breuer discussed her case extensively. The woman was experiencing symptoms of a condition that was then known as hysteria and found that talking about her problems helped relieve her symptoms. Her case played an important part in the development of talk therapy as an approach to mental health treatment.
• Phineas Gage : Phineas Gage was a railroad employee who experienced a terrible accident in which an explosion sent a metal rod through his skull, damaging important portions of his brain. Gage recovered from his accident but was left with serious changes in both personality and behavior.
• Genie : Genie was a young girl subjected to horrific abuse and isolation. The case study of Genie allowed researchers to study whether language learning was possible, even after missing critical periods for language development. Her case also served as an example of how scientific research may interfere with treatment and lead to further abuse of vulnerable individuals.

Such cases demonstrate how case research can be used to study things that researchers could not replicate in experimental settings. In Genie's case, her horrific abuse denied her the opportunity to learn a language at critical points in her development.

This is clearly not something researchers could ethically replicate, but conducting a case study on Genie allowed researchers to study phenomena that are otherwise impossible to reproduce.

There are a few different types of case studies that psychologists and other researchers might use:

• Collective case studies : These involve studying a group of individuals. Researchers might study a group of people in a certain setting or look at an entire community. For example, psychologists might explore how access to resources in a community has affected the collective mental well-being of those who live there.
• Descriptive case studies : These involve starting with a descriptive theory. The subjects are then observed, and the information gathered is compared to the pre-existing theory.
• Explanatory case studies : These   are often used to do causal investigations. In other words, researchers are interested in looking at factors that may have caused certain things to occur.
• Exploratory case studies : These are sometimes used as a prelude to further, more in-depth research. This allows researchers to gather more information before developing their research questions and hypotheses .
• Instrumental case studies : These occur when the individual or group allows researchers to understand more than what is initially obvious to observers.
• Intrinsic case studies : This type of case study is when the researcher has a personal interest in the case. Jean Piaget's observations of his own children are good examples of how an intrinsic case study can contribute to the development of a psychological theory.

The three main case study types often used are intrinsic, instrumental, and collective. Intrinsic case studies are useful for learning about unique cases. Instrumental case studies help look at an individual to learn more about a broader issue. A collective case study can be useful for looking at several cases simultaneously.

The type of case study that psychology researchers use depends on the unique characteristics of the situation and the case itself.

There are a number of different sources and methods that researchers can use to gather information about an individual or group. Six major sources that have been identified by researchers are:

• Archival records : Census records, survey records, and name lists are examples of archival records.
• Direct observation : This strategy involves observing the subject, often in a natural setting . While an individual observer is sometimes used, it is more common to utilize a group of observers.
• Documents : Letters, newspaper articles, administrative records, etc., are the types of documents often used as sources.
• Interviews : Interviews are one of the most important methods for gathering information in case studies. An interview can involve structured survey questions or more open-ended questions.
• Participant observation : When the researcher serves as a participant in events and observes the actions and outcomes, it is called participant observation.
• Physical artifacts : Tools, objects, instruments, and other artifacts are often observed during a direct observation of the subject.

If you have been directed to write a case study for a psychology course, be sure to check with your instructor for any specific guidelines you need to follow. If you are writing your case study for a professional publication, check with the publisher for their specific guidelines for submitting a case study.

Here is a general outline of what should be included in a case study.

Section 1: A Case History

This section will have the following structure and content:

Background information : The first section of your paper will present your client's background. Include factors such as age, gender, work, health status, family mental health history, family and social relationships, drug and alcohol history, life difficulties, goals, and coping skills and weaknesses.

Description of the presenting problem : In the next section of your case study, you will describe the problem or symptoms that the client presented with.

Describe any physical, emotional, or sensory symptoms reported by the client. Thoughts, feelings, and perceptions related to the symptoms should also be noted. Any screening or diagnostic assessments that are used should also be described in detail and all scores reported.

Your diagnosis : Provide your diagnosis and give the appropriate Diagnostic and Statistical Manual code. Explain how you reached your diagnosis, how the client's symptoms fit the diagnostic criteria for the disorder(s), or any possible difficulties in reaching a diagnosis.

Section 2: Treatment Plan

This portion of the paper will address the chosen treatment for the condition. This might also include the theoretical basis for the chosen treatment or any other evidence that might exist to support why this approach was chosen.

• Cognitive behavioral approach : Explain how a cognitive behavioral therapist would approach treatment. Offer background information on cognitive behavioral therapy and describe the treatment sessions, client response, and outcome of this type of treatment. Make note of any difficulties or successes encountered by your client during treatment.
• Humanistic approach : Describe a humanistic approach that could be used to treat your client, such as client-centered therapy . Provide information on the type of treatment you chose, the client's reaction to the treatment, and the end result of this approach. Explain why the treatment was successful or unsuccessful.
• Psychoanalytic approach : Describe how a psychoanalytic therapist would view the client's problem. Provide some background on the psychoanalytic approach and cite relevant references. Explain how psychoanalytic therapy would be used to treat the client, how the client would respond to therapy, and the effectiveness of this treatment approach.
• Pharmacological approach : If treatment primarily involves the use of medications, explain which medications were used and why. Provide background on the effectiveness of these medications and how monotherapy may compare with an approach that combines medications with therapy or other treatments.

This section of a case study should also include information about the treatment goals, process, and outcomes.

When you are writing a case study, you should also include a section where you discuss the case study itself, including the strengths and limitiations of the study. You should note how the findings of your case study might support previous research. 

In your discussion section, you should also describe some of the implications of your case study. What ideas or findings might require further exploration? How might researchers go about exploring some of these questions in additional studies?

Need More Tips?

Here are a few additional pointers to keep in mind when formatting your case study:

• Never refer to the subject of your case study as "the client." Instead, use their name or a pseudonym.
• Read examples of case studies to gain an idea about the style and format.
• Remember to use APA format when citing references .

Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach .  BMC Med Res Methodol . 2011;11:100.

Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach . BMC Med Res Methodol . 2011 Jun 27;11:100. doi:10.1186/1471-2288-11-100

Gagnon, Yves-Chantal.  The Case Study as Research Method: A Practical Handbook . Canada, Chicago Review Press Incorporated DBA Independent Pub Group, 2010.

Yin, Robert K. Case Study Research and Applications: Design and Methods . United States, SAGE Publications, 2017.

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Case Study Research Method in Psychology

Saul McLeod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

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Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

On This Page:

Case studies are in-depth investigations of a person, group, event, or community. Typically, data is gathered from various sources using several methods (e.g., observations & interviews).

The case study research method originated in clinical medicine (the case history, i.e., the patient’s personal history). In psychology, case studies are often confined to the study of a particular individual.

The information is mainly biographical and relates to events in the individual’s past (i.e., retrospective), as well as to significant events that are currently occurring in his or her everyday life.

The case study is not a research method, but researchers select methods of data collection and analysis that will generate material suitable for case studies.

Freud (1909a, 1909b) conducted very detailed investigations into the private lives of his patients in an attempt to both understand and help them overcome their illnesses.

This makes it clear that the case study is a method that should only be used by a psychologist, therapist, or psychiatrist, i.e., someone with a professional qualification.

There is an ethical issue of competence. Only someone qualified to diagnose and treat a person can conduct a formal case study relating to atypical (i.e., abnormal) behavior or atypical development.

 Famous Case Studies

• Anna O – One of the most famous case studies, documenting psychoanalyst Josef Breuer’s treatment of “Anna O” (real name Bertha Pappenheim) for hysteria in the late 1800s using early psychoanalytic theory.
• Little Hans – A child psychoanalysis case study published by Sigmund Freud in 1909 analyzing his five-year-old patient Herbert Graf’s house phobia as related to the Oedipus complex.
• Bruce/Brenda – Gender identity case of the boy (Bruce) whose botched circumcision led psychologist John Money to advise gender reassignment and raise him as a girl (Brenda) in the 1960s.
• Genie Wiley – Linguistics/psychological development case of the victim of extreme isolation abuse who was studied in 1970s California for effects of early language deprivation on acquiring speech later in life.
• Phineas Gage – One of the most famous neuropsychology case studies analyzes personality changes in railroad worker Phineas Gage after an 1848 brain injury involving a tamping iron piercing his skull.

Clinical Case Studies

• Studying the effectiveness of psychotherapy approaches with an individual patient
• Assessing and treating mental illnesses like depression, anxiety disorders, PTSD
• Neuropsychological cases investigating brain injuries or disorders

Child Psychology Case Studies

• Studying psychological development from birth through adolescence
• Cases of learning disabilities, autism spectrum disorders, ADHD
• Effects of trauma, abuse, deprivation on development

Types of Case Studies

• Explanatory case studies : Used to explore causation in order to find underlying principles. Helpful for doing qualitative analysis to explain presumed causal links.
• Exploratory case studies : Used to explore situations where an intervention being evaluated has no clear set of outcomes. It helps define questions and hypotheses for future research.
• Descriptive case studies : Describe an intervention or phenomenon and the real-life context in which it occurred. It is helpful for illustrating certain topics within an evaluation.
• Multiple-case studies : Used to explore differences between cases and replicate findings across cases. Helpful for comparing and contrasting specific cases.
• Intrinsic : Used to gain a better understanding of a particular case. Helpful for capturing the complexity of a single case.
• Collective : Used to explore a general phenomenon using multiple case studies. Helpful for jointly studying a group of cases in order to inquire into the phenomenon.

Where Do You Find Data for a Case Study?

There are several places to find data for a case study. The key is to gather data from multiple sources to get a complete picture of the case and corroborate facts or findings through triangulation of evidence. Most of this information is likely qualitative (i.e., verbal description rather than measurement), but the psychologist might also collect numerical data.

1. Primary sources

• Interviews – Interviewing key people related to the case to get their perspectives and insights. The interview is an extremely effective procedure for obtaining information about an individual, and it may be used to collect comments from the person’s friends, parents, employer, workmates, and others who have a good knowledge of the person, as well as to obtain facts from the person him or herself.
• Observations – Observing behaviors, interactions, processes, etc., related to the case as they unfold in real-time.
• Documents & Records – Reviewing private documents, diaries, public records, correspondence, meeting minutes, etc., relevant to the case.

2. Secondary sources

• News/Media – News coverage of events related to the case study.
• Academic articles – Journal articles, dissertations etc. that discuss the case.
• Government reports – Official data and records related to the case context.
• Books/films – Books, documentaries or films discussing the case.

3. Archival records

Searching historical archives, museum collections and databases to find relevant documents, visual/audio records related to the case history and context.

Public archives like newspapers, organizational records, photographic collections could all include potentially relevant pieces of information to shed light on attitudes, cultural perspectives, common practices and historical contexts related to psychology.

4. Organizational records

Organizational records offer the advantage of often having large datasets collected over time that can reveal or confirm psychological insights.

Of course, privacy and ethical concerns regarding confidential data must be navigated carefully.

However, with proper protocols, organizational records can provide invaluable context and empirical depth to qualitative case studies exploring the intersection of psychology and organizations.

• Organizational/industrial psychology research : Organizational records like employee surveys, turnover/retention data, policies, incident reports etc. may provide insight into topics like job satisfaction, workplace culture and dynamics, leadership issues, employee behaviors etc.
• Clinical psychology : Therapists/hospitals may grant access to anonymized medical records to study aspects like assessments, diagnoses, treatment plans etc. This could shed light on clinical practices.
• School psychology : Studies could utilize anonymized student records like test scores, grades, disciplinary issues, and counseling referrals to study child development, learning barriers, effectiveness of support programs, and more.

How do I Write a Case Study in Psychology?

Follow specified case study guidelines provided by a journal or your psychology tutor. General components of clinical case studies include: background, symptoms, assessments, diagnosis, treatment, and outcomes. Interpreting the information means the researcher decides what to include or leave out. A good case study should always clarify which information is the factual description and which is an inference or the researcher’s opinion.

1. Introduction

• Provide background on the case context and why it is of interest, presenting background information like demographics, relevant history, and presenting problem.
• Compare briefly to similar published cases if applicable. Clearly state the focus/importance of the case.

2. Case Presentation

• Describe the presenting problem in detail, including symptoms, duration,and impact on daily life.
• Include client demographics like age and gender, information about social relationships, and mental health history.
• Describe all physical, emotional, and/or sensory symptoms reported by the client.
• Use patient quotes to describe the initial complaint verbatim. Follow with full-sentence summaries of relevant history details gathered, including key components that led to a working diagnosis.
• Summarize clinical exam results, namely orthopedic/neurological tests, imaging, lab tests, etc. Note actual results rather than subjective conclusions. Provide images if clearly reproducible/anonymized.
• Clearly state the working diagnosis or clinical impression before transitioning to management.

3. Management and Outcome

• Indicate the total duration of care and number of treatments given over what timeframe. Use specific names/descriptions for any therapies/interventions applied.
• Present the results of the intervention,including any quantitative or qualitative data collected.
• For outcomes, utilize visual analog scales for pain, medication usage logs, etc., if possible. Include patient self-reports of improvement/worsening of symptoms. Note the reason for discharge/end of care.

4. Discussion

• Analyze the case, exploring contributing factors, limitations of the study, and connections to existing research.
• Analyze the effectiveness of the intervention,considering factors like participant adherence, limitations of the study, and potential alternative explanations for the results.
• Identify any questions raised in the case analysis and relate insights to established theories and current research if applicable. Avoid definitive claims about physiological explanations.
• Offer clinical implications, and suggest future research directions.

5. Additional Items

• Thank specific assistants for writing support only. No patient acknowledgments.
• References should directly support any key claims or quotes included.
• Use tables/figures/images only if substantially informative. Include permissions and legends/explanatory notes.
• Provides detailed (rich qualitative) information.
• Provides insight for further research.
• Permitting investigation of otherwise impractical (or unethical) situations.

Case studies allow a researcher to investigate a topic in far more detail than might be possible if they were trying to deal with a large number of research participants (nomothetic approach) with the aim of ‘averaging’.

Because of their in-depth, multi-sided approach, case studies often shed light on aspects of human thinking and behavior that would be unethical or impractical to study in other ways.

Research that only looks into the measurable aspects of human behavior is not likely to give us insights into the subjective dimension of experience, which is important to psychoanalytic and humanistic psychologists.

Case studies are often used in exploratory research. They can help us generate new ideas (that might be tested by other methods). They are an important way of illustrating theories and can help show how different aspects of a person’s life are related to each other.

The method is, therefore, important for psychologists who adopt a holistic point of view (i.e., humanistic psychologists ).

Limitations

• Lacking scientific rigor and providing little basis for generalization of results to the wider population.
• Researchers’ own subjective feelings may influence the case study (researcher bias).
• Difficult to replicate.
• Time-consuming and expensive.
• The volume of data, together with the time restrictions in place, impacted the depth of analysis that was possible within the available resources.

Because a case study deals with only one person/event/group, we can never be sure if the case study investigated is representative of the wider body of “similar” instances. This means the conclusions drawn from a particular case may not be transferable to other settings.

Because case studies are based on the analysis of qualitative (i.e., descriptive) data , a lot depends on the psychologist’s interpretation of the information she has acquired.

This means that there is a lot of scope for Anna O , and it could be that the subjective opinions of the psychologist intrude in the assessment of what the data means.

For example, Freud has been criticized for producing case studies in which the information was sometimes distorted to fit particular behavioral theories (e.g., Little Hans ).

This is also true of Money’s interpretation of the Bruce/Brenda case study (Diamond, 1997) when he ignored evidence that went against his theory.

Breuer, J., & Freud, S. (1895).  Studies on hysteria . Standard Edition 2: London.

Curtiss, S. (1981). Genie: The case of a modern wild child .

Diamond, M., & Sigmundson, K. (1997). Sex Reassignment at Birth: Long-term Review and Clinical Implications. Archives of Pediatrics & Adolescent Medicine , 151(3), 298-304

Freud, S. (1909a). Analysis of a phobia of a five year old boy. In The Pelican Freud Library (1977), Vol 8, Case Histories 1, pages 169-306

Freud, S. (1909b). Bemerkungen über einen Fall von Zwangsneurose (Der “Rattenmann”). Jb. psychoanal. psychopathol. Forsch ., I, p. 357-421; GW, VII, p. 379-463; Notes upon a case of obsessional neurosis, SE , 10: 151-318.

Harlow J. M. (1848). Passage of an iron rod through the head.  Boston Medical and Surgical Journal, 39 , 389–393.

Harlow, J. M. (1868).  Recovery from the Passage of an Iron Bar through the Head .  Publications of the Massachusetts Medical Society. 2  (3), 327-347.

Money, J., & Ehrhardt, A. A. (1972).  Man & Woman, Boy & Girl : The Differentiation and Dimorphism of Gender Identity from Conception to Maturity. Baltimore, Maryland: Johns Hopkins University Press.

Money, J., & Tucker, P. (1975). Sexual signatures: On being a man or a woman.

Further Information

• Case Study Approach
• Case Study Method
• Enhancing the Quality of Case Studies in Health Services Research
• “We do things together” A case study of “couplehood” in dementia
• Using mixed methods for evaluating an integrative approach to cancer care: a case study

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Methodology

• What Is a Case Study? | Definition, Examples & Methods

What Is a Case Study? | Definition, Examples & Methods

Published on May 8, 2019 by Shona McCombes . Revised on November 20, 2023.

A case study is a detailed study of a specific subject, such as a person, group, place, event, organization, or phenomenon. Case studies are commonly used in social, educational, clinical, and business research.

A case study research design usually involves qualitative methods , but quantitative methods are sometimes also used. Case studies are good for describing , comparing, evaluating and understanding different aspects of a research problem .

Table of contents

When to do a case study, step 1: select a case, step 2: build a theoretical framework, step 3: collect your data, step 4: describe and analyze the case, other interesting articles.

A case study is an appropriate research design when you want to gain concrete, contextual, in-depth knowledge about a specific real-world subject. It allows you to explore the key characteristics, meanings, and implications of the case.

Case studies are often a good choice in a thesis or dissertation . They keep your project focused and manageable when you don’t have the time or resources to do large-scale research.

You might use just one complex case study where you explore a single subject in depth, or conduct multiple case studies to compare and illuminate different aspects of your research problem.

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Once you have developed your problem statement and research questions , you should be ready to choose the specific case that you want to focus on. A good case study should have the potential to:

• Provide new or unexpected insights into the subject
• Challenge or complicate existing assumptions and theories
• Propose practical courses of action to resolve a problem
• Open up new directions for future research

TipIf your research is more practical in nature and aims to simultaneously investigate an issue as you solve it, consider conducting action research instead.

Unlike quantitative or experimental research , a strong case study does not require a random or representative sample. In fact, case studies often deliberately focus on unusual, neglected, or outlying cases which may shed new light on the research problem.

Example of an outlying case studyIn the 1960s the town of Roseto, Pennsylvania was discovered to have extremely low rates of heart disease compared to the US average. It became an important case study for understanding previously neglected causes of heart disease.

However, you can also choose a more common or representative case to exemplify a particular category, experience or phenomenon.

Example of a representative case studyIn the 1920s, two sociologists used Muncie, Indiana as a case study of a typical American city that supposedly exemplified the changing culture of the US at the time.

While case studies focus more on concrete details than general theories, they should usually have some connection with theory in the field. This way the case study is not just an isolated description, but is integrated into existing knowledge about the topic. It might aim to:

• Exemplify a theory by showing how it explains the case under investigation
• Expand on a theory by uncovering new concepts and ideas that need to be incorporated
• Challenge a theory by exploring an outlier case that doesn’t fit with established assumptions

To ensure that your analysis of the case has a solid academic grounding, you should conduct a literature review of sources related to the topic and develop a theoretical framework . This means identifying key concepts and theories to guide your analysis and interpretation.

There are many different research methods you can use to collect data on your subject. Case studies tend to focus on qualitative data using methods such as interviews , observations , and analysis of primary and secondary sources (e.g., newspaper articles, photographs, official records). Sometimes a case study will also collect quantitative data.

Example of a mixed methods case studyFor a case study of a wind farm development in a rural area, you could collect quantitative data on employment rates and business revenue, collect qualitative data on local people’s perceptions and experiences, and analyze local and national media coverage of the development.

The aim is to gain as thorough an understanding as possible of the case and its context.

In writing up the case study, you need to bring together all the relevant aspects to give as complete a picture as possible of the subject.

How you report your findings depends on the type of research you are doing. Some case studies are structured like a standard scientific paper or thesis , with separate sections or chapters for the methods , results and discussion .

Others are written in a more narrative style, aiming to explore the case from various angles and analyze its meanings and implications (for example, by using textual analysis or discourse analysis ).

In all cases, though, make sure to give contextual details about the case, connect it back to the literature and theory, and discuss how it fits into wider patterns or debates.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

• Normal distribution
• Degrees of freedom
• Null hypothesis
• Discourse analysis
• Control groups
• Mixed methods research
• Non-probability sampling
• Quantitative research
• Ecological validity

Research bias

• Rosenthal effect
• Implicit bias
• Cognitive bias
• Selection bias
• Negativity bias
• Status quo bias

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Teaching by the Case Method

• Preparing to Teach
• Leading in the Classroom
• Providing Assessment & Feedback
• Sample Class

Case Method in Practice

Chris Christensen described case method teaching as "the art of managing uncertainty"—a process in which the instructor serves as "planner, host, moderator, devil's advocate, fellow-student, and judge," all in search of solutions to real-world problems and challenges.

Unlike lectures, case method classes unfold without a detailed script. Successful instructors simultaneously manage content and process, and they must prepare rigorously for both. Case method teachers learn to balance planning and spontaneity. In practice, they pursue opportunities and "teachable moments" that emerge throughout the discussion, and deftly guide students toward discovery and learning on multiple levels. The principles and techniques are developed, Christensen says, "through collaboration and cooperation with friends and colleagues, and through self-observation and reflection."

This section of the Christensen Center website explores the Case Method in Practice along the following dimensions:

• Providing Assessment and Feedback

Each subsection provides perspectives and guidance through a written overview, supplemented by video commentary from experienced case method instructors. Where relevant, links are included to downloadable documents produced by the Christensen Center or Harvard Business School Publishing. References for further reading are provided as well.

An additional subsection, entitled Resources, appears at the end. It combines references from throughout the Case Method in Practice section with additional information on published materials and websites that may be of interest to prospective, new, and experienced case method instructors.

Note: We would like to thank Harvard Business School Publishing for permission to incorporate the video clips that appear in the Case Method in Practice section of our website. The clips are drawn from video excerpts included in Participant-Centered Learning and the Case Method: A DVD Case Teaching Tool (HBSP, 2003).

Christensen Center Tip Sheets

• Characteristics of Effective Case Method Teaching
• Elements of Effective Class Preparation
• Guidelines for Effective Observation of Case Instructors
• In-Class Assessment of Discussion-Based Teaching
• Questions for Class Discussions
• Teaching Quantitative Material
• Strategies and Tactics for Sensitive Topics

Curriculum Innovation

The case method has evolved so students may act as decision-makers in new engaging formats:

Game Simulations

Multimedia cases, ideo: human-centered service design.

Case Study Method

Oct 07, 2014

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January 2008. Case Study Method. Strategic Management How to handle a case study? Objectives Classic Strategic Management Process Method for Preparation Material from Strategic Management, Hitt, Ireland and Hoskisson, 2005, « Preparing an effective Case analysis », p.I-XI.

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January 2008 Case Study Method Strategic Management How to handle a case study? Objectives Classic Strategic Management Process Method for Preparation Material from Strategic Management, Hitt, Ireland and Hoskisson, 2005, « Preparing an effective Case analysis », p.I-XI. Slides Daniel Degravel

2 Outline What is a Case Study? Why using Case Study Method? Student preparation Method and its steps In-class discussion Evaluation

3 What is a Case Study? 1- A story / situation / problem 2. Qualitative and quantitative information 3- At a certain level: Industry, Group of Organizations, Organization or part of an Organization 4- Questions or one large question 5- Focus on a specific topic 6- Characterized by uncertainty and necessity of assumptions

4 Why Using Case Study Method? 1- Bring reality into the classroom Link material and real situations Use the Strategic Management process to identify and solve organizational problems 2- Increases students’ involvement Personal learning experience John Dewey: « Only by wrestling with the conditions of this problem at hand, seeking and finding his way out, does the student think and learn ».

5 Why Using Case Study Method? 3- Understand complexity and ambiguity of practical world Few elements are certain Partial and incomplete Information Situation is the result of multiple interconnected causes 4- Development of skills Analytical and judgment skills To Read, To Understand, To Identify underlying problems, To Analyze, To Ask questions and To make pertinent recommendations; To Become a Manager: In fact Problem-Solving skills Communication skills: Oral and Written presentations 5- Make a more informed career decision Wide variety of Industries, Situations/Problems, Organizations and Roles

6 Student Preparation 1- Key element Preparation: major determinant of the quality of learning for students 2- Requirements Mastery of case facts Some independent analysis of the case: you have been thinking about the case, alone or in group, but you have to bring some personal insight and reflection 3- Taking notes For class discussion, having short notes with main ideas and facts is of considerable help

7 In-class discussion Several possible levels for structuration of the case study discussion Strong, Intermediate and Weak My preferred orientation is Intermediate (some questions but freedom within this framework) Instructor’s Role: Facilitator Guide discussion Solicit alternative points of view Encourage participation I will listen, ask questions, challenge individual’s views and extend the analysis Presentation Presentation by a Team (15mn maximum) and challenge/question by «challenging team(s) » Then in-class Discussion For presentation, you can use part or the whole question framework provided by the Instructor for each case study.

8 Evaluation • Pertinence of work in solving the problem • Pertinence • Completeness • Cohesion • Substance • Clarity of work • Originality • Balance between Analysis and Recommendations

9 Classic Strategic Management Process • Analysis of Goals, Strategic Mission and Intent • Analysis of external Environment and internal Environment • KRAS (Key Result Areas: zones of strategic « sensivity ») • Identification of Strategic Options • Choice of Strategic Actions (Objectives and criteria for choice) • Implementation of Strategic Actions • Control of Implementation

10 Contents Context and Environment of the Organization I Implementation Put your strategic orientations and decisions into the real life of the Organization D A D Design Analysis Definition Choose your strategy and define it precisely, founding it on the outcomes of the Analytical step Understand the external and internal environment as determinants of your strategic choice Define Strategic Management and the way it works (actors and processes)

11 CS Resolution Process I. Preparatory work Be familiar of content and objective of CS Be able to master the problem-solving process (I do have the answer to elementary questions) II. Body work III. Conclusion work Be able to integrate elementary answers into a coherent system to answer the central question

12 CS Resolution Process (Ctd.) I. Preparatory work Be familiar of content and objective of CS • Reading of CS introduction and questions for first idea • First complete reading of the CS, taking notes in margin • Short analysis of the available material and topics: what type of material is available? • [Second reading of the CS (if time)] • Which ideas come up naturally (short brainstorming)

13 CS Resolution Process (Ctd.) II. Body work Be able to master the problem-solving process (I do have the answer to elementary questions) II.a Meta-Analysis What is the main issue of the CS? Which fundamental questions should I need to explore/answer? M N times II.b Elementary analyses What is the elementary question? How can I answer (tool/means)? Use of method to determine/construct answer Reliability and limits of answer?

14 CS Resolution Process (Ctd.) Be able to integrate elementary answers into a coherent system to answer the central question III. Conclusion work • Integration of several answers / topics into a coherent system • Development of final answer for central question • What is quality of my work? • Transformation into communicable format (report, speech, etc.) • Which other topics could be explored? • What is practical value for managers?

15 CS Resolution Process (Ctd.) • No question • 2. A large open question • 3. Several detailed questions You’re the VP in charge of IKS’ s Business Development division. In your opinion, which strategy should IDK undertake at the 2013 time horizon? • What do you think of IDK’s competitive environment? • What have been the main trends in IDK’s industry for the last decade? • What is IDK’s competitive position? • What do you think of IDK’s low-cost strategy? • Do you think that the globalization strategy could be a valuable way of development for IDK? • Does IDK have capabilities to sustain such a strategy? • What are IDK’s main weaknesses? • Is IDK’s organizational structure adapted to its strategic requirements? • Why did IDK’s CEO try to change the culture of the firm? • IDK has increasing its outsourcing to India? What do you think? • What would you recommend to IDK’s CEO?

16 CS Resolution Process (Ctd.) Tools Analysis of internal environment Analysis of external environment Goals Mission Intent PEST Marketing analysis (seg.) Industry value-chain Competitor analysis P5F Strategic mapping KSF SMP RBV (R&C) Competitive advantage Performance (function) Firm value-chain CSR S W O T Structure HR Culture Identification of Key result areas KRA CL-S BL-S Deployt. Function. Identification of strategic options Choice of strategic options with criteria Implementation (virtual) (only forecast or intent) F F F F F

17 Method for Preparation 1- Gaining familiarity Become familiar with the case data In general (What, Who, How, Why and When) In detail (places, persons, situations and activities) Assess the status of information (First reading of the case) 2- Recognizing symptoms Something is not desired or expected Ensure that symptoms are not assumed to be the problem Symptoms should lead to the problem 3- Identifying Goals List goals by major parties

18 Method for Preparation 1- Gaining familiarity Become familiar with the case data In general (What, Who, How, Why and When) In detail (places, persons, situations and activities) Assess the status of information (First reading of the case) 2- Recognizing symptoms Something is not desired or expected Ensure that symptoms are not assumed to be the problem Symptoms should lead to the problem 3- Identifying Goals List goals by major parties

19 Method for Preparation 4- Conducting Analysis Choose models and tools for analysis Apply to situation (several iterations if necessary) 5- Making Diagnosis Identify problems and predicaments Prioritize problems and predicaments 6- Choose Strategic Action Identify (Discover or Invent) feasible strategic actions Examine their probable consequences Select a course of strategic actions (citeria to evaluate possible actions) 7- Doing Action Planning Design an implementation schedule 8- Controlling Assess the action to be implemented

20 Dimensions ANALYSIS CAUSE SYNTHESIS EFFECT

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What the Case Study Method Really Teaches

• Nitin Nohria

Seven meta-skills that stick even if the cases fade from memory.

It’s been 100 years since Harvard Business School began using the case study method. Beyond teaching specific subject matter, the case study method excels in instilling meta-skills in students. This article explains the importance of seven such skills: preparation, discernment, bias recognition, judgement, collaboration, curiosity, and self-confidence.

During my decade as dean of Harvard Business School, I spent hundreds of hours talking with our alumni. To enliven these conversations, I relied on a favorite question: “What was the most important thing you learned from your time in our MBA program?”

• Nitin Nohria is the George F. Baker Jr. and Distinguished Service University Professor. He served as the 10th dean of Harvard Business School, from 2010 to 2020.

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• Open access
• Published: 10 August 2024

How can health systems approach reducing health inequalities? An in-depth qualitative case study in the UK

• Charlotte Parbery-Clark 1 ,
• Lorraine McSweeney 2 ,
• Joanne Lally 3 &
• Sarah Sowden 4  

BMC Public Health volume  24 , Article number:  2168 ( 2024 ) Cite this article

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Metrics details

Addressing socioeconomic inequalities in health and healthcare, and reducing avoidable hospital admissions requires integrated strategy and complex intervention across health systems. However, the understanding of how to create effective systems to reduce socio-economic inequalities in health and healthcare is limited. The aim was to explore and develop a system’s level understanding of how local areas address health inequalities with a focus on avoidable emergency admissions.

In-depth case study using qualitative investigation (documentary analysis and key informant interviews) in an urban UK local authority. Interviewees were identified using snowball sampling. Documents were retrieved via key informants and web searches of relevant organisations. Interviews and documents were analysed independently based on a thematic analysis approach.

Interviews ( n  = 14) with wide representation from local authority ( n  = 8), NHS ( n  = 5) and voluntary, community and social enterprise (VCSE) sector ( n  = 1) with 75 documents (including from NHS, local authority, VCSE) were included. Cross-referenced themes were understanding the local context, facilitators of how to tackle health inequalities: the assets, and emerging risks and concerns. Addressing health inequalities in avoidable admissions per se was not often explicitly linked by either the interviews or documents and is not yet embedded into practice. However, a strong coherent strategic integrated population health management plan with a system’s approach to reducing health inequalities was evident as was collective action and involving people, with links to a “strong third sector”. Challenges reported include structural barriers and threats, the analysis and accessibility of data as well as ongoing pressures on the health and care system.

We provide an in-depth exploration of how a local area is working to address health and care inequalities. Key elements of this system’s working include fostering strategic coherence, cross-agency working, and community-asset based approaches. Areas requiring action included data sharing challenges across organisations and analytical capacity to assist endeavours to reduce health and care inequalities. Other areas were around the resilience of the system including the recruitment and retention of the workforce. More action is required to embed reducing health inequalities in avoidable admissions explicitly in local areas with inaction risking widening the health gap.

Highlights:

• Reducing health inequalities in avoidable hospital admissions is yet to be explicitly linked in practice and is an important area to address.

• Understanding the local context helps to identify existing assets and threats including the leverage points for action.

• Requiring action includes building the resilience of our complex systems by addressing structural barriers and threats as well as supporting the workforce (training and wellbeing with improved retention and recruitment) in addition to the analysis and accessibility of data across the system.

Peer Review reports

Introduction

The health of our population is determined by the complex interaction of several factors which are either non-modifiable (such as age, genetics) or modifiable (such as the environment, social, economic conditions in which we live, our behaviours as well as our access to healthcare and its quality) [ 1 ]. Health inequalities are the avoidable and unfair systematic differences in health and healthcare across different population groups explained by the differences in distribution of power, wealth and resources which drive the conditions of daily life [ 2 , 3 ]. Essentially, health inequalities arise due to the systematic differences of the factors that influence our health. To effectively deal with most public health challenges, including reducing health inequalities and improving population health, broader integrated approaches [ 4 ] and an emphasis on systems is required [ 5 , 6 ] . A system is defined as ‘the set of actors, activities, and settings that are directly or indirectly perceived to have influence in or be affected by a given problem situation’ (p.198) [ 7 ]. In this case, the ‘given problem situation' is reducing health inequalities with a focus on avoidable admissions. Therefore, we must consider health systems, which are the organisations, resources and people aiming to improve or maintain health [ 8 , 9 ] of which health services provision is an aspect. In this study, the system considers NHS bodies, Integrated Care Systems, Local Authority departments, and the voluntary and community sector in a UK region.

A plethora of theories [ 10 ], recommended policies [ 3 , 11 , 12 , 13 ], frameworks [ 1 , 14 , 15 ], and tools [ 16 ] exist to help understand the existence of health inequalities as well as provide suggestions for improvement. However, it is reported that healthcare leaders feel under-skilled to reduce health inequalities [ 17 ]. A lack of clarity exists on how to achieve a system’s multi-agency coherence to reduce health inequalities systematically [ 17 , 18 ]. This is despite some countries having legal obligations to have a regard to the need to attend to health and healthcare inequalities. For example, the Health and Social Care Act 2012 [ 19 ], in England, mandated Clinical Commissioning Groups (CCGs), now transferred to Integrated Care Boards (ICBs) [ 20 ], to ‘have a regard to the need to reduce inequalities between patients with respect to their ability to access health services, and reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health services’. The wider determinants of health must also be considered. For example, local areas have a mandatory requirement to have a joint strategic needs assessment (JSNA) and joint health and wellbeing strategy (JHWS) whose purpose is to ‘improve the health and wellbeing of the local community and reduce inequalities for all ages' [ 21 ] This includes addressing the wider determinants of health [ 21 ]. Furthermore, the hospital care costs to the NHS associated with socioeconomic inequalities has been previously reported at £4.8 billion a year due to excess hospitalisations [ 22 ]. Avoidable emergency admissions are admissions into hospital that are considered to be preventable with high-quality ambulatory care [ 23 ]. Both ambulatory care sensitive conditions (where effective personalised care based in the community can aid the prevention of needing an admission) and urgent care sensitive conditions (where a system on the whole should be able to treat and manage without an admission) are considered within this definition [ 24 ] (encompassing more than 100 International Classification of Diseases (ICD) codes). The disease burden sits disproportionately with our most disadvantaged communities, therefore highlighting the importance of addressing inequalities in hospital pressures in a concerted manner [ 25 , 26 ].

Research examining one component of an intervention, or even one part of the system, [ 27 ] or which uses specific research techniques to control for the system’s context [ 28 ] are considered as having limited use for identifying the key ingredients to achieve better population health and wellbeing [ 5 , 28 ]. Instead, systems thinking considers how the system’s components and sub-components interconnect and interrelate within and between each other (and indeed other systems) to gain an understanding of the mechanisms by which things work [ 29 , 30 ]. Complex interventions or work programmes may perform differently in varying contexts and through different mechanisms, and therefore cannot simply be replicated from one context to another to automatically achieve the same outcomes. Ensuring that research into systems and systems thinking considers real-world context, such as where individuals live, where policies are created and interventions are delivered, is vital [ 5 ]. How the context and implementation of complex or even simple interventions interact is viewed as becoming increasingly important [ 31 , 32 ]. Case study research methodology is founded on the ‘in-depth exploration of complex phenomena in their natural, or ‘real-life’, settings’ (p.2) [ 33 ]. Case study approaches can deepen the understanding of complexity addressing the ‘how’, ‘what’ and ‘why’ questions in a real-life context [ 34 ]. Researchers have highlighted the importance of engaging more deeply with case-based study methodology [ 31 , 33 ]. Previous case study research has shown promise [ 35 ] which we build on by exploring a systems lens to consider the local area’s context [ 16 ] within which the work is implemented. By using case-study methodology, our study aimed to explore and develop an in-depth understanding of how a local area addresses health inequalities, with a focus on avoidable hospital admissions. As part of this, systems processes were included.

Study design

This in-depth case study is part of an ongoing larger multiple (collective [ 36 ]) case study approach. An instrumental approach [ 34 ] was taken allowing an in-depth investigation of an issue, event or phenomenon, in its natural real-life context; referred to as a ‘naturalistic’ design [ 34 ]. Ethics approval was obtained by Newcastle University’s Ethics Committee (ref 13633/2020).

Study selection

This case study, alongside the other three cases, was purposively [ 36 ] chosen considering overall deprivation level of the area (Indices of Multiple Deprivation (IMD) [ 37 ]), their urban/rural location, differing geographical spread across the UK (highlighted in patient and public feedback and important for considering the North/South health divide [ 38 ]), and a pragmatic judgement of likely ability to achieve the depth of insight required [ 39 ]. In this paper, we report the findings from one of the case studies, an urban local authority in the Northern region of the UK with high levels of socioeconomic disadvantage. This area was chosen for this in-depth case analysis due to high-level of need, and prior to the COVID-19 pandemic (2009-2018) had experienced a trend towards reducing socioeconomic inequalities in avoidable hospital admission rates between neighbourhoods within the local area [ 40 ]. Thereby this case study represents an ‘unusual’ case [ 41 ] to facilitate learning regarding what is reported and considered to be the key elements required to reduce health inequalities, including inequalities in avoidable admissions, in a local area.

Semi-structured interviews

The key informants were identified iteratively through the documentary analysis and in consultation with the research advisory group. Initially board level committee members (including lay, managerial, and clinical members) within relevant local organisations were purposively identified. These individuals were systems leaders charged with the remit of tackling health inequalities and therefore well placed to identify both key personnel and documents. Snowball sampling [ 42 ] was undertaken thereafter whereby interviewees helped to identify additional key informants within the local system who were working on health inequalities, including avoidable emergency admissions, at a systems level. Interview questions were based on an iteratively developed topic guide (supplementary data 1), informed from previous work’s findings [ 43 ] and the research advisory network’s input. A study information sheet was emailed to perspective interviewees, and participants were asked to complete an e-consent form using Microsoft Forms [ 42 ]. Each interviewee was interviewed by either L.M. or C.P.-C. using the online platforms Zoom or Teams, and lasted up to one hour. Participants were informed of interviewers’ role, workplace as well as purpose of the study. Interviewees were asked a range of questions including any work relating to reducing health inequalities, particularly avoidable emergency admissions, within the last 5 years. Brief notes were taken, and the interviews were recorded, transcribed verbatim and anonymised.

Documentary analysis

The documentary analysis followed the READ approach [ 44 ]. Any documents from the relevant local/regional area with sections addressing health inequalities and/or avoidable emergency admissions, either explicitly stated or implicitly inferred, were included. A list of core documents was chosen, including the local Health and Wellbeing Strategy (Table 1 ). Subsequently, other documents were identified by snowballing from these core documents and identification by the interviewees. All document types were within scope if produced/covered a period within 5 years (2017-2022), including documents in the public domain or not as well as documents pertaining to either a regional, local and neighbourhood level. This 5-year period was a pragmatic decision in line with the interviews and considered to be a balance of legacy and relevance. Attempts were made to include the final version of each document, where possible/applicable, otherwise the most up-to-date version or version available was used.

An Excel spreadsheet data extraction tool was adapted with a priori criteria [ 44 ] to extract the data. This tool included contextual information (such as authors, target area and document’s purpose). Also, information based on previous research on addressing socioeconomic inequalities in avoidable emergency admissions, such as who stands to benefit, was extracted [ 43 ]. Additionally, all documents were summarised according to a template designed according to the research’s aims. Data extraction and summaries were undertaken by L.M. and C.P.-C. A selection was doubled coded to enhance validity and any discrepancies were resolved by discussion.

Interviews and documents were coded and analysed independently based on a thematic analysis approach [ 45 ], managed by NVivo software. A combination of ‘interpretive’ and ‘positivist’ stance [ 34 , 46 ] was taken which involved understanding meanings/contexts and processes as perceived from different perspectives (interviewees and documents). This allowed for an understanding of individual and shared social meanings/reasonings [ 34 , 36 ]. For the documentary analysis, a combination of both content and thematic analysis as described by Bowen [ 47 ] informed by Braun and Clarke’s approach to thematic analysis [ 45 ] was used. This type of content analysis does not include the typical quantification but rather a review of the document for pertinent and meaningful passages of text/other data [ 47 ]. Both an inductive and deductive approach for the documentary analysis’ coding [ 46 , 47 ] was chosen. The inductive approach was developed a posteriori; the deductive codes being informed by the interviews and previous findings from research addressing socioeconomic inequalities in avoidable emergency admissions [ 43 ]. In line with qualitative epistemological approach to enquiry, the interview and documentary findings were viewed as ‘truths’ in themselves with the acceptance that multiple realities can co-exist [ 48 ]. The analysis of each set of themes (with subthemes) from the documentary analysis and interviews were cross-referenced and integrated with each other to provide a cohesive in-depth analysis [ 49 ] by generating thematic maps to explore the relationships between the themes. The codes, themes and thematic maps were peer-reviewed continually with regular meetings between L.M., C.P.-C., J.L. and S.S. Direct quotes are provided from the interviews and documentary analysis. Some quotes from the documents are paraphrased to protect anonymity of the case study after following a set process considering a range of options. This involved searching each quote from the documentary analysis in Google and if the quote was found in the first page of the result, we shortened extracts and repeated the process. Where the shortened extracts were still identifiable, we were required to paraphrase that quote. Each paraphrased quote and original was shared and agreed with all the authors reducing the likelihood of inadvertently misinterpreting or misquoting. Where multiple components over large bodies of text were present in the documents, models were used to evidence the broadness, for example, using Dahlgren’s and Whitehead’s model of health determinants [ 1 ]. Due to the nature of the study, transcripts and findings were not shared with participants for checking but will be shared in a dissemination workshop in 2024.

Patient and public involvement and engagement

Four public contributors from the National Institute for Health and Care Research (NIHR) Research Design Service (RDS) North East and North Cumbria (NENC) Public and Patient Involvement (PPI) panel have been actively engaged in this research from its inception. They have been part of the research advisory group along with professional stakeholders and were involved in the identification of the sampling frame’s key criteria. Furthermore, a diverse group of public contributors has been actively involved in other parts of the project including developing the moral argument around action by producing a public facing resource exploring what health inequalities mean to people and public views of possible solutions [ 50 ].

Semi-structured interviews: description

Sixteen participants working in health or social care, identified through the documentary analysis or snowballing, were contacted for interview; fourteen consented to participate. No further interviews were sought as data sufficiency was reached whereby no new information or themes were being identified. Participant roles were broken down by NHS ( n  = 5), local authority/council ( n  = 8), and voluntary, community and social enterprise (VSCE) ( n  = 1). To protect the participants’ anonymity, their employment titles/status are not disclosed. However, a broad spectrum of interviewees with varying roles from senior health system leadership (including strategic and commissioner roles) to roles within provider organisations and the VSCE sector were included.

Documentary analysis: description

75 documents were reviewed with documents considering regional ( n  = 20), local ( n  = 64) or neighbourhood ( n  = 2) area with some documents covering two or more areas. Table 2 summarises the respective number of each document type which included statutory documents to websites from across the system (NHS, local government and VSCE). 45 documents were named by interviewees and 42 documents were identified as either a core document or through snowballing from other documents. Of these, 12 documents were identified from both. The timescales of the documents varied and where possible to identify, was from 2014 to 2031.

Integrative analysis of the documentary analysis and interviews

The overarching themes encompass:

Understanding the local context

Facilitators to tacking health inequalities: the assets

Emerging risks and concerns

Figure 1 demonstrates the relationships between the main themes identified from the analysis for tackling health inequalities and improving health in this case study.

Diagram of the relationship between the key themes identified regarding tackling health inequalities and improving health in a local area informed by 2 previous work [ 14 , 51 ]. NCDs = non-communicable diseases; HI = health inequalities

Understanding the local context was discussed extensively in both the documents and the interviews. This was informed by local intelligence and data that was routinely collected, monitored, and analysed to help understand the local context and where inequalities lie. More bespoke, in-depth collection and analysis were also described to get a better understanding of the situation. This not only took the form of quantitative but also considered qualitative data with lived experience:

‛So, our data comes from going out to talk to people. I mean, yes, especially the voice of inequalities, those traditional mechanisms, like surveys, don't really work. And it's about going out to communities, linking in with third sector organisations, going out to communities, and just going out to listen…I think the more we can bring out those real stories. I mean, we find quotes really, really powerful in terms of helping people understand what it is that matters.’ (LP16).

However, there were limitations to the available data including the quality as well as having enough time to do the analysis justice. This resulted in difficulties in being able to fully understand the context to help identify and act on the required improvements.

‘A lack of available data means we cannot quantify the total number of vulnerable migrants in [region]’ (Document V).

‛So there’s lots of data. The issue is joining that data up and analysing it, and making sense of it. That’s where we don’t have the capacity.’ (LP15).

Despite the caveats, understanding the context and its data limitations were important to inform local priorities and approaches on tackling health inequalities. This understanding was underpinned by three subthemes which were understanding:

the population’s needs including identification of people at higher risk of worse health and health inequalities

the driving forces of those needs with acknowledgement of the impact of the wider determinants of health

the threats and barriers to physical and mental health, as well as wellbeing

Firstly, the population’s needs, including identification of people at higher risk of worse health and health inequalities, was important. This included considering risk factors, such as smoking, specific groups of people and who was presenting with which conditions. Between the interviews and documents, variation was seen between groups deemed at-risk or high-risk with the documents identifying a wider range. The groups identified across both included marginalised communities, such as ethnic minority groups, gypsy and travellers, refugees and asylum seekers as well as people/children living in disadvantaged area.

‘There are significant health inequalities in children with asthma between deprived and more affluent areas, and this is reflected in A&E admissions.' (Document J).

Secondly, the driving forces of those needs with acknowledgement of the impact of the wider determinants of health were described. These forces mapped onto Dahlgren’s and Whitehead’s model of health determinants [ 1 ] consisting of individual lifestyle factors, social and community networks, living and working conditions (which include access to health care services) as well as general socio-economic, cultural and environmental conditions across the life course.

…. at the centre of our approach considering the requirements to improve the health and wellbeing of our area are the wider determinants of health and wellbeing, acknowledging how factors, such as housing, education, the environment and economy, impact on health outcomes and wellbeing over people’s lifetime and are therefore pivotal to our ambition to ameliorate the health of the poorest the quickest. (Paraphrased Document P).

Thirdly, the threats and barriers to health included environmental risks, communicable diseases and associated challenges, non-communicable conditions and diseases, mental health as well as structural barriers. In terms of communicable diseases, COVID-19 predominated. The environmental risks included climate change and air pollution. Non-communicable diseases were considered as a substantial and increasing threat and encompassed a wide range of chronic conditions such as diabetes, and obesity.

‛Long term conditions are the leading causes of death and disability in [case study] and account for most of our health and care spending. Cases of cancer, diabetes, respiratory disease, dementia and cardiovascular disease will increase as the population of [case study] grows and ages.’ (Document A).

Structural barriers to accessing and using support and/or services for health and wellbeing were identified. These barriers included how the services are set up, such as some GP practices asking for proof of a fixed address or form of identification to register. For example:

Complicated systems (such as having to make multiple calls, the need to speak to many people/gatekeepers or to call at specific time) can be a massive barrier to accessing healthcare and appointments. This is the case particularly for people who have complex mental health needs or chaotic/destabilized circumstances. People who do not have stable housing face difficulties in registering for GP and other services that require an address or rely on post to communicate appointments. (Paraphrased Document R).

A structural threat regarding support and/or services for health and wellbeing was the sustainability of current funding with future uncertainty posing potential threats to the delivery of current services. This also affected the ability to adapt and develop the services, or indeed build new ones.

‛I would say the other thing is I have a beef [sic] [disagreement] with pilot studies or new innovations. Often soft funded, temporary funded, charity funded, partnership work run by enthusiasts. Me, I've done them, or supported people doing many of these. And they're great. They can make a huge impact on the individuals involved on that local area. You can see fantastic work. You get inspired and you want to stand up in a crowd and go, “Wahey, isn't this fantastic?” But actually the sad part of it is on these things, I've seen so many where we then see some good, positive work being done, but we can't make it permanent or we can't spread it because there's no funding behind it.’ (LP8).

Facilitators to tackling health inequalities: the assets

The facilitators for improving health and wellbeing and tackling health inequalities are considered as assets which were underpinned by values and principles.

Values driven supported by four key principles

Being values driven was an important concept and considered as the underpinning attitudes or beliefs that guide decision making [ 52 ]. Particularly, the system’s approach was underpinned by a culture and a system's commitment to tackle health inequalities across the documents and interviews. This was also demonstrated by how passionately and emotively some interviewees spoke about their work.

‛There's a really strong desire and ethos around understanding that we will only ever solve these problems as a system, not by individual organisations or even just part of the system working together. And that feels great.’ (LP3).

Other values driving the approach included accountability, justice, and equity. Reducing health inequalities and improving health were considered to be the right things to do. For example:

We feel strongly about social justice and being inclusive, wishing to reflect the diversity of [case study]. We campaign on subjects that are important to people who are older with respect and kindness. (Paraphrased Document O).

Four key principles were identified that crosscut the assets which were:

Shared vision

Strong partnership

Asset-based approaches

Willingness and ability to act on learning

The mandated strategy, identifying priorities for health and wellbeing for the local population with the required actions, provided the shared vision across each part of the system, and provided the foundations for the work. This shared vision was repeated consistently in the documents and interviews from across the system.

[Case study] will be a place where individuals who have the lowest socioeconomic status will ameliorate their health the quickest. [Case study] will be a place for good health and compassion for all people, regardless of their age. (Paraphrased Document A).

‛One thing that is obviously becoming stronger and stronger is the focus on health inequalities within all of that, and making sure that we are helping people and provide support to people with the poorest health as fast as possible, so that agenda hasn’t shifted.’ (LP7).

This drive to embed the reduction of health inequalities was supported by clear new national guidance encapsulated by the NHS Core20PLUS5 priorities. Core20PLUS5 is the UK's approach to support a system to improve their healthcare inequalities [ 53 ]. Additionally, the system's restructuring from Clinical Commissioning Groups (CCGs) to Integrated Care Boards (ICBs) and formalisation of the now statutory Integrated Care Systems (ICS) in England was also reported to facilitate the driving of further improvement in health inequalities. These changes at a regional and local level helped bring key partners across the system (NHS and local government among others) to build upon their collective responsibility for improving health and reducing health inequalities for their area [ 54 ].

‛I don’t remember the last time we’ve had that so clear, or the last time that health inequalities has had such a prominent place, both in the NHS planning guidance or in the NHS contract. ’ (LP15). ‛The Health and Care Act has now got a, kind of, pillar around health inequalities, the new establishment of ICPs and ICBs, and also the planning guidance this year had a very clear element on health inequalities.’ (LP12)

A strong partnership and collaborative team approach across the system underpinned the work from the documents and included the reoccurrence of the concept that this case study acted as one team: ‘Team [case study]'.

Supporting one another to ensure [case study] is the best it can be: Team [case study]. It involves learning, sharing ideas as well as organisations sharing assets and resources, authentic partnerships, and striving for collective impact (environmental and social) to work towards shared goals . (Paraphrased Document B).

This was corroborated in the interviews as working in partnership to tackle health inequalities was considered by the interviewees as moving in the right direction. There were reports that the relationship between local government, health care and the third sector had improved in recent years which was still an ongoing priority:

‘I think the only improvement I would cite, which is not an improvement in terms of health outcomes, but in terms of how we work across [case study] together has moved on quite a lot, in terms of teams leads and talking across us, and how we join up on things, rather than see ourselves all as separate bodies' (LP15).

‘I think the relationship between local authorities and health and the third sector, actually, has much more parity and esteem than it had before.' (LP11)

The approaches described above were supported by all health and care partners signing up to principles around partnership; it is likely this has helped foster the case study's approach. This also builds on the asset-based approaches that were another key principle building on co-production and co-creation which is described below.

We begin with people : instead of doing things to people or for them, we work with them, augmenting the skills, assets and strength of [case study]’s people, workforce and carers. We achieve : actions are focused on over words and by using intelligence, every action hones in on the actual difference that we will make to ameliorate outcomes, quality and spend [case study]’s money wisely; We are Team [case study ]: having kindness, working as one organisation, taking responsibility collectively and delivering on what we agreed. Problems are discussed with a high challenge and high support attitude. (Paraphrased Document D).

At times, the degree to which the asset-based approaches were embedded differed from the documents compared to the interviews, even when from the same part of the system. For example, the documents often referred to the asset-based approach as having occurred whilst interviewees viewed it more as a work in progress.

‘We have re-designed many of our services to focus on needs-led, asset-based early intervention and prevention, and have given citizens more control over decisions that directly affect them .’ (Document M).

‘But we’re trying to take an asset-based approach, which is looking at the good stuff in communities as well. So the buildings, the green space, the services, but then also the social capital stuff that happens under the radar.’ (LP11).

A willingness to learn and put in action plans to address the learning were present. This enables future proofing by building on what is already in place to build the capacity, capability and flexibility of the system. This was particularly important for developing the workforce as described below.

‘So we’ve got a task and finish group set up, […] So this group shows good practice and is a space for people to discuss some of the challenges or to share what interventions they are doing around the table, and also look at what other opportunities that they have within a region or that we could build upon and share and scale.’ (LP12).

These assets that are considered as facilitators are divided into four key levels which are the system, services and support, communities and individuals, and workforce which are discussed in turn below.

Firstly, the system within this case study was made up of many organisations and partnerships within the NHS, local government, VSCE sector and communities. The interviewees reported the presence of a strong VCSE sector which had been facilitated by the local council's commitment to funding this sector:

‘Within [case study], we have a brilliant third sector, the council has been longstanding funders of infrastructure in [case study], third sector infrastructure, to enable those links [of community engagement] to be made' (LP16).

In both the documents and interviews, a strong coherent strategic integrated population health management plan with a system’s approach to embed the reduction of health inequalities was evident. For example, on a system level regionally:

‘To contribute towards a reduction in health inequalities we will: take a system wide approach for improving outcomes for specific groups known to be affected by health inequalities, starting with those living in our most deprived communities….’ (Document H).

This case study’s approach within the system included using creative solutions and harnessing technology. This included making bold and inventive changes to improve how the city and the system linked up and worked together to improve health. For example, regeneration work within the city to ameliorate and transform healthcare facilities as well as certain neighbourhoods by having new green spaces, better transport links in order to improve city-wide innovation and collaboration (paraphrased Document F) were described. The changes were not only related to physical aspects of the city but also aimed at how the city digitally linked up. Being a leader in digital innovation to optimise the health benefits from technology and information was identified in several documents.

‘ Having the best connected city using digital technology to improve health and wellbeing in innovative ways.’ (Document G).

The digital approaches included ongoing development of a digitalised personalised care record facilitating access to the most up-to-date information to developing as well as having the ‘ latest, cutting edge technologies’ ( Document F) in hospital care. However, the importance of not leaving people behind by embedding digital alternatives was recognised in both the documents and interviews.

‘ We are trying to just embed the culture of doing an equity health impact assessment whenever you are bringing in a digital solution or a digital pathway, and that there is always an alternative there for people who don’t have the capability or capacity to use it. ’ (LP1).

The successful one hundred percent [redacted] programme is targeting some of our most digitally excluded citizens in [case study]. For our city to continue to thrive, we all need the appropriate skills, technology and support to get the most out of being online. (Paraphrased Document Q)

This all links in with the system that functions in a ‘place' which includes the importance of where people are born, grow, work and live. Working towards this place being welcoming and appealing was described both regionally and locally. This included aiming to make the case study the place of choice for people.

‘Making [case study] a centre for good growth becoming the place of choice in the UK to live, to study, for businesses to invest in, for people to come and work.’ (Document G).

Services and support

Secondly, a variety of available services and support were described from the local authority, NHS, and voluntary community sectors. Specific areas of work, such as local initiatives (including targeted work or campaigns for specific groups or specific health conditions) as well as parts of the system working together with communities collaboratively, were identified. This included a wide range of work being done such as avoiding delayed discharges or re-admissions, providing high quality affordable housing as well as services offering peer support.

‘We have a community health development programme called [redacted], that works with particular groups in deprived communities and ethnically diverse communities to work in a very trusted and culturally appropriate way on the things that they want to get involved with to support their health.’ (LP3 ).

It is worth noting that reducing health inequalities in avoidable admissions was not often explicitly specified in the documents or interviews. However, either specified or otherwise inferred, preventing ill health and improving access, experience, and outcomes were vital components to addressing inequalities. This was approached by working with communities to deliver services in communities that worked for all people. Having co-designed, accessible, equitable integrated services and support appeared to be key.

‘Reducing inequalities in unplanned admissions for conditions that could be cared for in the community and access to planned hospital care is key.’ (Document H)

Creating plans with people: understanding the needs of local population and designing joined-up services around these needs. (Paraphrased Document A).

‘ So I think a core element is engagement with your population, so that ownership and that co-production, if you're going to make an intervention, don't do it without because you might miss the mark. ’ (LP8).

Clear, consistent and appropriate communication that was trusted was considered important to improve health and wellbeing as well as to tackle health inequalities. For example, trusted community members being engaged to speak on the behalf of the service providers:

‘The messenger is more important than the message, sometimes.’ (LP11).

This included making sure the processes are in place so that the information is accessible for all, including people who have additional communication needs. This was considered as a work in progress in this case study.

‘I think for me, things do come down to those core things, of health, literacy, that digital exclusion and understanding the wider complexities of people.’ (LP12)

‘ But even more confusing if you've got an additional communication need. And we've done quite a lot of work around the accessible information standard which sounds quite dry, and doesn't sound very- but actually, it's fundamental in accessing health and care. And that is, that all health and care organisations should record your communication preferences. So, if I've got a learning disability, people should know. If I've got a hearing impairment, people should know. But the systems don’t record it, so blind people are getting sent letters for appointments, or if I've got hearing loss, the right provisions are not made for appointments. So, actually, we're putting up barriers before people even come in, or can even get access to services.’ (LP16).

Flexible, empowering, holistic care and support that was person-centric was more apparent in the documents than the interviews.

At the centre of our vision is having more people benefiting from the life chances currently enjoyed by the few to make [case study] a more equal place. Therefore, we accentuate the importance of good health, the requirement to boost resilience, and focus on prevention as a way of enabling higher quality service provision that is person-centred. [Paraphrased Document N).

Through this [work], we will give all children and young people in [case study], particularly if they are vulnerable and/or disadvantaged, a start in life that is empowering and enable them to flourish in a compassionate and lively city. [Paraphrased Document M].

Communities and individuals

Thirdly, having communities and individuals at the heart of the work appeared essential and viewed as crucial to nurture in this case study. The interconnectedness of the place, communities and individuals were considered a key part of the foundations for good health and wellbeing.

In [case study], our belief is that our people are our greatest strength and our most important asset. Wellbeing starts with people: our connections with our friends, family, and colleagues, our behaviour, understanding, and support for one another, as well as the environment we build to live in together . (Paraphrased Document A).

A recognition of the power of communities and individuals with the requirement to support that key principle of a strength-based approach was found. This involved close working with communities to help identify what was important, what was needed and what interventions would work. This could then lead to improved resilience and cohesion.

‛You can't make effective health and care decisions without having the voice of people at the centre of that. It just won't work. You won't make the right decisions.’ (LP16).

‘Build on the strengths in ourselves, our families, carers and our community; working with people, actively listening to what matters most to people, with a focus on what’s strong rather than what’s wrong’ (Document G).

Meaningful engagement with communities as well as strengths and asset-based approaches to ensure self-sufficiency and sustainability of communities can help communities flourish. This includes promoting friendships, building community resilience and capacity, and inspiring residents to find solutions to change the things they feel needs altering in their community . (Paraphrased Document B).

This close community engagement had been reported to foster trust and to lead to improvements in health.

‘But where a system or an area has done a lot of community engagement, worked really closely with the community, gained their trust and built a programme around them rather than just said, “Here it is. You need to come and use it now,” you can tell that has had the impact. ' (LP1).

Finally, workforce was another key asset; the documents raised the concept of one workforce across health and care. The key principles of having a shared vision, asset-based approaches and strong partnership were also present in this example:

By working together, the Health and Care sector makes [case study] the best area to not only work but also train for people of all ages. Opportunities for skills and jobs are provided with recruitment and engagement from our most disadvantaged communities, galvanizing the future’s health and care workforce. By doing this, we have a very skilled and diverse workforce we need to work with our people now as well as in the future. (Paraphrased Document E).

An action identified for the health and care system to address health inequalities in case study 1 was ‘ the importance of having an inclusive workforce trained in person-centred working practices ’ (Document R). Several ways were found to improve and support workforce skills development and embed awareness of health inequalities in practice and training. Various initiatives were available such as an interactive health inequalities toolkit, theme-related fellowships, platforms and networks to share learning and develop skills.

‛We've recently launched a [redacted] Fellowship across [case study’s region], and we've got a number of clinicians and managers on that………. We've got training modules that we've put on across [case study’s region], as well for health inequalities…we've got learning and web resources where we share good practice from across the system, so that is our [redacted] Academy.’ (LP2).

This case study also recognised the importance of considering the welfare of the workforce; being skilled was not enough. This had been recognised pre-pandemic but was seen as even more important post COVID-19 due to the impact that COVID-19 had on staff, particularly in health and social care.

‛The impacts of the pandemic cannot be underestimated; our colleagues and services are fatigued and still dealing with the pressures. This context makes it even more essential that we share the responsibility, learn from each other at least and collaborate with each other at best, and hold each other up to be the best we can.’ (Document U).

Concerns were raised such as the widening of health inequalities since the pandemic and cost of living crisis. Post-pandemic and Brexit, recruiting health, social care and third sector staff was compounding the capacity throughout this already heavily pressurised system.

In [case study], we have seen the stalling of life expectancy and worsening of the health inequality gap, which is expected to be compounded by the effects of the pandemic. (Paraphrased Document T)

‘I think key barriers, just the immense pressure on the system still really […] under a significant workload, catching up on activity, catching up on NHS Health Checks, catching up on long-term condition reviews. There is a significant strain on the system still in terms of catching up. It has been really difficult because of the impact of COVID.’ (LP7).

‘Workforce is a challenge, because the pipelines that we’ve got, we’ve got fewer people coming through many of them. And that’s not just particular to, I don't know, nursing, which is often talking talked [sic] about as a challenged area, isn't it? And of course, it is. But we’ve got similar challenges in social care, in third sector.’ (LP5).

The pandemic was reported to have increased pressures on the NHS and services not only in relation to staff capacity but also regarding increases in referrals to services, such as mental health. Access to healthcare changed during the pandemic increasing barriers for some:

‘I think people are just confused about where they're supposed to go, in terms of accessing health and care at the moment. It's really complex to understand where you're supposed to go, especially, at the moment, coming out of COVID, and the fact that GPs are not the accessible front door. You can't just walk into your GP anymore.’ (LP16).

‘Meeting this increased demand [for work related to reducing ethnic inequalities in mental health] is starting to prove a challenge and necessitates some discussion about future resourcing.’ (Document S)

Several ways were identified to aid effective adaptation and/or mitigation. This included building resilience such as developing the existing capacity, capability and flexibility of the system by learning from previous work, adapting structures and strengthening workforce development. Considerations, such as a commitment to Marmot Principles and how funding could/would contribute, were also discussed.

The funding’s [linked to Core20PLUS5] purpose is to help systems to ensure that health inequalities are not made worse when cost-savings or efficiencies are sought…The available data and insight are clear and [health inequalities are] likely to worsen in the short term, the delays generated by pandemic, the disproportionate effect of that on the most deprived and the worsening food and fuel poverty in all our places. (Paraphrased Document L).

Learning from the pandemic was thought to be useful as some working practices had altered during COVID-19 for the better, such as needing to continue to embed how the system had collaborated and resist old patterns of working:

‘So I think that emphasis between collaboration – extreme collaboration – which is what we did during COVID is great. I suppose the problem is, as we go back into trying to save money, we go back into our old ways of working, about working in silos. And I think we’ve got to be very mindful of that, and continue to work in a different way.’ (LP11).

Another area identified as requiring action, was the collection, analysis, sharing and use of data accessible by the whole system.

‘So I think there is a lot of data out there. It’s just how do we present that in such a way that it’s accessible to everyone as well, because I think sometimes, what happens is that we have one group looking at data in one format, but then how do we cascade that out?’ (LP12)

We aimed to explore a system’s level understanding of how a local area addresses health inequalities with a focus on avoidable emergency admissions using a case study approach. Therefore, the focus of our research was strategic and systematic approaches to inequalities reduction. Gaining an overview of what was occurring within a system is pertinent because local areas are required to have a regard to address health inequalities in their local areas [ 20 , 21 ]. Through this exploration, we also developed an understanding of the system's processes reported to be required. For example, an area requiring action was viewed as the accessibility and analysis of data. The case study described having health inequalities ‘at the heart of its health and wellbeing strategy ’ which was echoed across the documents from multiple sectors across the system. Evidence of a values driven partnership with whole systems working was centred on the importance of place and involving people, with links to a ‘strong third sector ’ . Working together to support and strengthen local assets (the system, services/support, communities/individuals, and the workforce) were vital components. This suggested a system’s committed and integrated approach to improve population health and reduce health inequalities as well as concerted effort to increase system resilience. However, there was juxtaposition at times with what the documents contained versus what interviewees spoke about, for example, the degree to which asset-based approaches were embedded.

Furthermore, despite having a priori codes for the documentary analysis and including specific questions around work being undertaken to reduce health inequalities in avoidable admissions in the interviews with key systems leaders, this explicit link was still very much under-developed for this case study. For example, how to reduce health inequalities in avoidable emergency admissions was not often specified in the documents but could be inferred from existing work. This included work around improving COVID-19 vaccine uptake in groups who were identified as being at high-risk (such as older people and socially excluded populations) by using local intelligence to inform where to offer local outreach targeted pop-up clinics. This limited explicit action linking reduction of health inequalities in avoidable emergency admissions was echoed in the interviews and it became clear as we progressed through the research that a focus on reduction of health inequalities in avoidable hospital admissions at a systems level was not a dominant aspect of people’s work. Health inequalities were viewed as a key part of the work but not necessarily examined together with avoidable admissions. A strengthened will to take action is reported, particularly around reducing health inequalities, but there were limited examples of action to explicitly reduce health inequalities in avoidable admissions. This gap in the systems thinking is important to highlight. When it was explicitly linked, upstream strategies and thinking were acknowledged as requirements to reduce health inequalities in avoidable emergency admissions.

Similar to our findings, other research have also found networks to be considered as the system’s backbone [ 30 ] as well as the recognition that communities need to be central to public health approaches [ 51 , 55 , 56 ]. Furthermore, this study highlighted the importance of understanding the local context by using local routine and bespoke intelligence. It demonstrated that population-based approaches to reduce health inequalities are complex, multi-dimensional and interconnected. It is not about one part of the system but how the whole system interlinks. The interconnectedness and interdependence of the system (and the relevant players/stakeholders) have been reported by other research [ 30 , 57 ], for example without effective exchange of knowledge and information, social networks and systems do not function optimally [ 30 ]. Previous research found that for systems to work effectively, management and transfer of knowledge needs to be collaborative [ 30 ], which was recognised in this case study as requiring action. By understanding the context, including the strengths and challenges, the support or action needed to overcome the barriers can be identified.

There are very limited number of case studies that explore health inequalities with a focus on hospital admissions. Of the existing research, only one part of the health system was considered with interviews looking at data trends [ 35 ]. To our knowledge, this research is the first to build on this evidence by encompassing the wider health system using wider-ranging interviews and documentary analysis. Ford et al. [ 35 ] found that geographical areas typically had plans to reduce total avoidable emergency admissions but not comprehensive plans to reduce health inequalities in avoidable emergency admissions. This approach may indeed widen health inequalities. Health inequalities have considerable health and costs impacts. Pertinently, the hospital care costs associated with socioeconomic inequalities being reported as £4.8 billion a year, mainly due to excess hospitalisations such as avoidable admissions [ 58 ] and the burden of disease lies disproportionately with our most disadvantaged communities, addressing inequalities in hospital pressures is required [ 25 , 26 ].

Implications for research and policy

Improvements to life expectancy have stalled in the UK with a widening of health inequalities [ 12 ]. Health inequalities are not inevitable; it is imperative that the health gap between the deprived and affluent areas is narrowed [ 12 ]. This research demonstrates the complexity and intertwining factors that are perceived to address health inequalities in an area. Despite the evidence of the cost (societal and individual) of avoidable admissions, explicit tackling of inequality in avoidable emergency admissions is not yet embedded into the system, therefore highlights an area for policy and action. This in-depth account and exploration of the characteristics of ‘whole systems’ working to address health inequalities, including where challenges remain, generated in this research will be instrumental for decision makers tasked with addressing health and care inequalities.

This research informs the next step of exploring each identified theme in more detail and moving beyond description to develop tools, using a suite of multidimensional and multidisciplinary methods, to investigate the effects of interventions on systems as previously highlighted by Rutter et al. [ 5 ].

Strengths and limitations

Documentary analysis is often used in health policy research but poorly described [ 44 ]. Furthermore, Yin reports that case study research is often criticised for not adhering to ‘systematic procedures’ p. 18 [ 41 ]. A clear strength of this study was the clearly defined boundary (in time and space) case as well as following a defined systematic approach, with critical thought and rationale provided at each stage [ 34 , 41 ]. A wide range and large number of documents were included as well as interviewees from across the system thereby resulting in a comprehensive case study. Integrating the analysis from two separate methodologies (interviews and documentary analysis), analysed separately before being combined, is also a strength to provide a coherent rich account [ 49 ]. We did not limit the reasons for hospital admission to enable a broad as possible perspective; this is likely to be a strength in this case study as this connection between health inequalities and avoidable hospital admissions was still infrequently made. However, for example, if a specific care pathway for a health condition had been highlighted by key informants this would have been explored.

Due to concerns about identifiability, we took several steps. These included providing a summary of the sectors that the interviewees and document were from but we were not able to specify which sectors each quote pertained. Additionally, some of the document quotes required paraphrasing. However, we followed a set process to ensure this was as rigorous as possible as described in the methods section. For example, where we were required to paraphrase, each paraphrased quote and original was shared and agreed with all the authors to reduce the likelihood to inadvertently misinterpreting or misquoting.

The themes are unlikely to represent an exhaustive list of the key elements requiring attention, but they represent the key themes that were identified using a robust methodological process. The results are from a single urban local authority with high levels of socioeconomic disadvantage in the North of England which may limit generalisability to different contexts. However, the findings are still generalisable to theoretical considerations [ 41 ]. Attempts to integrate a case study with a known framework can result in ‘force-fit’ [ 34 ] which we avoided by developing our own framework (Fig. 1 ) considering other existing models [ 14 , 59 ]. The results are unable to establish causation, strength of association, or direction of influence [ 60 ] and disentangling conclusively what works versus what is thought to work is difficult. The documents’ contents may not represent exactly what occurs in reality, the degree to which plans are implemented or why variation may occur or how variation may affect what is found [ 43 , 61 ]. Further research, such as participatory or non-participatory observation, could address this gap.

Conclusions

This case study provides an in-depth exploration of how local areas are working to address health and care inequalities, with a focus on avoidable hospital admissions. Key elements of this system’s reported approach included fostering strategic coherence, cross-agency working, and community-asset based working. An area requiring action was viewed as the accessibility and analysis of data. Therefore, local areas could consider the challenges of data sharing across organisations as well as the organisational capacity and capability required to generate useful analysis in order to create meaningful insights to assist work to reduce health and care inequalities. This would lead to improved understanding of the context including where the key barriers lie for a local area. Addressing structural barriers and threats as well as supporting the training and wellbeing of the workforce are viewed as key to building resilience within a system to reduce health inequalities. Furthermore, more action is required to embed reducing health inequalities in avoidable admissions explicitly in local areas with inaction risking widening the health gap.

Availability of data and materials

Individual participants’ data that underlie the results reported in this article and a data dictionary defining each field in the set are available to investigators whose proposed use of the data has been approved by an independent review committee for work. Proposals should be directed to [email protected] to gain access, data requestors will need to sign a data access agreement. Such requests are decided on a case by case basis.

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Acknowledgements

Thanks to our Understanding Factors that explain Avoidable hospital admission Inequalities - Research study (UNFAIR) PPI contributors, for their involvement in the project particularly in the identification of the key criteria for the sampling frame. Thanks to the research advisory team as well.

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This research was funded by the National Institute for Health and Care Research (NIHR), grant number (ref CA-CL-2018-04-ST2-010). The funding body was not involved in the study design, collection of data, inter-pretation, write-up, or submission for publication. The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health and Social Care or Newcastle University.

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Charlotte Parbery-Clark

Post-Doctoral Research Associate, Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK

Lorraine McSweeney

Senior Research Methodologist & Public Involvement Lead, Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK

Joanne Lally

Senior Clinical Lecturer &, Faculty of Medical Sciences, Honorary Consultant in Public Health, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK

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Conceptualization - J.L. and S.S.; methodology - C.P.-C., J.L. & S.S.; formal analysis - C. P.-C. & L.M.; investigation- C. P.-C. & L.M., resources, writing of draft manuscript - C.P.-C.; review and editing manuscript L.M., J.L., & S.S.; visualization including figures and tables - C.P.-C.; supervision - J.L. & S.S.; project administration - L.M. & S.S.; funding acquisition - S.S. All authors have read and agreed to the published version of the manuscript.

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Parbery-Clark, C., McSweeney, L., Lally, J. et al. How can health systems approach reducing health inequalities? An in-depth qualitative case study in the UK. BMC Public Health 24 , 2168 (2024). https://doi.org/10.1186/s12889-024-19531-5

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Micropapillary breast carcinoma in comparison with invasive duct carcinoma. Does it have an aggressive clinical presentation and an unfavorable prognosis?

• Yasmine Hany Abdel Moamen Elzohery 1 , 5 ,
• Amira H. Radwan 2 , 5 ,
• Sherihan W. Y. Gareer 2 , 5 ,
• Mona M. Mamdouh 3 , 5 ,
• Inas Moaz 4 , 5 ,
• Abdelrahman Mohammad Khalifa 5 ,
• Osama Abdel Mohen 5 ,
• Mohamed Fathy Abdelfattah Abdelrahman Elithy 5   nAff6 &
• Mahmoud Hassaan 5   nAff7  

BMC Cancer volume  24 , Article number:  992 ( 2024 ) Cite this article

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Metrics details

Invasive micropapillary carcinoma (IMPC) was first proposed as an entity by Fisher et al. In the 2003 World Health Organization (WHO) guidelines for histologic classification of the breast tumors. IMPC was recognized as a distinct, rare histological subtype of breast cancer.

IMPC is emerging as a surgical and oncological challenge due to its tendency to manifest as a palpable mass, larger in size and higher in grade than IDC with more rate of lymphovascular invasion (LVI) and lymph node (LN) involvement, which changes the surgical and adjuvant management plans to more aggressive, with comparative prognosis still being a point of ongoing debate.

Aim of the study

In this study, we compared the clinicopathological characteristics, survival and surgical management of breast cancer patients having invasive micropapillary carcinoma pathological subtype in comparison to those having invasive duct carcinoma.

This is a comparative study on female patients presented to Baheya center for early detection and treatment of breast cancer, in the period from 2015 to 2022 diagnosed with breast cancer of IMPC subtype in one group compared with another group of invasive duct carcinoma. we analyzed 138 cases of IMPC and 500 cases of IDC.

The incidence of LVI in the IMPC group was 88.3% in comparison to 47.0% in the IDC group (p < 0.001). IMPC had a higher incidence of lymph node involvement than the IDC group (68.8% and 56% respectively). IMPC had a lower rate of breast conserving surgery (26% vs.37.8%) compared with IDC.

The survival analysis indicated that IMPC patients had no significant difference in overall survival compared with IDC patients and no differences were noted in locoregional recurrence rate and distant metastasis rate comparing IMPCs with IDCs.

The results from our PSM analysis suggested that there was no statistically significant difference in prognosis between IMPC and IDC patients after matching them with similar clinical characteristics. However, IMPC was found to be more aggressive, had larger tumor size, greater lymph node metastasis rate and an advanced tumor stage.

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Introduction

Breast cancer is the most common cancer in women. In the 2012 World Health Organization (WHO) classification of breast cancer. Breast Cancer is classified into up to 21 different histological types depending on cell growth, morphology and architecture patterns [ 1 ]. The invasive carcinoma of no special type (IBC-NST), which is known as invasive ductal carcinoma (IDC), is the most frequently occurring histological type, which constitutes around 75% of invasive breast carcinoma [ 2 ].

Invasive micropapillary carcinoma (IMPC) was first proposed as an entity by Fisher et al. in 1980 [ 3 ] and first described as the term “invasive micropapillary carcinoma” by Siriaunkgul et al. [ 4 ] in 1993.

In the 2003 World Health Organization (WHO) guidelines for histologic classification of the breast tumors [ 5 ]. IMPC was recognized as a distinct, rare histological subtype of breast cancer. While micropapillary histological architecture is present in 2–8% of breast carcinomas, pure micropapillary carcinoma is uncommon and accounts for 0.9–2% of all breast cancers [ 6 ].

IMPC exhibits more distinct morphologic architecture than the IDC, characterized by pseudopapillary and tubuloalveolar arrangements of tumor cell clusters in clear empty sponge-like spaces that resemble extensive lymphatic invasion [ 7 ]. The neoplastic cell exhibits an “inside-out” pattern, known as the reverse polarity pattern [ 2 ].

Most studies demonstrate that the radiological findings of IMPC are irregular-shaped masses with an angular or spiculated margin on ultrasound, mammography and MRI with heterogeneous enhancement and washout kinetics on MRI [ 8 ].

IMPC had tendency to manifest as a palpable mass, larger in size and higher in grade than IDC with more rate of lymphovascular invasion (LVI) and lymph node (LN) involvement, which changes the surgical and adjuvant management plans to more aggressive, with comparative prognosis still being a point of ongoing debate [ 9 ].

In this study, we compared the clinicopathological characteristics, survival and surgical management of breast cancer patients having invasive micropapillary carcinoma pathological subtype in comparison to those having invasive ductal carcinoma.

Patient and method

This is a comparative study on female patients presented to Baheya center for early detection and treatment of breast cancer, in the period from 2015 to 2022 diagnosed with breast cancer of IMPC subtype in one group compared with another group of invasive duct carcinoma.

This retrospective study analyzed 138 cases of IMPC and 500 cases of IDC. Informed consent was obtained from all patients. Ethical approval is obtained from Baheya center for early detection and treatment of breast cancer and National research center ethics committee. Baheya IRB protocol number:202305150022.

The following clinical-pathological features were analyzed for each case: patient age at diagnosis, clinical presentation, laterality, imaging findings, histopathological examination, treatment plan with either primary surgical intervention or other treatment protocol according to tumor stage and biological subtypes.

A breast pathologist evaluated the tumor size, type, grade, lymphovascular invasion, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) receptor and the axillary lymph node involvement.

According to the ASCO/CAP guideline update, 2019: Samples with 1% to 100% of tumor nuclei positive for ER or progesterone receptor (PgR) are interpreted as positive. If ER (not PgR), 1% to 10% of tumor cell nuclei are immunoreactive, the sample are reported as ER Low Positive. There are limited data on the overall benefit of endocrine therapies for patients with low level (1%-10%) ER expression, but they currently suggest possible benefit, so patients are considered eligible for endocrine treatment. A sample is considered negative for ER or PgR if < 1% or 0% of tumor cell nuclei are immunoreactive [ 10 ]. An Allred score between 0 and 8. This scoring system looks at what percentage of cells test positive for hormone receptors, along with how well the receptors show up after staining, called intensity: proportion of cells staining (0, no staining; 1, < 1%; 2, between 1 and 10%; 3, between 11 and 33%; 4, between 34 and 66% and 5, between 67%–100% of the cells staining). Intensity of positive tumor cells (0, none; 1, weak, 2, intermediate; and 3, strong) [ 11 ].

HER2 Test Guideline IHC Recommendations, 2018. IHC 0: as defined by no staining observed or membrane staining that is incomplete and is faint/barely perceptible and within <  = 10% of the invasive tumor cells. IHC 1 + : as defined by incomplete membrane staining that is faint/barely perceptible and within > 10% of the invasive tumor cells. IHC 2 + : The revised definition of IHC 2 + (equivocal) is weak to moderate complete membrane staining observed in > 10% of tumor cells. IHC 3 + : based on circumferential membrane staining that is complete, intense in > 10% of tumor cells. [ 12 ].

ASCO–CAP HER2 SISH Test Guideline Recommendations,2018 Twenty nuclei (each containing red (Chr17) and black (HER2) signals) should be enumerated. The final results for the HER2 status are reported based on the ratio formed by dividing the sum of HER2 signals for all 20 nuclei divided by the sum of Chromosome 17 signals for all 20 nuclei. The amplification status is defined as Amplified if the HER2/Chromosome 17 ratio > / = 2.0 and the average Her2 gene copy number is > / = 4.0. It is non-Amplified if the HER2/Chromosome 17 ratio < 2.0 with the Her2 gene copy number is < 4.0. If the HER2/Chr17 ratio is < 2 and the Her2 gene copy number is between 4.0 and 6.0, or, HER2/Chr17 ratio is > / = 2 and the Her2 gene copy number is < 4, or HER2/Chr17 ratio is < 2 and the Her2 gene copy number is > / = 6.0, an additional work should be done. [ 12 ].

Follow-up duration was calculated from the date of diagnosis to the date of the last follow-up. Patients still alive at the last follow-up censored or to the date of occurrence of any event or death.

Disease-free survival was defined as the duration (months) from the initial diagnosis of breast cancer to first any type of recurrence (invasive ipsilateral breast tumor recurrence, local invasive recurrence, regional invasive recurrence, invasive contra lateral breast cancer, distant metastasis.

Overall survival (OS) is defined as the time from diagnosis of breast cancer to death from any cause.

Data were statistically analyzed using an IBM-compatible personal computer with Statistical Package for the Social Sciences (SPSS) version 23. Quantitative data were expressed as mean, standard deviation (SD) and range (minimum–maximum). Qualitative data were expressed as Number (N) and percentage (%), while A P value of < 0.05 was statistically significant. For comparison of unmatched data, chi-square tests were used for categorical variables and t-tests or Mann–Whitney tests for continuous variables.

In this study, we analyzed 138 cases of IMPC which presented to our center in the period from 2015 to 2022.We included a total number of 500 cases of IDC as controls with a ratio of controls to cases 4:1.

Propensity score matching (PSM) is a method for filtrating experimental and control cases of similar characteristics, which are called the matching variables, from existing data to make them comparable in a retrospective analysis. PSM reduce the effect of selection bias. So, the comparison of outcomes between two groups can be fair.

The variables for propensity score matching were selected as follows: age (years), tumour size (cm), nodal status, HR status and HER2 status.

To diminish the effects of baseline differences and potential confounds in clinical characteristics and patients across histology subtypes for outcome differences (disease-free survival and overall survival), PSM method was applied with each micropapillary patient matched to one IDC patient who showed similar baseline characteristics in terms of: menopausal status, comorbidities, multiplicity, histologic grade, tumor size, stage, nodal status, ER /PR status. Differences in prognosis were assessed by Kaplan–Meier analysis.

Most of the patients were postmenopausal, the mean age of patients in IMPC group was 57.36 ± 11.321 years while the mean age of the IDC group was 56.63 ± 9.719 years ( p  = 0.45) (Table 1 ).

The most common presentation of IMPC on breast mammography was an irregular shaped mass with a non-circumscribed spiculated margin. while, the most common sonographic finding of IMPC was hypoechoic mass with irregular shapes and spiculated margins. Associated microcalcifications were found in 49 patients (35.5%) of IMPC group. Figs. ( 1 , 2 ): Radiological characteristics of IMPC.

A , B 37-years-old female patient presented with Left breast UOQ extensive fine pleomorphic and amorphous calcifications of segmental distribution, with UOQ multiple indistinct irregular masses. C ultrasound showed left breast UOQ multiple irregular hypoechoic masses with calcific echogenic foci, the largest is seen at 1 o’clock measuring 13 × 15mm. Intraductal echogenic lesions are noted

A , B , C 40-years-old female patient presented with left UOQ extensive pleomorphic microcalcifications of segmental distribution reaching the areola, with multiple well-circumscribed small obscured masses. D , E complementary Ultrasound showed left 2 o’clock multiple ill-defined and well-defined hypoechoic masses (BIRADS 5)

All patients underwent axillary sonography where 77 patients (55.8%) of the IMPC group exhibited pathological lymph nodes and 18 patients (13%) had indeterminate lymph nodes demonstrating preserved hila and associated with either a symmetrical increase of their cortical thickness reaching 3mm or with a focal increase in the cortical thickness.

Multiple lesions were detected in 30% of IMPC patients in comparison to 7% of IDC patients. Intra-ductal extension with nipple involvement was found in 44 patients (31.9%) of the IMPC group (Table 2 ).

MRI was done for 5 cases (3.6%), while CESM was performed for 18 cases (13%) of the IMPC group, the commonest presentation of IMPC in contrast study was irregular shaped enhanced mass in 21 patients and non-mass enhancement was found in 5 patients. Figs. ( 3 , 4 ).

Further imaging modalities. A , B , C 60-years-old female patient had right breast irregular hypoechoic solid mass by ultrasound (BIRADS 5). D , E CESM showed a right breast irregular heterogeneously enhancing solid mass

Role of CESM in diagnosis of IMPC patients. A , B 42-years-old patient presented with a left LIQ irregular spiculated mass with suspicious microcalcifications, other similar lesions were seen anterior and posterior at the same line. C Ultrasound showed a heterogeneously hypoechoic irregular mass with a spiculated outline with multiple similar satellite lesions were seen anterior and posterior to the main lesions

The average tumor size in the IMPC and IDC groups was 3.37 ± 2.04 cm and 2.72 ± 1.39 cm, respectively ( P  < 0.001).

The percentage of tumors larger than 5cm, was reported 9.5% in IMPC and 7.4% in IDC.

The pure form of IMPC was the most common type and found in 90 cases (65%) and 47 cases (34%) were mixed type where IDC was the commonest associated type.

There are 6 cases in the IMPC group diagnosed as invasive mucinous carcinoma on biopsy, then in the specimen was mixed invasive micropapillary, IBC-NST and invasive mucinous carcinoma.

On core biopsy, 28 cases were diagnosed as IMPC with focal IDC component, but in corresponding specimens 10 cases were only approved to be mixed invasive micropapillary and invasive duct carcinoma, while others diagnosed as pure invasive micropapillary carcinoma without IDC component.

On the other hand, 48 of our cases were diagnosed as IDC on core biopsy, but in the final specimen examination, 17 of these cases were diagnosed as pure invasive micropapillary carcinoma without invasive ductal component.

The explanation of controversy in proper histologic subtyping of carcinoma on core biopsy and the definite subtype on the corresponding specimen was that the ductal component which only represented in the biopsy is a very minor component of the tumor or the limited sampling, tissue fragmentation and architecture distortion in core biopsy may cause diagnostic pitfalls as regard precise subtyping of the tumor.

The incidence of LVI in the IMPC group was 88.3% in comparison to 47.0% in the IDC group ( p  < 0.001).

IMPC had a higher incidence of lymph node involvement than the IDC group (68.8% and 56% respectively) with N3 stage reported in 12.4% of IMPC patients.

IMPC had a higher nuclear grade than the IDC group (25.1% and 15.2% respectively).

The percentage of ER-positive patients was 97.8% in the IMPC group and 87.6% in the IDC group ( p  < 0.001), while PR-positive cases were 98.6% in the IMPC group and 88.8% in the IDC group ( p  < 0.001). HER2 status was positive in 4.3% of IMPCs and 8% of IDCs ( p  = 0.23) (Table 3 ) (Figs. 5 ,  6 ).

A case of invasive micropapillary carcinoma. A case of invasive micropapillary carcinoma, grade II. A Tissue core biopsy, × 100, B MRM specimen × 100 with Positive metastatic L. nodes 2/15, C ER is positive in > 90% of tumor cells, × 100, D PR is positive in > 90% of tumor cells, × 400, E HER2/neu is negative, × 400 and F) Ki-67 labelling index is high, × 200. This case was considered as luminal type pure invasive micropapillary carcinoma. (100 micron 20__ 50 micron 40)

A case of invasive duct carcinoma. A case of invasive duct carcinoma, grade II. A Tissue core biopsy, × 100, B MRM specimen, × 200 with negative L. nodes 0/16, C ER is positive in > 90% of tumor cells, × 200, D PR is positive in > 90% of tumor cells, × 100, E HER2/neu is negative, × 400. This case was considered as luminal type pure invasive duct carcinoma

Regarding definitive surgical management, IMPC had a lower rate of breast conserving surgery (26% vs.37.8%) compared with IDC. While, 49.3% of IMPC patients underwent modified radical mastectomy in comparison to 46% of the IDC patients. Such high incidence of mastectomy was due to the advanced stage at presentation, presence of multiple lesions and presence of intra-ductal extension with nipple involvement.

The incidence of re-surgery in the IMPC group was only in 3 cases, two of them underwent completion mastectomy after the initial conservative breast surgery and axillary clearance. While one patient underwent wider margin excision as positive margin for an invasive residual disease was found.

Two patients in the IMPC group had distant metastasis at the initial diagnosis, they had multiple metastatic lesions and received systemic treatment but one of them underwent palliative mastectomy.

Systemic chemotherapy was administered to 107 patients (77.5%) in the IMPC group and to 207 patients (41%) in the IDC group. Hormonal therapy was administered to all IMPC patients and 76% patients in the IDC group (Table 4 ).

The overall median follow-up duration was 21 months (range 6 – 88 months) with mean follow up duration = 29.8months.

Among the 138 IMPC patients, local recurrence developed in 3 cases, they developed a recurrence at 6,18 and 48 months postoperative. Distant metastasis developed in 5 patients in the form of bone, lung, hepatic and mediastinal lymph node metastasis.

The survival analysis indicated that IMPC patients had no significant difference in overall survival compared with IDC patients and no differences were noted in locoregional recurrence rate comparing IMPCs with IDCs (2.2% and 0.4% respectively). P value for local recurrence = 0.12 (yates corrected chi square).

Distant metastasis rate comparing IMPCs with IDCs was (3.7% and 5.4% respectively). P value for distant metastasis = 0.53 (Table 5 ).

Comparison of OS between IDC and micropapillary cases (Matched by propensity score matching -PSM).

Case Processing Summary

Overall Comparisons

• Test of equality of survival distributions for the different levels type

Disease free survival

• Test of equality of survival distributions for the different levels of type

IMPC is a highly invasive type of breast cancer. Hashmi A.A. et al. [ 13 ] found that the incidence of IMPC is very low accounting for 0.76–3.8% of breast carcinomas.

Shi WB et al.; [ 7 ] in a study comparing 188 IMPC cases and 1,289 invasive ductal carcinoma (IDC) cases from China showed that IMPC can occur either alone or mixed with other histological types, such as ductal carcinoma in situ, mucinous carcinoma and IDC. Furthermore, the majority of patients had mixed IMPC.

Fakhry et al. [ 14 ] reported that 64.7% of IMPC patients were pure type. In our study, we found that the pure form of IMPC was the commonest type and presented in 90 patients (65%) and 47 cases (34%) were mixed type which was similar to that reported by Nassar et al. [ 15 ], and Guo et al. [ 16 ] in their studies.

In our study, the commonest finding of IMPC on breast mammography was an irregular shaped mass with a non-circumscribed spiculated margin. While, the commonest sonographic finding of IMPC was hypoechoic mass with irregular shapes and spiculated margins.

These findings were similar to the results demonstrated by Jones et al., [ 17 ] which found that the commonest morphologic finding of IMPC was an irregular high-density lesion (50% of patients) with spiculated margin (42% of patients). However, Günhan-Bilgen et al. [ 18 ] reported that an ovoid or round lesion was found in 53.8% of patients.

Alsharif et al., [ 19 ] reported that the commonest sonographic finding of IMPC was hypoechoic masse (39/41, 95%) with irregular shape (30/41, 73.2%) and angular or spiculated margin (26/41, 63.4%).

In our study, MRI was done for 5 cases (3.6%), while CESM was performed for 18 cases (13%) of the IMPC group, the commonest presentation of IMPC in contrast study was irregular shaped enhanced lesion in 21 cases and non-mass enhancement was presented in 5 cases.

Nangogn et al. [ 20 ] and yoon et al. [ 8 ] recorded that the commonest finding of IMPCs in MRI was spiculated irregular mass with early rapid initial heterogenous enhancement, indicating that the MRI findings correlated with the invasiveness of IMPC.

Fakhry et al. [ 14 ] conducted a study on 68 cases, out of which 17 cases underwent CEM. In all of these cases, the masses showed pathological enhancement, which was either in the form of mass enhancement (12/17 patients, 70.6%) or non-mass enhancement (4/17 patients, 23.5%). The majority of the enhanced masses were irregular in shape (11/12 patients, 91.7%).

All patients underwent axillary sonography and 77 patients (55.8%) of the IMPC group exhibited pathological lymph nodes; this percentage was similar to that recorded by Nangong et al. [ 20 ] which was 54.8% and lower than that recorded by Jones et al. [ 17 ] but higher than that of Günhan et al. [ 18 ] which were 67% and 38% respectively.

Günhan et al. [ 18 ] reported microcalcification in about 66.7% of the cases. In our study, associated microcalcifications were found in 49 patients (35.5%) of the IMPC group. Yun et al. [ 21 ] and Adrada et al. [ 22 ] showed a fine pleomorphic appearance (66.7% and 68%).

Hao et al. [ 23 ] compared the rate of tumors larger than 5cm, reporting 3% in IDC and 4.3% in IMPC. In our study, the rate of tumors larger than 5cm, was reported 7.4% in the IDC patients and 9.5% in the IMPC patients.

Yu et al., et al. [ 24 ] documented in a study comparing 72 cases of IMPC and 144 cases of IDC of the breast that IMPC had a higher nuclear grade than IDC (52.8% vs. 37.5% respectively). In our study, IMPC had a higher nuclear grade than the IDC group (25.1% and 15.2% respectively).

Verras GI et al.; [ 9 ] demonstrated that IMPC was an aggressive breast cancer subtype with a great tendency to lymphovascular invasion and lymph node metastasis. In our study, the incidence of LVI in the IMPC patients was 88.3% in comparison to 47.0% in the IDC patients ( p  < 0.001). Tang et al., [ 25 ] also reported that lymphovascular involvement was more common among the IIMPC group than IDC group, with a percentage of 14.7% compared to only 0.1% in the IDC group.

Also, Shi et al. [ 7 ] reported that LVI was detected in 74.5% of cases. Furthermore, the frequency of LVI was found to be greater in IMPC cases when compared to IDC cases. Jones et al., [ 17 ] recorded angiolymphatic invasion in 69% of cases.

Hashmi et al. [ 13 ] reported in his comparative study that nodal involvement was present in 49.5% of IDC patients and N3 stage was only 15.6% in IDC patients compared to 33% in IMPC patients. In our study, the percentage of lymph node involvement of IMPC and IDC patients were 68.8% and 56% respectively with N3 stage reported in 12.4% of IMPC patients.

Guan et al. [ 26 ], Lewis et al., [ 27 ], Pettinato et al., [ 28 ] and De La Cruz et al., [ 29 ] recorded a higher percentage of lymph node metastasis in IMPC patients, reaching 90%, 92.9%,55.2% and 60.9% respectively.

The management of IMPC remains controversial, particularly among breast surgeons. Modified radical mastectomy was the preferred surgical procedure for the majority of IMPC case reports, as found in a study conducted by Yu et al., [ 24 ] where 99% of IMPC cases underwent modified radical mastectomy. Fakhry et al. [ 14 ] reported that 76.5% of the patients underwent modified radical mastectomy. In our study, 49.3% of IMPC patients received modified radical mastectomy.

IMPC patients were also prone to accept BCS rather than mastectomy in the previous series conducted by Lewis GD,et al. [ 27 ] and Vingiani, A. et al. [ 30 ]. However, the precise prognosis value of BCS for patients with IMPC remained unknowable. In our study, IMPC had a lower rate of breast conserving surgery (26% vs.37.8%) compared with IDC.

IMPC was characterized by a high incidence of ER and PR positivity. Our study recorded a high percentage of ER (97.8%) and PR (98.6%) expression. Our findings are similar to those found by Walsh et al., [ 31 ] who reported ER and PR expression of 90% and 70%, respectively. Zekioglu et al. [ 32 ] demonstrated a rate of ER and PR expression of 68% and 61%respectively.

In this study, we reported a relatively lower percentage of HER-2 positivity (4.3%). Also, Nangong et al. [ 20 ] showed HER 2 overexpression in 26.4% of cases.

However, Cui et al. [ 33 ] reported a much higher incidence of HER 2 positivity and Perron et al., [ 34 ] reported that 65% of IMPCs were HER-2 positive.

Chen, A et al. [ 35 ] reported that that the percentage of radiation therapy for IMPC patients was similar to those seen in IDC patients and demonstrates a similar benefit of radiation treatment in both groups. In our study,77.5% patients received radiotherapy in IMPC group in compared to 59.4% patients in IDC group.

Shi et al. [ 7 ] found that patients with IMPC had worse recurrence-free survival (RFS) and overall survival (OS) rates as compared to those with IDC. However, because IMPC is relatively rare, most studies had reported on small sample sizes with limited follow-ups.

Yu et al., [ 24 ] conducted a comparison between IMPC and IDC patients, and the results showed that the IMPC group had a greater tendency for LRR compared to the IDC group ( P  = 0.03), but the distant metastasis rate ( P  = 0.52) and OS rate ( P  = 0.67) of the IMPC showed no statistical differences from the IDC group.

Nevertheless, several recent studies documented that IMPC had better or similar prognosis in comparison to IDC.

Hao et al. [ 23 ] and Vingiani et al. [ 30 ] documented that there was no statistically significant difference in OS and disease-free survival between IMPC patients and IDC patients which was similar to our results. locoregional recurrence rate comparing IMPCs with IDCs was (2.2% and 0.4% respectively). P value for local recurrence = 0.12 (yates corrected chi square). Distant metastasis rate comparing IMPCs with IDCs was (3.7% and 5.4% respectively). P value for distant metastasis = 0.53.

Chen H et al. [ 36 ], compared the overall survival in patient groups with similar nodal involvement and found that IMPC group had better breast cancer–specific survival and overall survival than IDC group.

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No datasets were generated or analysed during the current study.

Abbreviations

Invasive micropapillary carcinoma

Invasive duct carcinoma

Modified radical mastectomy

Conserving breast surgery

Estrogen receptor

Progesterone receptor

Lymphovascular invasion

Contrast enhanced spectral mammography

Overall survival

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Mohamed Fathy Abdelfattah Abdelrahman Elithy

Present address: Department of Surgical Oncology, Faculty of Medicine, Al Azhar University, Cairo, Egypt

Mahmoud Hassaan

Present address: Departement of Surgical Oncology, National Cancer Institute, Cairo University, Giza, Egypt

Authors and Affiliations

Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Yasmine Hany Abdel Moamen Elzohery

Department of Radiodiagnosis, NCI, Cairo University, Giza, Egypt

Amira H. Radwan & Sherihan W. Y. Gareer

Department of Pathology, National Cancer Institute, Cairo University, Giza, Egypt

Mona M. Mamdouh

Department of Epidemiology and Preventive Medicine, National Liver Institute, Menoufia, Egypt

Baheya Center for Early Detection and Treatment of Breast Cancer, Giza, Egypt

Yasmine Hany Abdel Moamen Elzohery, Amira H. Radwan, Sherihan W. Y. Gareer, Mona M. Mamdouh, Inas Moaz, Abdelrahman Mohammad Khalifa, Osama Abdel Mohen, Mohamed Fathy Abdelfattah Abdelrahman Elithy & Mahmoud Hassaan

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Mohamed fathy participated in the sequence alignment and Yasmine hany drafted the manuscript. Mahmoud Hassan participated in the design of the study. Inas Moaz and Abdelrahman Mohammad performed the statistical analysis. Amira H. Radwan and Sherihan WY Gareer conceived the study. Mona M Mamdouh and Osama abdel Mohen participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.

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Elzohery, Y.H.A.M., Radwan, A.H., Gareer, S.W.Y. et al. Micropapillary breast carcinoma in comparison with invasive duct carcinoma. Does it have an aggressive clinical presentation and an unfavorable prognosis?. BMC Cancer 24 , 992 (2024). https://doi.org/10.1186/s12885-024-12673-0

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Received : 05 April 2024

Accepted : 23 July 2024

Published : 12 August 2024

DOI : https://doi.org/10.1186/s12885-024-12673-0

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