HCS: Case study, Context and Complex interventions (TRIPLE C) - development of guidance and publication standards to support case study-based research

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Complex interventions (e.g. redesign of stroke services, urban regeneration programmes) are widely used in the health service and in public health practice. The issue of how one develops, implements and evaluates complex interventions remains a key one for researchers. Traditional research methods have been stretched to the limit in meeting this challenge. There has been growing interest in developing research methods that support improved development and implementation in health care, and in ways that account for the contexts (communities, organisations and so on) in which complex interventions are intended. Case study research is widely recognised as offering such methods, and as a vital resource for understanding the influence of context on complex interventions. A significant literature on case study research already exists in health services research and the social sciences. This literature has evolved out of different disciplines (e.g. psychology, sociology, management), and research traditions (e.g. qualitative or quantitative). It has yet to be interrogated in a way that can support improved development and implementation of complex interventions in health care and public health. Traditional approaches to systematic literature review attempt to collate all evidence that fits pre-specified eligibility criteria in order to answer a specific research question. Such approaches lend themselves to certain (often quite narrow) areas of work but tend to be far less helpful when reviewing diverse, cross-disciplinary topics like the role of case study research in evaluating complex interventions. We therefore propose a meta-narrative review: in other words, using a systematic, theory-driven technique to guide reviewing the wide-ranging literature on case study methods and help us to understand how such methods have been differently conceptualised and used by different groups of researchers. Meta-narrative review is an on-going process, involving the reviewer in understanding what will be most useful to the intended audience, illuminating the topic from multiple angles, capturing how research traditions have unfolded over time, examining 'conflicting data' from different research traditions, continually reflecting on emerging findings and gaining feedback from an external audience to guide further reflection and analysis. We will combine data from key sources to produce an account of how and why case study traditions have evolved, and then compare findings from these different traditions to build a rich picture of case study research on complex interventions from multiple perspectives.Having summarised the relevant literature, we will conduct an online survey with a group of up to 30 experts in case study research (ensuring a range of perspectives, organisations and locations). The idea will be to share our summary of the literature with the group, stimulate reflection and (over three rounds of online discussion) work towards getting as close as possible to consensus on draft guidance on the use of case study when researching complex interventions. We plan to then test this draft guidance with up to five teams of researchers who have conducted and published highly regarded case studies of complex interventions, as well as a group of up to 10 case study experts. Through this iterative process, we will develop methodological guidance on how to design and carry out case studies of complex interventions in health care, and publish standards for case study-based research on complex interventions. We will make these freely available. We also plan to build a community of practice around case study research in this field, bringing together experts from different disciplines and traditions to inform future development, implementation and evaluation of complex system-level interventions.