Managing school behavior: a qualitative case study

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The purposes of this dissertation research were to understand the methods by which building-level school administrators collect office discipline referral data, and to understand the ways they make decisions based on that data. In order to achieve this overall objective, the following research questions framed this study:

1. To what extent do administrators have access to behavior data that inform their decisions on how to improve student success in school and society?

2. To what extent do administrators use behavior data to improve student success in school and in society?

3. What do administrators perceive it would take to enhance the effectiveness of their current efforts to improve students' success in school and society?

One mid-sized suburban school district from the Midwest was selected for this case study research. Eleven school building administrators were interviewed to provide insight into the research questions. Participants in the study self-selected pseudonyms to preserve anonymity. Interviews were conducted face to face, and then transcribed.

The themes that emerged from the interviews include: (1) participants' perceptions of and experiences with collecting and analyzing student behavior data, (2) participants' perceptions of and experiences with using behavior data to improve student success in school and in society, and (3) participants' perceptions of necessary steps to take to enhance the effectiveness of their current efforts to improve students' success in school and society. The findings from this study describe practices used for collecting student attendance data, office referral data, and suspension and expulsion data. Building-level school leaders recognize that data collection and analysis of building- and school district-level conduct and/or behavior data would help them establish patterns of behavior for individual students, as well as students throughout the building. The aim for school administrators should be to use research-based strategies, practices, and programs that have proven successful when they plan interventions and programmatic changes for students.

Based on its findings, this study recommends that further investigation into data collection processes that lead to improved behavioral outcomes for students be conducted. Consistent data collection, supported by a systemic procedure to analyze that data, is paramount to increase the effectiveness of any behavior support program. As schools continue to face challenges associated with providing adequate behavioral supports for students, building capacity with teaching and administrative staff is recommended, so that a continuum of behavioral supports could be provided to meet the diverse behavioral needs of buildings, schools, and districts.


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  • 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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Methodology or method? A critical review of qualitative case study reports

Despite on-going debate about credibility, and reported limitations in comparison to other approaches, case study is an increasingly popular approach among qualitative researchers. We critically analysed the methodological descriptions of published case studies. Three high-impact qualitative methods journals were searched to locate case studies published in the past 5 years; 34 were selected for analysis. Articles were categorized as health and health services ( n= 12), social sciences and anthropology ( n= 7), or methods ( n= 15) case studies. The articles were reviewed using an adapted version of established criteria to determine whether adequate methodological justification was present, and if study aims, methods, and reported findings were consistent with a qualitative case study approach. Findings were grouped into five themes outlining key methodological issues: case study methodology or method, case of something particular and case selection, contextually bound case study, researcher and case interactions and triangulation, and study design inconsistent with methodology reported. Improved reporting of case studies by qualitative researchers will advance the methodology for the benefit of researchers and practitioners.

Case study research is an increasingly popular approach among qualitative researchers (Thomas, 2011 ). Several prominent authors have contributed to methodological developments, which has increased the popularity of case study approaches across disciplines (Creswell, 2013b ; Denzin & Lincoln, 2011b ; Merriam, 2009 ; Ragin & Becker, 1992 ; Stake, 1995 ; Yin, 2009 ). Current qualitative case study approaches are shaped by paradigm, study design, and selection of methods, and, as a result, case studies in the published literature vary. Differences between published case studies can make it difficult for researchers to define and understand case study as a methodology.

Experienced qualitative researchers have identified case study research as a stand-alone qualitative approach (Denzin & Lincoln, 2011b ). Case study research has a level of flexibility that is not readily offered by other qualitative approaches such as grounded theory or phenomenology. Case studies are designed to suit the case and research question and published case studies demonstrate wide diversity in study design. There are two popular case study approaches in qualitative research. The first, proposed by Stake ( 1995 ) and Merriam ( 2009 ), is situated in a social constructivist paradigm, whereas the second, by Yin ( 2012 ), Flyvbjerg ( 2011 ), and Eisenhardt ( 1989 ), approaches case study from a post-positivist viewpoint. Scholarship from both schools of inquiry has contributed to the popularity of case study and development of theoretical frameworks and principles that characterize the methodology.

The diversity of case studies reported in the published literature, and on-going debates about credibility and the use of case study in qualitative research practice, suggests that differences in perspectives on case study methodology may prevent researchers from developing a mutual understanding of practice and rigour. In addition, discussion about case study limitations has led some authors to query whether case study is indeed a methodology (Luck, Jackson, & Usher, 2006 ; Meyer, 2001 ; Thomas, 2010 ; Tight, 2010 ). Methodological discussion of qualitative case study research is timely, and a review is required to analyse and understand how this methodology is applied in the qualitative research literature. The aims of this study were to review methodological descriptions of published qualitative case studies, to review how the case study methodological approach was applied, and to identify issues that need to be addressed by researchers, editors, and reviewers. An outline of the current definitions of case study and an overview of the issues proposed in the qualitative methodological literature are provided to set the scene for the review.

Definitions of qualitative case study research

Case study research is an investigation and analysis of a single or collective case, intended to capture the complexity of the object of study (Stake, 1995 ). Qualitative case study research, as described by Stake ( 1995 ), draws together “naturalistic, holistic, ethnographic, phenomenological, and biographic research methods” in a bricoleur design, or in his words, “a palette of methods” (Stake, 1995 , pp. xi–xii). Case study methodology maintains deep connections to core values and intentions and is “particularistic, descriptive and heuristic” (Merriam, 2009 , p. 46).

As a study design, case study is defined by interest in individual cases rather than the methods of inquiry used. The selection of methods is informed by researcher and case intuition and makes use of naturally occurring sources of knowledge, such as people or observations of interactions that occur in the physical space (Stake, 1998 ). Thomas ( 2011 ) suggested that “analytical eclecticism” is a defining factor (p. 512). Multiple data collection and analysis methods are adopted to further develop and understand the case, shaped by context and emergent data (Stake, 1995 ). This qualitative approach “explores a real-life, contemporary bounded system (a case ) or multiple bounded systems (cases) over time, through detailed, in-depth data collection involving multiple sources of information … and reports a case description and case themes ” (Creswell, 2013b , p. 97). Case study research has been defined by the unit of analysis, the process of study, and the outcome or end product, all essentially the case (Merriam, 2009 ).

The case is an object to be studied for an identified reason that is peculiar or particular. Classification of the case and case selection procedures informs development of the study design and clarifies the research question. Stake ( 1995 ) proposed three types of cases and study design frameworks. These include the intrinsic case, the instrumental case, and the collective instrumental case. The intrinsic case is used to understand the particulars of a single case, rather than what it represents. An instrumental case study provides insight on an issue or is used to refine theory. The case is selected to advance understanding of the object of interest. A collective refers to an instrumental case which is studied as multiple, nested cases, observed in unison, parallel, or sequential order. More than one case can be simultaneously studied; however, each case study is a concentrated, single inquiry, studied holistically in its own entirety (Stake, 1995 , 1998 ).

Researchers who use case study are urged to seek out what is common and what is particular about the case. This involves careful and in-depth consideration of the nature of the case, historical background, physical setting, and other institutional and political contextual factors (Stake, 1998 ). An interpretive or social constructivist approach to qualitative case study research supports a transactional method of inquiry, where the researcher has a personal interaction with the case. The case is developed in a relationship between the researcher and informants, and presented to engage the reader, inviting them to join in this interaction and in case discovery (Stake, 1995 ). A postpositivist approach to case study involves developing a clear case study protocol with careful consideration of validity and potential bias, which might involve an exploratory or pilot phase, and ensures that all elements of the case are measured and adequately described (Yin, 2009 , 2012 ).

Current methodological issues in qualitative case study research

The future of qualitative research will be influenced and constructed by the way research is conducted, and by what is reviewed and published in academic journals (Morse, 2011 ). If case study research is to further develop as a principal qualitative methodological approach, and make a valued contribution to the field of qualitative inquiry, issues related to methodological credibility must be considered. Researchers are required to demonstrate rigour through adequate descriptions of methodological foundations. Case studies published without sufficient detail for the reader to understand the study design, and without rationale for key methodological decisions, may lead to research being interpreted as lacking in quality or credibility (Hallberg, 2013 ; Morse, 2011 ).

There is a level of artistic license that is embraced by qualitative researchers and distinguishes practice, which nurtures creativity, innovation, and reflexivity (Denzin & Lincoln, 2011b ; Morse, 2009 ). Qualitative research is “inherently multimethod” (Denzin & Lincoln, 2011a , p. 5); however, with this creative freedom, it is important for researchers to provide adequate description for methodological justification (Meyer, 2001 ). This includes paradigm and theoretical perspectives that have influenced study design. Without adequate description, study design might not be understood by the reader, and can appear to be dishonest or inaccurate. Reviewers and readers might be confused by the inconsistent or inappropriate terms used to describe case study research approach and methods, and be distracted from important study findings (Sandelowski, 2000 ). This issue extends beyond case study research, and others have noted inconsistencies in reporting of methodology and method by qualitative researchers. Sandelowski ( 2000 , 2010 ) argued for accurate identification of qualitative description as a research approach. She recommended that the selected methodology should be harmonious with the study design, and be reflected in methods and analysis techniques. Similarly, Webb and Kevern ( 2000 ) uncovered inconsistencies in qualitative nursing research with focus group methods, recommending that methodological procedures must cite seminal authors and be applied with respect to the selected theoretical framework. Incorrect labelling using case study might stem from the flexibility in case study design and non-directional character relative to other approaches (Rosenberg & Yates, 2007 ). Methodological integrity is required in design of qualitative studies, including case study, to ensure study rigour and to enhance credibility of the field (Morse, 2011 ).

Case study has been unnecessarily devalued by comparisons with statistical methods (Eisenhardt, 1989 ; Flyvbjerg, 2006 , 2011 ; Jensen & Rodgers, 2001 ; Piekkari, Welch, & Paavilainen, 2009 ; Tight, 2010 ; Yin, 1999 ). It is reputed to be the “the weak sibling” in comparison to other, more rigorous, approaches (Yin, 2009 , p. xiii). Case study is not an inherently comparative approach to research. The objective is not statistical research, and the aim is not to produce outcomes that are generalizable to all populations (Thomas, 2011 ). Comparisons between case study and statistical research do little to advance this qualitative approach, and fail to recognize its inherent value, which can be better understood from the interpretive or social constructionist viewpoint of other authors (Merriam, 2009 ; Stake, 1995 ). Building on discussions relating to “fuzzy” (Bassey, 2001 ), or naturalistic generalizations (Stake, 1978 ), or transference of concepts and theories (Ayres, Kavanaugh, & Knafl, 2003 ; Morse et al., 2011 ) would have more relevance.

Case study research has been used as a catch-all design to justify or add weight to fundamental qualitative descriptive studies that do not fit with other traditional frameworks (Merriam, 2009 ). A case study has been a “convenient label for our research—when we ‘can't think of anything ‘better”—in an attempt to give it [qualitative methodology] some added respectability” (Tight, 2010 , p. 337). Qualitative case study research is a pliable approach (Merriam, 2009 ; Meyer, 2001 ; Stake, 1995 ), and has been likened to a “curious methodological limbo” (Gerring, 2004 , p. 341) or “paradigmatic bridge” (Luck et al., 2006 , p. 104), that is on the borderline between postpositivist and constructionist interpretations. This has resulted in inconsistency in application, which indicates that flexibility comes with limitations (Meyer, 2001 ), and the open nature of case study research might be off-putting to novice researchers (Thomas, 2011 ). The development of a well-(in)formed theoretical framework to guide a case study should improve consistency, rigour, and trust in studies published in qualitative research journals (Meyer, 2001 ).

Assessment of rigour

The purpose of this study was to analyse the methodological descriptions of case studies published in qualitative methods journals. To do this we needed to develop a suitable framework, which used existing, established criteria for appraising qualitative case study research rigour (Creswell, 2013b ; Merriam, 2009 ; Stake, 1995 ). A number of qualitative authors have developed concepts and criteria that are used to determine whether a study is rigorous (Denzin & Lincoln, 2011b ; Lincoln, 1995 ; Sandelowski & Barroso, 2002 ). The criteria proposed by Stake ( 1995 ) provide a framework for readers and reviewers to make judgements regarding case study quality, and identify key characteristics essential for good methodological rigour. Although each of the factors listed in Stake's criteria could enhance the quality of a qualitative research report, in Table I we present an adapted criteria used in this study, which integrates more recent work by Merriam ( 2009 ) and Creswell ( 2013b ). Stake's ( 1995 ) original criteria were separated into two categories. The first list of general criteria is “relevant for all qualitative research.” The second list, “high relevance to qualitative case study research,” was the criteria that we decided had higher relevance to case study research. This second list was the main criteria used to assess the methodological descriptions of the case studies reviewed. The complete table has been preserved so that the reader can determine how the original criteria were adapted.

Framework for assessing quality in qualitative case study research.

Adapted from Stake ( 1995 , p. 131).

Study design

The critical review method described by Grant and Booth ( 2009 ) was used, which is appropriate for the assessment of research quality, and is used for literature analysis to inform research and practice. This type of review goes beyond the mapping and description of scoping or rapid reviews, to include “analysis and conceptual innovation” (Grant & Booth, 2009 , p. 93). A critical review is used to develop existing, or produce new, hypotheses or models. This is different to systematic reviews that answer clinical questions. It is used to evaluate existing research and competing ideas, to provide a “launch pad” for conceptual development and “subsequent testing” (Grant & Booth, 2009 , p. 93).

Qualitative methods journals were located by a search of the 2011 ISI Journal Citation Reports in Social Science, via the database Web of Knowledge (see No “qualitative research methods” category existed in the citation reports; therefore, a search of all categories was performed using the term “qualitative.” In Table II , we present the qualitative methods journals located, ranked by impact factor. The highest ranked journals were selected for searching. We acknowledge that the impact factor ranking system might not be the best measure of journal quality (Cheek, Garnham, & Quan, 2006 ); however, this was the most appropriate and accessible method available.

International Journal of Qualitative Studies on Health and Well-being.

Search strategy

In March 2013, searches of the journals, Qualitative Health Research , Qualitative Research , and Qualitative Inquiry were completed to retrieve studies with “case study” in the abstract field. The search was limited to the past 5 years (1 January 2008 to 1 March 2013). The objective was to locate published qualitative case studies suitable for assessment using the adapted criterion. Viewpoints, commentaries, and other article types were excluded from review. Title and abstracts of the 45 retrieved articles were read by the first author, who identified 34 empirical case studies for review. All authors reviewed the 34 studies to confirm selection and categorization. In Table III , we present the 34 case studies grouped by journal, and categorized by research topic, including health sciences, social sciences and anthropology, and methods research. There was a discrepancy in categorization of one article on pedagogy and a new teaching method published in Qualitative Inquiry (Jorrín-Abellán, Rubia-Avi, Anguita-Martínez, Gómez-Sánchez, & Martínez-Mones, 2008 ). Consensus was to allocate to the methods category.

Outcomes of search of qualitative methods journals.

In Table III , the number of studies located, and final numbers selected for review have been reported. Qualitative Health Research published the most empirical case studies ( n= 16). In the health category, there were 12 case studies of health conditions, health services, and health policy issues, all published in Qualitative Health Research . Seven case studies were categorized as social sciences and anthropology research, which combined case study with biography and ethnography methodologies. All three journals published case studies on methods research to illustrate a data collection or analysis technique, methodological procedure, or related issue.

The methodological descriptions of 34 case studies were critically reviewed using the adapted criteria. All articles reviewed contained a description of study methods; however, the length, amount of detail, and position of the description in the article varied. Few studies provided an accurate description and rationale for using a qualitative case study approach. In the 34 case studies reviewed, three described a theoretical framework informed by Stake ( 1995 ), two by Yin ( 2009 ), and three provided a mixed framework informed by various authors, which might have included both Yin and Stake. Few studies described their case study design, or included a rationale that explained why they excluded or added further procedures, and whether this was to enhance the study design, or to better suit the research question. In 26 of the studies no reference was provided to principal case study authors. From reviewing the description of methods, few authors provided a description or justification of case study methodology that demonstrated how their study was informed by the methodological literature that exists on this approach.

The methodological descriptions of each study were reviewed using the adapted criteria, and the following issues were identified: case study methodology or method; case of something particular and case selection; contextually bound case study; researcher and case interactions and triangulation; and, study design inconsistent with methodology. An outline of how the issues were developed from the critical review is provided, followed by a discussion of how these relate to the current methodological literature.

Case study methodology or method

A third of the case studies reviewed appeared to use a case report method, not case study methodology as described by principal authors (Creswell, 2013b ; Merriam, 2009 ; Stake, 1995 ; Yin, 2009 ). Case studies were identified as a case report because of missing methodological detail and by review of the study aims and purpose. These reports presented data for small samples of no more than three people, places or phenomenon. Four studies, or “case reports” were single cases selected retrospectively from larger studies (Bronken, Kirkevold, Martinsen, & Kvigne, 2012 ; Coltart & Henwood, 2012 ; Hooghe, Neimeyer, & Rober, 2012 ; Roscigno et al., 2012 ). Case reports were not a case of something, instead were a case demonstration or an example presented in a report. These reports presented outcomes, and reported on how the case could be generalized. Descriptions focussed on the phenomena, rather than the case itself, and did not appear to study the case in its entirety.

Case reports had minimal in-text references to case study methodology, and were informed by other qualitative traditions or secondary sources (Adamson & Holloway, 2012 ; Buzzanell & D'Enbeau, 2009 ; Nagar-Ron & Motzafi-Haller, 2011 ). This does not suggest that case study methodology cannot be multimethod, however, methodology should be consistent in design, be clearly described (Meyer, 2001 ; Stake, 1995 ), and maintain focus on the case (Creswell, 2013b ).

To demonstrate how case reports were identified, three examples are provided. The first, Yeh ( 2013 ) described their study as, “the examination of the emergence of vegetarianism in Victorian England serves as a case study to reveal the relationships between boundaries and entities” (p. 306). The findings were a historical case report, which resulted from an ethnographic study of vegetarianism. Cunsolo Willox, Harper, Edge, ‘My Word’: Storytelling and Digital Media Lab, and Rigolet Inuit Community Government (2013) used “a case study that illustrates the usage of digital storytelling within an Inuit community” (p. 130). This case study reported how digital storytelling can be used with indigenous communities as a participatory method to illuminate the benefits of this method for other studies. This “case study was conducted in the Inuit community” but did not include the Inuit community in case analysis (Cunsolo Willox et al., 2013 , p. 130). Bronken et al. ( 2012 ) provided a single case report to demonstrate issues observed in a larger clinical study of aphasia and stroke, without adequate case description or analysis.

Case study of something particular and case selection

Case selection is a precursor to case analysis, which needs to be presented as a convincing argument (Merriam, 2009 ). Descriptions of the case were often not adequate to ascertain why the case was selected, or whether it was a particular exemplar or outlier (Thomas, 2011 ). In a number of case studies in the health and social science categories, it was not explicit whether the case was of something particular, or peculiar to their discipline or field (Adamson & Holloway, 2012 ; Bronken et al., 2012 ; Colón-Emeric et al., 2010 ; Jackson, Botelho, Welch, Joseph, & Tennstedt, 2012 ; Mawn et al., 2010 ; Snyder-Young, 2011 ). There were exceptions in the methods category ( Table III ), where cases were selected by researchers to report on a new or innovative method. The cases emerged through heuristic study, and were reported to be particular, relative to the existing methods literature (Ajodhia-Andrews & Berman, 2009 ; Buckley & Waring, 2013 ; Cunsolo Willox et al., 2013 ; De Haene, Grietens, & Verschueren, 2010 ; Gratton & O'Donnell, 2011 ; Sumsion, 2013 ; Wimpenny & Savin-Baden, 2012 ).

Case selection processes were sometimes insufficient to understand why the case was selected from the global population of cases, or what study of this case would contribute to knowledge as compared with other possible cases (Adamson & Holloway, 2012 ; Bronken et al., 2012 ; Colón-Emeric et al., 2010 ; Jackson et al., 2012 ; Mawn et al., 2010 ). In two studies, local cases were selected (Barone, 2010 ; Fourie & Theron, 2012 ) because the researcher was familiar with and had access to the case. Possible limitations of a convenience sample were not acknowledged. Purposeful sampling was used to recruit participants within the case of one study, but not of the case itself (Gallagher et al., 2013 ). Random sampling was completed for case selection in two studies (Colón-Emeric et al., 2010 ; Jackson et al., 2012 ), which has limited meaning in interpretive qualitative research.

To demonstrate how researchers provided a good justification for the selection of case study approaches, four examples are provided. The first, cases of residential care homes, were selected because of reported occurrences of mistreatment, which included residents being locked in rooms at night (Rytterström, Unosson, & Arman, 2013 ). Roscigno et al. ( 2012 ) selected cases of parents who were admitted for early hospitalization in neonatal intensive care with a threatened preterm delivery before 26 weeks. Hooghe et al. ( 2012 ) used random sampling to select 20 couples that had experienced the death of a child; however, the case study was of one couple and a particular metaphor described only by them. The final example, Coltart and Henwood ( 2012 ), provided a detailed account of how they selected two cases from a sample of 46 fathers based on personal characteristics and beliefs. They described how the analysis of the two cases would contribute to their larger study on first time fathers and parenting.

Contextually bound case study

The limits or boundaries of the case are a defining factor of case study methodology (Merriam, 2009 ; Ragin & Becker, 1992 ; Stake, 1995 ; Yin, 2009 ). Adequate contextual description is required to understand the setting or context in which the case is revealed. In the health category, case studies were used to illustrate a clinical phenomenon or issue such as compliance and health behaviour (Colón-Emeric et al., 2010 ; D'Enbeau, Buzzanell, & Duckworth, 2010 ; Gallagher et al., 2013 ; Hooghe et al., 2012 ; Jackson et al., 2012 ; Roscigno et al., 2012 ). In these case studies, contextual boundaries, such as physical and institutional descriptions, were not sufficient to understand the case as a holistic system, for example, the general practitioner (GP) clinic in Gallagher et al. ( 2013 ), or the nursing home in Colón-Emeric et al. ( 2010 ). Similarly, in the social science and methods categories, attention was paid to some components of the case context, but not others, missing important information required to understand the case as a holistic system (Alexander, Moreira, & Kumar, 2012 ; Buzzanell & D'Enbeau, 2009 ; Nairn & Panelli, 2009 ; Wimpenny & Savin-Baden, 2012 ).

In two studies, vicarious experience or vignettes (Nairn & Panelli, 2009 ) and images (Jorrín-Abellán et al., 2008 ) were effective to support description of context, and might have been a useful addition for other case studies. Missing contextual boundaries suggests that the case might not be adequately defined. Additional information, such as the physical, institutional, political, and community context, would improve understanding of the case (Stake, 1998 ). In Boxes 1 and 2 , we present brief synopses of two studies that were reviewed, which demonstrated a well bounded case. In Box 1 , Ledderer ( 2011 ) used a qualitative case study design informed by Stake's tradition. In Box 2 , Gillard, Witt, and Watts ( 2011 ) were informed by Yin's tradition. By providing a brief outline of the case studies in Boxes 1 and 2 , we demonstrate how effective case boundaries can be constructed and reported, which may be of particular interest to prospective case study researchers.

Article synopsis of case study research using Stake's tradition

Ledderer ( 2011 ) used a qualitative case study research design, informed by modern ethnography. The study is bounded to 10 general practice clinics in Denmark, who had received federal funding to implement preventative care services based on a Motivational Interviewing intervention. The researcher question focussed on “why is it so difficult to create change in medical practice?” (Ledderer, 2011 , p. 27). The study context was adequately described, providing detail on the general practitioner (GP) clinics and relevant political and economic influences. Methodological decisions are described in first person narrative, providing insight on researcher perspectives and interaction with the case. Forty-four interviews were conducted, which focussed on how GPs conducted consultations, and the form, nature and content, rather than asking their opinion or experience (Ledderer, 2011 , p. 30). The duration and intensity of researcher immersion in the case enhanced depth of description and trustworthiness of study findings. Analysis was consistent with Stake's tradition, and the researcher provided examples of inquiry techniques used to challenge assumptions about emerging themes. Several other seminal qualitative works were cited. The themes and typology constructed are rich in narrative data and storytelling by clinic staff, demonstrating individual clinic experiences as well as shared meanings and understandings about changing from a biomedical to psychological approach to preventative health intervention. Conclusions make note of social and cultural meanings and lessons learned, which might not have been uncovered using a different methodology.

Article synopsis of case study research using Yin's tradition

Gillard et al. ( 2011 ) study of camps for adolescents living with HIV/AIDs provided a good example of Yin's interpretive case study approach. The context of the case is bounded by the three summer camps of which the researchers had prior professional involvement. A case study protocol was developed that used multiple methods to gather information at three data collection points coinciding with three youth camps (Teen Forum, Discover Camp, and Camp Strong). Gillard and colleagues followed Yin's ( 2009 ) principles, using a consistent data protocol that enhanced cross-case analysis. Data described the young people, the camp physical environment, camp schedule, objectives and outcomes, and the staff of three youth camps. The findings provided a detailed description of the context, with less detail of individual participants, including insight into researcher's interpretations and methodological decisions throughout the data collection and analysis process. Findings provided the reader with a sense of “being there,” and are discovered through constant comparison of the case with the research issues; the case is the unit of analysis. There is evidence of researcher immersion in the case, and Gillard reports spending significant time in the field in a naturalistic and integrated youth mentor role.

This case study is not intended to have a significant impact on broader health policy, although does have implications for health professionals working with adolescents. Study conclusions will inform future camps for young people with chronic disease, and practitioners are able to compare similarities between this case and their own practice (for knowledge translation). No limitations of this article were reported. Limitations related to publication of this case study were that it was 20 pages long and used three tables to provide sufficient description of the camp and program components, and relationships with the research issue.

Researcher and case interactions and triangulation

Researcher and case interactions and transactions are a defining feature of case study methodology (Stake, 1995 ). Narrative stories, vignettes, and thick description are used to provoke vicarious experience and a sense of being there with the researcher in their interaction with the case. Few of the case studies reviewed provided details of the researcher's relationship with the case, researcher–case interactions, and how these influenced the development of the case study (Buzzanell & D'Enbeau, 2009 ; D'Enbeau et al., 2010 ; Gallagher et al., 2013 ; Gillard et al., 2011 ; Ledderer, 2011 ; Nagar-Ron & Motzafi-Haller, 2011 ). The role and position of the researcher needed to be self-examined and understood by readers, to understand how this influenced interactions with participants, and to determine what triangulation is needed (Merriam, 2009 ; Stake, 1995 ).

Gillard et al. ( 2011 ) provided a good example of triangulation, comparing data sources in a table (p. 1513). Triangulation of sources was used to reveal as much depth as possible in the study by Nagar-Ron and Motzafi-Haller ( 2011 ), while also enhancing confirmation validity. There were several case studies that would have benefited from improved range and use of data sources, and descriptions of researcher–case interactions (Ajodhia-Andrews & Berman, 2009 ; Bronken et al., 2012 ; Fincham, Scourfield, & Langer, 2008 ; Fourie & Theron, 2012 ; Hooghe et al., 2012 ; Snyder-Young, 2011 ; Yeh, 2013 ).

Study design inconsistent with methodology

Good, rigorous case studies require a strong methodological justification (Meyer, 2001 ) and a logical and coherent argument that defines paradigm, methodological position, and selection of study methods (Denzin & Lincoln, 2011b ). Methodological justification was insufficient in several of the studies reviewed (Barone, 2010 ; Bronken et al., 2012 ; Hooghe et al., 2012 ; Mawn et al., 2010 ; Roscigno et al., 2012 ; Yeh, 2013 ). This was judged by the absence, or inadequate or inconsistent reference to case study methodology in-text.

In six studies, the methodological justification provided did not relate to case study. There were common issues identified. Secondary sources were used as primary methodological references indicating that study design might not have been theoretically sound (Colón-Emeric et al., 2010 ; Coltart & Henwood, 2012 ; Roscigno et al., 2012 ; Snyder-Young, 2011 ). Authors and sources cited in methodological descriptions were inconsistent with the actual study design and practices used (Fourie & Theron, 2012 ; Hooghe et al., 2012 ; Jorrín-Abellán et al., 2008 ; Mawn et al., 2010 ; Rytterström et al., 2013 ; Wimpenny & Savin-Baden, 2012 ). This occurred when researchers cited Stake or Yin, or both (Mawn et al., 2010 ; Rytterström et al., 2013 ), although did not follow their paradigmatic or methodological approach. In 26 studies there were no citations for a case study methodological approach.

The findings of this study have highlighted a number of issues for researchers. A considerable number of case studies reviewed were missing key elements that define qualitative case study methodology and the tradition cited. A significant number of studies did not provide a clear methodological description or justification relevant to case study. Case studies in health and social sciences did not provide sufficient information for the reader to understand case selection, and why this case was chosen above others. The context of the cases were not described in adequate detail to understand all relevant elements of the case context, which indicated that cases may have not been contextually bounded. There were inconsistencies between reported methodology, study design, and paradigmatic approach in case studies reviewed, which made it difficult to understand the study methodology and theoretical foundations. These issues have implications for methodological integrity and honesty when reporting study design, which are values of the qualitative research tradition and are ethical requirements (Wager & Kleinert, 2010a ). Poorly described methodological descriptions may lead the reader to misinterpret or discredit study findings, which limits the impact of the study, and, as a collective, hinders advancements in the broader qualitative research field.

The issues highlighted in our review build on current debates in the case study literature, and queries about the value of this methodology. Case study research can be situated within different paradigms or designed with an array of methods. In order to maintain the creativity and flexibility that is valued in this methodology, clearer descriptions of paradigm and theoretical position and methods should be provided so that study findings are not undervalued or discredited. Case study research is an interdisciplinary practice, which means that clear methodological descriptions might be more important for this approach than other methodologies that are predominantly driven by fewer disciplines (Creswell, 2013b ).

Authors frequently omit elements of methodologies and include others to strengthen study design, and we do not propose a rigid or purist ideology in this paper. On the contrary, we encourage new ideas about using case study, together with adequate reporting, which will advance the value and practice of case study. The implications of unclear methodological descriptions in the studies reviewed were that study design appeared to be inconsistent with reported methodology, and key elements required for making judgements of rigour were missing. It was not clear whether the deviations from methodological tradition were made by researchers to strengthen the study design, or because of misinterpretations. Morse ( 2011 ) recommended that innovations and deviations from practice are best made by experienced researchers, and that a novice might be unaware of the issues involved with making these changes. To perpetuate the tradition of case study research, applications in the published literature should have consistencies with traditional methodological constructions, and deviations should be described with a rationale that is inherent in study conduct and findings. Providing methodological descriptions that demonstrate a strong theoretical foundation and coherent study design will add credibility to the study, while ensuring the intrinsic meaning of case study is maintained.

The value of this review is that it contributes to discussion of whether case study is a methodology or method. We propose possible reasons why researchers might make this misinterpretation. Researchers may interchange the terms methods and methodology, and conduct research without adequate attention to epistemology and historical tradition (Carter & Little, 2007 ; Sandelowski, 2010 ). If the rich meaning that naming a qualitative methodology brings to the study is not recognized, a case study might appear to be inconsistent with the traditional approaches described by principal authors (Creswell, 2013a ; Merriam, 2009 ; Stake, 1995 ; Yin, 2009 ). If case studies are not methodologically and theoretically situated, then they might appear to be a case report.

Case reports are promoted by university and medical journals as a method of reporting on medical or scientific cases; guidelines for case reports are publicly available on websites ( ). The various case report guidelines provide a general criteria for case reports, which describes that this form of report does not meet the criteria of research, is used for retrospective analysis of up to three clinical cases, and is primarily illustrative and for educational purposes. Case reports can be published in academic journals, but do not require approval from a human research ethics committee. Traditionally, case reports describe a single case, to explain how and what occurred in a selected setting, for example, to illustrate a new phenomenon that has emerged from a larger study. A case report is not necessarily particular or the study of a case in its entirety, and the larger study would usually be guided by a different research methodology.

This description of a case report is similar to what was provided in some studies reviewed. This form of report lacks methodological grounding and qualities of research rigour. The case report has publication value in demonstrating an example and for dissemination of knowledge (Flanagan, 1999 ). However, case reports have different meaning and purpose to case study, which needs to be distinguished. Findings of our review suggest that the medical understanding of a case report has been confused with qualitative case study approaches.

In this review, a number of case studies did not have methodological descriptions that included key characteristics of case study listed in the adapted criteria, and several issues have been discussed. There have been calls for improvements in publication quality of qualitative research (Morse, 2011 ), and for improvements in peer review of submitted manuscripts (Carter & Little, 2007 ; Jasper, Vaismoradi, Bondas, & Turunen, 2013 ). The challenging nature of editor and reviewers responsibilities are acknowledged in the literature (Hames, 2013 ; Wager & Kleinert, 2010b ); however, review of case study methodology should be prioritized because of disputes on methodological value.

Authors using case study approaches are recommended to describe their theoretical framework and methods clearly, and to seek and follow specialist methodological advice when needed (Wager & Kleinert, 2010a ). Adequate page space for case study description would contribute to better publications (Gillard et al., 2011 ). Capitalizing on the ability to publish complementary resources should be considered.

Limitations of the review

There is a level of subjectivity involved in this type of review and this should be considered when interpreting study findings. Qualitative methods journals were selected because the aims and scope of these journals are to publish studies that contribute to methodological discussion and development of qualitative research. Generalist health and social science journals were excluded that might have contained good quality case studies. Journals in business or education were also excluded, although a review of case studies in international business journals has been published elsewhere (Piekkari et al., 2009 ).

The criteria used to assess the quality of the case studies were a set of qualitative indicators. A numerical or ranking system might have resulted in different results. Stake's ( 1995 ) criteria have been referenced elsewhere, and was deemed the best available (Creswell, 2013b ; Crowe et al., 2011 ). Not all qualitative studies are reported in a consistent way and some authors choose to report findings in a narrative form in comparison to a typical biomedical report style (Sandelowski & Barroso, 2002 ), if misinterpretations were made this may have affected the review.

Case study research is an increasingly popular approach among qualitative researchers, which provides methodological flexibility through the incorporation of different paradigmatic positions, study designs, and methods. However, whereas flexibility can be an advantage, a myriad of different interpretations has resulted in critics questioning the use of case study as a methodology. Using an adaptation of established criteria, we aimed to identify and assess the methodological descriptions of case studies in high impact, qualitative methods journals. Few articles were identified that applied qualitative case study approaches as described by experts in case study design. There were inconsistencies in methodology and study design, which indicated that researchers were confused whether case study was a methodology or a method. Commonly, there appeared to be confusion between case studies and case reports. Without clear understanding and application of the principles and key elements of case study methodology, there is a risk that the flexibility of the approach will result in haphazard reporting, and will limit its global application as a valuable, theoretically supported methodology that can be rigorously applied across disciplines and fields.

Conflict of interest and funding

The authors have not received any funding or benefits from industry or elsewhere to conduct this study.

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Qualitative study design: Case Studies

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In depth description of the experience of a single person, a family, a group, a community or an organisation.

An example of a qualitative case study is a life history which is the story of one specific person.  A case study may be done to highlight a specific issue by telling a story of one person or one group. 

  • Oral recording

Ability to explore and describe, in depth, an issue or event. 

Develop an understanding of health, illness and health care in context. 

Single case can be used to develop or disprove a theory. 

Can be used as a model or prototype .  


Labour intensive and generates large diverse data sets which can be hard to manage. 

Case studies are seen by many as a weak methodology because they only look at one person or one specific group and aren’t as broad in their participant selection as other methodologies. 

Example questions

This methodology can be used to ask questions about a specific drug or treatment and its effects on an individual.

  • Does thalidomide cause birth defects?
  • Does exposure to a pesticide lead to cancer?

Example studies

  • Choi, T. S. T., Walker, K. Z., & Palermo, C. (2018). Diabetes management in a foreign land: A case study on Chinese Australians. Health & Social Care in the Community, 26(2), e225-e232. 
  • Reade, I., Rodgers, W., & Spriggs, K. (2008). New Ideas for High Performance Coaches: A Case Study of Knowledge Transfer in Sport Science.  International Journal of Sports Science & Coaching , 3(3), 335-354. 
  • Wingrove, K., Barbour, L., & Palermo, C. (2017). Exploring nutrition capacity in Australia's charitable food sector.  Nutrition & Dietetics , 74(5), 495-501. 
  • Green, J., & Thorogood, N. (2018). Qualitative methods for health research (4th ed.). London: SAGE. 
  • University of Missouri-St. Louis. Qualitative Research Designs. Retrieved from   
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Case study design, using case study design in the applied doctoral experience (ade), applicability of case study design to applied problem of practice, case study design references.

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The field of qualitative research there are a number of research designs (also referred to as “traditions” or “genres”), including case study, phenomenology, narrative inquiry, action research, ethnography, grounded theory, as well as a number of critical genres including Feminist theory, indigenous research, critical race theory and cultural studies. The choice of research design is directly tied to and must be aligned with your research problem and purpose. As Bloomberg & Volpe (2019) explain:

Choice of research design is directly tied to research problem and purpose. As the researcher, you actively create the link among problem, purpose, and design through a process of reflecting on problem and purpose, focusing on researchable questions, and considering how to best address these questions. Thinking along these lines affords a research study methodological congruence (p. 38).

Case study is an in-depth exploration from multiple perspectives of a bounded social phenomenon, be this a social system such as a program, event, institution, organization, or community (Stake, 1995, 2005; Yin, 2018). Case study is employed across disciplines, including education, health care, social work, sociology, and organizational studies. The purpose is to generate understanding and deep insights to inform professional practice, policy development, and community or social action (Bloomberg 2018).

Yin (2018) and Stake (1995, 2005), two of the key proponents of case study methodology, use different terms to describe case studies. Yin categorizes case studies as exploratory or descriptive . The former is used to explore those situations in which the intervention being evaluated has no clear single set of outcomes. The latter is used to describe an intervention or phenomenon and the real-life context in which it occurred. Stake identifies case studies as intrinsic or instrumental , and he proposes that a primary distinction in designing case studies is between single and multiple (or collective) case study designs. A single case study may be an instrumental case study (research focuses on an issue or concern in one bounded case) or an intrinsic case study (the focus is on the case itself because the case presents a unique situation). A longitudinal case study design is chosen when the researcher seeks to examine the same single case at two or more different points in time or to capture trends over time. A multiple case study design is used when a researcher seeks to determine the prevalence or frequency of a particular phenomenon. This approach is useful when cases are used for purposes of a cross-case analysis in order to compare, contrast, and synthesize perspectives regarding the same issue. The focus is on the analysis of diverse cases to determine how these confirm the findings within or between cases, or call the findings into question.

Case study affords significant interaction with research participants, providing an in-depth picture of the phenomenon (Bloomberg & Volpe, 2019). Research is extensive, drawing on multiple methods of data collection, and involves multiple data sources. Triangulation is critical in attempting to obtain an in-depth understanding of the phenomenon under study and adds rigor, breadth, and depth to the study and provides corroborative evidence of the data obtained. Analysis of data can be holistic or embedded—that is, dealing with the whole or parts of the case (Yin, 2018). With multiple cases the typical analytic strategy is to provide detailed description of themes within each case (within-case analysis), followed by thematic analysis across cases (cross-case analysis), providing insights regarding how individual cases are comparable along important dimensions. Research culminates in the production of a detailed description of a setting and its participants, accompanied by an analysis of the data for themes or patterns (Stake, 1995, 2005; Yin, 2018). In addition to thick, rich description, the researcher’s interpretations, conclusions, and recommendations contribute to the reader’s overall understanding of the case study.

Analysis of findings should show that the researcher has attended to all the data, should address the most significant aspects of the case, and should demonstrate familiarity with the prevailing thinking and discourse about the topic. The goal of case study design (as with all qualitative designs) is not generalizability but rather transferability —that is, how (if at all) and in what ways understanding and knowledge can be applied in similar contexts and settings. The qualitative researcher attempts to address the issue of transferability by way of thick, rich description that will provide the basis for a case or cases to have relevance and potential application across a broader context.

Qualitative research methods ask the questions of "what" and "how" a phenomenon is understood in a real-life context (Bloomberg & Volpe, 2019). In the education field, qualitative research methods uncover educational experiences and practices because qualitative research allows the researcher to reveal new knowledge and understanding. Moreover, qualitative descriptive case studies describe, analyze and interpret events that explain the reasoning behind specific phenomena (Bloomberg, 2018). As such, case study design can be the foundation for a rigorous study within the Applied Doctoral Experience (ADE).

Case study design is an appropriate research design to consider when conceptualizing and conducting a dissertation research study that is based on an applied problem of practice with inherent real-life educational implications. Case study researchers study current, real-life cases that are in progress so that they can gather accurate information that is current. This fits well with the ADE program, as students are typically exploring a problem of practice. Because of the flexibility of the methods used, a descriptive design provides the researcher with the opportunity to choose data collection methods that are best suited to a practice-based research purpose, and can include individual interviews, focus groups, observation, surveys, and critical incident questionnaires. Methods are triangulated to contribute to the study’s trustworthiness. In selecting the set of data collection methods, it is important that the researcher carefully consider the alignment between research questions and the type of data that is needed to address these. Each data source is one piece of the “puzzle,” that contributes to the researcher’s holistic understanding of a phenomenon. The various strands of data are woven together holistically to promote a deeper understanding of the case and its application to an educationally-based problem of practice.

Research studies within the Applied Doctoral Experience (ADE) will be practical in nature and focus on problems and issues that inform educational practice.  Many of the types of studies that fall within the ADE framework are exploratory, and align with case study design. Case study design fits very well with applied problems related to educational practice, as the following set of examples illustrate:

Elementary Bilingual Education Teachers’ Self-Efficacy in Teaching English Language Learners: A Qualitative Case Study

The problem to be addressed in the proposed study is that some elementary bilingual education teachers’ beliefs about their lack of preparedness to teach the English language may negatively impact the language proficiency skills of Hispanic ELLs (Ernst-Slavit & Wenger, 2016; Fuchs et al., 2018; Hoque, 2016). The purpose of the proposed qualitative descriptive case study was to explore the perspectives and experiences of elementary bilingual education teachers regarding their perceived lack of preparedness to teach the English language and how this may impact the language proficiency of Hispanic ELLs.

Exploring Minority Teachers Experiences Pertaining to their Value in Education: A Single Case Study of Teachers in New York City

The problem is that minority K-12 teachers are underrepresented in the United States, with research indicating that school leaders and teachers in schools that are populated mainly by black students, staffed mostly by white teachers who may be unprepared to deal with biases and stereotypes that are ingrained in schools (Egalite, Kisida, & Winters, 2015; Milligan & Howley, 2015). The purpose of this qualitative exploratory single case study was to develop a clearer understanding of minority teachers’ experiences concerning the under-representation of minority K-12 teachers in urban school districts in the United States since there are so few of them.

Exploring the Impact of an Urban Teacher Residency Program on Teachers’ Cultural Intelligence: A Qualitative Case Study

The problem to be addressed by this case study is that teacher candidates often report being unprepared and ill-equipped to effectively educate culturally diverse students (Skepple, 2015; Beutel, 2018). The purpose of this study was to explore and gain an in-depth understanding of the perceived impact of an urban teacher residency program in urban Iowa on teachers’ cultural competence using the cultural intelligence (CQ) framework (Earley & Ang, 2003).

Qualitative Case Study that Explores Self-Efficacy and Mentorship on Women in Academic Administrative Leadership Roles

The problem was that female school-level administrators might be less likely to experience mentorship, thereby potentially decreasing their self-efficacy (Bing & Smith, 2019; Brown, 2020; Grant, 2021). The purpose of this case study was to determine to what extent female school-level administrators in the United States who had a mentor have a sense of self-efficacy and to examine the relationship between mentorship and self-efficacy.

Suburban Teacher and Administrator Perceptions of Culturally Responsive Teaching to Promote Connectedness in Students of Color: A Qualitative Case Study

The problem to be addressed in this study is the racial discrimination experienced by students of color in suburban schools and the resulting negative school experience (Jara & Bloomsbury, 2020; Jones, 2019; Kohli et al., 2017; Wandix-White, 2020). The purpose of this case study is to explore how culturally responsive practices can counteract systemic racism and discrimination in suburban schools thereby meeting the needs of students of color by creating positive learning experiences. 

As you can see, all of these studies were well suited to qualitative case study design. In each of these studies, the applied research problem and research purpose were clearly grounded in educational practice as well as directly aligned with qualitative case study methodology. In the Applied Doctoral Experience (ADE), you will be focused on addressing or resolving an educationally relevant research problem of practice. As such, your case study, with clear boundaries, will be one that centers on a real-life authentic problem in your field of practice that you believe is in need of resolution or improvement, and that the outcome thereof will be educationally valuable.

Bloomberg, L. D. (2018). Case study method. In B. B. Frey (Ed.), The SAGE Encyclopedia of educational research, measurement, and evaluation (pp. 237–239). SAGE.

Bloomberg, L. D. & Volpe, M. (2019). Completing your qualitative dissertation: A road map from beginning to end . (4th Ed.). SAGE.

Stake, R. E. (1995). The art of case study research. SAGE.

Stake, R. E. (2005). Qualitative case studies. In N. K. Denzin and Y. S. Lincoln (Eds.), The SAGE handbook of qualitative research (3rd ed., pp. 443–466). SAGE.

Yin, R. (2018). Case study research and applications: Designs and methods. SAGE.

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Examining the short and long-term impacts of child sexual abuse: a review study

  • Review Paper
  • Open access
  • Published: 15 February 2024
  • Volume 4 , article number  56 , ( 2024 )

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  • Sana Ali   ORCID: 1 , 2 ,
  • Saadia Anwar Pasha   ORCID: 3 ,
  • Ann Cox   ORCID: 4 &
  • Enaam Youssef 5  

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Child sexual abuse is a growing problem, representing an egregious abuse of power, trust, and authority with far-reaching implications for the victims. This review study highlights the intricate psychological impacts of child sexual abuse, addressing both short and long-term consequences. Existing literature highlights the deep impacts on the victims’ psychological health and well-being, necessitating an in-depth examination of the subject. Drawing from a sample of n = 19 research articles selected through stringent inclusion and exclusion criteria and the PRISMA approach, this study synthesizes results from publications spanning 2010 to 2022. The review reveals various detrimental impacts on the victims’ psychological well-being, including short-term consequences, i.e., isolation, bullying, stress, anxiety, and post-traumatic stress disorder (PTSD). Long-term effects encompass PTSD in later life, disrupted intimate relationships, social and emotional health concerns, revictimization, and more. In conclusion, the study emphasizes the lack of a definitive number of impacts, highlighting the need to discuss and raise awareness about child sexual abuse. This increased awareness is important for parents, guardians, and responsible authorities to effectively counteract these crimes against children. Also, providing emotional support to victims is important to mitigate the long-term impacts. The researchers offer implications and discuss limitations, providing an extensive overview and foundation for future research and interventions.

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Child sexual abuse is prevalent across class, race, and ethnicity, with both short-term and long-term impacts. It mainly involves an interaction between the abuser and the child, in which the child is the focus of the sexual stimulation of an observer or the offender (Wagenmans et al. 2018 ). Child sexual abuse is anticipated as silencing the minor, and consequently, reporting such incidents is much less. Even without knowing the full ratio of the relevant incidents, experts agree that 500,000 children face sexual abuse yearly ( 2017 ). This sexual offence against children has always been an existing phenomenon in all societies and historical eras. For instance, ancient civilizations openly adopted child sexual abuse as a normal, cultural, and social practice aimed at the learning and development of children (Ali 2019 ). Despite the perceptions about child sexual abuse historically varied, we found varying perceptions ranging from acceptance (justifiable) to rejection (children’s rights violation) (DiLillo et al. 2014 ). Child sexual abuse is not limited only to penetration; instead, showing a child pornographic photos, voyeurism, touching a child’s genitals, and even making the child touch or see the perpetrator’s private body parts is also considered sexual abuse (National Sexual Violence Resource Center 2011 ). It is also notable that both boys and girls are strongly susceptible to sexual abuse. However, girls are more vulnerable as they confront sexual abuse three times more than boys, while boys are more likely to be severely injured or die after sexual molestation (National Sexual Violence Resource Center 2011 ). A report by the World Health Organization in 2006 revealed that more than 20% of women and 8% of men in 39 countries reported that they had faced sexual abuse during childhood.

Similarly, data from 2012 to 2013 shows that 2% of boys and 4% of girls experience some sexual abuse every year (Chan et al. 2013 ). Another report (UNICEF 2020a ) revealed that more than 120 million individuals worldwide face forced sexual acts during their childhood. Most are females (89%), and 11% are males. Globally, this statistic is much higher as every one out of four girls and one in every six boys during the early years of their lives ( 2017 ).

Similarly, sexual abuse of children is possible in almost every social setting and location, i.e., schools, roads, justice institutions, and homes. Also, it is prevalent equally among all socio-economic classes and age groups; children facing sexual abuse sometimes cannot realize their molestation (Selengia et al. 2020 ). Around 92.0 of the reported incidents were linked by acquittances (closed relatives), indicating the prevalence of incestuous abuse (Ali et al. 2021 ). Notably, there are three dynamic factors behind child sexual abuse, i.e., psychological, economic, and social. For instance, social factors involve one’s personal experience of sexual exploitation during childhood (Middleton et al. 2017 ). Economic factors involve poverty. For example, parents may ask their girl child to look for a capable man to take care of her primary needs, which may further lead to engaging in sexual activities in return for monetary support (Simuforosa 2015 , p. 1792).

On the other hand, psychological factors are mainly defined as sexual interest in children due to a mental disorder (Tenbergen et al. 2015 ). However, the economic factors responsible for perpetuating child sexual abuse mainly involve forcibly engaging children in sexual acts, selling or buying children pornography, and all the other relevant factors that lead to the economic benefits for the perpetrators (Ali 2019 ). Notably, the impacts of child sexual use are detrimental from different aspects. For instance, these impacts are immediate yet prolonged, indicating their severity during adulthood. According to (Downing et al. 2021 ), stress-induced variations in the pro-inflammatory substances, i.e., alterations in gene expression and cortisol, mediate these detrimental impacts.

Additionally, risky sexual behaviours against children and the opposite gender are further attributed to the impacts of child sexual abuse (Fisher et al. 2017 , p. 11). Child sexual abuse poses an influential societal challenge, demanding careful examination to understand its complexities fully.

Aim and purpose

This research aims to scrutinize the role of Child Sexual Abuse as a risk factor for causing several psychological concerns among the victims. The researcher has reviewed some studies on Child Sexual Abuse and its impacts. Drawing on the aims of this article, the study aims to examine (1) the short-term psychological impacts of Child Sexual Abuse and (2) the long-term psychological impacts of Child Sexual Abuse according to studies conducted during the past twelve years (2010–2022). The overarching goal is to provide a comprehensive synthesis of existing literature, shedding light on the multifaceted consequences of child sexual abuse over both short and long-term durations. By systematically analyzing and assessing a selected set of articles, this study seeks to contribute to the understanding of prevalent themes, methodologies, and gaps in the existing literature surrounding the psychological impacts of child sexual abuse. The significance of this work extends to informing future research, interventions, and policymaking related to child protection and well-being. Finally, the aim is to facilitate the development of targeted and effective strategies for preventing, intervening, and supporting individuals affected by children.

In response to the urgent need for a comprehensive understanding, this review study uses the PRISMA approach to navigate existing literature. Addressing the CSA in current knowledge, we highlight the major difficulties associated with unravelling the complexities of child sexual abuse. This review not only synthesizes an extensive body of research but also discusses their findings and insights to overcome the inherent challenges in comprehending the short and long-term impacts of child sexual abuse. Our study seeks to make a distinctive contribution by explaining the intercity of this fragile subject matter, thus laying the groundwork for more effective interventions and support systems. It addresses the following research questions based on the aims and purposes of current research.

RQ1. What constitutes Child Sexual Abuse, and how can it be accurately defined within the current literature?

RQ2. How does Child Sexual Abuse affect the mental health and overall well-being of individuals, considering both short-term and long-term impacts?

This study is based on the systematic literature review approach. The review-based studies are a significant part of the existing literature as they closely witness the ongoing trends and complexities in the field under study (Ali and Pasha 2022 ). Besides, the relevant studies also highlight the major findings to further the gap and conduct an in-depth analysis of the other aspects of the same concern.

Assumptions and justifications

In the context of this systematic literature review, certain assumptions were made to facilitate the synthesis and analysis of the selected studies. These assumptions are integral to the nature of the review process. First, it was deemed that the definitions of key terms, i.e., “child sexual abuse” and “psychological impacts,” were relatively consistent across the selected studies. This assumption is grounded in the anticipation that researchers within the field comply with widely accepted definitions and classifications. While variations in terminologies exist, a comprehensive screening process and compliance with inclusion criteria mitigated possible discrepancies. The study focused on articles with clear and relevant definitions, assuring homogeneity in the selected literature.

Further, the decision to include articles published from 2010 onwards was based on the assumption that recent research mirrors current trends and developments in comprehending the psychological impacts of child sexual abuse. The rationale is rooted in the dynamic nature of research, focusing on current perspectives. This assumption allows for analyzing the most recent insights into the subject matter and recognizing the evolving nature of societal attitudes and academic discourse.

Evaluation of assumptions

While these assumptions were important for the systematic review process, it is important to acknowledge their probable impact on the results. A few considerations emphasize how these assumptions may affect the outcomes. For example, despite efforts to ensure consistency, variations in definitions across studies may introduce complexities in interpreting psychological impacts. This could influence the synthesis of results, and readers should be aware of the potential heterogeneity in conceptualizing key terms. Besides, the focus on recent publications assumes that newer research accurately represents the current landscape. However, this may bias contemporary perspectives, potentially bypassing practical insights from earlier studies.

Thus, considering the problem’s complexity and continuous research, the researcher selected three specialized platforms: PubMed, Science Direct, and APA PsycNet. However, the selection criteria were not restricted to any age, gender, race, ethnicity, nationality, and language. The keywords for the search were “impacts of child sexual abuse, child sexual abuse, psychological effects of child sexual abuse, short-term effects of child sexual abuse, and long-term effects of child sexual abuse. Later the researcher tabulated the data using Microsoft Excel, which further helped calculate the included articles’ percentages and frequencies. The researcher used the PRISMA method for systematic review, as suggested by (Page and McKenzie 2021 ). Table  1 summarizes the inclusion and exclusion criteria used in the current study:

Based on the PRISMA method of screening, evaluation and Selection, the researchers gathered a total of 113 records from the selected database. After removing the duplicates, 106 total articles were further screened for full-text availability (93). Finally, the researchers selected n  = 19 articles adhering to the selection criteria (See Fig.  1 ).

figure 1

PRISMA flow chart for the articles selection process

Table  2 summarizes the frequencies and percentages of the literature according to their database. It is observable that most of the articles were from PubMed (n = 11 or 57.8). APA PsyNet provided n = 7 or 36.8% articles, while n  = 1 (5.2%) article was obtained from Science Direct.

Table  3 summarizes the frequencies and percentages of the selected literature according to their publication years. As visible, most of the studies ( n  = 12, 63.1%) were published from 2015 to 2020, indicating that these years focused mainly on research scholars in psychology, communication, sociology, criminology, and other fields. These results also reflect the prevalence of the relevant concern demanding a strong consideration towards children’s rights and health protection (Ali and Pasha 2022 ). Followed by 04 or 21.0% of studies published between 2010–2015, n  = 03 or 1.7% of studies published until the end of November 2022.

Concerning the frequencies and percentages of the cited literature according to their designs, most studies (09 or 47.3%) were based on a review approach. Followed by experimental design ( n  = 06 or 31.5%), 03 or 15.7% of studies were based on the perspective method. Finally, online n  = 1 (5.2%) of the study was based on the case study method, and the same number of studies ( n  = 1, 5.2%) was categorized as “other” (See Table  4 ). Additionally, n  = 11 or 7.8% of studies were based on a qualitative approach, n = 11 or 57.8% were based on the quantitative approach, and only one study was based on the mixed method approach (See Table  5 ).

The researchers calculated the frequencies and percentages of the cited literature according to the data-gathering approaches used by the relevant researchers (See Table  3 ). Most studies ( n  = 13, 68.4%) were based on the survey method. Besides, the interview approach was preferred in 04% of studies. While n  = 1 (5.2%) study was based on the literature review approach, and the same number of literature ( n  = 1, 5.2%) was categorized as “other”.

Validation of selected methodology

The methodology used in this systematic literature review underwent a thorough validation process to ensure its reliability and comprehensiveness. Key elements of the validation process are.

Adherence to PRISMA Guidelines: The systematic review methodology rigorously adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, as Page and McKenzie ( 2021 ) recommended. PRISMA guidelines are widely recognized and accepted standards for conducting systematic reviews, assuring a systematic and transparent approach to literature synthesis.

Inclusion and Exclusion Criteria: Establishing clear and strict inclusion and exclusion criteria contributed to the robustness of the methodology. These criteria were designed to select studies that specifically addressed the psychological impacts of child sexual abuse, enhancing the relevance and reliability of the synthesized literature.

Search Strategy: The search strategy employed in selecting articles was exhaustive, using three specialized platforms—PubMed, Science Direct, and APA PsycNet. The chosen keywords were carefully selected to encompass diverse dimensions of child sexual abuse and its psychological impacts, minimizing the risk of overlooking pertinent studies.

Data Tabulation and Analysis: Using Microsoft Excel for data tabulation provided a structured and organized approach to handling the extensive information extracted from the selected articles. This facilitated a systematic calculation of frequencies and percentages, assuring accuracy and consistency in reporting.

PRISMA Flow Chart: A PRISMA flow chart (Fig.  1 ) visually represents the systematic article selection, screening, and inclusion process. This chart improves transparency and serves as a visual validation of the methodological stringency applied in the study.

While this systematic review does not involve the same type of validation as experimental or modelling studies, the validation lies in compliance with established guidelines, rigorous criteria for article selection, and transparent reporting of the review process. These elements collectively contribute to the robustness and credibility of the methodology used in this study.

Review of literature

Defining child sexual abuse.

According to (Pulverman et al. 2018 ), the definition of child sexual abuse has been a major concern for many researchers since the 1970s. The prevalent cases and recent concerns indicate that providing and establishing the definition of child sexual abuse is urgent and needs strong consideration. Notably, it is important to keep the complexity and sensitivity of the relevant issue under consideration when providing a potential definition of child sexual abuse (Pulverman et al. 2018 ) theoretically defined child sexual abuse as the unconscionability of the acts, which further indicates four types of activities such as the relationship of power between an adult and child, the child in the lower position facing inequality, the child’s susceptibility is exploited based on their detriment, and truancy of true consent (Table 6 ).

Defining sexual abuse can vary on a different basis. For instance, (Vaillancourt-Morel et al. 2016 ) argue that child sexual abuse mainly relies on the legal definition. Several self-reported cases of child sexual abuse remained affirmed, leading to further legal actions, yet some cases indicate doubtful accusations. As in the empirical study (Vaillancourt-Morel et al. 2016 ), results indicated 21.3% sexual abuse among females and 19.6% among males. At the same time, 7.1% of females and 3.8% remained consistent with self-defined child sexual abuse. However, (Ma 2018 ) stated that the relevant definition could vary according to the prevalence estimation. Besides, this definition is based on five criteria, including the age of the childhood, the age of the perpetrator or the age difference between the victim and the perpetrator, the relationship between the victim and the perpetrator, the type of sexual acts performed by the perpetrator, and the extension of the coercion. According to (Pulverman et al. 2018 ), child sexual abuse can be defined as unwanted sexual activities between an adult and a child, including vaginal, oral, and anal penetration. Besides, online child sexual abuse, including online sex, child pornography, and others, is also considered a vital type of child sexual abuse.

Impacts of child sexual abuse

Child sexual abuse is strongly detrimental to children’s physical and psychological health. In this regard, researchers and medical experts claim physical consequences as serious as brain damage and immediate death. Minor injuries are also found in some cases. However, death is the most common physical outcome of child sexual abuse (Habes et al. 2022 ). As noted by (Beltran 2010 ), no single impact patterns exist. Sometimes, a victim does not show any prominent impacts that may impede the development of a psychological syndrome that adversely affects a child’s social, emotional and cognitive abilities. Some researchers claim that only 20–30% of children remain emotionally and physically stable after sexual molestation. However, although they remain normal, internally, they develop latent effects of sexual abuse. The short-term and immediate psychological impacts of sexual abuse may involve painful emotions, Post-traumatic stress disorder, cognitive distortions, and disturbed mood. These victims respond to sexual abuse in diverse ways that can be changed over time. However, the psychological harm is still severe and can result in even adverse consequences. During sexual abuse, victims can feel fear, anxiety, self-blame, guilt, confusion, and anger. They feel self-conscious and humiliated, unable to talk about what happened, which can result in stress and frustration (Pulverman et al. 2018 ). Table  1 below provides a summary of studies witnessing the physical and psychological consequences of child sexual abuse (Table 7 ).

(Batool and Abtahi 2017 ) named short-term effects “initial effects”, as these reactions mainly occur during the first two years of abuse. Previous studies revealed that 66.0% of children were emotionally disturbed due to sexual abuse, 5.2% were mild to moderately disturbed, and 24.0% remained stable after the sexual abuse. Similarly, a study conducted by (Fontes et al. 2017 ) also witnessed the short-term impacts of sexual abuse on the mental health of the victims. Results gathered by using the Propensity Score Matching technique revealed that 13.3% of sexually abused children reported a greater feeling of loneliness, 7.5% were having difficulty in making friends, and 9.5% reported insomnia. Despite these effects differing among male and female children, both were equally confronting to the relevant mental disturbances.

Further, regarding the long-term effects of child sexual abuse, (Petersen et al. 2014 ) stated that it results in both short and long-term effects. A survivor may feel peer rejection, confusion, lack of self-confidence, conduct disorder, oppositional defiant disorder, and aggression. Similarly, in the later years, the survivor may also develop other extreme psychiatric disorders such as depression, low economic productivity, drug addiction and even severe medical illness. According to (Hodder and Gow 2012 ), long-term child sexual abuse can also result in substance abuse, long-term depression, negative attributions, and even eating disorders. Most recently, practitioners also found even more chronic mental disorders such as delusions, schizophrenia, and personality disorders. However, children who have experienced abuse involving penetration are more likely to develop these chronic psychotic and schizophrenic disorders. Likewise, sexually abused children also have low self-esteem and overly sexualized behaviour, which, in many cases, results in teen pregnancy and motherhood and even an increased vulnerability to another victimization (Townsend 2013 ). Besides, socially isolated children with a disability or emotional disorder are comparatively more vulnerable to victimization. Once the abuse has happened, they also face threats to end the relationship if they refuse to perform sex or threats to publicly share their sexual images (UNICEF 2020b ) (Table 8 ).

Wagenmans et al. ( 2018 ) highlighted the occurrence of prolonged and severe psychological disorders among individuals who previously experienced child sexual abuse. As noted, the prolonged effects are more common when there is a repetitive and interpersonal nature of abuse, mostly leading to develop Post-Traumatic Stress Disorder (PTSD) in later years. Those with a history of Child Sexual Abuse risk developing issues in interpersonal relationships, emotional regulation, and self-concept that result in “Complex PTSD” (p. 2). As (Gupta and Garg 2020 ) noted, child sexual abuse indicates an increased self-harming behaviour, fear, depression, impaired brain development, and others that are criteria for developing Post-Traumatic Stress Disorder (PTSD). Notably, this sexual abuse is not limited to physical and sexual harm; it also involves emotional abuse that further indicates the severity of the relevant issue today. It is also worth mentioning that most victims report sexual abuse in their later life. These victims also indicate their revictimization as one of the most consistent outcomes of child sexual abuse (Papalia et al. 2021 ). The term revictimization is also defined as any further victimization even during childhood, adolescence, or adulthood after the first incident of sexual abuse during childhood (P.1). However, there can be different factors, including sex, mental health issues, age at initial abuse, and others as different determinants of revictimization (Papalia et al. 2021 ). (MacIntosh and Ménard 2021 ) synthesized the status of research witnessing the long-term impacts of child sexual abuse over the past thirty years. As noted, different researchers have witnessed different impacts. Disturbed academic functioning, substance abuse and alcoholism in later years, revictimization and developing Post-Traumatic Stress Disorder (PTSD). Besides, sexual disorders, sex-related cognitions, disturbed intimate relationships, and emotional aspects of sexuality remain highlighted, witnessed, and still need much more consideration. Finally, the study by (Schreier et al. 2017 ) highlighted another important dimension regarding the impacts of child sexual abuse, as their focus was on the victims’ siblings as an important factor to determine in post-abuse scenarios. As noted, siblings can confront several emotional responses after disclosing the child’s sexual abuse. Siblings’ reactions are important as negative behaviour can increase the post-abuse stress among the victim and the family. Thus, it is concluded that the siblings should also be provided clinical services to reduce the negative impacts of child sexual abuse. Siblings also indicate symptoms of distress on an average level that needs strong consideration.

The gathered evidence unequivocally highlights the pervasive and profound negative impacts of child sexual abuse on the psychological health, cognitive development, and overall well-being of victims. The complex dynamics of the relationship between the abuser and the child, initially built on trust and affection, morph into a distressing paradigm of power, domination, victimization, and, in some examples, revictimization. The susceptibility of children in such situations places their psychological health at considerable risk, necessitating urgent and effective preventive measures to protect their well-being. This study serves to highlight the enduring and detrimental repercussions of child sexual abuse that can persist throughout a child’s life. The complexities of the psychological toll highlight the need for targeted interventions and support mechanisms. Our findings indicate that discussions and heightened awareness surrounding child sexual abuse are imperative. It is not merely a matter of quantifying impacts but a call to action to proactively empower parents, guardians, and responsible authorities to counteract these blatant crimes against children. Thus, our study affirms the critical importance of providing emotional support to victims, recognizing it as an integral component in mitigating the long-term impacts of child sexual abuse. By shedding light on the deep consequences and supporting awareness, we aim to contribute to the collective efforts toward a safer environment for children, free from the effects of sexual abuse.


Incidents of child sexual abuse are prevalent, especially since access to vulnerable children is even more feasible due to social media and other digital platforms (Ali et al. 2021 ). Consequently, children are at increased risk of maltreatment, particularly sexual abuse. Consequently, this research has some implications for the service and police departments, parents, and mental healthcare practitioners across the globe.

Families should receive prevention support and guidance through proper risk assessment and multi-level parent education (Tener et al. 2020 ). Parents informing the children about the protection measures can also help them prevent any detrimental incident that may further nullify the impacts of sexual abuse.

Providing mental healthcare services to the victims, their families, and their siblings, as also emphasized by (Schreier et al. 2017 ), also ensures the children’s mental well-being and development, especially among those who have been through any abusive exposure.

Besides psychological impacts, there are other detrimental impacts that child faces after sexual abuse that necessitate the provision of adequate healthcare services. These healthcare services aim to ensure the different consequences of abuse and that the victim may overcome the incident (Rahnavardi et al. 2022 ).

Medical healthcare providers, including staff, should also support and guide the victim and their families. Although exposure to a CSA victim can be traumatizing for healthcare practitioners, their behaviour and support patterns can help the victims cope with the challenges, especially with the psychological impacts (Pérez-Fuentes et al. 2013 ).

A victim can also face other consequences that may further worsen the impact of sexual abuse, including bullying. Schools and teachers can also effectively nullify these impacts by supporting and scrutinizing the victims. The focus should be on avoiding any further outcomes on their mental health (Sawyerr and Bagley 2017 ).

Implementing laws and active consideration towards welfare programs and training sessions for children, parents, and teachers as caregivers can also mitigate the impacts of child sexual abuse (Batool and Abtahi 2017 ).

Limitations and recommendations

Although this study synthesized the findings of recent literature witnessing both short-term and long-term impacts of child sexual abuse, it also contains some primary limitations. First, this study does not involve human subjects or clinical trials that may witness the impacts under study in a particular setting. Second, the Selection of the cited articles was strict and based on only three databases, limiting its scope. Third, the research does not provide any country-specific evidence. Instead, the cited literature is scattered and based on studies from around the world. Finally, although the study empirically witnesses the impacts of child sexual abuse, there are many regions where empirical research on child sexual abuse, its impacts, and causes are understudied. Consequently, this study emphasizes conducting more research on the impacts of child sexual abuse, its prevalence, and causal factors that may further provide strong insights regarding the relevant issue and help propose implications and nullify its impacts.

Data availability

No data is associated with this research project.

Code availability

No codes are available for this study.

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S.A. conceived the first draft of the manuscript. Dr. S.A.P. gathered data and conducted the analysis. Dr. A.C. revised the manuscript and formatted the language and references. Dr. E.Y. contributed in the final revisions and also contributed to restructuring the questions and validation of selected methodology.

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Ali, S., Pasha, S., Cox, A. et al. Examining the short and long-term impacts of child sexual abuse: a review study. SN Soc Sci 4 , 56 (2024).

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