Students with disabilities in the tertiary education sector are more than a just a phenomenon, they are a reality. In general, little attention is devoted to their needs despite the fact that they need more care and attention.
This paper, through a case study at the University of Mauritius, sought to answer some pertinent questions regarding students with disabilities. Does the University of Mauritius have sufficient facilities to support these students? Are students aware of existing facilities? What additional structures need to be put in place so that students with any form of disability are neither victimised, nor their education undermined? Are there any local laws about students with disabilities in higher education?
To answer these questions and others, an online questionnaire was sent to 500 students and the responses were then analysed and discussed. The response rate was 24.4% which showed that students were not reticent to participate in this study.
Our survey revealed that most students were not aware of existing facilities and were often neglected in terms of supporting structures and resources. ICT facilities were found to be the best support that is provided at the University of Mauritius. The right legal framework for tertiary education was also missing.
Ideally, students with disabilities should have access to special facilities to facilitate their learning experiences at tertiary institutions. Awareness about existing facilities must also be raised in order to offer equal opportunities to them and to enable a seamless inclusion.
According to the 2011 population census, there are 59 868 people with disabilities in the Republic of Mauritius, which corresponds to a disability prevalence rate of about 5% (Statistics Mauritius 2015). Although this is lower than the global disability prevalence rate (WHO 2011), the Republic of Mauritius has been implementing laws and policies for the well-being of people with disabilities since 1976 with the promulgation of the National Pensions Act 1976 (Supreme Court 2017). The Republic of Mauritius signed the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) in 2007 and ratified it in 2010 although certain reservations were made in relation to Articles 9.2(d), 9.2(e), 11 and 24.2(b) (UNTC 2017). Article 24 of the UNCRPD stipulates that all member states shall ensure that people with disabilities should be given equal opportunities to follow tertiary education (UNCRPD 2006). Article 28 of the United Nations Convention on the Rights of the Child also guarantees the right to a free primary education (OHCHR 2016). According to the World Disability report (WHO 2011), there are about 1 billion people in this world who have some form of disability. For example, in Malawi, more than 97% of children with disabilities do not have access to education (Chilemba 2013). Despite the fact that many countries, including Mauritius, have signed and ratified the UNCRPD, most of them, have failed in their obligations to conceptualise and implement the right to education for students with disabilities as envisaged by the international conceptual approaches and legal standards of inclusive standard in the UNCRPD. The UNCRPD defines a disability as a long-term physical, mental, intellectual or sensory impairment, which may hinder a person’s full and effective participation in society on an equal basis with others. Persons with disabilities are often the subject of severe social stigma, discrimination and harassment which consequently force them to live under the misguided belief that their lives are shameful and not worthy of respect (Peltzer 2014; Waterstone & Stein 2008). This has resulted in the creation of a culture of marginalisation and routine discrimination, in a society which is already on the downfall, especially in developing countries where children with disabilities do not have access to education. Poverty, unemployment and social tensions (civil wars, discrimination) also account for this. Therefore, there is an uncontested connection between poverty and disability (Degener 2017; Rubey 2002; Schneider, Mokomane & Graham 2016).
Because of political or social reasons, some countries are even more affected than others, in terms of equal rights and equal opportunities, with adverse affects education. The UNCRPD has played an important role in the improvement of the dignity of all persons with disabilities, but there are many challenges ahead in terms of its implementation at the national level. Some legislations such as the Mental Health Care Act 1998 (Act 24/1998), the HIV/AIDS Act 2006 (Act 31/206) and Mauritius Mental Health Association Act 1974 (Act 8/19740) are indirectly involved in the protection of persons with disabilities, to allow these citizens to enjoy their rights, on an equal footing with others. The Training and Employment of Disabled Persons Act 1996, the National Council for Life Rehabilitation of Disabled Persons Act 1986, the Society for the Welfare of the Deaf Act 1968, the Lois Lagesse Trust Fund Act 1983, the Child Protection Act 1994, the Ombudsperson for Children Act 2003 and the Unemployment Hardship Relief Act 1983 are some of the legislations which have been promulgated to help, protect and promote a more inclusive life for disabled persons in Mauritius. All the above-mentioned legislations are available from the Supreme Court of the Republic of Mauritius (Supreme Court 2017).
The primary aim of this research is to report on students’ perceptions regarding support structures available to students with disabilities in the hope that this will encourage states and tertiary education institutions to implement policies and measures to support the education of students with disabilities, based on the findings of this study. This research aims at increasing the awareness about the facilities that exist in tertiary institutions for students with disabilities at the University of Mauritius. Through this study, the researchers hope to ensure that these students are not overlooked in tertiary education, and also make a recommendation for the adoption of e-learning as a possible solution to integrate students with disabilities into the mainstream tertiary education. In the same vein, this paper attempts to encourage tertiary institutions to provide facilities and support structures to enable students with disabilities to enjoy the same benefits on campus as mainstream students, thus providing them equal rights and opportunities for education. After an introduction, the structure of this paper follows a traditional pattern. A brief review of related literature is discussed in the next section, before the research methodology adopted in this study is described. The findings of this study are then presented. This empirical paper ends with a conclusion and a brief presentation of the limitations of this study. Finally, the list of cited references is provided.
Georgeson, Mamas and Swain (2015) define a disabled student as ‘any student who has a sensory, cognitive, physical or psychological impairment’. The White Paper on Education (in South Africa) defines a person with a disability as ‘a person limited or impaired in one or more functional activities which prevents full and equal academic, social and economic participation’ (UKZN 2004). The impairment may be permanent, recurring or transitory and may be sensory, physical, cognitive or psychological (UKZN 2004). There is a general increase in the number of students with disabilities entering higher education in developed countries (AHEAD 2015; Altbach, Reisberg & Rumbley 2009; NCES 2016). Especially when distance education institutions understood the special needs of students with disabilities, they began to develop support systems that assisted these students by providing materials using alternative forms of media, and by adopting enabling technologies (Kirkup 2015).
The Open University of Japan (OUJ) provides support for students with disabilities by allowing them to study from home. This includes adopting special arrangements for examinations and classroom-based activities, extensive use of radio and TV for lecture transmission; providing transcripts and captions for all learning materials and making texts available in digital form for screen reader users (Cooper 2015).
However, despite this increase in e-learning facilities, students with disabilities continue to display lower retention rates when compared to mainstream students (Lichiello 2012; NCLD 2014). This lower retention rate may be because of institutional barriers. Georgeson et al. (2015) outline that disabled university students face many challenges, which may include a lack of suitable facilities, struggles to access learning materials, a lack of understanding and respect from both fellow students and academics, to name a few. In a study in the United Kingdom, it was found that the issues faced by students with disabilities were exacerbated by the lack of a coordinated effort, across the institution, to address these special needs (Cooper 2015).
Furthermore, locally, in Africa, Van Jaarsveldt and Ndeya-Ndereya (2015) identified technological barriers, a lack of awareness and poor liaison among the institutional stakeholders and lecturers who distanced themselves from the responsibility of providing learner support to students with disabilities as the challenges that students with disabilities faced. Research has shown that students with disabilities feel they have to work harder than other students, because they have to manage a double workload – their disability and their studies (Gorman 1999).
Uncaptioned videos, disorganised websites and course materials that cannot be read by screen readers, or accessed without a mouse, and educators who have little knowledge of how to ensure that their courses are accessible compound the difficulties faced by students with disabilities (Cooper 2015). The introduction of relevant technologies can provide support to them in their learning. Often it is thought that technology can help to reduce the barriers to equitable education for students with disabilities and thus promote better integration of students with disabilities into mainstream higher education (Ahmad 2015; DFID 2015). Data collected from students with disabilities in a UK higher education institution showed that students with disabilities lack the correct digital capital to enable them to succeed within higher education environments. Thus, it is important for higher education institutions to ‘conceptualise’ and ‘organise’ technology-related support services for students with disabilities, to support and promote access to equitable educational experiences and outcomes (Georgeson et al. 2015).
The adoption of digital technologies, such as virtual learning environments and e-learning, can help to achieve increased levels of accessibility and inclusion (Douce 2015). However, simply adopting these technologies does not ensure ‘accessibility’. Educators or administrators have to make sure that these relatively new digital tools are indeed accessible to all. The solution maybe lies in using standard design principles which are universally accepted. When creating e-learning materials for students with disabilities, learning materials must cater for all four major disability categories: visual, hearing, motor and cognitive impairments. The emphasis of universal design is on social inclusion while accessibility focuses on the implementation of specific features and processes. Thus, this inclusive nature of universal design and accessibility can greatly enhance the interaction of students with disabilities with e-learning (Van Rooij & Zirkle 2016). It is essential that the developers of the e-learning environment, aiming to integrate accessibility into the e-learning environment, familiarise themselves with both the capabilities and limitations of the institution’s technology, early in the development process, to minimise the repetitive nature of having to re-design elements that cannot be supported by the current infrastructure.
Adopting a learner-centred approach may require academics to adapt their educational practices to enhance learning for all students, to include disabled students. The design and implementation of e-learning spaces and learning materials that are accessible to all students can be accomplished by providing multiple means of representation, action and expression, as well as engagement, which meet recognised design principles. Successful e-learning environments that support students with disabilities are flexible and robust enough to afford opportunities to students with disabilities to enter inclusive education settings, without being marginalised (Van Jaarsveldt & Ndeya-Ndereya 2015). Ultimately, technology provides unique opportunities to assist students with disabilities to learn more easily. The key to achieve this though is to develop e-learning environments that make their learning processes interactive, accessible and inclusive (Yahya et al. 2015).
The transition from paper-based to digital and eventually to web-based learning has brought with it new uses of technology to support students with disabilities, as well as challenges for these students (Kirkup 2015). Although e-learning enhances the availability of access to content material, the full potential of this benefit can only be realised if the student has access to the appropriate assistive technologies (AT). As Georgeson et al. (2015) explain, students with disabilities obtain more meaningful learning experiences if they have access to AT like alternative interfaces (e.g. screen readers), reading tools (e.g. text-to-speech), recording tools (e.g. voice recording), writing tools (e.g. word prediction), planning tools (e.g. mind-mapping software) and communication tools (e.g. synthetic speech). Inaccessible design of e-learning portals can be a barrier to students with disabilities. Thus, technology is a ‘double-edged sword’ and if students with disabilities are exposed to poorly designed e-learning environments in higher education, they will be on the ‘wrong side of a second digital divide’. To improve the adoption of e-learning, academics are urged to improve their practices and support for the use of AT. This also includes empowering students with disabilities to be more active users of technology and assisting them in making more informed decisions about the benefits of actively engaging with technology to enhance their learning processes.
Furthermore, to improve the experiences of students with disabilities in higher education institutions, it is imperative that we listen to their voices, which provide us with information on the challenges they face while being learners at these institutions. The aspect of sharing good practices should not be neglected either, as case studies represent a powerful approach to help to learn from academics’ experiences, thus increasing ‘the volume of important voices’ (Douce 2015). As Cooper (2015) states, there is a need for ‘formal research that documents the experiences of academics with disability students in online learning’. More strategies need to be explored to address the complex issues of access and inclusion. The creation of an inclusive learning environment at higher education institutions will remain elusive if academics distance themselves from providing learner support to students with disabilities. Merely transferring the responsibilities to support services, such as the unit for students with disabilities, at the institution will frustrate the learning of these students (Van Jaarsveldt & Ndeya-Ndereya 2015).
In Japan, the United Kingdom and the United States, the law is seen very much as a driver for change (Cooper 2015), forcing higher education institutions to implement facilities to support students with disabilities. However, it must be stressed that abiding by the law alone will not affect a dramatic change. A greater participation of all stakeholders in higher education is required to ensure that students with disabilities become a part of the mainstream students in higher education institutions. As Van Jaarsveldt and Ndeya-Ndereya (2015) have stated, ‘beyond legislation and institutional policies relating to students with disabilities, academics should accept responsibility for and have an understanding of accessibility and the establishment of inclusive learning environments’. It is thus imperative to expand our research to identify methods, which can empower students with disabilities, and provide them with deeper and more enriched learning experiences.
In South Africa, inclusive education was implemented following the introduction of the Higher Education Act of 1997 (Council on Higher Education 1997) and the National Plan for Higher Education in 2001 (Ministry of Education 2001). The Education White Paper 6 on Special Needs Education (2001) outlines the inclusion of students with disabilities in broad terms and specifically mentions that higher education institutions are required to draft their own institutional plans to support students with disabilities (Department of Education 2001). These institutional plans must include the strategies and steps that will be taken by the institution to implement the guidelines provided by the legislation. More recently, the Department of Higher Education and Training in South Africa approved the White Paper for Post-School Education and Training which aims to produce a single, coordinated post-school education and training system (DHET 2013).
Many South African universities have established specialised disability units, to facilitate and coordinate specific support services for students with disabilities (UKZN 2004). These services may include sign language interpretation, Braille services, infrastructure, equipment and software installation, to facilitate easier learning (Van Jaarsveldt & Ndeya-Ndereya 2015). These units have also created institutional policies to help support their processes. These institutional policies aim to provide current and prospective students and staff who have disabilities with the opportunity for full participation at the universities of their choice. For these policies to be successfully implemented, they should be reviewed on a regular basis in consultation with people with disabilities to allow them to make input into improvements required to make their opportunity for full participation in university life possible (Hall & Healey 2004).
Despite the reservations made in the UNCRPD, the Republic of Mauritius has a number of domestic laws for the protection and inclusion of people with disabilities or special needs in mainstream life. In 2008, the Equal Opportunities Act was enacted to prevent all kinds of discrimination based on disability (Supreme Court 2017). The Building Control Act 2013 ensures that all new public buildings and infrastructures are accessible to people with disabilities (Supreme Court 2017). The Training and Employment of Disabled Persons Act requires that all employers having 35 or more staff should employ at least 3% people with disabilities. A number of public bodies such as the Disability Empowerment Unit, the National Council for the Rehabilitation of Disabled Persons and the Training and Employment of Disabled Person Board have been set up to carry out government policies based on domestic laws and the recommendation of the UNCRPD. People with disabilities who are victims of discrimination can seek redress directly not only from the police or the office of public prosecutions but also from the Equal Opportunity Tribunal, National Human Rights Commission, the Office of the Ombudsman, the Office of the Attorney General and the committee on Economic, Social and Cultural Rights (MSSNSRI 2016; Statistics Mauritius 2015). Depending on the severity of their disability and their age, people with disabilities also receive a pension every month. Thus, we can see that in general, there exist sufficient laws in the Republic of Mauritius, which have been put in place for the well-being of people with disabilities.
Although the Republic of Mauritius currently does not have any statutes specifically for the education of people with disabilities, it has been doing a lot for promoting inclusive education despite the UNCRPD reservation made on Article 24.2(b). The Special Education Needs and Inclusive Education (SEN & IE) Policy and Strategy (MoEHR 2006) states that:
‘An inclusive educational system, starting in the early years of development, and aimed at responding to the educational needs of each student through a child-centred pedagogical approach and a flexible and adapted curriculum will help each child of Mauritius develop his/her full potential.’ (p. 5)
Currently, in Mauritius, many students with disabilities attend specialised schools but the government is working towards the goal of total inclusion (MoEHR 2006). Students with disabilities are offered free transport by the government. Laws and regulations have been amended to make the school environments more accessible. Many nongovernmental ogranisations like the Global Rainbow Foundation (GRF 2016) help students with disabilities in the acquisition of assistive devices for walking, hearing, talking, sight, etc., so that they can be included in mainstream education. In terms of tertiary institutions, to our knowledge, out of 10 publicly funded institutions and 53 private ones (TEC 2017), only the University of Mauritius has so far produced formal regulations with regard to the facilities that are available to students with disabilities (University of Mauritius 2016). The other universities, colleges and schools provide tailored support on a case-by-case basis. In the past few years, the Ministry of Education (MoEHRTESR 2016) has been giving scholarships to students with disabilities who wish to study at a local public university.
Research design and methodology
An online self-administered or self-completion questionnaire (Appendix 1), which included a mixture of open-ended and closed questions, was used for the data collection process. This questionnaire was benchmarked against similar studies undertaken internationally (Dent et al. 2015; Healey et al. 2015; Meyer et al. 2012; Roualdes 2013). The primary data collected were derived from the anonymous responses received to the online questionnaire. The questionnaire focused on gathering information on the general awareness of students regarding students with disabilities, the perceived views of students about the support structures available to students with disabilities, the awareness of laws by students to support students with disabilities, the obstacles students with any form of disability are facing in tertiary and higher education and the role of e-learning in providing a more supportive learning environment for students with disabilities.
The population for this study was students at the University of Mauritius. The questionnaire was electronically distributed through the use of Google Forms to 500 students, which included those with disabilities. The sample selected adopted a combination of convenience and purposive sampling. Convenience, as the students were available for participation at the university, and purposive, because it focused solely on the University of Mauritius. No exclusion criteria were adopted in this process. Post-data collection, the quantitative responses were analysed using simple data analysis techniques, while the qualitative data were extracted into themes for discussion. Responses are reported with an R, indicating a respondent in the discussion of the findings.
Therefore, this article attempts to reflect a better understanding of this phenomenon, and thus enable more effective measures against it, in the Mauritian context, to provide better facilities and encourage students with disabilities to adapt and succeed in tertiary education.
Ethical clearance procedures were completed. Participants were informed of the voluntary nature of the survey, the anonymity of their responses and the purpose of the survey.
Findings and results
As presented earlier, the questionnaire was distributed to 500 students, which represents about 4% of the total student population of the University of Mauritius. A total of 122 responses, which represents a response rate of 24.4%, were received in total, with 6 responses from students with disabilities.
Overview of students with disabilities
Figure 1 represents an overview of the students with disabilities in this study. For the 2015–2016 academic years, there were 52 students (0.4% of the student population) who declared that they have some form of disability or an other. About 27% of these 52 students have mobility problems (hand, leg or other parts of the body), about 21% have visual problems, 11% have hearing problems, another 12% have asthma problems and the rest have other medical problems such as diabetes, stammering, difficulty to concentrate and other rare or complex conditions. This information was received from the University of Mauritius.
Types of disabilities among students of the University of Mauritius.
The questionnaire was distributed in such a way so as to get students from different levels of study at the University of Mauritius. Figure 2 shows the demographics of participants including undergraduates (81.1%), postgraduates (16.4%), alumni (0.01%), graduates (0.01%) and unspecified (0.01%). Thus, the overwhelming majority of students were undergraduates while a few who responded to the invitations were no longer students of the university. Out of the 122 respondents, 54 (44.3%) participants were male students and 68 (55.7%) were female students.
Level of study of the participants.
Figure 3 represents the age distribution of the participants. Most participants were younger students. Participants who were 20 and under totalled 81 (66.4%), 39 (32%) were between 21 and 30 years, while just 2 (1.6%) were older learners who were between 31 and 45 years of age. There were 99 (81.1%) participants who were full-time students, 12 were part-timers (9.8%), 9 (0.07%) participants identified themselves as both full-time and part-time students and 2 (0.02%) were distance learning students.
Age distribution of participants.
Awareness levels and support structures
Following the demographic data collection, the next part of the questionnaire gathered information about the respondents’ awareness levels of students with disabilities. It also gathered their views on the current support structures available for students with disabilities. Nineteen (15.6%) students indicated that they have a close relative or friend who had or has some form of disability, which impacted on their ability to study at a tertiary institution. Furthermore, 81 (66.4%) respondents affirmed that they are aware that there are students with disabilities at the university.
Despite being aware of the fact that there are students with disabilities at the University of Mauritius, 80 respondents (65.6%) mentioned that they were unaware of the amount of funds that are injected by the University of Mauritius in order to provide the necessary facilities and support structures for students with disabilities. One hundred and three (84.4%) respondents stated that they felt public and private tertiary institutions in Mauritius are ill-equipped to provide these facilities.
Figure 4 summarises the respondents’ views on the support provided by the University of Mauritius for students with disabilities, in terms of IT, library facilities, general accessibility, sports and recreational facilities and departmental facilities. All facilities were consistently rated by the majority of the respondents as either ‘poor’ or ‘very poor’. General accessibility was ranked the highest with 45 (36.9%) respondents rating these facilities as satisfactory. Although specific IT facilities were not investigated, general IT support 6 (4.9%) topped the ‘good to very good’ category.
Provision for students with disabilities.
In many higher education institutions abroad, facilities to support students with disabilities include: rooms that are designed to support students with mobility disabilities, specialist software for students with sight and dyslexic disabilities, alternate access facilities to buildings and support group structures for students with disabilities (Georgeson et al. 2015; Lichiello 2012). At the University of Mauritius, some of these facilities have been provided. For example, lectures for students with mobility problems are done in places which are easily accessible to them. Students with visual problems are allowed 25% additional time to submit their scripts. The font size on question papers is also enlarged. Colours may also be used as appropriate. There is also provision for Braille-printed exam papers. For students with other types of disabilities, the faculties should provide necessary and appropriate facilities as far as is possible with the resources available and without compromising academic standards.
The adoption of e-learning, and its associated tools, was viewed favourably by most respondents (92.6%) as facilities that could enhance and encourage better learning for students with disabilities. The greatest motivations for these opinions was flexibility: ‘the ability to allow them the flexibility to work from home’ – respondents R6, R18, R20. This was supported by respondents R8 and R14, who said that these students ‘will not have to travel long distances’ (R8, R14) which is sometimes difficult for those who do not have transport facilities. However, respondent R9 felt that e-learning would be inappropriate as these students ‘want to attend university’ like regular students do. Respondent R5 also supported this view stating that ‘e-learning would make them feel like they are different from other students and hence deprive them from social interaction which is in a way rejecting them from society’.
The questionnaire thereafter moved on to investigating awareness and appropriateness of laws associated with protecting and assisting students with disabilities. A large number of respondents, totalling 71 (58.2%), were not aware of any disability laws in Mauritius. Of the 51 (41.2%) respondents who were aware of disability laws in Mauritius, 12 respondents (23.5%) stated that these laws do not protect students with disabilities, while 6 respondents (11.8%) were unsure. The motivations provided by these respondents supported the statistics above, as most of the comments discussed laws that protect disabled citizens in general, rather than specifically focusing on students with disabilities. Respondent R7 stated that laws for people with disabilities ‘gives them the opportunity to get jobs … they do not suffer from discrimination’ (R7, male, student). This was supported by respondent R87 who indicated that there are ‘… laws that are enforced for recruitment of disabled persons’ (R87, female, student) and respondents R113 and R121 who spoke about ‘incentives and protection against discrimination’ (R113, R121, male, student). Respondent R49 stated that ‘these laws are not well enforced in every institution … they should be reviewed and amended to help the student’ (R49, female, student). Only four respondents (3.3%) were aware of any foreign laws that supported people with some form of disabilities.
Feedback from students with disabilities
The next part of the survey focused on views from students with disabilities. Only six responses (4.9%) were received from students with disabilities. Nevertheless, their feedback is of crucial importance for this study. The largest form of disability indicated was visual impairment (three respondents) followed by mobility difficulty (one respondent), partial hearing loss (one respondent) and one asthmatic student.
Five of these respondents (83.3%) indicated that their parents provided them with the necessary medical support to assist them in being an active member of society. All six participants (100%) further affirmed that they are unaware of any university disability advisor at the University of Mauritius who they can contact to discuss their requirements and problems.
The next set of questions gathered the views of students with disabilities about their actual experience at the University of Mauritius, which are presented in Figure 5.
Views of students with disabilities about their university experience.
Three (50%) respondents indicated that that their choice of subjects was affected by the limitations they faced with their disability. The selection of university at which to study did not seem to have a role to play. Only two respondents (33.3%) faced difficulties with lectures, tutorials, practicals, technical facilities and learning resources. One (16.7%) respondent indicated that his disability was a barrier for him to complete his assessments successfully. The respondents’ experience with regard to the support they obtained from their lecturers was very positive, as the majority of them (83.3%) were very satisfied with their lecturers’ role in their studies. Support staff was equally helpful, as indicated by 4 (66.7%) respondents.
In the general comments section, respondents R13, R20 and R25 were keen on learning about the laws in Mauritius that specifically catered for students with disabilities. An interesting suggestion was made by R9 with regard to increasing the accessibility of the university campus by students with disabilities. The respondent proposed that by allowing students with disabilities from different faculties to suggest inaccessible places (which are important to them), the University of Mauritius will be in a better position to take appropriate measures to make the campus more accessible for such students.
Discussion of findings
Of the 500 students who were sent the questionnaire, only 122 responded, out of which 6 were students with disabilities. Compared to the percentage of students with disabilities at the University of Mauritius, this is a relatively high response rate. The University of Mauritius has a population of 12 500 students. This could indicate that these students were not reticent to participate in this study to demonstrate their knowledge or voice their concerns. For ethical and data privacy reasons, it was not possible to get a named list of students with disabilities from the University of Mauritius. It was noted that participants were aware of family members and fellow students with disabilities.
The University of Mauritius may not be doing enough to inform the student community about the support that they offer for students with disabilities. This was indicated by the large number of respondents who were not aware of the facilities and support structures that are provided to students with disabilities. The results indicate that the IT facilities are the best support provided at the university for both able-bodied students and students with disabilities. This correlates with the large support for the adoption of e-learning as a tool to promote better interactivity and inclusivity of students with disabilities into the mainstream education structure.
The awareness of laws supporting people with disabilities was restricted to laws relating to social justice and higher education. There is a general feeling among the respondents that laws associated with better support and inclusion of students with disabilities into tertiary education are required, or if such laws exist, they should be made aware of them. There was very little knowledge of foreign laws associated with students with disabilities. Responses received from students with disabilities, although small in number, provided insights into their experiences while studying at the University of Mauritius. Although they are provided with support from their parents, they seem to be getting little support at the institution itself. Lecturers and support staff were identified as being sensitive to the disabilities of students, but a formal support structure at the University of Mauritius seems to be lacking. This calls for greater investigation by the relevant stakeholders, at the university, to find ways to enhance the learning experience at the institution, for students with disabilities.
This study indicates that the University of Mauritius has been making some effort to provide special facilities and arrangements to support students with disabilities. Nevertheless, some support structures, such as student liaison officers, appropriate recreational and sport facilities and special access features have been identified as lacking at the university by the students. The introduction of these facilities coupled with increased awareness of them will ensure that students with disabilities are able to pursue their studies with the same amount of effort as those without any disabilities. Most students identified e-learning as having a key role to play in the support of students with disabilities. Essentially, the problems and barriers that are faced by students with disabilities in tertiary education must not be overlooked, in order to offer equal opportunities to every student. To conclude, students with disabilities are neither forgotten nor excluded at the University of Mauritius; however, more effort is certainly required for their seamless inclusion.
Two limitations associated with this study are the small number of participants with disabilities and that the context is restricted to the University of Mauritius. Future research should look at expanding this to include the participation of more students with disabilities and more tertiary institutions in Mauritius and abroad in order to get a more holistic picture of the situation.
The authors declare that they have no financial or personal relationships that may have inappropriately influenced the writing of this article.
R.P.G. was the project leader. S.P. and U.G.S. were responsible for experimental and project design. R.P.G. and U.G.S. performed most of the experiments. R.P.G. made conceptual contributions while U.G.S. and S.P. analysed the results and discussed the findings.
All information would be kept private and confidential.
Please complete this survey anonymously. Do not write your name, address or any personal details anywhere in the form.
Researchers: Mr S Pudaruth, Dr RP Gunputh and Dr UG Singh
A survey on general awareness of laws and facilities for students with disabilities at the University of Mauritius
- What level of study are you in?
- At what age did you commence your studies?
20 and under
- How do you study?
- Do you have any close relatives or friends who suffer from any form of disability which consequently has a serious impact on his/her studies in a tertiary education?
- Are you aware that there are students at your University who suffer from any form of disability? *
- How much funds do you think the tertiary education where you are registered actually is ready to finance so that students who are suffering from any form of disability may be provided with the necessary facilities they need?
More than 1 million rupees annually
More than 2 million rupees annually
More than 3 million rupees annually
More than 4 million rupees annually
I have no idea
- Do you think that public and private tertiary institutions are well equipped to provide facilities for students suffering from disabilities?
Please rate Questions 9 to 13 using the scale provided.
Very Poor Poor Satisfactory Good Very Good
How would you rate the University’s IT provisions for disabled students?
How would you rate the University’s Library provision for disabled students?
How would you rate the accessibility, for disabled student, of the University’s campus, in general?
How would you rate the University’s Sports and Recreation facilities, for disabled students?
How would you rate the facilities in your Department/School to support disability requirements?
- Do you think e-learning would encourage students who are suffering from any form of disabilities to register on e-learning programmes to be graduated?
Motivate your answer to Question 14
- Are you aware of any disability laws in Mauritius?
- Do you think this/these law(s) protect(s) people suffering from disabilities?
Why? Motivate your answer to Question 17
- Do you suffer from any disability?
- Which of the following categories best describes your disability? (Please select as many as apply to you)
Unseen disability (e.g. asthma, epilepsy)
Wheelchair user/Mobility difficulty
Mental health difficulty
- Do your parents provide the necessary medical support (medical treatment/medical devices) in order for you to cope properly with your studies at the university you have joined and registered? *
- Are you aware of any University Disability Advisor at the University? *
Please rate the statements in questions 23 to 32 using the rate scale provided *
Strongly Agree Agree Neutral Disagree Strongly Disagree
My disability affected my choice of subject(s) to study.
I chose to study at this University because it offers support for disability students.
I have faced disability-related barriers, at the University, which have impacted on my learning experience in lectures.
I have faced barriers, related to my disability, at the University, which have impacted on my learning experience in on-campus laboratory and/or practical work.
I have faced barriers, related to my disability, at the University, which have impacted on my learning experience in other on-campus classes (e.g. seminars, tutorials).
I have faced barriers, related to my disability, at the University, which have had an impact on my use of technical facilities (e.g. computers, multimedia, audio/visual equipment, photocopying).
I have faced barriers, related to my disability, at the University, which have affected my use of learning resources, (e.g. lecture handouts, computer-assisted learning packages).
I have faced barriers, related to my disability, at the University, which have affected my experience with assessments/tests/examinations.
Academic staff (e.g. lecturers/tutors) have been supportive and helpful when I have approached them with concerns about to disability-related barriers I have experienced
Support staff (e.g. administrators, technicians, librarians) have been supportive and helpful when I have approached them with concerns about disability-related barriers I have experienced
Are you aware of any foreign legislation which may improve our local legislation on disability law, with particular focus on tertiary institutions?
Do you have any suggestions/recommendations to improve this survey?
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Volume 18, No. 1, Art. 19 – January 2017
Case Study Research: Foundations and Methodological Orientations
Helena Harrison, Melanie Birks, Richard Franklin & Jane Mills
Abstract: Over the last forty years, case study research has undergone substantial methodological development. This evolution has resulted in a pragmatic, flexible research approach, capable of providing comprehensive in-depth understanding of a diverse range of issues across a number of disciplines. Change and progress have stemmed from parallel influences of historical transformations in approaches to research and individual researcher's preferences, perspectives, and interpretations of this design. Researchers who have contributed to the development of case study research come from diverse disciplines with different philosophical perspectives, resulting in a variety of definitions and approaches. For the researcher new to using case study, such variety can create a confusing platform for its application. In this article, we explore the evolution of case study research, discuss methodological variations, and summarize key elements with the aim of providing guidance on the available options for researchers wanting to use case study in their work.
Key words: case study; method; methodology; nursing research; qualitative; research design; research
Table of Contents
2. History and Evolution
3. Foundational Concepts
3.1 Definitions and descriptions
3.2 Methodology or method
3.3 Philosophical orientation
3.4 Philosophical variation
3.4.1 YIN: Realist—postpositivist
3.4.2 MERRIAM: Pragmatic constructivist
3.4.3 STAKE: Relativist—constructivist/interpretivist
4. Common Characteristics of Case Study Research
Case study research has grown in reputation as an effective methodology to investigate and understand complex issues in real world settings. Case study designs have been used across a number of disciplines, particularly the social sciences, education, business, law, and health, to address a wide range of research questions. Consequently, over the last 40 years, through the application of a variety of methodological approaches, case study research has undergone substantial development. Change and progress have stemmed from parallel influences from historical approaches to research and individual researcher's preferences, perspectives on, and interpretations of case study research. Central to these variations is the underpinning ontological and epistemological orientations of those involved in the evolution of case study research. Researchers who have contributed to the development of case study research come from diverse disciplines and their philosophical underpinnings have created variety and diversity in approaches used. Consequently, various designs have been proposed for preparing, planning, and conducting case study research with advice on key considerations for achieving success. As a result, while case study research has evolved to be a pragmatic, flexible research approach, the variation in definition, application, validity, and purposefulness can create a confusing platform for its use. 
In this article, we examine each of these issues in turn, with the aim of improving our understanding of case study research and clarifying the requisite tenets to consider when designing a case study. We begin with an overview of the history and evolution of case study research, followed by a discussion of the methodological and philosophical variations found within case study designs. We end with a summary of the common characteristics of case study research and a table that brings together the fundamental elements that we found common in all case study approaches to research. 
2. History and Evolution
Case study research as a strategy for methodological exploration, according to FLYVBJERG (2011) "has been around as long as recorded history" (p.302). Contemporary case study research is said to have its origins in qualitative approaches to research in the disciplines of anthropology, history, psychology, and sociology (MERRIAM, 1998; SIMONS, 2009; STEWART, 2014). Historical examples of case study stem as far back as the early nineteenth century with the biography of Charles DARWIN (STEWART, 2014). Most attribute the origins of case study research to studies undertaken in anthropology and social sciences in the early twentieth century when lengthy, detailed ethnographic studies of individuals and cultures were conducted using this design (JOHANSSON, 2003, MERRIAM, 2009; SIMONS, 2009; STEWART, 2014). Sociologists and anthropologists investigated people's lives, experiences, and how they understood the social and cultural context of their world, with the aim of gaining insight into how individuals interpreted and attributed meaning to their experiences and constructed their worlds (JOHANSSON, 2003; SIMONS, 2009). Such investigations were conducted in the natural setting of those experiences with results presented descriptively or as a narrative (MERRIAM, 2009). The most notable case studies include THOMAS and ZNANIECKI's (1958 [1918-1920]) study of Polish peasants in Europe and America and, the ethnographic work by MALINOWSKI (1913) in the Trobriand Islands in Melanesia that spanned over several years (CRESWELL, HANSON, PLANO CLARK & MORALES, 2007; JOHANSSON, 2003; STEWART, 2014). 
With the emergence and dominance of positivism in science in the late 1940s and 1950s, quantitative methods became a popular focus for the social sciences. As a result, surveys, experiments, and statistical methods anchored in quantitative approaches were favored and considered more rigorous than qualitative designs (JOHANSSON, 2003). The dominance of research using experimental designs continued through the 1960s and 1970s with quantitative empirical results considered to be gold standard evidence. Case studies continued to be used during this time, however usually as a method within quantitative studies or referred to as descriptive research to study a specific phenomenon (MERRIAM, 2009). At the same time, case study research was often criticized for its inability to support generalizability and thus considered to provide limited validity and value as a research design (JOHANSSON, 2003; MERRIAM, 2009; STEWART, 2014). This context led to a philosophical division in research approaches: those supporting positivism and quantitative approaches and those aligned with qualitative methods embedded in constructivist and interpretivist paradigms. 
Antecedents of modern day case study research are most often cited as being conducted in the Chicago School of Sociology between the 1920-1950s (STEWART, 2014). Here, anthropologists practiced their methods on university cultures or by conducting lengthy case studies involving field-based observations of groups with the aim of understanding their social and cultural lives (CRESWELL et al., 2007; JOHANSSON, 2003; STEWART, 2014). Parallel to the use of case studies in anthropology, medicine and disciplines in the social sciences such as sociology, education and political science also embraced case study as a form of inquiry (ANTHONY & JACK, 2009; BROWN, 2008; CRESWELL et al., 2007; GEORGE & BENNETT, 2005; GERRING, 2004; SIMONS, 2009; YIN, 2014). 
A second generation of case study researchers emerged with the advent of grounded theory methodology (GLASER & STRAUSS, 1967). Grounded theory "merged qualitative field study methods from the Chicago School of Sociology with quantitative methods of data analysis" (JOHANSSON, 2003, p.8), resulting in an inductive methodology that used detailed systematic procedures to analyze data. This renewed interest in qualitative methodology led to a revival in the use of case study in a number of disciplines (ANTHONY & JACK, 2009; GEORGE & BENNETT, 2005; JOHANSSON, 2003; MERRIAM, 2009; STAKE, 1995). According to JOHANSSON (2003), Robert YIN followed this progress, and drawing on scientific approaches to research gained from his background in the social sciences, applied experimental logic to naturalistic inquiry, and blended this with qualitative methods, further bridging the methodological gap and strengthening the methodological quality of case study research. He presented a structured process for undertaking case study research where formal propositions or theories guide the research process and are tested as part of the outcome, highlighting his realist approach to qualitative case study research. While still qualitative and inductive, it was deterministic in nature with an emphasis on cause and effect, testing theories, and an apprehension of the truth (BROWN, 2008; YIN, 2014). 
Similarly, the uptake of case study research in the political sciences, particularly during the 1980's and 1990’s, led to a more integrated methodological approach with the aim of theoretical development and testing (GEORGE & BENNETT, 2005). The integration of formal, statistical, and narrative methods in a single study, combined with the use of empirical methods for case selection and causal inference, demonstrated the versatility of case study design and made a significant contribution to its methodological evolution (ibid.). Similarly, case studies in international relations integrated rigorous, standardized methods with statistical and formal methods, including qualitative comparative analysis and process tracing to improve understanding of world politics (BENNETT & ELMAN, 2007; GERRING, 2004; LEVY, 2007). According to GEORGE and BENNETT (2005) "scholars have formalized case study methods more completely and linked them to underlying arguments in the philosophy of science" (p.6). The continued use of case study to understand the complexities of institutions, practices, processes, and relations in politics, has demonstrated the utility of case study for researching complex issues, and testing causal mechanisms that can be applied across varied disciplines. 
Corresponding with these developments, in the 1970's, educational research embraced case study as a way to evaluate curriculum design and innovation (MERRIAM, 2009; SIMONS, 2009; STAKE, 1995). Methods were required that could be used to explore factors such as participants' perspectives and the influence of socio-political contexts on curriculum successes and failures (SIMONS, 2009). Development of case study research in education, focused on the need to determine the impact of educational programs and provide relevant evidence for policy and practice decisions that supported social and educational change in the United Kingdom and the United States (ibid.). The most significant contributors to this field were STAKE (1995, 2006) and MERRIAM (1998, 2009). STAKE (1995), an educational psychologist with an interest in developing program evaluation methods, used a constructivist orientation to case study. This resulted in placing more emphasis on inductive exploration, discovery, and holistic analysis that was presented in thick descriptions of the case. Similarly, MERRIAM (1998, 2009) used case study research to explore and evaluate educational programs. MERRIAM's approach emphasized defining and understanding the case through the products of inquiry and drew on the work of both YIN and STAKE. MERRIAM (2009) described case study research by its characteristics: particularistic, descriptive and heuristic, highlighting the purpose and qualitative nature of case study research, the focus on a specific entity and, the motivation to understand and describe the findings. Similar to STAKE (1995, 2006), MERRIAM (1998, 2009) was not as structured in her approach as YIN (2014), but promoted the use of a theoretical framework or research questions to guide the case study and organized, systematic data collection to manage the process of inquiry. 
Simple in theory yet complex in nature, the planning, preparation and execution of case study research has developed to a point where the continued application of case study research across a number of professions particularly education, health, and social sciences, has provided a unique platform for credible research endeavors. Case study research has grown in sophistication and is viewed as a valid form of inquiry to explore a broad scope of complex issues, particularly when human behavior and social interactions are central to understanding topics of interest (ANTHONY & JACK, 2009; FLYVBJERG, 2011; GEORGE & BENNETT, 2005; LUCK, JACKSON & USHER, 2006; MERRIAM, 2009; STAKE, 2006; YIN, 2014). 
In Figure 1, developed by JOHANSSON (2003) and adapted for this discussion, a summary of the evolution of case study across a timeline dating back to 1600 is displayed. Key contributors to case study research and major contextual influences on its evolution are included. As the figure highlights, early case studies were conducted in the social sciences. With the dominance of logical positivism from the 1940's through to the 1960's and 1970's case study methodology was viewed with skepticism and criticism. The development of grounded theory in the 1960's led to a resurgence in case study research, with its application in the social sciences, education, and the humanities. Over the last 50 years, case study has been re-established as a credible, valid research design that facilitates the exploration of complex issues.
Figure 1: The history and evolution of case study research (JOHANSSON, 2003, p.7) 
3. Foundational Concepts
While over time the contributions of researchers from varied disciplines have helped to develop and strengthen case study research, the variety of disciplinary backgrounds has also added complexity, particularly around how case study research is defined, described, and applied in practice. In the sections that follow, the nature of this complexity in explored. 
3.1 Definitions and descriptions
There are a number of definitions and descriptions presented across the literature, which can create confusion when attempting to understand case study research. The most common definitions come from the work of YIN (2014), STAKE (1995), and MERRIAM (2009). YIN's two-part definition (2014) focuses on the scope, process, and methodological characteristics of case study research, emphasizing the nature of inquiry as being empirical, and the importance of context to the case. On the other hand, STAKE (1995) takes a more flexible stance and while concerned with rigor in the processes, maintains a focus on what is studied (the case) rather than how it is studied (the method). For STAKE case study research is "the study of the particularity and complexity of a single case, coming to understand its activity within important circumstances" (p.xi). MERRIAM (2009) includes what is studied and the products of the research when defining case study as: "... an in depth description and analysis of a bounded system" (p.40). Like STAKE, MERRIAM emphasizes the defining feature of case study research as being the object of the study (the bounded system; i.e., the case) adding that case study research focuses on a particular thing and that the product of an investigation should be descriptive and heuristic in nature. In discussing the proliferation of definitions (and subsequent confusion), FLYVBJERG (2011) contends that using a simple definition might be a more useful approach, citing the MERRIAM-WEBSTER DICTIONARY's (2009) definition, as an example that captures the key requisites in the context of research: "an intensive analysis of an individual unit (as a person or community) stressing developmental factors in relation to environment" (p.103). These varied definitions stem from the researchers' differing approaches to developing case study methodology and often reflect the elements they emphasize as central to their designs. The diversity of approaches subsequently adds diversity to definition and description. 
3.2 Methodology or method
A further challenge to understanding case study research relates to it being referred to and used as both a methodology and a method. MILLS (2014) distinguishes methods as procedures and techniques employed in the study, while methodology is the lens through which the researcher views and makes decisions about the study. Given the variation in definitions and descriptions, referring to case study research as a methodology and/or a single method can be perplexing, misleading, and at times counterproductive (ANTHONY & JACK, 2009; BOBLIN, IRELAND, KIRKPATRICK & ROBERTSON, 2013; FLYVBJERG, 2011). Furthermore, advocates of case study encourage the use of both quantitative and qualitative methods within their designs adding further obscurity to the question of methodology (MERRIAM, 1998; STAKE, 1995; STEWART, 2014; YIN, 2014). 
The ambiguity about case study being either or both a methodology and method, is compounded by the terminology used in discussions about case study. Across the literature, case study is referred to as a methodology and a method, an approach, research and research design, research strategy, and/or a form of inquiry (ANTHONY & JACK, 2009; BROWN, 2008; CRESWELL, 2014; GERRING, 2004; MERRIAM, 2009; SIMONS, 2009, STAKE, 1995, 2006; STEWART, 2014; YIN, 2014). Often these terms are used interchangeably without definitional clarity. For example, YIN (2014) discusses case study research and in the context of presenting case study, refers to it as a research method while emphasizing the procedures used. He does not use the terms methodology or strategy. CRESWELL (2014) refers to case studies as a qualitative design, while others use the term case study (FLYVBJERG, 2011; STAKE, 1995, 2006; STEWART, 2014), qualitative case study (MERRIAM, 2009), or describe case study as an approach (SIMONS, 2009). This mixed use of terminology is confusing given the definitional separations between methodology and methods and the varied application of case study in research endeavors. 
Prominent case study researchers do however emphasize that an overarching methodology shapes a case study design and that multiple sources of data and methods can be used (MERRIAM, 2009; STAKE, 2006; YIN, 2014), thus providing the distinction between the two. This distinction accentuates the need for researchers to describe the particular underpinning methodology adopted and to clarify the alignment of chosen methods used with their philosophical assumptions and their chosen approach. Exploring the philosophical orientation of case study research and variations in different case study approaches can help to clarify these differences, and promote a better understanding of how to apply these principles in practice. 
3.3 Philosophical orientation
Many methodologies are aligned with specific philosophical positions that guide the research process. Case study, however, has a practical versatility in its agnostic approach whereby "it is not assigned to a fixed ontological, epistemological or methodological position" (ROSENBERG & YATES, 2007, p.447). Philosophically, case study research can be orientated from a realist or positivist perspective where the researcher holds the view that there is one single reality, which is independent of the individual and can be apprehended, studied and measured, through to a relativist or interpretivist perspective. A relativist or interpretivist perspective adopts the premises that multiple realities and meanings exist, which depend on and are co-created by the researcher (LINCOLN, LYNHAM & GUBA, 2011; YIN, 2014). This philosophical versatility provides the researcher with the opportunity to decide the methodological orientation used in the conduct of the case study (STEWART, 2014; YIN, 2014). Examples of this choice are discussed later where the philosophical variations of MERRIAM (2009), STAKE (1995), and YIN (2014) are explicated. 
In the context of healthcare research and specifically nursing, LUCK et al. (2006) describe case study research as "a bridge across paradigms" (p.103). As a result, some case study approaches are either quantitatively or qualitatively orientated while others encompass both qualitative and quantitative aims and methods (MERRIAM, 2009; MILES, HUBERMAN & SALDANA, 2014; YIN, 2014). DENZIN and LINCOLN (2011) emphasize the qualitative essence of case study, while acknowledging its evolution and fluidity with regard to accommodating varied ontologies, epistemologies, methodologies, and methods. This ability to accommodate a range of philosophical positions is seen as an advantage whereby case study enables the opportunity to design research that can be specifically tailored to the inherent complexity of the research problem (ANTHONY & JACK, 2009; CASEY & HOUGHTON, 2010; FLYVBJERG, 2011; FARQUHAR, 2012; LUCK et al., 2006; MERRIAM, 2009; STAKE, 2006; YIN, 2014). 
Case study research is most often described as qualitative inquiry (CRESWELL, 2014; DENZIN & LINCOLN, 2011; MERRIAM, 2009; MILES et al., 2014; STAKE, 2006). Qualitative paradigms are broad and can encompass exploratory, explanatory, interpretive, or descriptive aims. Examples include narrative research, phenomenology, grounded theory, and ethnography (DENZIN & LINCOLN, 2011). Each methodology is unique in approach depending on the ontological and epistemological stance, however all stem from the motivation to explore, seek understanding, and establish the meaning of experiences from the perspective of those involved (ibid.; see also MERRIAM, 2009). For this purpose, qualitative researchers can employ a broad scope of methods and interpretative practices in any one study, although they typically include observations, interviews, and analysis of participants' words (DENZIN & LINCOLN, 2011; MERRIAM, 2009). DENZIN and LINCOLN (2011, pp. 8-10) summarize the characteristics of qualitative research into five key attributes:
reducing the use of positivist or post positivist perspectives;
accepting postmodern sensibilities;
capturing the individual's point of view;
examining the constraints of everyday life;
securing rich descriptions. 
These attributes are commonly exemplified in case study research. The fundamental goal of case study research is to conduct an in-depth analysis of an issue, within its context with a view to understand the issue from the perspective of participants (MERRIAM, 2009; SIMONS, 2009; STAKE, 2006, YIN, 2014). Like other forms of qualitative research, the researcher will seek to explore, understand and present the participants' perspectives and get close to them in their natural setting (CRESWELL, 2013). Interaction between participants and the researcher is required to generate data, which is an indication of the researcher's level of connection to and being immersed in the field. Because of this, constructivism and interpretivism commonly permeate the implementation of this research design. Methods used in case study to facilitate achieving the aim of co-constructing data most often include observations, interviews, focus groups, document and artifact analysis (MERRIAM, 2009; SIMONS, 2009; STAKE, 1995; 2006; STEWART, 2014; YIN, 2014). The researcher's perceptions and interpretations become part of the research and as a result, a subjective and interpretive orientation flows throughout the inquiry (CRESWELL, 2014). Subjectivity is openly acknowledged and to manage this, the researcher embraces a reflexive stance within the study, adopting methods such as memoing and journaling that support this position (DENZIN & LINCOLN, 2011; MILES et al., 2014, STAKE, 2006; YIN, 2014). 
3.4 Philosophical variation
In choosing a methodological position, careful consideration of the different case study approaches is required to determine the design that best addresses the aim of the study, and that aligns with the researcher's worldview. The goal of this alignment is to engender coherence between the researcher's philosophical position, their research question, design, and methods to be used in the study (FARQUHAR, 2012; LUCK et al., 2006; STEWART, 2014; YIN, 2014). To assist in understanding and achieving this alignment, the qualitative case study approaches developed by YIN (2014), STAKE (1995) and MERRIAM (1998, 2009) are explored in the following sections. Examples are provided of how these researchers' philosophical orientation influences the application of case study in practice. 
3.4.1 YIN: Realist—postpositivist
YIN (2014) conceptualizes case study research as a form of social science. Post-positivism is evident in how he defines "case study as a form of empirical inquiry" (p.16). YIN himself describes his approach to case study as using a "realist perspective" (p.17) and focuses on maintaining objectivity in the methodological processes within the design. 
Postpositivist qualitative researchers conduct research that embraces the ideals of objectivity and the generalizability of results (ELLINGSON, 2011). The goal of a postpositivist researcher is to use science as a way to apprehend the nature of reality while understanding that all measurement is imperfect. Therefore, emphasis is placed on using multiple methods with triangulation to circumvent errors and understand what is happening in reality as close as possible to the "truth" (LINCOLN et al., 2011). The researcher will often categorize qualitative data to create quantitative data that can then be analyzed using statistical methods. Validity of research results are verified through the scrutiny of others and, as such, adherence to mechanisms that ensure rigor in data collection and analysis is vital. Furthermore, postpositivists accept that everyone is inherently biased in worldviews, which ultimately influence how the methods used are deployed. Interaction with research subjects therefore needs to be minimized and subjectivity managed to avoid biasing the results (ibid.). 
Embedded within YIN's (2014) case study design are the hallmarks of a postpositivist approach to research: seeking rival explanations and falsifying hypotheses, the capability for replication with a multiple case study design, the pursuit of generalizations (if required), minimizing levels of subjectivity, and the use of multiple methods of qualitative and quantitative data collection and analysis. While objectivity is a goal, YIN also recognizes the descriptive and interpretive elements of case study. According to YIN what makes case study research distinct from experimental studies is the case study is investigated in context, examined in its "real world setting" (p.16). Selection of cases is based on the purpose of the research and related to the theoretical propositions about the topic of interest. YIN suggests careful screening in the selection of cases to ensure specific relevance to the issues of interest and the use of replication logic: cases are chosen to produce anticipated contrasting findings (theoretical replication) or similar findings (literal replication). Precision, process, and practicality are core attributes of YIN's approach to case study. Design features are sequentially structured and motivated by empirical application. This positioning reflects the axiology of postpositivism where maintaining intellectual honesty, managing bias, and acknowledging limitations, coupled with meticulous data collection and accurate reporting are critical elements in the conduct of research (KILLAM, 2013; YIN, 2014). 
3.4.2 MERRIAM: Pragmatic constructivist
MERRIAM (1998) maintains a constructivist approach to case study research, whereby the researcher assumes that reality is constructed intersubjectively through meanings and understandings developed socially and experientially. Like YIN (2014), MERRIAM (1998, 2009) asserts that when information is plentiful and concepts abstract, it is important to utilize processes that help interpret, sort, and manage information and that adapt findings to convey clarity and applicability to the results. In this way, MERRIAM's perspective brings forth a pragmatic approach to constructivist inquiry. MERRIAM (2009) acknowledges case study research can use both quantitative and qualitative methods; however, when working on qualitative case studies, methods aimed at generating inductive reasoning and interpretation rather than testing hypothesis take priority. Cases are selected based on the research purpose and question, and for what they could reveal about the phenomenon or topic of interest. The aim is to provide a rich holistic description that illuminates one's understanding of the phenomena (MERRIAM, 1998). Interviews are the most common form of qualitative data collection, although MERRIAM does not stipulate prioritizing a particular method for data collection or analysis, she does emphasize the importance of rigorous procedures to frame the research process. Advocating for careful planning, development, and execution of case study research, MERRIAM (1998, 2009) discusses the pragmatic structures that ensure case study research is manageable, rigorous, credible, and applicable. Processes such as descriptive, thematic and content analysis, and triangulation are significant in ensuring the quality of a study, therefore, methods of data collection and analysis need to be organized and systematized with a detailed chain of evidence (MERRIAM, 2009). Theoretical frameworks or research questions are used and drawn from the literature or discipline (MERRIAM, 1998). According to BROWN (2008), Merriam's style brings forth a practical application of pluralistic strategies that guide pragmatic constructivist research to derive knowledge about an area of inquiry. 
3.4.3 STAKE: Relativist—constructivist/interpretivist
STAKE (1995, 2006) has an approach to case study research that is qualitative and closely aligned with a constructivist and interpretivist orientation. While having a disciplined approach to the process and acknowledging that case study can use quantitative methods, STAKE's approach is underpinned by a strong motivation for discovering meaning and understanding of experiences in context. The role of the researcher in producing this knowledge is critical, and STAKE emphasizes the researcher's interpretive role as essential in the process. An interpretative position views reality as multiple and subjective, based on meanings and understanding. Knowledge generated from the research process is relative to the time and context of the study and the researcher is interactive and participates in the study. In terms of epistemology, STAKE argues that situation shapes activity, experience, and one's interpretation of the case. For STAKE (2006), to understand the case "requires experiencing the activity of the case as it occurs in its context and in its particular situation" (p.2). The researcher attempts to capture her or his interpreted reality of the case, while studying the case situationally enables an examination of the integrated system in which the case unfolds. Similar to YIN (2014) and MERRIAM (2009), a case or cases are selected for what they can reveal about topic of interest and depend on the aim and conditions of the study. A case is selected because it is interesting in itself or can facilitate the understanding of something else; it is instrumental in providing insight on an issue (STAKE, 2006). 
For STAKE, multiple sources and methods of data collection and analysis can be used, however, interviews and observations are the preferred and dominant data collection method. In seeking understanding and meaning, the researcher is positioned with participants as a partner in the discovery and generation of knowledge, where both direct interpretations, and categorical or thematic grouping of findings are used. STAKE (1995) recommends vignettes—episodes of storytelling—to illustrate aspects of the case and thick descriptions to convey findings, a further illustration of his constructivist and interpretivist approach to case study research. 
BROWN (2007) suggests the three approaches used by these seminal researchers rest along a quantitative-qualitative continuum where the postpositivist methodology of YIN (2014) sits at one end, STAKE's interpretivist design (1995, 2006) sits at the other end and MERRIAM (1998, 2009) who as a pragmatic constructivist draws on the elements of both, rests toward the center. BROWN (2008) sums up the influences of each, saying that "case study research is supported by the pragmatic approach of Merriam, informed by the rigour of Yin and enriched by the creative interpretation described by Stake" (p.9). While some may argue that mixing qualitative and quantitative methods could threaten the veracity of the research (BOBLIN et al., 2013; SANDELOWSKI, 2011), MERRIAM's approach demonstrates that when the integrity of the design is robust, methodological flexibility can be accommodated. 
4. Common Characteristics of Case Study Research
Despite variation in the approaches of the different exponents of case study, there are characteristics common to all of them. Case study research is consistently described as a versatile form of qualitative inquiry most suitable for a comprehensive, holistic, and in-depth investigation of a complex issue (phenomena, event, situation, organization, program individual or group) in context, where the boundary between the context and issue is unclear and contains many variables (CRESWELL, 2014; FLYVBJERG, 2011; MERRIAM, 2009; SIMONS, 2009; STAKE, 2006; YIN, 2014). Case study research can be used to study a range of topics and purposes (SIMONS, 2009; STAKE, 2006; STEWART, 2014) however, the essential requisite for employing case study stems from one's motivation to illuminate understanding of complex phenomena (MERRIAM, 2009; STAKE, 2006; YIN, 2014). Primarily exploratory and explanatory in nature, case study is used to gain an understanding of the issue in real life settings and recommended to answer how andwhy or less frequently what research questions (FLYVBJERG, 2011; MERRIAM, 2009; SIMONS, 2009; STAKE, 2006; STEWART, 2014; YIN 2014). 
Defining the case (unit of analysis or object of the study) and bounding the case can be difficult as many points of interest and variables intersect and overlap in case study research. Developing research questions and/or propositions to select the case, identify the focus, and refine the boundaries is recommended to effectively establish these elements in the research design (MERRIAM, 2009; STAKE, 2006; YIN, 2014). Bounding the case is essential to focusing, framing, and managing data collection and analysis. This involves being selective and specific in identifying the parameters of the case including the participant/s, location and/or process to be explored, and establishing the timeframe for investigating the case (MERRIAM, 2009; STAKE, 2006; YIN, 2014). 
The use of multiple methods to collect and analyze data are encouraged and found to be mutually informative in case study research where together they provide a more synergistic and comprehensive view of the issue being studied (FLYVBJERG, 2011; MERRIAM, 2009; STAKE, 2006; YIN, 2014). How the methods are used will vary and depend on the research purpose and design, which is often a variation of a single or multiple case study research design. Interviews and focus groups, observations, and exploring artifacts are most commonly employed to collect and generate data with triangulation of methods and data, however, this is not exclusive. 
The fundamental elements of case study research (Table 1) are evident in the approaches of MERRIAM (2009), STAKE (1995, 2006), and YIN (2014) as well as other case study researchers who have contributed to the development and discussion of case study research (CRESWELL, 2013, 2014; FLYVBJERG, 2011; GEORGE & BENNETT, 2007; MILES et al., 2014; SIMONS, 2009). These elements delineate case study from other forms of research and inform the critical aspects of the research design and execution.
Object of the case study identified as the entity of interest or unit of analysis
Program, individual, group, social situation, organization, event, phenomena, or process
A bounded system
Bounded by time, space, and activity
Encompasses a system of connections
Bounding applies frames to manage contextual variables
Boundaries between the case and context can be blurred
Studied in context
Studied in its real life setting or natural environment
Context is significant to understanding the case
Contextual variables include political, economic, social, cultural, historical, and/or organizational factors
Chosen for intensive analysis of an issue
Fieldwork is intrinsic to the process of the inquiry
Subjectivity a consistent thread—varies in depth and engagement depending on the philosophical orientation of the research, purpose, and methods
Reflexive techniques pivotal to credibility and research process
Selecting the case
Based on the purpose and conditions of the study
Involves decisions about people, settings, events, phenomena, social processes
Scope: single, within case and multiple case sampling
Broad: capture ordinary, unique, varied and/or accessible aspects
Methods: specified criteria, methodical and purposive; replication logic: theoretical or literal replication (YIN, 2014)
Multiple sources of evidence
Multiple sources of evidence for comprehensive depth and breadth of inquiry
Methods of data collection: interviews, observations, focus groups, artifact and document review, questionnaires and/or surveys
Methods of analysis: vary and depend on data collection methods and cases; need to be systematic and rigorous
Triangulation highly valued and commonly employed
Case study design
Descriptive, exploratory, explanatory, illustrative, evaluative
Single or multiple cases
Embedded or holistic (YIN, 2014)
Particularistic, heuristic, descriptive (MERRIAM, 1998, 2009)
Intrinsic, instrumental, and collective (STAKE, 1995, 2006)
Table 1: Case study elements and descriptors 
A final, critical point when conducting case study research is the importance of careful preparation and planning, coupled with the development of a systematic implementation structure (FLYVBJERG, 2011; MERRIAM, 2009; STAKE, 2006; STEWART, 2014; YIN, 2014). As discussed earlier, ensuring the alignment of philosophy and methodology with the research purpose and methods employed underpins a rigorous research process (STEWART, 2014). Clarity in this alignment is fundamental to ensuring the veracity of the research and depends on the design developed. During this process, researchers are encouraged to "logically justify their philosophical position, research design and include a coherent argument for inclusion of varying research methods" (LUCK et al., 2006, p.107). Study propositions, theory, research or issue questions work as a conceptual framework and need to align with the case to guide the design and determine methods of data collection and analysis (STAKE, 2006; STEWART, 2014; YIN, 2014). Maintaining meticulous records and a systematic chain of evidence over the duration of the study is critical; as is being able to access, present and explain procedures supports the ethical integrity and rigor of the research and findings (MERRIAM, 2009; STEWART, 2014; YIN, 2014). Collective alignment of these elements articulates a justifiable framework for the research study and cultivates trustworthiness and the validity, reliability and credibility of the research findings. 
Considering these fundamental elements and common approaches to case study research, the definition from CRESWELL et al. (2007) seems to best capture the full depth and breadth of case study concepts and descriptions. The authors describe case study as "a methodology, a type of design in qualitative research, an object of study and a product of the inquiry" (p.245). They conclude with a definition that collates the hallmarks of key approaches and represents the core features of a case study:
"Case study research is a qualitative approach in which the investigator explores a bounded system (a case) or multiple bounded systems (cases) over time through detailed, in-depth data collection involving multiple sources of information (e.g., observations, interviews, audiovisual material, and documents and reports) and reports a case description and case-based themes" (ibid.). 
Since the 1980's a broad scope of case study approaches have developed. This range accentuates the flexibility of case study research as a distinct form of inquiry that enables comprehensive and in-depth insight into a diverse range of issues across a number of disciplines. While differences exist in some areas, commonalities are evident that can guide the application of a case study research design. Key contributors to the development of case study agree that the focus of a case study is the detailed inquiry of a unit of analysis as a bounded system (the case), over time, within its context. The versatility of case study research to accommodate the researcher's philosophical position presents a unique platform for a range of studies that can generate greater insights into areas of inquiry. With the capacity to tailor approaches, case study designs can address a wide range of questions that ask why, what, and how of an issue and assist researchers to explore, explain, describe, evaluate, and theorize about complex issues in context. Outcomes can lead to an in-depth understanding of behaviors, processes, practices, and relationships in context. Professions including the social sciences, education, health, law, management, business, and urban planning have embraced case study research, demonstrating these outcomes. Ongoing application of and sound debate about the value, validity, and capability of case study research have strengthened the efficacy of case study approaches as powerful forms of qualitative research. 
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Helena HARRISON, MN(Ed) is a PhD candidate in the College of Healthcare Sciences, Division of Tropical Health and Medicine, James Cook University, Australia. Her research interests include undergraduate and postgraduate nurse education with her current study focusing on the practice readiness of new graduate registered nurses in Australia.
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Melanie Birks, PhD is professor and Head of Nursing, Midwifery and Nutrition at James Cook University, Australia. Her research interests are in the areas of accessibility, innovation, relevance and quality in nursing education.
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Richard Franklin, Ph.D. is an associate professor at the College of Public Health, Medical & Veterinary Sciences at James Cook University. Richard's public health projects have explored injury prevention and safety promotion and focused areas of farm safety, rural safety, occupational health and safety, falls, disasters, health promotion, and alcohol and aquatic safety. Richard's research interests include translating evidence into practice, epidemiological, program and product evaluation, surveillance and using mixed methods research for solving real world problems.
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Jane Mills, PhD is professor and Pro Vice Chancellor of the College of Health at Massey University in New Zealand. Her research interests are primary health care, public health and health systems strengthening.
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Harrison, Helena; Birks, Melanie; Franklin, Richard & Mills, Jane (2017). Case Study Research: Foundations and Methodological Orientations [34 paragraphs]. Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, 18(1), Art. 19,