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Designing process evaluations using case study to explore the context of complex interventions evaluated in trials.

Grant, Aileen; Bugge, Carol; Wells, Mary


Carol Bugge

Mary Wells


Process evaluations are an important component of an effectiveness evaluation as they focus on understanding the relationship between interventions and context to explain how and why interventions work or fail, and whether they can be transferred to other settings and populations. However, historically, context has not been sufficiently explored and reported resulting in the poor uptake of trial results. Therefore, suitable methodologies are needed to guide the investigation of context. Case study is one appropriate methodology, but there is little guidance about what case study design can offer the study of context in trials. We address this gap in the literature by presenting a number of important considerations for process evaluation using a case study design. In this paper, we define context, the relationship between complex interventions and context, and describe case study design methodology. A well-designed process evaluation using case study should consider the following core components: the purpose; definition of the intervention; the trial design, the case, the theories or logic models underpinning the intervention, the sampling approach and the conceptual or theoretical framework. We describe each of these in detail and highlight with examples from recently published process evaluations. There are a number of approaches to process evaluation design in the literature; however, there is a paucity of research on what case study design can offer process evaluations. We argue that case study is one of the best research designs to underpin process evaluations, to capture the dynamic and complex relationship between intervention and context during implementation. We provide a comprehensive overview of the issues for process evaluation design to consider when using a case study design.


GRANT, A., BUGGE, C. and WELLS, M. 2020. Designing process evaluations using case study to explore the context of complex interventions evaluated in trials. Trials [online], 21, article number 982. Available from:

Journal Article Type Commentary
Acceptance Date Nov 6, 2020
Online Publication Date Nov 27, 2020
Publication Date Dec 31, 2020
Deposit Date Dec 2, 2020
Publicly Available Date Dec 2, 2020
Journal Trials
Print ISSN 1745-6215
Electronic ISSN 1745-6215
Publisher Springer
Peer Reviewed Peer Reviewed
Volume 21
Article Number 982
Keywords Process evaluation; Context; Trials; Case study design
Public URL


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