Health (Nursing, Medicine, Allied Health)

"Foreground" vs. Background Research Questions

In order to most appropriately choose an information resource and craft a search strategy, it is necessary to consider what kind of question you are asking: a specific, narrow "foreground" question, or a broader background question that will help give context to your research?

Foreground (PICO) Questions

Using a structured question frame can help you clearly define the concepts or variables that make up the specific research question.  PICO(T) is the most common question frame used in health sciences research, where the question is composed of the:

• Population/Problem/Patient
  • What is the problem to be addressed? What are the characteristics of the patient population, or disease of interest?  
  • Think of this element as the dependent variable
• Intervention
  • What is the relevant treatment or exposure? What action or change would affect the patient/problem/population?
  • Think of this element as the independent variable
• Comparison
  • What is the alternative to the intervention? (A different intervention? The usual standard of care? Not intervening at all?)
  • Think of this element like a "control group"
• Outcome 
  • What are the relevant effects? 
  • Think of this element as what is measured to show what the intervention has accomplished or improved
• Timeframe or Type of Study (Optional)
  • Think of this element as additional, optional constraints to narrow the question
    • In what time frame should the intervention achieve the outcome?
    • What type of study would best address the PICO question?

For example:

"For adolescents with type II diabetes (P) does the use of telehealth consultations (I) compared to in-person consultations (C) improve blood sugar control (O)?

Framing Different Types of Clinical Questions

Different types of clinical questions are suited to different syntaxes and phrasings, but all will clearly define the PICO elements.  The definitions and frames below may be helpful for organizing your question:

Intervention/Therapy

Questions addressing how a clinical issue, illness, or disability is treated.

"In__________________(P), how does__________________(I) compared to_________________(C) affect______________(O)?"

Etiology

Questions that address the causes or origin of disease, the factors which produce or predispose toward a certain disease or disorder.

"Are_________________(P), who have_________________(I) compared with those without_________________(C) at_________________risk for/of_________________(O) over_________________(T)?" 

Diagnosis:

Questions addressing the act or process of identifying or determining the nature and cause of a disease or injury through evaluation.

In_________________(P) are/is_________________(I) compared with_________________(C) more accurate in diagnosing_________________(O)?

Prognosis/Prediction:

Questions addressing the prediction of the course of a disease.

In_________________(P), how does_________________(I) compared to_________________ (C) influence_________________(O)?

Meaning

Questions addressing how one experiences a phenomenon or why we need to approach practice differently.

"How do_________________(P) with_________________(I) perceive_________________(O)?" 

Adapted from: Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

Background Questions

To craft a strong and reasonable PICO question, it is important to have a firm understanding of the concepts of interest.  As such, it is often necessary to ask background questions, which ask for more general, foundational knowledge about a disorder, disease, patient population, policy issue, etc. 

For example, consider the PICO question outlined above:

"For adolescents with type II diabetes does the use of telehealth consultations compared to in-person consultations improve blood sugar control?

To best make sense of the literature that might address this PICO question, you would also need a deep understanding of background questions like:

• What are the unique barriers or challenges related to blood sugar management in adolescents with TII diabetes?
• What are the measures of effective blood sugar control?
• What kinds of interventions would fall under the umbrella of 'telehealth'?
• What are the qualitative differences in patient experience in telehealth versus in-person interactions with healthcare providers?