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?
A "foreground" question in health research is one that is relatively specific, and is usually best addressed by locating primary research evidence.
Using a structured question framework can help you clearly define the concepts or variables that make up the specific research question.
Across most frameworks, you’ll often be considering:
PICO is the most common framework for developing a clinical research question, but multiple question frameworks exist.
Appropriate for: clinical questions, often addressing the effect of an intervention/therapy/treatment
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)?
|Population / problem||Who is the group of people being studied?||adolescents with T2D|
|What is the intervention being investigated? (independent variable)||telehealth consultations|
|Comparison||To what is the intervention being compared?||in person consultations|
|Outcome||What are the desired outcomes of the intervention? (dependent variable)||blood sugar control|
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:
Questions addressing how a clinical issue, illness, or disability is treated.
"In__________________(P), how does__________________(I) compared to_________________(C) affect______________(O)?"
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)?"
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)?
Questions addressing the prediction of the course of a disease.
In_________________(P), how does_________________(I) compared to_________________ (C) influence_________________(O)?
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.
PICO is a useful framework for clinical research questions, but may not be appropriate for all kinds of reviews. Also consider:
Appropriate for: describing association between particular exposures/risk factors and outcomes
Example: How do preparation programs (E) influence the development of teaching competence (O) among novice nurse educators (P)?
|Population||Who is the group of people being studied?||novice nurse educators|
|What is the population being exposed to (independent variable)?||preparation programs|
|Outcome||What is the outcome that may be affected by the exposure (dependent variable)?||teaching competence|
Appropriate for: questions of experience or perspectives (questions that may be addressed by qualitative or mixed methods research)
Example: What are the experiences and perspectives (E) of undergraduate nursing students (S) in clinical placements within prison healthcare settings(PI)?
|Sample||Who is the group of people being studied?||undergraduate nursing students|
|What are the reasons for behavior and decisions?||clinical placements in prison healthcare settings|
|Design||How has the research been collected (e.g., interview, survey)?||interview and surveys|
|Evaluation||What is the outcome being impacted?||attitudes, experiences and reflections on learning|
|Research type||What type of research?||qualitative, quantitative or mixed methods|
Appropriate for: evaluating the outcomes of a service, project, or intervention
Example: What are the impacts and best practices for workplace (S) transition support programs (I) for the retention (E) of newly-hired, new graduate nurses (P)?
|Setting||What is the context for the question? (Where?)||nursing workplaces (healthcare settings)|
|For whom is this intervention/program/service designed (users, potential users, stakeholders)?||new graduate nurses|
|Intervention/Interest/Exposure||What action is taken for the users, potential users, or stakeholders?||long term transition support programs (residency/mentorship)|
|Comparison||What are the alternative interventions?||no or limited transition support / orientation|
|Evaluation||What is the results of the intervention or service/how is success measured?||retention of newly hired nurses|
Appropriate for: broader (scoping) questions
Example: How do nursing schools (Context) teach, measure, and maintain nursing students' (P) technological literacy (Concept))throughout their educational programs?
|Population/Problem||What are the important characteristics of the participants, or the problem of focus?||nursing students|
|What is the core concept being examined by the review?||technological literacy|
|Context||What is the context for the question? (Could include geographic location, or details about the setting of interest)?||nursing schools|
To craft a strong and reasonable foreground research 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: