Evidence Based Practice

This guide is designed to provide information on what Evidence Based Practice is and how to find evidence.

The PICO question framework

The first stage of any evidence-based practice process is formulating an answerable question. This forms the foundation for quality searching. A well-formulated question will facilitate the search for evidence and will assist you in determining whether the evidence is relevant to your question.

The most commonly used framework for formatting questions is PICO. The acronym translates to:

Population or Problem
  • Which problem, disease or condition are you looking at?
  • How is your population defined? (age, gender, ethnic group …)
Intervention
  • How is the problem being treated?
Comparison
  • Which alternative method are you comparing this with? (It’s ok to leave this one blank if you are not doing a comparison)
Outcome
  • Which result are you focusing on or measuring?

 

Other variables that can be added to this PICO framework are:

Timeframe
  • What is the duration of the intervention?
  • What is the follow up schedule?
Type of study
or
Study design
  • Which type of study will you be using? (e.g. Randomised Control Trials, Treatment Outcome Studies)
Setting
  • Where is your intervention of interest taking place?

 

The PICo variation is useful for for qualitative studies

Population or Problem
  • Which problem, disease or condition are you looking at?
  • How is your population defined? (age, gender, ethnic group …)
Interest
  • Which experience, activity, process or event are you interesting in focusing on?
Context
  • Where is this happening? (Geographical location, e.g. Australia / Service location, e.g. hospital)

An example of using PICO to formulate the question and search strategy

Example of the scenario that the question comes from:

A nurse in aged care home has a lot of patients who get bed sores because they are in bed all, or most of the day. Is there any way to stop them getting bedsores as often? And how can they be treated so that they don't keep getting worse?

 

The example question laid out using the PICO framework:

Population aged care residents
Intervention  
Comparison  
Outcome reduction in incidence and severity of bedsores

NOTE: You don't have to fill in all of the fields. In this case you can't fill in the intervention, because that is what you are trying to discover. And because there is no intervention, you can't add a comparison intervention either.

 

Example question reworded as a clinical question for research:

Which interventions reduce the incidence and severity of bed sores in residents of aged care facilities?

 

Keywords from the example question and possible alternatives:

Words from PICO Synonyms / Alternatives you could also use
aged care residents aged care, nursing home, aged, elderly, geriatric
bed sores bedsores, pressure sores, pressure ulcers, decubitus ulcers
reduction reduce, reducing, lessen, decrease, minimise, minimize, prevent, improve

 

The database search string from the example question

("aged care residents" OR "aged care" OR "nursing home" OR aged OR elderly OR geriatric) AND ("bed sores" OR bedsores OR "pressure sores" OR "pressure ulcers" OR "decubitus ulcers") AND (reduc* OR lessen OR decrease OR minimi?e OR prevent OR improve)

Notes:

  • reduc* will tell the database to search for reduce, reduces, reduced, reducing, reduction, and reductions.
  • minimi?e will tell it to search for both minimise (English spelling) and minimize (American spelling).
  • Go to the Searching databases page for information on how to structure your search like this one.

 

Other limits you can apply in a database for this search

  • Age range, e.g. Aged 80 and over.
  • Subject headings, e.g. wound care. (You can use the database subject headings to narrow the focus of your search.)
  • Publication date range, e.g. in the last 10 years.
  • Publication type, e.g. case study. (Sometimes this is a filter. Sometimes you need to use it as a search term.)
  • Geography, e.g. Australia. (Sometimes this is a filter. Sometimes you need to use it as a search term.)

Printable PICO worksheet

This worksheet was adapted from Syrene A. Miller, PICO Worksheet and Search Strategy, National Center for Dental Hygiene Research.

Other Search Frameworks

The PICO Framework may not fit the type of issue or topic you may want to research, therefore, here are some other frameworks that may assist in building a research question.

 

ECLIPSE – can facilitate the building of a review question looking at health policy and management. The aim of ECLIPSE is to focus on terms that differ to those used in the medical profession.

Expectation
  • What is the information you find going to be used to support?
Client group
  • Who is the service for?
Location
  • Where is the service run from? E.g. community centre or hospital
Impact
  • What is the desired change to service, is any?
  • How are you defining success?
  • How will you measure success?
Professionals
  • Who is providing the service?
  • Who will be involved in improving the service?
SErvice
  • Which service are you searching for information on?

 

SPIDER – has been designed to enable researchers to develop a research question and search strategy that is focused on qualitative and mixed methods primary research.

Sample
  • Who are your participants?
Phenomenon of
Interest
  • What are their attitudes and experiences in relation the issue you are focussing on?
Design
  • What type of study are you doing?
Evaluation
  • Which result are you focussing on?
  • How are you measuring it?
Research type
  • Is it qualitative, quantitative or a mixture of both?

 

SPICE – was formulated to assist in the development of research questions and search strategies looking to evaluate the outcomes of a specific intervention.

Setting
  • Where is this taking place?
Perspective
  • Who are the patients?
  • How are you defining this population?
Intervention
  • How is this issue being dealt with?
Comparison
  • What alternative method are you comparing this with?
Evaluation
  • How was success measured in the studies you used?
  • What do you need to measure?