Evidence Based Practice

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

Framing your question for searching

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.

There are a number of frameworks available and the one you use will depend on your discipline area and the focus of your question. Examples include PICO, ECLIPSE, SPIDER and SPICE.

PICO, which is used for clinical questions, is explained below with an example and a printable worksheet.

See the Framing your research question guide for more frameworks. If you're unsure of which one to choose, start with the table of frameworks by question type/focus, or the discipline area table.

PICO and its variants

PICO is the framework most used by health researchers when formulating their clinical questions.

Population or Problem
  • How is your population defined? (e.g. age, gender, ethnic group …)
  • Which of their problems, diseases or conditions are you looking at
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?
  • What are you hoping to improve?

 

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 question
  • Is this a question about diagnosis, treatment, prevention, prognosis, or aetiology?
Type of study
or
Study design
  • Which study type(s) will you be searching for?
Setting
  • Where is your intervention of interest taking place?
Context
  • Where is this happening? (e.g. geographical location or service location)
  • What is the social or cultural context for your population?

 

Variant frameworks:

  • PICOC = Population, Intervention, Comparison, Outcome, Context
  • PICOS = Population, Intervention, Comparison, Outcome, Study type
  • PICOT = Population, Intervention, Comparison, Outcome, Time
  • PICOTS = Population, Intervention, Comparison, Outcome, Timing, Setting
  • PICOTT = Population, Intervention, Comparison, Outcome, Type of question, Type of study
  • PIO = Population, Intervention, Outcome

 

The PICo variation is useful for qualitative studies.

Population or Problem
  • How is your population defined? (e.g. age, gender, ethnic group …)
  • Which of their problems, diseases or conditions are you looking at
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)

 

This variation of PICO is used for evaluating diagnostic tests.

Patient or Participants or Population
  • How is your population defined? (e.g. age, gender, ethnic group …)
  • Which of their problems, diseases or conditions are you looking at
Index tests
  • Which test are you evaluating?
Comparator or reference tests
  • Which alternative 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?
  • What are you hoping to improve?

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

 

An example of a 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.