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 is the framework most used by health researchers when formulating their clinical questions.
Population or Problem |
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Intervention |
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Comparison |
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Outcome |
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Other variables that can be added to this PICO framework are:
Timeframe |
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Type of question |
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Type of study or Study design |
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Setting |
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Context |
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Variant frameworks:
The PICo variation is useful for qualitative studies.
Population or Problem |
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Interest |
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Context |
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This variation of PICO is used for evaluating diagnostic tests.
Patient or Participants or Population |
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Index tests |
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Comparator or reference tests |
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Outcome |
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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 at risk of getting bedsores |
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:
Other limits you can apply in a database for this search
This worksheet was adapted from Syrene A. Miller, PICO Worksheet and Search Strategy, National Center for Dental Hygiene Research.