Formulating Research Questions
School of Health Sciences and Social Work
EBP steps
• Formulate a clinically relevant and
“answerable” question
• Find the best evidence
• Evaluate the evidence
• Integrate with clinical expertise and patient
values and apply to your patient
• Evaluate your performance
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Aims of this Step
• To learn how to define an answerable research
question
• To gain an understanding of the different
types of clinical questions you may ask
• To be able to translate ideas from your
workplace into well-defined questions
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Benefits of a Clearly Defined
Research Question
• Helps to clarify the problem in your own
mind
• Can help you to search for the kind of
evidence you need to answer it
• Will help you to search more effectively
• Can save you a great deal of search
time
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Forming an Answerable Question
(PICO/PECO)
Break the question down into parts:
•
•
•
•
Population
Intervention/Exposure
Comparison
Outcome
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PICO/PECO
Component
Key step
Example
Patient
Problem
population
How would I succinctly
describe a group of similar
patients?
In children under 12
years with condition
x…
Intervention /
Exposure
(test, treatment,
process of care)
What is the main action I
am considering?
… would adding drug Y
to their current
therapy…
Comparison
or alternative
What is/are the other
option(s)?
…compared to
increasing the dose of
their current therapy…
Outcome
What do I/the patients want
or not want to happen?
…lead to increased
control with no increase
in side effects?
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Population
• Try to be as specific as possible.
• Make sure you are describing the patients or
problem that you are interested in.
• This may be too specific when searching, but
it is a good start point.
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Population
Factors that might need to be considered:
• Disease or condition of interest
• Age
• Sex
• Suffering similar symptoms
• Setting
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Intervention or Exposure?
• An intervention is something planned to be
“done” to be a patient/client
• Exposure occurs when the patient/client
comes into contact with something e.g.
exposure to a smoky atmosphere.
• Exposure is usually naturally occurring
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Intervention/Exposure
These may include:
• Treatment regime
• Diagnostic test
• Specific risk factors
• Differing environments/settings
• Advice or information package
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Intervention/Exposure
• Try to be as specific as possible with the
intervention at this stage
• You can always back track later if you can’t
find any evidence
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Comparison
What is/are the other options or alternatives that
could be offered to the patient/client?
• You may compare two or more groups
• One is often known as the control group
• The other group can be another treatment
group
• The other group can be current practice
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Outcomes
Identify the outcomes that are of primary
importance to you and the patient/client e.g.
• Survival
• Disease
• Quality of life
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Activity
• Try to identify the individual PICO / PECO
components for each of the following
scenarios.
And
• Formulate a research question for each
scenario.
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Scenario 1
A 40 year old woman visits her GP complaining
of moderate depression. She has experienced
bouts of depression in the past and was
prescribed a traditional antidepressant which she
feels was helpful. However, she experienced
some unpleasant side effects with the drug she
was prescribed. She has recently been told by a
friend about the use of St John’s Wort in treating
depression and feels she would like to try this in
treating her current depression.
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Scenario 2
A 35-year-old man is recovering from surgery after
injuring his hand while cleaning the blades of his
lawnmower. He holds a managerial position with a local
manufacturer, working to some very short deadlines, and
his injury could not have come at a worst time. He needs
his hand to be fully functioning, but is concerned that the
time he may have to spend in rehabilitation will have a
negative effect on his business. The physiotherapist
believes that a favourable outcome would be best achieved
through early physiotherapy management of his hand, but
needs to convince him that such an investment of his time
is likely to prove effective.
(Adapted from Booth and Madge, 1998)
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Scenario 3
You are a member of a research team interested
in the long term consequences on children of
living in a family where domestic violence
occurs. You are keen to formulate a set of
focussed research questions to guide your
research. Try and formulate one such question.
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Scenario 4
You are a member of a regional Tobacco Strategy Group.
The group is considering what support it gives – and
should give – people who want to stop smoking. General
practitioners have previously been holding a smoking
cessation clinic and a Health Promotion nurse offers
individual support. A debate follows about the place of
nicotine replacement therapy (NRT). Some people argue
that it is useful, others that will-power is enough. One
suggestion could be to spend savings within general
practices on supplying people with nicotine replacement
therapy on prescription but there is some resistance to this
approach. You want to find out whether NRT is effective.
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Scenario 1 – Example response
P 40 year old woman with moderate
depression
I St John’s wort
C Prozac
O Depressive symptoms and side effects
Question:
For a 40 year old female with moderate
depression, what is the efficacy and
tolerability of St John’s wort compared to
Prozac?
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Scenario 2 – Example response
P 35 year old male with hand injury that
has undergone surgical repair
I Early physiotherapy
C Other forms of physiotherapy
O full restoration of hand functioning
Question:
In a 35-year old male patient, not a manual worker, with a
hand injury that has undergone surgical repair, does early
physiotherapy management of the hand, when compared with
other forms of physiotherapy management, lead to full
restoration of the hand?
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Scenario 3 – Example response
P Children aged 16 years
E Living in a family where domestic
violence occurs
C Living in a family where domestic
violence does not occur
O Educational attainment
Question:
Is living in a family where domestic violence occurs
associated with reduced educational attainment in
children aged 16 years?
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Scenario 4 – Example response
P Smokers who want to stop smoking
I Nicotine Replacement Therapy
C Other support
O Smoking cessation
Question:
For smokers who want to stop smoking, does nicotine
replacement therapy, when compared with patients
relying on other means of support, increase their
chance of giving up smoking?
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PICO/PECO
• May not always be appropriate to specify an
intervention, but population and outcomes can
usually be identified.
• For complex problems, it will be necessary to
map out all component parts and ask a series
of questions.
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SPICE
• S
Setting
• P
• I
Perspective
Intervention
• C
• E
Comparison
Evaluation
In which context are you
addressing the question?
Who are the participants?
What is being done
to/for them?
What are your alternatives?
How will you measure
whether the intervention has
succeeded?
An alternative framework to consider when the building a
relevant question is using SPICE.
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SPICE Scenario
You are working on an ESRC funded project
looking at the benefits of a doula (a woman
experienced in childbirth who provides
continuous physical, emotional and
informational support to the mother before,
during and just after childbirth) for low income
mothers.
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SPICE example
• Setting –
•
•
•
•
the developed world (with
comparable health systems to
the UK)
Population – low income mothers
Intervention – Doula
Comparison – Professional support (or no
support)
Evaluation–Perceived levels of social
support, birth outcomes, levels
of breastfeeding etc.
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Another SPICE Scenario
You are a Health Psychologist wanting to study
the psychological problems encountered by
people preparing for heart surgery.
Have a go at formulating a set of SPICE
components
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SPICE example
• Setting - Awaiting surgery
• Population - Patients
• Intervention – Coronary Artery Bypass
Graft Surgery
• Comparison – None
• Evaluation – Uncertainty and Anxiety
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Broad or Narrow Questions?
• Broad
– Do complimentary therapies work in the treatment of
psychological disorders?
• Narrow
– Is St John’s wort effective in treating moderate
depression in females aged 30-40 years?
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Types of Clinical Questions
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Types of Research Question
•
•
•
•
•
•
•
•
Effectiveness
Causal
Incidence/Prevalence
Screening
Diagnostic
Prognosis
Cost-effectiveness
Psycho-social
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Effectiveness Questions
These usually evaluate methods of treatment
E.g. Is radical surgery better (more effective) than
conservative surgery in treatment of breast cancer?
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Causal Questions
These determine the cause of a disease or
adverse effects caused by specific treatments
E.g. What are the underlying factors that cause lung
cancer?
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Incidence/Prevalence Questions
These determine population
prevalence/incidence of disease or
characteristics of a disease etc.
E.g. How many woman have cervical
cancer(prevalence)?
How many new cases of dementia in the elderly were
recorded last year (incidence)?
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Screening Questions
Where a specific screening programme is
evaluated
E.g. Does cervical screening reduce deaths?
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Diagnostic Questions
Where different types of tests are evaluated
E.g. How effective is the nuchal translucency scan in
detecting foetuses with chromosomal abnormities?
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Prognosis Questions
These estimate the likely progress of the
patient/client's condition
E.g. If you sprain your ankle playing sport are you
more likely to have a recurrent sprains / unstable
ankles?
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Cost-effectiveness Questions
Where the economics of health care is
evaluated:
E.g. Is a short term (expensive) course of drugs for
ulcers better than a long term (cheaper) course of
drugs, knowing that the short term course of drugs
is slightly more effective?
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Psycho-social Questions
Where knowledge, attitude and behaviour
patterns are associated with psycho-social
factors:
E.g. Do patients prefer to be involved in decisionmaking about their treatment?
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Generating Your Own Research
Questions
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Generating Questions
Questions you ask may arise from:
• Your individual professional work
• A group initiative
• A topical issue
• A national initiative
• A professional desire
• A patient/client’s query
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Problems relevant to a range of
practitioners
• Needing help in diagnosing a particular condition
• Needing to find out more about the benefits and
possible adverse effects of a particular intervention
• Audit results showing poor outcomes
• A prominent issue is taken up by the media and
causes concern to service users
• Comparing the costs and benefits of different
therapies
• Patients/clients ask about a treatment of which
you do not know the answer
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Steps to Building a Focused Question
• Jot down ideas as they occur.
• Examine later and see whether you need to
spend time exploring further.
• Take time to refine your question using the
PICO / PECO formula.
• Consider various possible alternative outcomes
or interventions.
• Include the alternatives when performing your
searches.
• Decide what type of clinical question you are
asking.
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