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Database Searching - Health: Using a Question Framework

Guide for Database Searching for the Health Sciences

Using a framework to structure your question

Frameworks help researchers structure a research question and clarify search concepts.  There are many different frameworks depending on the type of question.  For clinical questions, the most well-known is PICO.  Sometimes your question may not fit perfectly into a framework.  You can use part of a framework if necessary.

Which Framework?

  • Effectiveness of a treatment or intervention: PICO
  • Prognostic: PFO
  • Prevalence/Incidence: CoCoPop
  • Cost/benefit analysis: PICOC, CLIP, ECLIPS(E)
  • For qualitative questions: PICo, PEO, SPICE, SPIDER

PICO

(for questions covering the effectiveness of an intervention, treatment etc.)

Patient, Population or Problem - who is the patient and/or what is the problem?
Intervention - what intervention is being considered?
Comparison - what intervention is this being compared with (a comparison is not always necessary)
Outcomes - what do you hope to accomplish, improve or affect?

 

Example:  Alternatives to drugs for controlling headaches in children

  • P - children
  • I - alternatives to drugs (complementary therapies? changes to lifestyle?)
  • C - drugs
  • O - controlling headaches

 

Extensions to PICO

There are extensions to the PICO framework available which you can use if your topic has additional concepts:

  • PICOS- here the S stands for study designs or setting (you can use this framework if you are only interested in examining specific designs of study or if the intervention is setting-specific like a hospital or nursing home)
  • PICOT- here the T stands for timeframe (you can use this framework if your outcomes need to be measured in a certain amount of time e.g. 24 hours after surgery).

Alternatives to PICO

  • SAPO (Setting, Approach, Primary Outcomes)

PFO

(for questions relating to prognosis issues)

Population- who and/or what is my question focused on?

Prognostic Factors- what is being prognosed?

Outcomes- what are the possible outcomes of the prognosis?

 

Example: How likely are children with febrile seizures to develop a seizure disorder?

  • P- children
  • F- febrile seizures
  • O- seizure disorders

 

CoCoPop

(for questions relating to the prevalence/incidence of a condition, problem etc.)

Condition- what condition/problem are you examining?

Context- in what context is your question set?

Population- what population/group are you examining

 

Example: What is the prevalence of claustrophobia in adult patients undergoing MRI?

  • Condition- claustrophobia
  • Context- MRI
  • Population- adults

PICOC

(for questions relating to cost/benefit, economic evaluations, service improvements etc.)

Patient, Population or Problem - who is the patient and/or what is the problem?

Intervention - what intervention is being considered?

Comparison - what intervention is this being compared with? (a comparison is not always necessary)

Outcomes - what do you hope to accomplish, improve or affect?

Context- in what context or place is the problem set?

 

Example: What is the cost effectiveness of self monitoring of blood glucose in type 2 diabetes in high income countries?

  • P- type 2 diabetes
  • I- self monitoring of blood glucose
  • C- N/A
  • O- cost effectiveness
  • C- high income countries

 

Alternatives to PICOC

  • PEAHEN (Population, Exposure, Adverse Health Effects, Negative reactions)

CLIP

(for questions relating to cost/benefit, economic evaluations, service improvements etc.)

Client – who is the service aimed at?

Location – where is the service site?

Improvement – what do you want to find out?

Professional – who is involved in providing/improving the service?

 

Example: Ways of improving health visiting services to elderly in rural communities

  • C - elderly
  • L - rural communities
  • I - how services can be improved
  • P - health visiting

ECLIPS(E)

(for questions relating to cost/benefit, economic evaluations, service improvements etc.)

Expectation - why do you need the information?
Client Group -who is the information needed for - e.g. health managers, GPs, patients
Location - where is the client group or service located
Impact - what is the change in the service, if any, you are looking for? What would constitute success? How is this being measured?
Professionals - what health professionals are involved in the service?
Service - what service are you considering changing? For example, outpatient services, nurse-led clinics, intermediate care.

 

Example:  retention of ICU nurses in the US

  • E- to find out retention rates
  • C- (patients? managers?)
  • L- US
  • I- retention of staff
  • P- nurses
  • S- ICU

PICo

(for qualitative questions evaluating experiences, meaningfulness etc.)

Patient, Population or Problem- who is the patient and/or what is the problem?

Interest- a defined event, experience, activity or process

Context- a setting or distinct characteristics

 

Example: What are the experiences of patients with pressure sores who receive treatment at home?

  • P- patients with pressure sores
  • I- experiences, views, opinions
  • Co- care in the home

PEO

(for qualitative questions evaluating experiences, meaningfulness etc.)

Population - who is my question focused on?

Exposure - what is the issue I'm interested in?

Outcomes or themes - what theme do I want to examine?

 

Example: The quality of life of caregivers for people with dementia

  • P- caregivers
  • E- dementia
  • O- quality of life

 

Alternatives to PEO

  • PEAS (Problem, Experiment, Alternative, Setting)
  • PIE (Problem, Intervention, Evaluation)

SPICE

(for qualitative questions evaluating experiences, meaningfulness etc.)

Setting - where is the study set e.g. in a specific country, community, in a hospital, in a care home etc.
Perspective - from whose perspective is the study done - e.g. the patients, the health professionals., the caregivers etc.
Intervention - what intervention is being examined?
Comparison - is the intervention being compared with another?
Evaluation - the outcome measures

 

Example: Attitudes of caregivers of people with dementia towards reminiscence therapy

  • S - (United Kingdom? care homes?)
  • P - caregivers
  • I - reminiscence therapy
  • C - NONE
  • E - attitudes

 

Alternatives to SPICE

  • SugABABes (Suggested Approach, Best Alternative, Best compromise)

SPIDER

(for qualitative questions evaluating experiences, meaningfulness etc.)

Sample - the group of people being looked at - because qualitative research is not easy to generalize, sample is preferred over patient.
Phenomenon of Interest -  reasons for behavior and decisions, rather than an intervention.
Design - the form of research used, such as interview or survey.
Evaluation - outcome measures.
Research type - qualitative, quantitative and/or mixed methods.

 

Example:  Young parents experiences of attending prenatal education

  • S - young parents
  • PI - attendance at prenatal education classes
  • D - (interviews? surveys?)
  • E - experiences
  • R - (qualitative studies?)