The clinical question should be relevant to the patient or the problem and formulated in such a way as to help with the search for an answer. Using a framework such as PICO can help you to work out the key elements of your question and know which concepts to combine in your literature searching. However, PICO has some limitations.
Did you know there are over 30 other question frameworks besides variations of PICO (Booth et al., 2019)? You should use the framework that best suits your type of question and that is most relevant to your project.
Booth A, Noyes J, Flemming K, Moore G, Tunçalp Ö, Shakibazadeh E. Formulating questions to explore complex interventions within qualitative evidence synthesis. BMJ Glob Health [Internet]. 2019; 4(Suppl 1), e001107. https://doi.org/10.1136/bmjgh-2018-001107
The SPIDER tool can be used when dealing with qualitative research questions, that is, when the research is about attitudes and experiences rather than quantitatively measurable data. It focuses less on the intervention and more on the design of the study, and deals with "samples" rather than "populations".
| S | Sample | The group of participants in qualitative research |
| PI | Phenomenon of Interest | The how and why of behaviours and experiences |
| D | Design | How the study was devised and conducted |
| E | Evaluation | Measurement of outcome might be subjective and not necessarily empirical |
| R | Research Type | Qualitative, or quantitative, or mixed? |
Cooke A, Smith D, Booth A. Beyond PICO: the SPIDER tool for qualitative evidence synthesis. Qual Health Res [Internet]. 2012; 22(10):1435-1443. https://doi-org.ezproxy.csu.edu.au/10.1177/1049732312452938
Search: S AND PI AND (D OR E) AND R
SPICE can be used when evaluating an intervention, policy or service. It is designed to structure qualitative research questions, focusing less on interventions and more on study design, and "samples" rather than populations.
Setting, Population or Perspective, Intervention, Comparison, Evaluation
SPICE question example:
"In hospital waiting rooms, do therapy dog visits (as opposed to no therapy dog visits), reduce anxiety in outpatients?"
| S | Setting | Hospital waiting rooms |
| P | Perspective/Population | Hospital outpatients |
| I | Intervention | Therapy dog visits |
| C | No therapy dog visits | No therapy dog visits |
| E | Reduced anxiety | Reduced anxiety |
Booth A. Clear and present questions: formulating questions for evidence based practice. Library Hi Tech [Internet]. 2006; 24(3):355-368. https://doi-org.ezproxy.csu.edu.au/10.1108/07378830610692127
JBI recommends the PCC (Population (or Participants), Concept, and Context) search framework to develop the research question of a scoping review. In some instances, just the concept and context are used in the search. It is useful for both qualitative and quantitative (mixed methods) topics.
Research question: Does handwashing reduce hospital acquired infections in elderly people?
| P | Population or Participants | elderly people |
| C | Concept | does handwashing reduce infections |
| C | Context | in hospital |
See the JBI Manual for Evidence Synthesis, Chapter 10: Scoping Reviews: 10.2.2 - Developing the title and question. This section includes recommendations for structuring the review title and question/s, incorporating the PCC elements.
Here is an example of a clinical problem:
"I work in an aged care facility where urinary tract infections are a common problem. I've heard that cranberry juice can help prevent UTIs. I wonder if there's any evidence for that and whether it might help our patients?"
But what if you were more interested in a qualitative study of the problem?
| S | Sample | Patients in aged care homes |
| PI | Phenomenon of Interest | Cranberry juice for the prevention of UTIs |
| D | Design | Survey |
| E | Evaluation | Experiences |
| R | Research Type | Qualitative |
Now your clinical research question could be structured this way:
What are the experiences of patients in aged care homes with the use of cranberry juice for UTIs?
Again, notice that the phrasing of the question is now clear, and so is a much better start for your searching.
ECLIPSE is used for investigating the outcome of a service or policy.
Expectation, Client group, Location, Impact, Professionals, SErvice
Research question: How can I increase access to wireless internet for hospital patients?
| E |
Expectation (what are you looking to improve/change?) |
To increase access to wireless internet in the hospital |
| C | Client Group | patients and families |
| L | Location | hospitals |
| I | Impact | clients have easy access to free internet |
| P | Professionals (who is involved in improving the service?) | IT, hospital administration |
| SE |
SErvice (what kind of service is this?) |
provision of free wireless internet to patients |
Wildridge V, Bell L. How CLIP became ECLIPSE: a mnemonic to assist in searching for health policy/management information. Health Info Lib J [Internet]. 2002; 19(2):113-115. https://doi.org/10.1046/j.1471-1842.2002.00378.x
The PEO framework is useful for qualitative research topics and questions about aetiology or risk. PEO questions identify three concepts: Population, Exposure, and Outcome.
Research question: What are the daily living experiences of mothers with postnatal depression?
| P | Population | mothers |
| E | Exposure | postnatal depression |
| O | Outcome | daily living experiences |
Moola S, Munn Z, Sears K, Sfetcu R, Currie M, Lisy K, et al. Conducting systematic reviews of association (etiology): The Joanna Briggs Institute's approach. Int J Evid Based Healthc [Internet]. 2015; 13(3):163–169. https://doi.org/10.1097/XEB.0000000000000064
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