Systematic reviews: Formulate your question
- Introduction
- Formulate your question
- Write a protocol
- Search the literature
- Manage references
- Select studies
- Assess the evidence
- Write your review
- Further resources
Defining the question
Defining the research question and developing a protocol are the essential first steps in your systematic review. The success of your systematic review depends on a clear and focused question, so take the time to get it right.
- A framework may help you to identify the key concepts in your research question and to organise your search terms in one of the Library's databases.
- Several frameworks or models exist to help researchers structure a research question and three of these are outlined on this page: PICO, SPICE and SPIDER.
- It is advisable to conduct some scoping searches in a database to look for any reviews on your research topic and establish whether your topic is an original one .
- Y ou will need to identify the relevant database(s) to search and your choice will depend on your topic and the research question you need to answer.
- By scanning the titles, abstracts and references retrieved in a scoping search, you will reveal the terms used by authors to describe the concepts in your research question, including the synonyms or abbreviations that you may wish to add to a database search.
- The Library can help you to search for existing reviews: make an appointment with your Subject Librarian to learn more.
The PICO framework
PICO may be the most well-known model framework: it has its origins in epidemiology and now is widely-used for evidence-based practice and systematic reviews.
PICO normally stands for Population (or Patient or Problem) - Intervention - Comparator - Outcome.
| Population defines the group you are studying. It may for example be healthy adults, or adults with dementia, or children under 5 years of age with asthma. |
| Intervention is the type of treatment you aim to study, e.g. a medicine or a physical therapy. |
| Comparator is another type of treatment you aim to compare the first treatment with, or perhaps a placebo. |
| Outcome is the result you intend to measure, for example (increased or decreased) life expectancy, or (cessation of) pain. |
The SPICE framework
SPICE is used mostly in social science and healthcare research. It stands for Setting - Population (or Perspective) - Intervention - Comparator - Evaluation. It is similar to PICO and was devised by Booth (2004).
| Setting: the location or environment relevant to your research (e.g. accident and emergency unit) |
| Population (or perspective): the type of group that you are studying (e.g. older people) |
| Intervention: the intervention/practice/treatment that you are evaluating (e.g. initial examination of patients by allied health staff) |
| Comparator: an intervention with which you compare the above comparator (e.g. initial examination by medical staff) |
| Evaluation: the hypothetical result you intend to evaluate e.g. lower mortality rates) |
The examples in the SPICE table are based on the following research question: Can mortality rates for older people be reduced if a greater proportion are examined initially by allied health staff in A&E? Source: Booth, A (2004) Formulating answerable questions. In Booth, A & Brice, A (Eds) Evidence Based Practice for Information Professionals: A handbook. (pp. 61-70) London: Facet Publishing.
The SPIDER framework
SPIDER was adapted from the PIC O framework in order to include searches for qualitative and mixed-methods research. SPIDER was developed by Cooke, Smith and Booth (2012).
| Sample: qualitative research may have fewer participants than quantitative research and findings may not be generalised to the entire population. |
| Phenonemon of Interest: experiences, behaviours or decisions may be of more interest to the qualitative researcher, rather than an intervention. |
| Design: the research method may be an interview or a survey. |
| Evaluation: outcomes may include more subjective ones, e.g. attitudes. |
| Research type: the search can encompass qualitative and mixed-methods research, as well as quantitative research. |
Source : Cooke, A., Smith, D. & Booth, A. (2012). Beyond PICO: the SPIDER tool for qualitative evidence synthesis. Qualitative Health Research (10), 1435-1443. http://doi.org/10.1177/1049732312452938 .
More advice about formulating a research question
Module 1 in Cochrane Interactive Learning explains the importance of the research question, some types of review question and the PICO framework. The Library is subscribing to Cochrane Interactive Learning .
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Formulating Questions for Evidence-Based Practice (SPICE Framework)
Booth, A. (2006). Clear and present questions: Formulating questions for evidence based practice. Library Hi Tech , 24 (3), 355-368. https://doi.org/10.1108/07378830610692127
Description
This framework offers a step-by-step approach to formulating practice questions for finding evidence in existing research. SPICE builds upon the PICO acronym (Population, Intervention, Comparison and Outcomes) in two ways. First, the population component is separated into two components: setting and perspective. Second, “outcomes” is replaced with “evaluation” in order to encourage a broader evaluation framework and incorporate concepts such as “outputs” and “impact” together.
Steps for Using Method/Tool
The framework guides users through five components:
- S etting – where?
- P erspective – for whom?
- I ntervention – what?
- C omparison – compared with what?
- E valuation – with what result?
These summaries are written by the NCCMT to condense and to provide an overview of the resources listed in the Registry of Methods and Tools and to give suggestions for their use in a public health context. For more information on individual methods and tools included in the review, please consult the authors/developers of the original resources.
We have provided the resources and links as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by McMaster University of any of the products, services or opinions of the external organizations, nor have the external organizations endorsed their resources and links as provided by McMaster University. McMaster University bears no responsibility for the accuracy, legality or content of the external sites.
Tool on pages 355-368
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Systematic Review and Evidence Synthesis
Acknowledgement.
The PICO, PCC, SPICE and SPIDER framework boxes were adapted from a guide developed by James Cook University Library with additional content from Cornell University Library.
Identifying the research question
Developing a well-constructed research question is one of the most important steps in a successful evidence synthesis review. Developing a research question is not always a straightforward process. You and your team have identified a knowledge gap in your field; now you should search the literature to see if this review has already been done. If the answer is no, then you can further explore the literature related to your question. Look for other reviews and literature that has been written on this topic. Use the literature you find to refine your question to narrow the focus and make it specific. Your question and the type of answers you are looking for will guide your choice on the type of evidence synthesis you will conduct.
Question Frameworks
A question framework provides support and structure for your evidence synthesis question.
- Systematic Review questions are typically narrow in focus and usually fit into the PICO question framework.
- Scoping Review questions are typically broader in scope than a systematic review question, and look at answering large, complex, exploratory research questions. These often do not fit into a PICO question format. JBI recommends the PCC mnemonic.
| opulation, Patient or Problem | Who are the people being studied or What is the problem being looked at? What are their characteristics? |
| ntervention | What is the treatment or intervention being studied? (treat, diagnose, observe) |
| omparison, Control or Comparator | What is the intervention compared to? (e.g. other interventions, standard treatment, no treatment) This can be optional if no comparison applies. |
| utcome | What are the relevant outcomes and how are they measured? |
Example: Is gabapentin (intervention), compared to placebo (comparison), effective in decreasing pain symptoms (outcome) in middle aged male amputees suffering phantom limb pain (population)?
Chapter 5 of the Cochrane Handbook for Systematic Reviews of Interventions has more information on the defining each element of the PICO acronym.
| opulation | Important characteristics of participants, including age and other qualifying criteria. |
| oncept | Use the ideas from your primary questions to determine your concept. The core concept examined by the scoping review should be clearly articulated to guide the scope and breadth of the inquiry. This may include details that pertain to elements that would be detailed in a standard systematic review, such as the "interventions" and/or "phenomena of interest" and/or "outcomes". |
| ontext | May include... cultural factors such as geographic location and/or specific racial or gender-based interests. In some cases, context may also encompass details about the specific setting |
Example: What are the market, non-market, regulatory and compliance incentives or compulsory/voluntary programs (context) for farmers (participants) to adopt environmentally sustainable practices (concept)? Source: Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z, editors. JBI Manual for Evidence Synthesis . JBI; 2024.
| etting | Where is the study being undertaken? |
| erspective | For whom? Who are the targets or participants of the study? |
| ntervention | What is the change or intervention being studied? |
| omparison | What is the intervention being compared to? |
| valuation | With what result? How is the result being measured? |
Example: Example: What are the benefits (evaluation) of a doula (intervention) for low income mothers (perspective) in the developed world (setting) compared to no support (comparison)?
Source: Booth, A. (2006). Clear and present questions: Formulating questions for evidence based practice. Library Hi Tech, 24(3), 355-368. https://doi.org/10.1108/07378830610692127
| ample | The group of people being looked at |
| henomenon of nterest | Looks at the reasons for behaviour and decisions, rather than an intervention. |
| esign | The form of research used, such as interview or survey. |
| valuation | The outcome measures. |
| esearch Type | Type of research. e.g. qualitative, quantitative or mixed method |
Example: What are the experiences (evaluation) of women (sample) undergoing IVF treatment (phenomenon of interest) as assessed?
Source: Cooke, A., Smith, D., & Booth, A. (2012). Beyond PICO: The SPIDER tool for qualitative evidence synthesis. Qualitative Health Research, 22(10), 1435-1443. https://doi.org/10.1177/1049732312452938
Further reading
There are many more frameworks that have been developed to guide develop questions which do not fit well with the dominant ones listed here. We recommend the following sites for further exploration:
James Cook University. Library & Information Service: Scoping Reviews - Define the Question.
This guide is especially well laid out and includes frameworks beyond those used for scoping reviews.
University of Maryland Libraries. Systematic Review - Framing a Research Question.
Includes a table of over 40 question frameworks. The table is derived from the below excellent book.
Foster, M. & Jewell, S. (Eds). (2022). Piecing together systematic reviews and other evidence syntheses . Rowman & Littlefield. pp. 48-50, Boxes 4.1, 4.2, 4.3, 4.4.
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Develop & Refine Your Research Question
Evidence synthesis guide : develop & refine your research question.
- Review Types & Decision Tree
- Standards & Reporting Results
- Materials in the Mayo Clinic Libraries
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A clear, well-defined, and answerable research question is essential for any systematic review, meta-analysis, or other form of evidence synthesis. The question must be answerable. Spend time refining your research question.
- PICO Worksheet
PICO Framework
Focused question frameworks.
The PICO mnemonic is frequently used for framing quantitative clinical research questions. 1
| Patient or problem being addressed | |
| Intervention or exposure being studied | |
| Comparison intervention or exposure | |
| Clinical Outcome |
The PEO acronym is appropriate for studies of diagnostic accuracy 2
| Patient | |
| Exposure (the test that is being evaluated) | |
| Outcome |
The SPICE framework is effective “for formulating questions about qualitative or improvement research.” 3
| Setting of your project | |
| Population being studied | |
| Intervention (drug, therapy, improvement program) | |
| Comparison | |
| Evaluation (how were outcomes evaluated?) |
The SPIDER search strategy was designed for framing questions best answered by qualitative and mixed-methods research. 4
| Sample: what groups are of interest? | |
| Phenomenon of Interest: what behaviors, decisions, or experience do you want to study? | |
| Design: are you applying a theoretical framework or specific research method? | |
| Evaluation: how were outcomes evaluated and measured? | |
| Research type: qualitative or mixed-methods? |
References & Recommended Reading
1. Anastasiadis E, Rajan P, Winchester CL. Framing a research question: The first and most vital step in planning research. Journal of Clinical Urology. 2015;8(6):409-411.
2. Speckman RA, Friedly JL. Asking Structured, Answerable Clinical Questions Using the Population, Intervention/Comparator, Outcome (PICO) Framework. PM&R. 2019;11(5):548-553.
3. Knowledge Into Action Toolkit. NHS Scotland. http://www.knowledge.scot.nhs.uk/k2atoolkit/source/identify-what-you-need-to-know/spice.aspx . Accessed April 23, 2021.
4. Cooke A, Smith D, Booth A. Beyond PICO: the SPIDER tool for qualitative evidence synthesis. Qualitative health research. 2012;22(10):1435-1443.
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Forming answerable search questions using frameworks
- Research question frameworks
- Example PICO
- Build your own PICO
The SPICE framework is useful for social sciences topics, or qualitative research questions that require subjective evaluation.
| Setting - where? | |
| Perspective - for whom? | |
| Intervention - what? | |
| Comparison - compared with what? | |
| Evaluation - with what result? |
| Setting - where? | Exeter | |
| Perspective - for whom? | University students | |
| Intervention - what? | Pet therapy | |
| Comparison - compared with what? | No support | |
| Evaluation - with what result? | Students' self-reported stress levels before exams |
Booth, A. (2006). Clear and present questions: Formulating questions for evidence based practice. Library Hi Tech , 24 (3), 355-368. https://doi.org/10.1108/07378830610692127
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Systematic Reviews in the Sciences
- Frameworks: PICO, SPIDER, SPICE
- Getting started
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- Topic analysis guide
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A framework provides a structure which can help you to clearly define your research question in terms of population, intervention or phenomenon of interest, comparisons, settings, outcomes and more.
Common frameworks include PICO, SPIDER and SPICE.
The PICO framework is most suitable for clinical and intervention based research questions. If you plan to review prognostic or qualitative data, or diagnostic test accuracy, another framework, such as SPIDER or SPICE, may be more suitable.
Common variations on PICO can include:
- PICOT = Population, Intervention, Comparison, Outcome, Type of Study or Time within which the outcome will be observed
- PPICO = If your population is more complex, it may need two descriptors for its population.
- PI_O = Your question many not need a comparison.
- PCC = Population/Problem, Concept, Context (often used for Scoping Reviews)
- PEO = Population, Exposure, Outcome.
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| ||
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| Patient, Population or Problem | What are the most important characteristics of the patients? (e.g. gender, age, and disease or condition |
|
| Intervention or Exposure | What is the main intervention? (e.g. drug treatment, diagnostic and screening test) |
|
| Comparison or Control | What is the main alternative to the intervention? (e.g. placebo, different drug, surgery, no treatment) |
|
| Outcome | What are you trying to accomplish improve, measure, effect? (e.g. quality of life, morbidity, complications) |
The SPIDER framework is useful for qualitative/mixed methods research.
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| ||
|
| Sample | What is the group of people you are studying? (e.g. young parents, first year university students) |
|
| Phenomenon of Interest | What is the topic of your research? |
|
| Design | How was the study conducted? (e.g. focus group, interview, observational study, survey) |
|
| Evaluation | What is the measurement of outcome of the study? This might be subjective and not necessarily empirical (e.g. experiences) |
|
| Research Type | Was it qualitative or mixed research? |
The SPICE framework is useful for qualitative research topics evaluating the outcomes of a service, project or intervention.
|
| ||
|
| Setting | What is the location or environment of the research or study? (e.g. South Korean Universities, a hospital emergency room) |
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| Perspective | Who is the group being studied? (e.g. adolescents, rural doctors) |
|
| Intervention | What is the intervention/interest/exposure that you are evaluating? |
|
| Comparison | What is the alternative strategy you would like to compare to the intervention? May include no intervention |
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| Evaluation | What is the result or outcome measures? (e.g. reduced anxiety, improved memory) |
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Good review practice: a researcher guide to systematic review methodology in the sciences of food and health
- About this guide
- Part A: Systematic review method
- What are Good Practice points?
- Part C: The core steps of the SR process
- 1.1 Setting eligibility criteria
- 1.2 Identifying search terms
- 1.3 Protocol development
- 2. Searching for studies
- 3. Screening the results
- 4. Evaluation of included studies: quality assessment
- 5. Data extraction
- 6. Data synthesis and summary
- 7. Presenting results
- Links to current versions of the reference guidelines
- Download templates
- Food science databases
- Process management tools
- Screening tools
- Reference management tools
- Grey literature sources
- Links for access to protocol repository and platforms for registration
- Links for access to PRISMA frameworks
- Links for access to 'Risk of Bias' assessment tools for quantitative and qualitative studies
- Links for access to grading checklists
- Links for access to reporting checklists
- What questions are suitable for the systematic review methodology?
- How to assess feasibility of using the method?
- What is a scoping study and how to construct one?
- How to construct a systematic review protocol?
- How to construct a comprehensive search?
- Study designs and levels of evidence
- Download a pdf version This link opens in a new window
Framing the question
The first and most important step in conducting a systematic review is framing the research question. the aim of this process is to break down the research question/issue into its main components or “key elements”. the key elements specify relevant concepts of a topic and set the boundaries for the study. .
An effective method of identifying the key elements is using a standard framework in relevance to the question type. The most used frameworks are the followings: PO , PECO/ PICO , PEO, PICOT . The acronyms P , I , E , O and T stand for the following key elements: P opulation, I ntervention or E xposure, C omparator, O utcome, and T imeframe. These frameworks were first created for healthcare studies but can be adopted and used in other food-related contexts.
The details for formulating different question types are laid out below for each framework:
Descriptive questions
This framework can be adopted to measure frequency of a variable among a target population for incidence , occurrence , and prevalence questions. Epidemiological studies may assess the changes over time and therefore factor a specific timeframe for the study ( POT ). In those cases, the framework POT is adopted.
Effectiveness/effect and exposure questions
The framework PICO can be used to measure the effect of deliberate interventions or exposures in different contexts. It can be used for assessing effectiveness and dose-dependent relationships for the state or extent of the variables. For instance, when an extent of a relationship between a food product and human health outcomes is evaluated PICO frameworks can be used. See examples in the table below.
Test accuracy questions:
Assessing accuracy relates to those research questions about sensitivity and accuracy of tests or analytical methods. In clinical topics diagnostic methods are reviewed for accuracy using PIT framework. In food related topics the accuracy of an analytical method for detection or quantification of a chemical in food products or a pathogen in plant-based or animal foods can be evaluated against a reference index using the PIT framework.
The SPICE framework:
The spice framework.
The acronym represents S etting, P erspective or P opulation, I ntervention, C omparator and E valuation method. It is a common approach in formulating broader practice questions that are aimed at evaluating outputs and impacts. It is used in framing questions within social and environmental sciences.
Question examples
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Please note you do not have access to teaching notes, clear and present questions: formulating questions for evidence based practice.
Library Hi Tech
ISSN : 0737-8831
Article publication date: 1 July 2006
The paper seeks to provide an overview and update of thinking in relation to the theory and practice of formulation of answerable research questions within evidence based information practice.
Design/methodology/approach
The paper reviews the healthcare and information literature on question formulation, augmented by structured and purposive internet searches.
Although a few key authors have published extensively on all aspects of the evidence‐based information practice process, including question formulation, there is little in the way of empirical research.
Research limitations/implications
In the absence of an empirical research base from within the specific domain of information practice, this conceptual paper extrapolates findings from healthcare research to general librarianship.
Practical implications
This article models the process of question formulation using a proposed conceptual framework (SPICE) and encourages practitioners to identify their own practice‐based questions.
Originality/value
This is the first article specifically to address question formulation for a general (i.e. non‐health) library audience.
- Evidence‐based practice
- Librarianship
Booth, A. (2006), "Clear and present questions: formulating questions for evidence based practice", Library Hi Tech , Vol. 24 No. 3, pp. 355-368. https://doi.org/10.1108/07378830610692127
Emerald Group Publishing Limited
Copyright © 2006, Emerald Group Publishing Limited
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Systematic and systematic-like review toolkit: Step 1: Formulating the research question
Systematic and systematic-like review toolkit.
- Systematic and systematic-like reviews overview
Step 1: Formulating the research question
- Step 2: Developing the search
- Step 3: Screening and selection of articles
- Step 4: Appraisal of articles
- Step 5: Writing and publishing
- Filters and complex search examples
- Evidence synthesis support services
Tip: Look for these icons for guidance on which technique is required
Email your Librarians
The first stage in a review is formulating the research question. The research question accurately and succinctly sums up the review's line of inquiry. This page outlines approaches to developing a research question that can be used as the basis for a review.
Research question frameworks
It can be useful to use a framework to aid in the development of a research question. Frameworks can help you identify searchable parts of a question and focus your search on relevant results
A technique often used in research for formulating a clinical research question is the PICO model. Slightly different versions of this concept are used to search for quantitative and qualitative reviews.
The PICO/ PECO framework is an adaptable approach to help you focus your research question and guide you in developing search terms. The framework prompts you to consider your question in terms of these four elements:
P : P atient/ P opulation/ P roblem
I/E : I ntervention/ I ndicator/ E xposure/ E vent
C : C omparison/ C ontrol
O : O utcome
For more detail, there are also the PICOT and PICOS additions:
PICO T - adds T ime
PICO S - adds S tudy design
PICO example
Consider this scenario:
Current guidelines indicate that nicotine replacement therapies (NRTs) should not be used as an intervention in young smokers. Counselling is generally the recommended best practice for young smokers, however youth who are at high risk for smoking often live in regional or remote communities with limited access to counselling services. You have been funded to review the evidence for the effectiveness of NRTs for smoking cessation in Australian youths to update the guidelines.
The research question stemming from this scenario could be phrased in this way:
In (P) adolescent smokers , how does (I) nicotine replacement therapy compared with (C) counselling affect (O) smoking cessation rates ?
| PICO element | Definition | Scenario |
|---|---|---|
| P (patient/population/problem) | Describe your patient, population, or problem | adolescent smokers |
| I (intervention/indicator | Describe your intervention or indicator | Nicotine Replacement Therapy (NRT) |
| C (comparison/control) | What is your comparison or control? | counselling |
| O (outcome) | What outcome are you looking for? | smoking cessation / risk of continued nicotine dependency |
Alternative frameworks
PICO is one of the most frequently used frameworks, but there are several other frameworks available to use, depending on your question.
Question type
- Qualitative; Aetiology or risk
- Services, policy, social care
- Prevalence & prognosis; Economics
Structuring qualitative questions?
Try PIC or SPIDER :
- P opulation, Phenomena of I nterest, C ontext
- S ample, P henomenon of I nterest, D esign, E valuation, R esearch type
Cooke, A., Smith, D., & Booth, A. (2012). Beyond PICO: the SPIDER tool for qualitative evidence synthesis . Qualitative health research, 22(10), 1435-1443.
Question about aetiology or risk?
- P opulation, E xposure, O utcomes
Moola, Sandeep; Munn, Zachary; Sears, Kim; Sfetcu, Ralucac; Currie, Marian; Lisy, Karolina; Tufanaru, Catalin; Qureshi, Rubab; Mattis, Patrick; Mu, Peifanf. Conducting systematic reviews of association (etiology) , International Journal of Evidence-Based Healthcare: September 2015 - Volume 13 - Issue 3 - p 163-169.
Evaluating an intervention, policy or service?
Try SPICE :
- S etting, P opulation or P erspective, I ntervention, C omparison, E valuation
Booth, A. (2006), " Clear and present questions: formulating questions for evidence based practice ", Library Hi Tech, Vol. 24 No. 3, pp. 355-368. https://doi-org.ezproxy-b.deakin.edu.au/10.1108/07378830610692127
Investigating the outcome of a service or policy?
Try ECLIPSE :
- E xpectation, C lient group, L ocation, I mpact, P rofessionals, SE rvice
Wildridge, V., & Bell, L. (2002). How CLIP became ECLIPSE: a mnemonic to assist in searching for health policy/management information . Health Information & Libraries Journal, 19(2), 113-115.
Working out prevalence or incidence?
Try CoCoPop :
- Co ndition, Co ntext, Pop ulation
Munn, Z., Moola, S., Lisy, K., Riitano, D., & Tufanaru, C. (2015). Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data . International journal of evidence-based healthcare, 13(3), 147-153.
Determining prognosis?
- P opulation, Prognostic F actors, O utcome
Conducting an economic evaluation?
Try PICOC :
- P opulation, I ntervention, C omparator/s, O utomes, Context
Petticrew, M., & Roberts, H. (2006). Systematic reviews in the social sciences: a practical guide . Blackwell Pub.
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.
The University of Notre Dame Australia provides information on some different frameworks available to help structure the research question.
Further Readings
Booth A, Noyes J, Flemming K, et al, Formulating questions to explore complex interventions within qualitative evidence synthesis . BMJ Global Health 2019;4:e001107. This paper explores the importance of focused, relevant questions in qualitative evidence syntheses to address complexity and context in interventions.
Kim, K. W., Lee, J., Choi, S. H., Huh, J., & Park, S. H. (2015). Systematic review and meta-analysis of studies evaluating diagnostic test accuracy: a practical review for clinical researchers-part I. General guidance and tips . Korean journal of radiology, 16(6), 1175-1187. As the use of systematic reviews and meta-analyses is increasing in the field of diagnostic test accuracy (DTA), this first of a two-part article provides a practical guide on how to conduct, report, and critically appraise studies of DTA.
Methley, A. M., Campbell, S., Chew-Graham, C., McNally, R., & Cheraghi-Sohi, S. (2014). PICO, PICOS and SPIDER: A comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews . BMC Health Services Research, 14(1), 579. In this article the ‘SPIDER’ search framework, developed for more effective searching of qualitative research, was evaluated against PICO and PICOD.
Munn, Z., Stern, C., Aromataris, E., Lockwood, C., & Jordan, Z. (2018). What kind of systematic review should I conduct? A proposed typology and guidance for systematic reviewers in the medical and health sciences . BMC medical research methodology, 18(1), 5. https://doi.org/10.1186/s12874-017-0468-4 This article aligns review types to question development frameworks.
Search for existing reviews
Before you start searching, find out whether any systematic reviews have been conducted recently on your topic. This is because similar systematic reviews could help with identifying your search terms, and information on your topic. It is also helpful to know if there is already a systematic review on your topic as it may mean you need to change your question.
Cochrane Library and Joanna Briggs Institute publish systematic reviews. You can also search for the term "systematic review" in any of the subject databases. You can also search PROSPERO , an international register of systematic reviews, to see if there are any related reviews underway but not yet published; there are additional review registers detailed below.
Watch this video to find out how to search for published systematic reviews
Protocols and Guidelines for reviews
It is recommended that authors consult relevant guidelines and create a protocol for their review.
Protocols provide a clear plan for how the review will be conducted, including what will and will not be included in the final review. Protocols are widely recommended for any systematic review and are increasingly a requirement for publication of a completed systematic review.
Guidelines provide specific information on how to perform a review in your field of study. A completed review may be evaluated against the relevant guidelines by peer reviewers or readers, so it makes sense to follow the guidelines as best you can.
Click the headings below to learn more about the importance of protocols and guidelines.
Your protocol (or plan for conducting your review) should include the rationale, objectives, hypothesis, and planned methods used in searching, screening and analysing identified studies used in the review. The rationale should clearly state what will be included and excluded from the review. The aim is to minimise any bias by having pre-defined eligibility criteria.
Base the protocol on the relevant guidelines for the review that you are conducting. PRISMA-P was developed for reporting and development of protocols for systematic reviews. Their Explanation and Elaboration paper includes examples of what to write in your protocol. York's CRD has also created a document on how to submit a protocol to PROSPERO .
There are several registers of protocols, often associated with the organisation publishing the review. Cochrane and Joanna Briggs Institute both have their own protocol registries, and PROSPERO is a wide-reaching registry covering protocols for Cochrane, non-Cochrane and non-JBI reviews on a range of health, social care, education, justice, and international development topics.
Before beginning your protocol, search within protocol registries such as those listed above, or Open Science Framework or Research Registry , or journals such as Systematic Reviews and BMJ Open . This is a useful step to see if a protocol has already been submitted on your review topic and to find examples of protocols in similar areas of research.
While a protocol will contain details of the intended search strategy, a protocol should be registered before the search strategy is finalised and run, so that you can show that your intention for the review has remained true and to limit duplication of in progress reviews.
A protocol should typically address points that define the kind of studies to be included and the kind of data required to ensure the systematic review is focused on the appropriate studies for the topic. Some points to think about are:
- What study types are you looking for? For example, randomised controlled trials, cohort studies, qualitative studies
- What sample size is acceptable in each study (power of the study)?
- What population are you focusing on? Consider age ranges, gender, disease severity, geography of patients.
- What type of intervention are you focusing on?
- What outcomes are of importance to the review, including how those outcomes are measured?
- What context should you be looking for in a study? A lab, acute care, school, community...
- How will you appraise the studies? What methodology will you use?
- Does the study differentiate between the target population and other groups in the data? How will you handle it if it does not?
- Is the data available to access if the article does not specify the details you need? If not, what will you do?
- What languages are you able to review? Do you have funding to translate articles from languages other than English?
Further reading
PLoS Medicine Editors. (2011). Best practice in systematic reviews: the importance of protocols and registration . PLoS medicine, 8(2), e1001009.
Systematic Review guidelines
The Cochrane handbook of systematic reviews of interventions is a world-renowned resource for information on designing systematic reviews of intervention.
Many other guidelines have been developed from these extensive guidelines.
General systematic reviews
- The PRISMA Statement includes the well-used Checklist and Flow Diagram.
- Systematic Reviews: CRD's guidance on undertaking reviews in health care . One of the founding institutions that developed systematic review procedure. CRD's guide gives detailed clearly written explanations for different fields in Health.
- National Academies Press (US); 2011. 3, Standards for Finding and Assessing Individual Studies. Provides guidance on searching, screening, data collection, and appraisal of individual studies for a systematic review.
Meta-analyses
- An alternative to PRISMA is the Meta‐analysis Of Observational Studies in Epidemiology (MOOSE) for observational studies. It is a 35‐item checklist. It pays more attention to certain aspects of the search strategy, in particular the inclusion of unpublished and non‐English‐language studies.
Surgical systematic reviews
- Systematic reviews in surgery-recommendations from the Study Center of the German Society of Surgery . Provides recommendations for systematic reviews in surgery with or without meta-analysis, for each step of the process with specific recommendations important to surgical reviews.
Nursing/Allied Health systematic reviews
Joanna Briggs Institute Manual for Evidence Synthesis a comprehensive guide to conducting JBI systematic and similar reviews
Nutrition systematic reviews
- Academy of Nutrition and Dietetics Evidence Analysis Manual is designed to guide expert workgroup members and evidence analysts to understand and carry out the process of conducting a systematic review.
Occupational therapy
- American Occupational Therapy Association: Guidelines for Systematic reviews . The American Journal of Occupational Therapy (AJOT) provides guidance for authors conducting systematic reviews.
Education/Law/ Sociology systematic reviews
- Campbell Collaboration, Cochrane's sister organisation provides guidelines for systematic reviews in the social sciences: MECIR
- Systematic Reviews in Educational Research: Methodology, Perspectives and Application
Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy
COSMIN Guideline for Systematic Reviews of Outcome Measurement Instruments – This was developed for patient reported outcomes (PROMs) but has since been adapted for use with other types of outcome measurements in systematic reviews.
Prinsen, C.A.C., Mokkink, L.B., Bouter, L.M. et al. COSMIN guideline for systematic reviews of patient-reported outcome measures . Qual Life Res 27, 1147–1157 (2018). https://doi.org/10.1007/s11136-018-1798-3
HuGENet™ Handbook of systematic reviews – particularly useful for describing population-based data and human genetic variants.
AHRQ: Methods Guide for Effectiveness and Comparative Effectiveness Reviews - from the US Department of Health and Human Services, guidelines on conducting systematic reviews of existing research on the effectiveness, comparative effectiveness, and harms of different health care interventions.
Mariano, D. C., Leite, C., Santos, L. H., Rocha, R. E., & de Melo-Minardi, R. C. (2017). A guide to performing systematic literature reviews in bioinformatics . arXiv preprint arXiv:1707.05813.
Integrative Review guidelines
Integrative reviews may incorporate experimental and non-experimental data, as well as theoretical information. They differ from systematic reviews in the diversity of the study methodologies included.
Guidelines:
- Whittemore, R. and Knafl, K. (2005), The integrative review: updated methodology. Journal of Advanced Nursing, 52: 546–553. doi:10.1111/j.1365-2648.2005.03621.x
- A step-by-step guide to conducting an Integrative Review (2020), edited by C.E. Toronto & Ruth Remington, Springer Books
Rapid Review guidelines
Rapid reviews differ from systematic reviews in the shorter timeframe taken and reduced comprehensiveness of the search.
Cochrane has a methods group to inform the conduct of rapid reviews with a bibliography of relevant publications .
A modified approach to systematic review guidelines can be used for rapid reviews, but guidelines are beginning to appear:
Crawford C, Boyd C, Jain S, Khorsan R and Jonas W (2015), Rapid Evidence Assessment of the Literature (REAL©): streamlining the systematic review process and creating utility for evidence-based health care . BMC Res Notes 8:631 DOI 10.1186/s13104-015-1604-z
Philip Moons, Eva Goossens, David R. Thompson, Rapid reviews: the pros and cons of an accelerated review process , European Journal of Cardiovascular Nursing, Volume 20, Issue 5, June 2021, Pages 515–519, https://doi.org/10.1093/eurjcn/zvab041
Rapid Review Guidebook: Steps for conducting a rapid review National Collaborating Centre for Methods and Tools (McMaster University and Public Health Agency Canada) 2017
Tricco AC, Langlois EV, Straus SE, editors (2017) Rapid reviews to strengthen health policy and systems: a practical guide (World Health Organization). This guide is particularly aimed towards developing rapid reviews to inform health policy.
Scoping Review guidelines
Scoping reviews can be used to map an area, or to determine the need for a subsequent systematic review. Scoping reviews tend to have a broader focus than many other types of reviews, however, still require a focused question.
- Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z (Editors). Joanna Briggs Institute Reviewer's Manual, JBI, 2020.
- Statement / Explanatory paper
Scoping reviews: what they are and how you can do them - Series of Cochrane Training videos presented by Dr. Andrea C. Tricco and Kafayat Oboirien
Martin, G. P., Jenkins, D. A., Bull, L., Sisk, R., Lin, L., Hulme, W., ... & Group, P. H. A. (2020). Toward a framework for the design, implementation, and reporting of methodology scoping reviews . Journal of Clinical Epidemiology, 127, 191-197.
Khalil, H., McInerney, P., Pollock, D., Alexander, L., Munn, Z., Tricco, A. C., ... & Peters, M. D. (2021). Practical guide to undertaking scoping reviews for pharmacy clinicians, researchers and policymakers . Journal of clinical pharmacy and therapeutics.
Colquhoun, H (2016) Current best practices for the conduct of scoping reviews (presentation)
Arksey H & O'Malley L (2005) Scoping studies: towards a methodological framework , International Journal of Social Research Methodology, 8:1, 19-32, DOI: 10.1080/1364557032000119616
Umbrella reviews
- Pollock M, Fernandes RM, Becker LA, Pieper D, Hartling L. Chapter V: Overviews of Reviews . In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021). Cochrane, 2021. Available from www.training.cochrane.org/handbook .
- Aromataris E, Fernandez R, Godfrey C, Holly C, Khalil H, Tungpunkom P. Chapter 10: Umbrella Reviews . In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis. JBI, 2020. Available from https://jbi-global-wiki.refined.site/space/MANUAL/4687363 .
- Aromataris, Edoardo; Fernandez, Ritin; Godfrey, Christina M.; Holly, Cheryl; Khalil, Hanan; Tungpunkom, Patraporn. Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach , International Journal of Evidence-Based Healthcare: September 2015 - Volume 13 - Issue 3 - p 132-140.
Meta-syntheses
Noyes, J., Booth, A., Cargo, M., Flemming, K., Garside, R., Hannes, K., ... & Thomas, J. (2018). Cochrane Qualitative and Implementation Methods Group guidance series—paper 1: introduction . Journal of clinical epidemiology, 97, 35-38.
Harris, J. L., Booth, A., Cargo, M., Hannes, K., Harden, A., Flemming, K., ... & Noyes, J. (2018). Cochrane Qualitative and Implementation Methods Group guidance series—paper 2: methods for question formulation, searching, and protocol development for qualitative evidence synthesis . Journal of clinical epidemiology, 97, 39-48.
Noyes, J., Booth, A., Flemming, K., Garside, R., Harden, A., Lewin, S., ... & Thomas, J. (2018). Cochrane Qualitative and Implementation Methods Group guidance series—paper 3: methods for assessing methodological limitations, data extraction and synthesis, and confidence in synthesized qualitative findings . Journal of clinical epidemiology, 97, 49-58.
Cargo, M., Harris, J., Pantoja, T., Booth, A., Harden, A., Hannes, K., ... & Noyes, J. (2018). Cochrane Qualitative and Implementation Methods Group guidance series—paper 4: methods for assessing evidence on intervention implementation . Journal of clinical epidemiology, 97, 59-69.
Harden, A., Thomas, J., Cargo, M., Harris, J., Pantoja, T., Flemming, K., ... & Noyes, J. (2018). Cochrane Qualitative and Implementation Methods Group guidance series—paper 5: methods for integrating qualitative and implementation evidence within intervention effectiveness reviews . Journal of clinical epidemiology, 97, 70-78.
Flemming, K., Booth, A., Hannes, K., Cargo, M., & Noyes, J. (2018). Cochrane Qualitative and Implementation Methods Group guidance series—Paper 6: Reporting guidelines for qualitative, implementation, and process evaluation evidence syntheses . Journal of Clinical Epidemiology, 97, 79-85.
Walsh, D. and Downe, S. (2005), Meta-synthesis method for qualitative research: a literature review . Journal of Advanced Nursing, 50: 204–211. doi:10.1111/j.1365-2648.2005.03380.x
Living reviews
- Akl, E.A., Meerpohl, J.J., Elliott, J., Kahale, L.A., Schünemann, H.J., Agoritsas, T., Hilton, J., Perron, C., Akl, E., Hodder, R. and Pestridge, C., 2017. Living systematic reviews: 4. Living guideline recommendations . Journal of clinical epidemiology, 91, pp.47-53.
Qualitative systematic reviews
- Dixon-Woods, M., Bonas, S., Booth, A., Jones, D. R., Miller, T., Sutton, A. J., . . . Young, B. (2006). How can systematic reviews incorporate qualitative research? A critical perspective . Qualitative Research,6(1), 27–44.
- Thomas, J., & Harden, A. (2008). Methods for the thematic synthesis of qualitative research in systematic reviews . BMC Medical Research Methodology,8, 45–45.
Mixed methods systematic review
- Lizarondo L, Stern C, Carrier J, Godfrey C, Rieger K, Salmond S, Apostolo J, Kirkpatrick P, Loveday H. Chapter 8: Mixed methods systematic reviews . In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis. JBI, 2020. Available from https://synthesismanual.jbi.global. https://doi.org/10.46658/JBIMES-20-09
- Pearson, A, White, H, Bath-Hextall, F, Salmond, S, Apostolo, J, & Kirkpatrick, P 2015, ' A mixed-methods approach to systematic reviews ', International Journal of Evidence-Based Healthcare, vol. 13, no. 3, p. 121-131. Available from: 10.1097/XEB.0000000000000052
- Dixon-Woods, M., Agarwal, S., Jones, D., Young, B., & Sutton, A. (2005). Synthesising qualitative and quantitative evidence: A review of possible methods . Journal of Health Services Research &Policy,10(1), 45–53.
Realist reviews
The RAMESES Projects - Includes information on publication, quality, and reporting standards, as well as training materials for realist reviews, meta-narrative reviews, and realist evaluation.
Rycroft-Malone, J., McCormack, B., Hutchinson, A. M., DeCorby, K., Bucknall, T. K., Kent, B., ... & Wilson, V. (2012). Realist synthesis: illustrating the method for implementation research . Implementation Science, 7(1), 1-10.
Wong, G., Westhorp, G., Manzano, A. et al. RAMESES II reporting standards for realist evaluations. BMC Med 14, 96 (2016). https://doi.org/10.1186/s12916-016-0643-1
Wong, G., Greenhalgh, T., Westhorp, G., Buckingham, J., & Pawson, R. (2013). RAMESES publication standards: realist syntheses. BMC medicine, 11, 21. https://doi.org/10.1186/1741-7015-11-21
Wong, G., Greenhalgh, T., Westhorp, G., Buckingham, J., & Pawson, R. (2013). RAMESES publication standards: realist syntheses. BMC medicine, 11(1), 1-14. https://doi.org/10.1186/1741-7015-11-21
Social sciences
- Chapman, K. (2021). Characteristics of systematic reviews in the social sciences . The Journal of Academic Librarianship, 47(5), 102396.
- Crisp, B. R. (2015). Systematic reviews: A social work perspective . Australian Social Work, 68(3), 284-295.
Further Reading
Uttley, L., Montgomery, P. The influence of the team in conducting a systematic review . Syst Rev 6, 149 (2017). https://doi.org/10.1186/s13643-017-0548-x
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Systematic Reviews for Non-Health Sciences
- Getting started
- Types of reviews
- 0. Planning the systematic review
- 1. Formulating the research question
Formulating a research question
Purpose of a framework, selecting a framework.
- 2. Developing the protocol
- 3. Searching, screening, and selection of articles
- 4. Critical appraisal
- 5. Writing and publishing
- Guidelines & standards
- Software and tools
- Software tutorials
- Resources by discipline
- Duke Med Center Library: Systematic reviews This link opens in a new window
- Overwhelmed? General literature review guidance This link opens in a new window
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Formulating a question.
Formulating a strong research question for a systematic review can be a lengthy process. While you may have an idea about the topic you want to explore, your specific research question is what will drive your review and requires some consideration.
You will want to conduct preliminary or exploratory searches of the literature as you refine your question. In these searches you will want to:
- Determine if a systematic review has already been conducted on your topic and if so, how yours might be different, or how you might shift or narrow your anticipated focus
- Scope the literature to determine if there is enough literature on your topic to conduct a systematic review
- Identify key concepts and terminology
- Identify seminal or landmark studies
- Identify key studies that you can test your research strategy against (more on that later)
- Begin to identify databases that might be useful to your search question
Systematic review vs. other reviews
Systematic reviews required a narrow and specific research question. The goal of a systematic review is to provide an evidence synthesis of ALL research performed on one particular topic. So, your research question should be clearly answerable from the data you gather from the studies included in your review.
Ask yourself if your question even warrants a systematic review (has it been answered before?). If your question is more broad in scope or you aren't sure if it's been answered, you might look into performing a systematic map or scoping review instead.
Learn more about systematic reviews versus scoping reviews:
- CEE. (2022). Section 2:Identifying the need for evidence, determining the evidence synthesis type, and establishing a Review Team. Collaboration for Environmental Evidence. https://environmentalevidence.org/information-for-authors/2-need-for-evidence-synthesis-type-and-review-team-2/
- DistillerSR. (2022). The difference between systematic reviews and scoping reviews. DistillerSR. https://www.distillersr.com/resources/systematic-literature-reviews/the-difference-between-systematic-reviews-and-scoping-reviews
- Nalen, CZ. (2022). What is a scoping review? AJE. https://www.aje.com/arc/what-is-a-scoping-review/
- Frame your entire research process
- Determine the scope of your review
- Provide a focus for your searches
- Help you identify key concepts
- Guide the selection of your papers
There are different frameworks you can use to help structure a question.
- PICO / PECO
- What if my topic doesn't fit a framework?
The PICO or PECO framework is typically used in clinical and health sciences-related research, but it can also be adapted for other quantitative research.
P — Patient / Problem / Population
I / E — Intervention / Indicator / phenomenon of Interest / Exposure / Event
C — Comparison / Context / Control
O — Outcome
Example topic : Health impact of hazardous waste exposure
| Population | E | Comparators | Outcomes |
|---|---|---|---|
| People living near hazardous waste sites | Exposure to hazardous waste | All comparators | All diseases/health disorders |
Fazzo, L., Minichilli, F., Santoro, M., Ceccarini, A., Della Seta, M., Bianchi, F., Comba, P., & Martuzzi, M. (2017). Hazardous waste and health impact: A systematic review of the scientific literature. Environmental Health , 16 (1), 107. https://doi.org/10.1186/s12940-017-0311-8
The SPICE framework is useful for both qualitative and mixed-method research. It is often used in the social sciences.
S — Setting (where?)
P — Perspective (for whom?)
I — Intervention / Exposure (what?)
C — Comparison (compared with what?)
E — Evaluation (with what result?)
Learn more : Booth, A. (2006). Clear and present questions: Formulating questions for evidence based practice. Library Hi Tech , 24 (3), 355-368. https://doi.org/10.1108/07378830610692127
The SPIDER framework is useful for both qualitative and mixed-method research. It is most often used in health sciences research.
S — Sample
PI — Phenomenon of Interest
D — Design
E — Evaluation
R — Study Type
Learn more : Cooke, A., Smith, D., & Booth, A. (2012). Beyond PICO: The SPIDER tool for qualitative evidence synthesis. Qualitative Health Research, 22 (10), 1435-1443. https://doi.org/10.1177/1049732312452938
The CIMO framework is used to understand complex social and organizational phenomena, most useful for management and business research.
C — Context (the social and organizational setting of the phenomenon)
I — Intervention (the actions taken to address/influence the phenomenon)
M — Mechanisms (the underlying processes or mechanisms that drive change within the phenomenon)
O — Outcomes (the resulting changes that occur due to intervention/mechanisms)
Learn more : Denyer, D., Tranfield, D., & van Aken, J. E. (2008). Developing design propositions through research synthesis. Organization Studies, 29 (3), 393-413. https://doi.org/10.1177/0170840607088020
Click here for an exhaustive list of research question frameworks from the University of Maryland Libraries.
You might find that your topic does not always fall into one of the models listed on this page. You can always modify a model to make it work for your topic, and either remove or incorporate additional elements. Be sure to document in your review the established framework that yours is based off and how it has been modified.
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Systematic Reviews
- Introduction to Systematic Reviews
- Systematic review
- Systematic literature review
- Scoping review
- Rapid evidence assessment / review
- Evidence and gap mapping exercise
- Meta-analysis
- Systematic searching for Faculty of Health students
- Systematic Reviews in Science and Engineering
- Timescales and processes
- Question frameworks (e.g PICO)
- Inclusion and exclusion criteria
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- Documenting your search and results
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- Systematic reviews A to Z
Using a framework to structure your research question
Your systematic review or systematic literature review will be defined by your research question. A well formulated question will help:
- Frame your entire research process
- Determine the scope of your review
- Provide a focus for your searches
- Help you identify key concepts
- Guide the selection of your papers
There are different models you can use to structure help structure a question, which will help with searching.
Selecting a framework
- What if my topic doesn't fit a framework?
A model commonly used for clinical and healthcare related questions, often, although not exclusively, used for searching for quantitively designed studies.
Example question: Does handwashing reduce hospital acquired infections in elderly people?
| opulation | Any characteristic that define your patient or population group. | Elderly people | |
| ntervention | What do you want to do with the patient or population? | Handwashing | |
| omparison (if relevant) | What are the alternatives to the main intervention? | No handwashing | |
| utcome | Any specific outcomes or effects of your intervention. | Reduced infection |
Richardson, W.S., Wilson, M.C, Nishikawa, J. and Hayward, R.S.A. (1995) 'The well-built clinical question: a key to evidence-based decisions.' ACP Journal Club , 123(3) pp. A12
PEO is useful for qualitative research questions.
Example question: How does substance dependence addiction play a role in homelessness?
| Who are the users - patients, family, practitioners or community being affected? What are the symptoms, condition, health status, age, gender, ethnicity? What is the setting e.g. acute care, community, mental health? | homeless persons | |
| Exposure to a condition or illness, a risk factor (e.g. smoking), screening, rehabilitation, service etc. | drug and alcohol addiction services | |
| Experiences, attitudes, feelings, improvement in condition, mobility, responsiveness to treatment, care, quality of life or daily living. | reduced homelessness |
Moola S, Munn Z, Sears K, Sfetcu R, Currie M, Lisy K, Tufanaru C, Qureshi R, Mattis P & Mu P. (2015) 'Conducting systematic reviews of association (etiology): The Joanna Briggs Institute's approach'. International Journal of Evidence - Based Healthcare, 13(3), pp. 163-9. Available at: 10.1097/XEB.0000000000000064.
PCC is useful for both qualitative and quantitative (mixed methods) topics, and is commonly used in scoping reviews.
Example question: “What patient-led models of care are used to manage chronic disease in high income countries?"
| Population | "Important characteristics of participants, including age and other qualifying criteria. You may not need to include this element unless your question focuses on a specific condition or cohort." | N/A. As our example considers chronic diseases broadly, not a specific condition/population - such as women with chronic obstructive pulmonary disorder. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Concept |
Chronic disease Patient-led care models Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis, JBI, 2020. Available from https://synthesismanual.jbi.global . https://doi.org/10.46658/JBIMES-20-12 A model useful for qualitative and mixed method type research questions. Example question: What are young parents’ experiences of attending antenatal education? (Cooke et al., 2012)
Cooke, A., Smith, D. and Booth, A. (2012) 'Beyond PICO: the SPIDER tool for qualitative evidence synthesis.' Qualitative Health Research , 22(10) pp. 1435-1443 A model useful for qualitative and mixed method type research questions. Example question: How effective is mindfulness used as a cognitive therapy in a counseling service in improving the attitudes of patients diagnosed with cancer?
Example question taken from: Tate, KJ., Newbury-Birch, D., and McGeechan, GJ. (2018) ‘A systematic review of qualitative evidence of cancer patients’ attitudes to mindfulness.’ European Journal of Cancer Care , 27(2) pp. 1 – 10. A model useful for qualitative and mixed method type research questions, especially for question examining particular services or professions. Example question: Cross service communication in supporting adults with learning difficulties
You might find that your topic does not always fall into one of the models listed on this page. You can always modify a model to make it work for your topic, and either remove or incorporate additional elements. The important thing is to ensure that you have a high quality question that can be separated into its component parts.
Conducting Research
Systematic Reviews
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2. Develop a Research Question
A well-developed and answerable question is the foundation for any systematic review. This process involves:
Other Question FrameworksPICO is a helpful framework for clinical research questions, but may not be the best for other types of research questions. Did you know there are at least 25 other question frameworks besides variations of PICO? Frameworks like PEO, SPIDER, SPICE, and ECLIPS can help you formulate a focused research question. The table and example below were created by the Medical University of South Carolina (MUSC) Libraries . The PEO question framework is useful for qualitative research topics. PEO questions identify three concepts: population, exposure, and outcome. Research question : What are the daily living experiences of mothers with postnatal depression?
The SPIDER question framework is useful for qualitative or mixed methods research topics focused on "samples" rather than populations. SPIDER questions identify five concepts: sample, phenomenon of interest, design, evaluation, and research type. Research question : What are the experiences of young parents in attendance at antenatal education classes?
The SPICE question framework is useful for qualitative research topics evaluating the outcomes of a service, project, or intervention. SPICE questions identify five concepts: setting, perspective, intervention/exposure/interest, comparison, and evaluation. Research question : For teenagers in South Carolina, what is the effect of provision of Quit Kits to support smoking cessation on number of successful attempts to give up smoking compared to no support ("cold turkey")?
The ECLIPSE framework is useful for qualitative research topics investigating the outcomes of a policy or service. ECLIPSE questions identify six concepts: expectation, client group, location, impact, professionals, and service. Research question: How can I increase access to wireless internet for hospital patients?
Forming Focused Questions with PICO: Other Question FrameworksCreated by health science librarians. 
Other question development frameworksPICO is a helpful framework for clinical research questions, but may not be the best for other types of research questions. Did you know there are at least 25 other question frameworks besides variations of PICO? Frameworks like PEO, SPIDER, SPICE, ECLIPSE, and others can help you formulate a focused research question. The table and example below were created by the Medical University of South Carolina (MUSC) Libraries . The PEO question framework is useful for qualitative research topics. PEO questions identify three concepts: population, exposure, and outcome.
Research question : What are the daily living experiences of mothers with postnatal depression? The SPIDER question framework is useful for qualitative or mixed methods research topics focused on "samples" rather than populations. SPIDER questions identify five concepts: sample, phenomenon of interest, design, evaluation,and research type.
Research question : What are the experiences of young parents in attendance at antenatal education classes? The SPICE question framework is useful for qualitative research topics evaluating the outcomes of a service, project, or intervention. SPICE questions identify five concepts: setting, perspective, intervention/exposure/interest, comparison, and evaluation.
Research question : For teenagers in South Carolina, what is the effect of provision of Quit Kits to support smoking cessation on number of successful attempts to give up smoking compared to no support ("cold turkey")? The ECLIPSE framework is useful for qualitative research topics investigating the outcomes of a policy or service. ECLIPSE questions identify six concepts: expectation, client group, location, impact, professionals, and service.
Research question : How can I increase access to wireless internet for hospital patients?
 Evidence-Based Practice
Question frameworks
Using a research question framework can help clarify and classify the concepts in your research question. There are many frameworks available, and which one you choose depends on the nature of your research. Frameworks are useful, but optional, as not all research aligns with the components. Explore the tabs to find examples of how to use the frameworks. The PICO structure is most commonly used in the health professions to research prognoses, diagnoses and therapies. It is mostly used to compare one intervention with another. PICO clinical question example: "In patients with cellulitis, does once-daily intravenous cephazolin and oral Probenecid, compared with twice daily intravenous Cephazolin, result in shorter time to recovery?"
SPICE can be used to evaluate the outcomes of a service, project, or intervention. For more information, please see Booth, A. (2006). Clear and present questions: Formulating questions for evidence based practice. Library Hi Tech, 24(3), 355-368. doi:10.1108/07378830610692127 SPICE question example: "In hospital waiting rooms, do therapy dog visits (as opposed to no therapy dog visits), reduce anxiety in outpatients?"
The SPIDER tool is designed to structure qualitative research questions, focusing less on interventions and more on study design, and "samples" rather than populations. The SPIDER question: "What are young parents’ experiences of attending antenatal education?"
Cooke, A., Smith, D., & Booth, A. (2012). Beyond PICO: The SPIDER tool for qualitative evidence synthesis. Qualitative Health Research, 22 (10), 1435-1443. doi:10.1177/1049732312452938 ECLIPSE is useful for investigating the outcomes of a policy or service. ECLIPSE question example: "How can I increase access to wireless internet for hospital patients?"
 Frameworks for creating answerable (re)search questions
SPIDER Framework -useful for finding qualitative and, in particular, mixed-method research: S - Sample (similar to Patient/Population of PICO ) PI - Phenomenon of interest (similar to PICO Intervention = topic of the research) D - Design (methods used by the qualitative researchers to gather data, e.g. Focus Groups, Interviews, Observations) E - Evaluation (similar to PICO Outcomes ) R - Research type (e.g. Phenomenology, Ethnography, Grounded theory, Case study)
"What are the barriers felt by clinicians that lead to the reluctance to use EBP in practice?" Possible keywords for the corresponding database search: clinician* OR health care professional OR health care provider AND evidence-based practice OR EBP AND interview* OR focus group* AND barrier* OR hinder* OR resist* AND phenomenology Cooke, A., Smith, D. and Booth, A. (2012) @Beyond PICO: The SPIDER tool for qualitative evidence synthesis', Quality Health Research, 22 (10), pp. 1435-1443. DOI: 10.1177/1049732312452938.
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SPICE is a tool to formulate practice questions for finding evidence in existing research. It consists of five features: Setting, Perspective, Intervention, Comparison and Evaluation.
Defining the question. Defining the research question and developing a protocol are the essential first steps in your systematic review. The success of your systematic review depends on a clear and focused question, so take the time to get it right. A framework may help you to identify the key concepts in your research question and to organise ...
This framework offers a step-by-step approach to formulating practice questions for finding evidence in existing research. SPICE builds upon the PICO acronym (Population, Intervention, Comparison and Outcomes) in two ways. First, the population component is separated into two components: setting and perspective. Second, “outcomes” is replaced with “evaluation” in order ...
The SPICE framework is useful for qualitative research questions where the outcome of a project, service, or intervention is evaluated. SPICE Example: In assisted living facilities ( S ), do therapy dog visits ( I) as opposed to no therapy dog visits ( C ), reduce feelings of loneliness ( E ) in older residents ( P )?
Definition of research question frameworks; Clinical research questions Toggle Dropdown. PICO ; Qualitative research questions. PEO ; SPICE ; SPIDER ; ECLIPSE ; Further help; SPICE. SPICE Framework-useful for qualitative research questions requiring subjective evaluation, for instance, in social science topics. S - Setting ...
The PICO, PCC, SPICE and SPIDER framework boxes were adapted from a guide developed by James Cook University Library with additional content from Cornell University Library. ... Developing a well-constructed research question is one of the most important steps in a successful evidence synthesis review. Developing a research question is not ...
A clear, well-defined, and answerable research question is essential for any systematic review, meta-analysis, or other form of evidence synthesis. The question must be answerable. Spend time refining your research question. ... The SPICE framework is effective "for formulating questions about qualitative or improvement research. ...
conceptual framework (SPICE) and encourages practitioners to identify their own practice-based questions. Originality/value - This is the first article specifically to address question formulation for a general (i.e. non-health) library audience. Keywords Evidence-based practice, Librarianship, Research Paper type Conceptual paper Introduction
The SPICE framework is useful for social sciences topics, or qualitative research questions that require subjective evaluation.
The PICO framework is most suitable for clinical and intervention based research questions. If you plan to review prognostic or qualitative data, or diagnostic test accuracy, another framework, such as SPIDER or SPICE, may be more suitable. Common variations on PICO can include: PICOT = Population, Intervention, Comparison, Outcome, Type of ...
The aim of this process is to break down the research question/issue into its main components or "key elements". The key elements specify relevant concepts of a topic and set the boundaries for the study. ... The SPICE framework: The SPICE framework. The acronym represents S etting, P erspective or P opulation, I ntervention, C omparator ...
Purpose. The paper seeks to provide an overview and update of thinking in relation to the theory and practice of formulation of answerable research questions within evidence based information practice. Design/methodology/approach. The paper reviews the healthcare and information literature on question formulation, augmented by structured and ...
A technique often used in research for formulating a clinical research question is the PICO model. Slightly different versions of this concept are used to search for quantitative and qualitative reviews. The PICO/ PECO framework is an adaptable approach to help you focus your research question and guide you in developing search terms. The ...
The SPICE framework is useful for both qualitative and mixed-method research. It is often used in the social sciences. S — Setting (where?). P — Perspective (for whom?). I — Intervention / Exposure (what?). C — Comparison (compared with what?). E — Evaluation (with what result?). Learn more: Booth, A. (2006).Clear and present questions: Formulating questions for evidence based practice.
The SPICE framework (Booth, 2004) was applied to formulate a review question and facilitate the decision of the inclusion and exclusion criteria at this stage. The question is, from the ...
Question frameworks (e.g PICO) - Systematic Reviews
Frameworks like PEO, SPIDER, SPICE, and ECLIPS can help you formulate a focused research question. The table and example below were created by the Medical University of South Carolina (MUSC) Libraries. PEO. The PEO question framework is useful for qualitative research topics. PEO questions identify three concepts: population, exposure, and outcome.
PerSPEcTiF is a new framework for formulating questions to explore complex interventions within qualitative evidence synthesis. It recognises context, perspective, time and space as critical factors to consider when evaluating complex interventions.
PICO is a helpful framework for clinical research questions, but may not be the best for other types of research questions. Did you know there are at least 25 other question frameworks besides variations of PICO? Frameworks like PEO, SPIDER, SPICE, ECLIPSE, and others can help you formulate a focused research question. The table and example below were created by the Medical University of South ...
The research question development tools used in this research are using the PICO Framework (population, intervention, comparison and outcome) although the pico framework has several weaknesses ...
Using a research question framework can help clarify and classify the concepts in your research question. There are many frameworks available, and which one you choose depends on the nature of your research. ... SPICE can be used to evaluate the outcomes of a service, project, or intervention. For more information, please see Booth, A. (2006 ...
Rapid review of 38 different frameworks for formulating questions. A question framework should (i) recognise setting, environment or context; (ii) acknowledge different stakeholder perspectives; (iii) accommodate time/timing and place; (iv) be sensitive to qualitative data.
SPIDER Framework-useful for finding qualitative and, in particular, mixed-method research: S - Sample (similar to Patient/Population of PICO). PI - Phenomenon of interest (similar to PICO Intervention = topic of the research). D - Design (methods used by the qualitative researchers to gather data, e.g. Focus Groups, Interviews, Observations). E - Evaluation (similar to PICO Outcomes)