Introduction to PICO: A Framework for Research Questions
The PICO framework is a useful tool for developing focused, researchable clinical questions. Each element of PICO helps you break down complex healthcare topics and structure questions that lead to effective, evidence-based answers.
What Does PICO Stand For?
- P (Patient/Population/Problem): Identify the patient group or problem you want to investigate. This could include specific characteristics, such as age, gender, health conditions, or population traits.
- I (Intervention): Define the main intervention, treatment, or exposure you are interested in studying. This could be a specific therapy, procedure, or health intervention.
- C (Comparison): Consider if there is an alternative intervention you want to compare. This element is optional and may not apply in every research scenario.
- O (Outcome): Determine the expected outcomes or what you hope to accomplish, measure, or improve. Outcomes can range from symptom reduction to improved quality of life.
Why Use PICO?
PICO helps organize research questions, making it easier to locate relevant, high-quality evidence in health databases. By clarifying each component of a clinical question, PICO facilitates efficient literature searches and enhances research accuracy.
Example of a PICO Question
If you are interested in exploring how exercise affects heart disease, your PICO question might look like this:
- P: Adults with heart disease
- I: Regular aerobic exercise
- C: No exercise or standard treatment
- O: Improvement in cardiovascular health
PICO Question: In adults with heart disease, does regular aerobic exercise improve cardiovascular health compared to no exercise?
Tips for Using PICO
- Start with a specific patient or problem and gradually define each component.
- Use PICO as a guide when searching for literature in databases like PubMed or CINAHL.
- Remember that not every PICO question needs a comparison element; it depends on your research focus.
Tutorials
- Tutorials: PubMedVideo tutorials on using PubMed by National Library of Medicine. For more instruction on PubMed, see the PubMed Online Training page on the NLM web site: https://www.nlm.nih.gov/oet/ed/pubmed/
- EBD PICO Tutorial: Forming a Clinical QuestionLearn about the impact of clinical questions on EBD research, the key elements of a clinical question, how to form an answerable clinical question, and the role of the clinical question in the overall EBD process, provided by Boston University Alumni Medical Library.
- Evidence-Based Practice
An interprofessional tutorial by the University of Minnesota. - Evidence-Based PracticeTutorials provided by Yale Library.
Databases
- ClinicalTrials.gov This link opens in a new window
ClinicalTrials.gov provides patients, family members, health care professionals, and members of the public easy access to information on clinical trials for a wide range of diseases and conditions.
- The Centre for Evidence-Based MedicineControlled editorially by academics from the Oxford University Centre for Evidence-Based Medicine. Authors produce rapid evidence reviews, data analyses and thought-provoking writing relating to the coronavirus pandemic and undertake systematic and regular searches for studies, assessing the quality and their implications.
- DARE (Database of Abstracts of Reviews of Effects)Located on the University of York Centre for Reviews and Dissemination platform, is an index of over 35,000 systematic reviews of health and social care interventions. The U.K. Department of Health and the National Institute for Health Research (NIHR) funded the production of DARE between 1994 and March 2015. The DARE records produced during this time are also available in many other health sciences databases, including PubMed. The DARE database has not been updated since March 2015.
- SAGE Research Methods This link opens in a new window
SAGE Research Methods is a research methods tool created to help researchers, faculty and students with their research projects. SAGE Research Methods links over 175,000 pages of SAGE’s renowned book, journal and reference content with truly advanced search and discovery tools. Researchers can explore methods concepts to help them design research projects, understand particular methods or identify a new method, conduct their research, and write up their findings. Since SAGE Research Methods focuses on methodology rather than disciplines, it can be used across the social sciences, health sciences, and more.
- SAGE Research Methods Cases This link opens in a new window
Search and browse this collection of case studies of real social research, specially commissioned and designed to help you understand abstract methodological concepts in practice.
- SAGE Research Methods Datasets This link opens in a new window
SAGE Research Methods Datasets is a collection of teaching datasets that can be used to support the teaching and independent learning of quantitative and qualitative analytical methods used in the social sciences. These are datasets taken from larger national and international data sources, cleaned and reduced in size and complexity for teaching and self-study purposes, perfect for researchers learning a new method or brushing up on an old one.
- SAGE Research Methods Video This link opens in a new window
SAGE Research Methods Video has over 480 videos, including hours of tutorials, interviews, video case studies and mini-documentaries covering the entire research process. You can search videos by method (SPSS, ethnography, etc.); by discipline (criminology, economics, nursing, etc.); or by video type (i.e. interview, case studies, etc.).
- Cochrane Database of Systematic Reviews This link opens in a new window
Contains full text articles, as well as protocols focusing on the effects of health care. The reviews are highly structured and systematic, with evidence included or excluded on the basis of explicit quality criteria, to minimize bias.
- Cochrane Central Register of Controlled Trials This link opens in a new window
Evidence based medical databases, with protocols, controlled trials, and full-text reviews
- Cochrane Methodology Register This link opens in a new windowThe Cochrane Methodology Register (CMR) is a bibliography of publications that report on methods used in the conduct of controlled trials. It includes journal articles, books, and conference proceedings, and the content is sourced from MEDLINE and hand searches. CMR contains studies of methods used in reviews and more general methodological studies that could be relevant to anyone preparing systematic reviews. CMR records contain the title of the article, information on where it was published (bibliographic details), and, in some cases, a summary of the article. They do not contain the full text of the article.
Surveys and Tools
If you need an actual copy of a research instrument, you must obtain both the instrument and permission to use it. Research instruments may be copyrighted. To obtain permission, contact the copyright holder in writing (either by print or email).
Here are some tips for finding the instrument:
- Try searching for the test title in Google or Google Scholar.
- Look for journal articles that include or append the test.
- Dissertations sometimes include the instrument in an appendix.
- Agency for Healthcare Research and QualityThe Agency for Healthcare Research and Quality (AHRQ) offers practical, research-based tools and other resources to help a variety of health care organizations, providers, and others make care safer in all health care settings.
- RAND SurveysRAND's researchers and survey experts have developed numerous health-related surveys. Available for free in the public domain, these surveys are designed for a wide range of purposes, including assessing patients' health, screening for mental health conditions, and measuring quality of care and quality of life.
- Substance Use Screening & Assessment Instruments @ UWTo help clinicians and researchers find instruments used for screening and assessment of substance use and substance use disorders.
- Tools from the Medical Outcomes Trust (MOT)The instruments in the MOT library have significant evidence of validity and have been widely adapted over many years. Typically, they require a licensing fee, which may include services such as data collection, analysis, and reporting, depending on the licensing organization or distributor. While the mode of access varies by instrument, all are copyrighted and most require a license. For specific information on copyright holders and where to obtain each instrument, please refer to the MOT website.
- Health Literacy Tool ShedThe Health Literacy Tool Shed is an online database of health literacy measures. The site contains information about measures, including their psychometric properties, based on a review of the peer-reviewed literature.
Evaluating Sources
Articles in databases have already been published, and have gone through a review and editing process, unlike web sites. But it is still a good idea to look at the information critically.
Source - Look for articles from scholarly journals, written by experts in the subject. There will be references that can lead you to additional books and articles on the topic. In some databases, you can limit your search by type of article -- a research article, an editorial, a review, or a clinical trial.
Length - The length of the article, noted in the citation, can be a good clue as to whether the article will be useful for research.
Authority - Use authoritative sources in your research. Use articles written by experts in the subject area, and who are affiliated with an academic institution.
Date – research in many subjects requires the most current information available. Is the article sufficiently up-to-date for your purpose?
Audience - For what type of reader is the author writing? If an article is written for other professionals, it will use terms and language special to the subject area.
Usefulness - Is the article relevant to your research topic?
Peer Reviewed - Is this article from a peer-reviewed or refereed publication?
When an article is submitted to a scholarly journal, it is evaluated by experts in the field who examine originality, quality of research, clarity of presentation, etc., and determine if the article falls within the scope of the publication. Also known as refereed, scholarly, or academic.
Evaluating Web Pages UC Berkeley
Evaluating Internet Resources Johns Hopkins University
Evaluating Information -- Applying the CRAAP Test California State University, Chico