Formulating an answerable research question using the PICO model

What is your question? Using PICO in health policyA presentation to Ministry Staff, Victoria BCDean Giustini, UBC biomedical librarianiSchool FacultyNovember 20th, 2014

OVERLOAD

LIBRARIAN PEARL: IT DOESN’T HAVE TO BE THIS WAY

Searching begins with an information request

• Information requests trigger questions!

• In medicine, the PICO model is used to clarify question

• And PICO helps to frame the question into four (4) parts:

• Problem, person (patient) or population

• Intervention

• Comparison

• Outcome

LIBRARIAN PEARL #2:Give your research questions some structure

Scenario #1:“…A physical therapist comes to see you about a 60yr old female patient recovering from a stroke. She needs information about mobility training, and best practices in using walking aids (such as walkers or canes) versus

leg braces (orthotics) to stabilize ankle and leg strength so the patient can learn how to walk again…”

WHAT IS MY PICO? WHAT IS MY RESEARCH QUESTION…• Problem, person (patient) or population— who, what?• Intervention – what will be tested or tried?• Comparison – what will be compared?• Outcome – what is the “optimal” outcome for this patient?

Formulating an answerable (re)search question using PICO

P – 60yr old female patient recovering from a stroke

I – walking aids (such as walkers or canes)

C – versus leg braces (orthotics)

O – walk again

From PICO to frame your research question:“…In a 60 year old patient recovering from stroke,

is mobility training best achieved by walking aids (a walker or cane)

OR by wearing leg braces (orthosis) to stabilize/aid ankle and leg strength... so the patient can walk again”?

Comparison

/Population

Davies KS. Formulating the evidence based practice question: a review of the frameworks. Evid Based Libr Info Pract. 2011;6(2): 75-80.

Formulating the EBP question …

Scenario #2:“…the Minister of Education and BC teachers are working on a new program called “FirstNationsFirst” to prevent high school students on reserves in BC from dropping out of school; the goal is to reduce high-

school drop-outs by 10% by 2020.”

WHAT IS MY ECLIPSE?• Expectation—what is expected? why is information needed?• Client group(s)— who is being targeted? (similar to P or population in PICO)• Location— where will the program being given (if different from where clients are located)• Impact—what impact or outcome is sought? What would success look like? How will it be measured?• Professionals — who will provide service? (private or public, P3)• SE — what service type is under consideration?

Formulating an answerable (re)search question using ECLIPSE

E – MOE is looking to reduce HS drop-out rates on BC reserves

C – High-school students on BC reserves

L – Reserves (could be specific reserves)

I – reduce drop-out rate of 10%

P – FirstNationsFirst team

S – dropout prevention service

From ECLIPSE, state your research question…

Impact

Client group

Location

Expectation

Professionals

Service

“Questions are the driving force behind evidence-based practice (EBP). The more urgent the question, the greater need to

place it in an EBP context…”Davies KS. Formulating the evidence based practice question: a review of the

frameworks. Evid Based Libr Info Pract. 2011;6(2): 75-80.

Why are questions important?

Background questions involve a single fact-finding mission:• What is Alzheimers disease?

• What does the Ministry of Health do?

• Are e-cigarettes prohibited in Victoria restaurants?

• Is it safe to swim in Victoria Harbour?

Most answers to background Qs involve use of standard textbooks & sources such as standard public health & government websites

Two (2) types of questions: Background OR Foreground

If you don’t know? Ask your librarian…

LIBRARIAN PEARL #3:

http://www.gov.bc.ca/health/

• “About” questions – things, programs, people, organizations

• Textbooks (and Wikipedia) may be useful sources

• Answers may be biased, not wholly reliable or outdated

Background questions

Examples of actual background Qs at MOHS/MCFD “What is the current thinking on knowledge management?” “What are five to ten of the most-cited articles on knowledge management?”

• “About” all the various options available

• Context, location, people (suits PICO)

• To find answers, you must go to literature & find evidence

• Systematic search results provide unbiased view

Foreground questions

http://scholar.google.ca/ http://ph.cochrane.org/

http://pubmed.gov/

1. What communication techniques and key principles are most effective for maternal health promotion to pregnant women of vulnerable populations?

2. Does spending time in nature outdoors positively impact an individual’s mental health and reduce overall health care costs?

3. What sexual and reproductive health strategies are currently being used or in the process of being updated, in Canada (provinces, territories and BC Health Authorities) and Australia?

4. What are the best kinds of tools to help older people (age 65 – 74) plan for healthy aging? (e.g., print resources such as a checklist or online resources that Q&A or provide direction for steps to take)

Background OR foreground?

• Place of residence, locale• Race/ethnicity• Occupation• Gender• Religious affiliation• Education• Socio-economic status• Social capital

Other factors in framing questions (PROGRESS)

LIBRARIAN PEARL #4:

• Linked to / result in policy change — linked to overall goals, plans

• Relevant — will the answer matter?

• Answerable — can question be answered?

• Clear — unambiguous, definite, objective

• Worthy — is answer worth all of the work?

• Applicable — generalizability

A good research question will be:

Librarians are your friends

CONCLUSION

Dean Giustini, UBC biomedical librarianiSchool Faculty

FINAL LIBRARIAN PEARL: