Ask - answerable questions

The first step in the EBP process is to translate your information need into an answerable and searchable question. This will help you to:

• focus on the key issues
• identify what evidence is needed to answer your question
• perform an efficient search for evidence

To make it easier to find an answer, time needs to be spent on structuring and refining your question. A useful process is to break your question into parts using a search mnemonic.

Search mnemonics

• Search mnemonics or frameworks (e.g. PICO) help you focus and break down your research question or scenario into concepts
• A mnemonic is a memory aid
• Some frameworks are more suitable for particular types of studies (e.g. quantitative, qualitative, mixed-methods etc.)

Why use them?

• To help identify key concepts
• To find relevant results/evidence
• Provides an opportunity to brainstorm

When to use them?

• At university when you are looking for evidence to support your assignments
• In practice when supporting patients or clients

Whilst structuring your clinical question using PICO is an important aspect of Evidence Based Practice, it may not be necessary to include all of the concepts in your search. Only use those concepts that can be clearly defined and translated into search terms.

The PICO framework can provide a useful structure to guide the development of your question. Think about your information need and identify:

• P - the population, patient or problem being addressed
• I - what main intervention or issue are you considering?
• C - what will the intervention/issue be compared to? (not all questions will include a comparison)
• O - what outcome does the intervention/issue seek to accomplish, measure, improve or affect?

Questions can be constructed as:

In P, how does I compared to C affect O?

You might also add:

Research design - which study type is most appropriate to answer this question?

Example

Isobel is a 72 year old woman who recently had a fall in her home. Her injuries were mild but she is anxious about it happening again. She has asked for advice on how she can reduce the likelihood of further falls. You think that a Tai Chi exercise program may help.

Question: In the elderly, does Tai Chi reduce the risk of falls?

For each concept, identify related keywords and synonyms.

The next step will be to translate your PICO concept map into a database search. The Health Databases guide includes help on how to use database features (such as subject headings and truncation) to search effectively.

SPIDER provides an alternative to PICO which may be helpful for qualitative questions:

Example

What are the experiences of elderly women in the community who have experienced falls?

'Formulating your question' - used with permission from Cushing/Whitney Medical Library, Yale University