Background questions are informational questions that improve the understanding of a topic. The questions usually have one or two concepts and do not require the process used in formulating a research or evidence based decision-making questiions. The answers to background questions can be found in books, reference materials and review articles that provide an overview of a topic.
Background questions usually start with what, when, where, how and why in relation to a disorder or aspect of a disorder. (Strauss, SE. et. al. Evidence-based Medicine: How to Practice and Teach EBM. New York: Elsevier, Churchill Livingstone, 2005.)
Answers to these questions can be found in secondary sources (informational articles) and tertiary sources (books). A minimum amount of time (5-10 minutes) is all that is needed to locate an authoritative source and find the answers to these questions.
Foreground questions are more complex than background questions, and usually contain several concepts. When asking a foreground question, the person asking the question is usually seeking a scientific basis as an answer or evidence based information for clinical decision making.
Foreground questions include a broad range of topics including biologic, psychologic and sociologic issues.(Strauss, SE. et. al. Evidence-based Medicine: How to Practice and Teach EBM. New York: Elsevier, Churchill Livingstone, 2005.) Questions arise from 6 aspects of clinical work: Clinical evidence, diagnosis, prognosis, therapy, prevention and education. (Richardson, WS. The Well-built clinical question: a key to evidence-based decisions. ACP Journal Club. 1995, 123(3): A12-3.)
PICO questions are a type of foreground question, but far more complex. PICO questions usually have 4 components or concepts and are used for clinical decision making. These questions compare the interventions, or actions, of health care professionals when caring for patients for the purpose of deciding which intervention is most beneficial. Most PICO questions address therapy and diagnosis.
Notice the order of the question and the components, or concepts, in the complex questions.
For more information, watch this video: Search for Evidence Based Information, by Lynne Fox at the University of Colorado Health Sciences Library, which will go into more detail about background and foreground questions.
This video Formulating Questions and Choosing Patient Important Outcomes from the World Health Organization and McMaster University, is part of the series The Grade Approach--Online Learning Modules for Guideline Development at WHO. The video will advance on it's own, but you may want to watch specific sections again by clicking on the table of contents on the left.