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Alternatives to PICO for Non-Clinical Research Questions

What is PICO?

PICO(T) is the most common question frame used in health sciences research, where the question is composed of the:

  • Population/Problem/Patient. What is the problem to be addressed? ...
  • Intervention. What is the relevant treatment or exposure? ...
  • Comparison. ...
  • Outcome. ...
  • Timeframe or Type of Study (Optional)

However ... not every research question is a clinical one that fits nicely into that particular format.

What PICO does is provide a framework for structuring a research question.  And frameworks are useful, because their structure helps you to identify keywords that you can use to search.  When you want to pursue inquiry that does not fit PICO, there are alternative frameworks you can explore.

That "C" in PICO

Sometimes PICO doesn't feel like it fits simply because of the "C," or comparison element.  

Not every clinical question needs a comparator.   And frankly, it's hard to find research that compares two different interventions in the same article.

Recommendations:

1.  Consider implicit comparisons, instead of explicit (intervention to intervention).  Implicit comparisons might be standard care, placebo, an intervention versus a non-intervention, etc.

2.  Reframe how you think of the "C" - "Comparison."  You don't always need one.  So instead of going into a PICO thinking you must compare two items, instead use the "C" to determine whether you need to compare at all.   Ask, "Is there another intervention to compare with the one I am interested in?" 

  • If "yes," identify that intervention and continue on. 
  • If "no," that's all the C you need.  

3.  Finally, if you do have two interventions to compare, know that making the comparison will fall to you in your literature review.  Few articles will actually research two different interventions and compare them for you.  While you can structure a PICO question to propose the comparison, you will need two research strategies.

Search One:   Population | Intervention One | Outcome

Search Two:  Population | Intervention Two | Outcome

During the course of your writing about these interventions, you will provide the C, or comparison.

Variations of PICO

Sometimes all you need is a slight modification to PICO to make the format work for your purposes.

Remember that it's the framework or structure that PICO (and its variations) provides that is its biggest benefit.  There is no reason you can't use a variation on that framework.


Situation:  I haven't identified an intervention.

Variation:  Try PECO.  Replace "Intervention" (a planned procedure) with "Exposure" (an unintentional occurrence or happening.)  PECO is a framework for formulating good questions to explore the association of environmental and other exposures with health outcomes.

Explanation Example:  Imagine you want to investigate whether noise exposure in the field of aviation leads to higher levels of hearing impairment amongst pilots.
Population Commercial airline pilots
Exposure Occupational exposure to noise
Comparison Occupational exposure to noise in other professions
Outcome Incidence of hearing impairment

Situation:  I'm interested in social interventions, ones that are depending on context for effectiveness.

Variation:  Try PICOC.  Add a "C" for "Context.  PICOC is a solid strategy for questions relating to cost effectiveness, economic evaluations, service improvements etc.  

Explanation Example: What is the cost effectiveness of self monitoring of blood glucose in type 2 diabetes in high income countries?
Patient, Population or Problem - who and/or what is my question focused on? Patients with Type 2 Diabetes
Intervention - what intervention is being considered? Self-monitoring of blood glucose
Comparison - what intervention is this being compared with? (a comparison is not always necessary) N/A
Outcomes - what do you hope to accomplish, improve or affect? Cost-effectiveness
Context- in what context or place is the problem set? High-income countries

Situation:  I want to look more deeply into the prevalence of a condition, disease, problem, or symptom, but I don't necessarily have an intervention identified or want to compare interventions.

Variation:  Use CoCoPop.

Explanation Example:  What is the prevalence of claustrophobia in adult patients undergoing MRI?

COndition

Which condition, disease, problem or symptom are you looking at?

Claustrophobia

COntext

When is this happening?

Where is this happening? (Geographical location, e.g. Australia / Service location, e.g. hospital)

MRI

POPulation

How is your population defined? (e.g. age, gender, ethnic group …)

Adults

Situation:  I want to investigate attitudes or opinions.

Variation:  Use SPICE, a framework for qualitative questions evaluating experiences, meaningfulness etc.

Explanation Example:  I want to know what caregivers of dementia patients think about reminiscence therapy.
Setting - where is the study set e.g. in a specific country, community, in a hospital, in a care home etc. This could be a country, or it could be nursing homes, memory care facilities, 
Population or Perspective: from whose perspective is the study done, e.g. the patients, the health professionals., the caregivers, etc. Caregivers
Intervention - what intervention is being examined? Reminiscence therapy
Comparison - is the intervention being compared with another? No comparison
Evaluation - the outcome measures Attitudes

 

ECLIPSE: A Framework for Health Policy and Management

The ECLIPSE framework can be very helpful when structuring a research question related to healthcare management.

Imagine that you have explained your research topic as follows:

There is a lack of continuity of care in my area for people with head injuries who are discharged from hospital to the community rehabilitation service. I would like to improve the discharge procedure to avoid this problem. The service involves both community health staff and social services. Has anyone else experienced similar problems and how have they overcome them?

  Item What does it mean? Example
E Expectation What does the search requestor / student want the information for?  Improvement, innovation, or information? I’m looking to improve the discharge procedure from the hospital to the community where rehabilitation will continue. What have other people done?
C Client group At whom is the service aimed? For example, older people, black and ethnic minority groups, people with a specific condition. People with head injuries.
L Location Location—where is the service sited? Is it in primary care, secondary care, community-based, across the entire healthcare system? Community
I Impact What is the change in service, if any, that is sought?  What would constitute success?  How is this being measured? Improved continuity of care; patient satisfaction increased; greater sense of communication between professionals.
P Professionals Who is involved in providing/improving the service? For example, doctors, nurses, lay people, social services. Hospital nurses, community staff, social services.
S Service What is the service area?  Outpatient services, intermediate care, nurse-led clinical site, etc. Community rehabilitation service.

 

Note:  there is no final "E" in the ECLIPSE acronym.