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Search Biomedical Literature: A How-To Guide

Overview of steps and resources to assist researchers searching biomedical literature

Step 1: Develop a Research Question

Develop a Research Question

Formulating a clear, well-defined research question of appropriate scope is key to a successful evidence synthesis. Use a framework to structure your research question by clarifying the main concepts of your topic you want to focus on. Your topic may not fit perfectly into a framework, just using part of a framework can be sufficient.

The framework you should use depends on the type of topic you will be researching.

The most common frameworks are:

  • PICO (for clinical / quantitative research topics) 
  • PICo, PEO, SPIDER or SPICE  (for qualitative research topics)
  • CLIP or ECLIPSE  (for topics relating to health management, policies, economics)

Please view the chart below for more information.

Source: Frameworks reproduced and modified with gratitude from the University of London: Using a framework to structure your question Research Guide.

Research Question Frameworks

Identify the PICO elements

(P) Patient, Population or Problem - This may include the primary problem, disease, or existing conditions. Sometimes the gender, age, or race of a patient may be relevant to the diagnosis or treatment of a disease.
(I) Intervention - Which main intervention, prognostic factor, or exposure are you considering? Or what factor may influence the prognosis of the patient - age, co-existing problems, or previous exposure?
(C) Comparison - What is the main alternative to compare with the intervention? 
(O) Outcomes - What are you hoping to accomplish, improve or affect?

Example:  Amongst children how does alternative therapies compare to pain medication for controlling headaches?

P - Children

I - Alternatives to drugs (complementary therapies? changes to lifestyle?)

C - Pain medication

O - Controlling headaches

Extensions to PICO

There are extensions to the PICO framework available which you can use if your topic has additional concepts:

PICOSS stands for study designs. Use framework if you are only interested in examining specific designs of study.

PICOT- T stands for timeframe. Use framework if your outcomes need to be measured in a certain amount of time - e.g. 24 hours after surgery.

PICOC- C stands for context. Use this framework if you are focusing on a particular organization or particular circumstances.

Source: Frameworks reproduced and modified with gratitude from the University of London: Using a framework to structure your question Research Guide.

Identify the PICo elements:

(P) Patient, Population or Problem- Who and/or what is my question focussed on? 

(I) Interest - A defined event, experience, activity or process.

(Co) Context - A setting or distinct characteristics.


Example: What are the experiences of patients with pressure sores who receive treatment at home?

P - Patients with pressure sores

I - Experiences, views, opinions

Co  - Care in the home

Identify the PEO elements:

(P) Population - who is my question focussed on?

(E) Exposure - what is the issue I'm interested in?

(O) Outcomes or themes - what, in relation to the issue, do I want to examine?

Example: The daily living experiences of mothers with postnatal depression

P- mothers

E- postnatal depression

O- experiences of daily living/quality of life

Identify the SPICE elements:

(S) Setting - Where is the study set e.g. in a specific country, community, in a hospital, in a care home etc.
(P) Perspective - From whose perspective is the study done e.g. the patients, the health professionals., the carers etc.
(I) Intervention - What intervention is being examined?
(C) Comparison - Is the intervention being compared with another?
(E) Evaluation - The outcome measures

Example: Amongst those living in long term facilities, what are the attitudes of carers of people with dementia towards reminiscence therapy?

S - long term care facilities

P - carers

I - reminiscence therapy


E - attitudes

Identify the SPICER elements:

(S) Sample - the group of people being looked at, because qualitative research is not easy to generalize, sample is preferred over patient.
(PI) Phenomenon of Interest -  reasons for behaviour and decisions, rather than an intervention.
(D) Design - the form of research used, such as interview or survey.
(E) Evaluation - outcome measures.
(R) Research type - qualitative, quantitative and/or mixed methods.

Example:  What are the experiences of first time parents attending antenatal classes at Island Health?

S - First time parents

PI - Attendance at ante-natal education classes

D - Interviews

E - Experiences

R - Qualitative studies

Identify the elements of CLIP:

(C) Client – who is the service aimed at?

(L) Location – where is the service sited?

(I) Improvement – what do you want to find out?

(P) Professional – who is involved in providing/improving the service?

Example: How can the clinic improve delivery of tele-health services to elderly patients in rural communities?

C - Elderly patients

L - Rural communities

I - How services can be improved

P - Tele-health professionals

Identify the elements of ECLIPS(E):

(E) Expectation - What is the information needed for?
(C) Client Group - Who is the information needed for e.g. health managers, GPs, patients
(L) Location - Where is the client group or service located
(I) Impact - What is the change in the service, if any, which is being looked for? What would constitute success? How is this being measured?
(P) Professionals - What health professionals are involved in the service?
(S) Service - For which service are you looking for information? For example, outpatient services, nurse-led clinics, intermediate care.


Example: Amongst medical students, what is the retention of female students?

E- To find out retention rates

C- School administrators


I- Retention of female students

P- Medical students

S- Physicians

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