# Welcome to SMIRK Unit
2 - PICO

- The PICO framework
- PICO: the elements in more detail
- PICO example
- Question templates
- Question templates - continued
- Some final points
- Back to main index

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SMIRK - Developing a practice based question by Jamie Frankis, Lesley Price, Ima Jackson SHLS modified by Marion Kelt, Glasgow Caledonian University is licensed under a Creative Commons Attribution 4.0 International License.

# The PICO framework

- Population
- Intervention
- Comparison
- Outcome

> ###### (CASP, 2002, p10)

Population: the situation, population or person you are interested in (for example, elderly in-patients with problems of compliance with treatment). They may seem easy to identify, however, without explicit description of who the population is, the clinician can get off on the wrong foot in searching. Careful consideration of the patient and the setting of interest is a good idea. Limiting the population to a certain age group or other special subgroup is also useful.

Intervention: the thing that you think will make a difference, for instance - a self-medication training package (an intervention may not always be required or appropriate, depending on the type of question). The intervention may include but is not limited to: any exposure, treatment, patient perception, diagnostic test, or prognostic factor. The more specifically the intervention of interest is defined, the more focussed the search will be.

Comparison: the comparison is measured against the intervention (a comparison is not always required or appropriate depending on the type of question). The comparison needs special consideration. The comparison can be a true control, such as a placebo. More commonly the comparison is another treatment, sometimes the usual standard of care. For example a comparison to the ‘self training medical package’ could be nurse delivered instructions. If there is no standard of care, the comparison may be ‘no treatment’ or ‘no intervention’ .

Outcome: the outcome is the end point of interest.
Specifically identifying the outcome enables the researcher to find evidence that examined the same outcome variable. This is important because sometimes a variable may be measured in different ways. For example, smoking cessation may be measured in terms of the proportion of people who quit for 3 months, or the average reduction in cigarettes smoked per person over 3 months.

Melnyk, B.M. & Fineout-Overholt, E. 2005, Evidence-based practice in nursing & healthcare: a guide to best practice, Lippincott Williams & Wilkins, Philadelphia.
Critical Appraisal Skills Programme. (CASP) (2002) Evidence-based Health Care, CASP: Milton Keynes

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SMIRK - Developing a practice based question by Jamie Frankis, Lesley Price, Ima Jackson SHLS modified by Marion Kelt, Glasgow Caledonian University is licensed under a Creative Commons Attribution 4.0 International License.

# PICO: the elements in
more detail

The patient population or disease of interest:

- With certain disorder (arthritis)
- Age
- Gender
- Ethnicity

The intervention used in the study, if applicable

The alternative to the intervention (such as the comparison) if applicable

- BUT
- For many questions, there is no intervention, only an issue of interest

Outcome of interest for example:

- Risk of disease
- Accuracy of diagnosis
- Rate of occurrence of adverse outcome such as death
- Attitudes, values, perceptions, experiences

These are some examples of outcome that may be specified. It is important to make your outcome specific, to save wasting search time. However, the tricky part is to be specific enough to avoid wasting time but not so specific that you fail to find potentially useful research. Start by taking a quite narrow focus, then if this doesn’t find enough useful research, try widening your search bit by bit.

Melnyk, B.M. & Fineout-Overholt, E. 2005, Evidence-based practice in nursing & healthcare: a guide to best practice, Lippincott Williams & Wilkins, Philadelphia.

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SMIRK - Developing a practice based question by Jamie Frankis, Lesley Price, Ima Jackson SHLS modified by Marion Kelt, Glasgow Caledonian University is licensed under a Creative Commons Attribution 4.0 International License.

# PICO example

Population | Intervention | Comparison | Outcome
--- | --- | --- | ---
Rent boys < 25 years Glasgow | Saliva HIV testing intervention Street based | Blood HIV testing intervention Clinic based | Know which service is more acceptable to population

Here is a PICO framework completed for one topic which may lead to the practice based question of :

How acceptable would a street-based saliva HIV testing intervention be to rent boys under 25 in Glasgow compared to a clinic based service?

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SMIRK - Developing a practice based question by Jamie Frankis, Lesley Price, Ima Jackson SHLS modified by Marion Kelt, Glasgow Caledonian University is licensed under a Creative Commons Attribution 4.0 International License.

# Question templates

It may also help you to identify and focus your practice based question by considering what type of question you can ask about your topic. Here are six types of questions that could be asked, with examples. The population, intervention, comparison and outcome for each question is pointed out to further show the use of the PICO framework . This shows how using both PICO and considering the question type can help you to develop a focused practice based question.

Therapy questions

- In **** what is the effect of **** on **** compared with ****?
- In male middle-aged long-term smokers (P) what is the effect of smoking cessation groups (I) on success rates (O) compared to the use of nicotine patches (C)?

Causation questions

- Are **** who have **** at **** risk for/of **** compared with **** with/without ****?
- Are 30-50 year old women (P) who have high blood pressure (I) at increased risk for myocardial infarction (O) compared with women without high blood pressure (C)?

Diagnostic question

- Are (is) **** more accurate in diagnosing **** compared with ****?
- Is the Edinburgh Post-Natal Depression Scale (I) more accurate in diagnosing (O) PND (P) than a generic mental health depression scale? (C) ?

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SMIRK - Developing a practice based question by Jamie Frankis, Lesley Price, Ima Jackson SHLS modified by Marion Kelt, Glasgow Caledonian University is licensed under a Creative Commons Attribution 4.0 International License.

# Question templates -
continued

Prevention question

- For **** does the use of **** reduce the future risk of **** compared with ****?
- For patients 65 years and older (P) does the use of flu vaccine (I) reduce the future risk of pneumonia (O) compared with patients who have not received the vaccine? (C).

Prognosis question

- Does **** influence **** in people who have ****?
- Does the number of sexual partners (I) influence the infertility rate (O) in sexually active women under 25 years of age in Scotland? (P)

Meaning and experiences

- How do **** diagnosed with **** perceive ****?
- What are the experiences of **** who have **** ?
- How do carers (P) of relatives diagnosed with Alzeimer’s disease perceive their support needs (O) ?

The next section will look at SPICE in detail and give you some general pointers and conclusions.

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SMIRK - Developing a practice based question by Jamie Frankis, Lesley Price, Ima Jackson SHLS modified by Marion Kelt, Glasgow Caledonian University is licensed under a Creative Commons Attribution 4.0 International License.

# Some final points

- There are a range of situations where evidence is needed to enhance practice
- There are different types of questions to yield different information
- It is important to focus questions
- Use the PICO or SPICE framework to assist question development

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SMIRK - Developing a practice based question by Jamie Frankis, Lesley Price, Ima Jackson SHLS modified by Marion Kelt, Glasgow Caledonian University is licensed under a Creative Commons Attribution 4.0 International License.