Systematic Reviews
Using a framework to structure your research question
Your systematic review or systematic literature review will be defined by your research question. A well formulated question will help:
- Frame your entire research process
- Determine the scope of your review
- Provide a focus for your searches
- Help you identify key concepts
- Guide the selection of your papers
There are different models you can use to structure help structure a question, which will help with searching.
Selecting a framework
A model commonly used for clinical and healthcare related questions, often, although not exclusively, used for searching for quantitively designed studies.
Example question: Does handwashing reduce hospital acquired infections in elderly people?
| P | Population | Any characteristic that define your patient or population group. | Elderly people |
| I | Intervention | What do you want to do with the patient or population? | Handwashing |
| C | Comparison (if relevant) | What are the alternatives to the main intervention? | No handwashing |
| O | Outcome | Any specific outcomes or effects of your intervention. | Reduced infection |
Richardson, W.S., Wilson, M.C, Nishikawa, J. and Hayward, R.S.A. (1995) 'The well-built clinical question: a key to evidence-based decisions.' ACP Journal Club, 123(3) pp. A12
PEO is useful for qualitative research questions.
Example question: How does substance dependence addiction play a role in homelessness?
| Population/Problem/Patient | Who are the users - patients, family, practitioners or community being affected? What are the symptoms, condition, health status, age, gender, ethnicity? What is the setting e.g. acute care, community, mental health? | homeless persons |
| Exposure | Exposure to a condition or illness, a risk factor (e.g. smoking), screening, rehabilitation, service etc. | drug and alcohol addiction services |
| Outcome | Experiences, attitudes, feelings, improvement in condition, mobility, responsiveness to treatment, care, quality of life or daily living. | reduced homelessness |
Moola S, Munn Z, Sears K, Sfetcu R, Currie M, Lisy K, Tufanaru C, Qureshi R, Mattis P & Mu P. (2015) 'Conducting systematic reviews of association (etiology): The Joanna Briggs Institute's approach'. International Journal of Evidence-Based Healthcare, 13(3), pp. 163-9. Available at: 10.1097/XEB.0000000000000064.
PCC is useful for both qualitative and quantitative (mixed methods) topics, and is commonly used in scoping reviews.
Example question: “What patient-led models of care are used to manage chronic disease in high income countries?"
| Population | "Important characteristics of participants, including age and other qualifying criteria. You may not need to include this element unless your question focuses on a specific condition or cohort." | N/A. As our example considers chronic diseases broadly, not a specific condition/population - such as women with chronic obstructive pulmonary disorder. | |
|---|---|---|---|
| Concept |
|
Chronic disease Patient-led care models |
|
| Context | "May include... cultural factors such as geographic location and/or specific racial or gender-based interests. In some cases, context may also encompass details about the specific setting." | High income countries |
Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis, JBI, 2020. Available from https://synthesismanual.jbi.global . https://doi.org/10.46658/JBIMES-20-12
A model useful for qualitative and mixed method type research questions.
Example question: What are young parents’ experiences of attending antenatal education? (Cooke et al., 2012)
| S | Sample | The group you are focusing on. | Young parents |
| P of I | Phenomenon of interest | The behaviour or experience your research is examining. | Experience of antenatal classes |
| D | Design | How the research will be carried out? | Interviews, questionnaires |
| E | Evaluation | What are the outcomes you are measuring? | Experiences and views |
| R | Research type | What is the research type you are undertaking? | Qualitative |
Cooke, A., Smith, D. and Booth, A. (2012) 'Beyond PICO: the SPIDER tool for qualitative evidence synthesis.' Qualitative Health Research, 22(10) pp. 1435-1443
A model useful for qualitative and mixed method type research questions.
Example question: How effective is mindfulness used as a cognitive therapy in a counseling service in improving the attitudes of patients diagnosed with cancer?
| S | Setting | The setting or the context | Counseling service |
| P | Population or perspective | Which population or perspective will the research be conducted for/from | Patients diagnosed with cancer |
| I | Intervention | The intervention been studied | Mindfulness based cognitive therapy |
| C | Comparison | Is there a comparison to be made? | No comparison |
| E | Evaluation | How well did the intervention work, what were the results? | Assess patients attitudes to see if the intervention improved their quality of life |
Example question taken from: Tate, KJ., Newbury-Birch, D., and McGeechan, GJ. (2018) ‘A systematic review of qualitative evidence of cancer patients’ attitudes to mindfulness.’ European Journal of Cancer Care, 27(2) pp. 1 – 10.
A model useful for qualitative and mixed method type research questions, especially for question examining particular services or professions.
Example question: Cross service communication in supporting adults with learning difficulties
| E | Expectation | Purpose of the study - what are you trying to achieve? | How communication can be improved between services to create better care |
| C | Client group | Which group are you focusing on? | Adult with learning difficulties |
| L | Location | Where is that group based? | Community |
| I | Impact | If your research is looking for service improvement, what is this and how is it being measured? | Better support services for adults with learning difficulties through joined up, cross-service working |
| P | Professionals | What professional staff are involved? | Community nurses, social workers, carers |
| S | Service | Which service are you focusing on? | Adult support services |
You might find that your topic does not always fall into one of the models listed on this page. You can always modify a model to make it work for your topic, and either remove or incorporate additional elements.
The important thing is to ensure that you have a high quality question that can be separated into its component parts.