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Systematic Reviews

Develop a Focused Research Question

Frameworks have been designed to structure research question.  It helps user to easily identify the key concepts of the research question. For example, using PICO framework to answer the clinical question. It is not necessary to conform to any framework if the topic cannot fit in. The alternative is to use the concept framework, i.e. to identify the key concepts to structure the search accordingly.  

It is important to discuss and find out more while working with a librarian if you are able to structure research question and retrieve enough studies based on the preliminary search using key concepts.

PICO for quantitative studies

PICO is a useful tool for asking quantitative focused questions and to translate the search question in search concepts.

Here is an example on how to formulate a more specific research question using the PICO formulation:

Topic: Sleep quality of dementia patient

Less specific: How to improve sleep quality of dementia patient

More specific: Light therapy for improving cognition, activities of daily living, sleep, challenging behaviour, and psychiatric disturbances in dementia. Source:


For a less specific research question, your initial search terms might be : "Sleep quality" AND dementia.

With a specific type of intervention such as light therapy for a specific group of population, the desired outcomes can be more than just sleep quality. Initial search terms can then be changed to: (Light therapy OR phototherapy) AND dementia 

This table depicts PICO as well as variants of PICO such as PIO/PECO/PICo:

PICO/PECO/PICOC/PICOS Elements Example based on above specific topic
P Problem/population Dementia
I/E Intervention (practice or program) /Exposure Light Therapy
C Control, Comparison Usual Care
O Outcome improving cognition, activities of daily living, sleep, challenging behaviour, and psychiatric disturbances
Framework Elements Source Diciplines
PICO Patient

Eriksen, M. B., & Frandsen, T. F. (2018). The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. Journal of the Medical Library Association : JMLA106(4), 420–431.

Clinical medicine


+context, patient values, and preferences

Bennett, S., & Bennett, J. W. (2000). The process of evidence‐based practice in occupational therapy: Informing clinical decisionsAustralian Occupational Therapy Journal, 47(4), 171-180. Occupational therapy



Petticrew, M., & Roberts, H. (2006). Systematic reviews in the social sciences: A practical guide. Malden, MA: Blackwell Publishers.  Social Sciences


Study Type

Methley, A. M., Campbell, S., Chew-Graham, C., McNally, R., & Cheraghi-Sohi, S. (2014). PICO, PICOS and SPIDER: a comparison study of specificity and sensitivity in three search tools for qualitative systematic reviewsBMC health services research14, 579. Medicine



Riva, J. J., Malik, K. M., Burnie, S. J., Endicott, A. R., & Busse, J. W. (2012). What is your research question? An introduction to the PICOT format for cliniciansThe Journal of the Canadian Chiropractic Association56(3), 167–171. Education, health care
PICO specific to diagnostic tests Patient/participants/population
Index tests
Comparator/reference tests
Kim, K. W., Lee, J., Choi, S. H., Huh, J., & Park, S. H. (2015). Systematic review and meta-analysis of studies evaluating diagnostic test accuracy: A practical review for clinical researchers - Part I. General guidance and tips. Korean Journal of Radiology, 16(6), 1175-1187. Diagnostic questions


Adapted from :Foster, M. & Jewell, S. (Eds). (2017). Assembling the pieces of a systematic review: Guide for librarians. Medical Library Association, Lanham: Rowman & Littlefield. p. 38-39, Table 3.3

Other Frameworks

The PEO question format is useful for qualitative research topics. 

Here is an example on how to formulate a more specific research question using the PEO formulation:

Topic: Association of sleep duration in middle and old age with incidence of dementia 


PEO Elements Example
P Population Aged between 50-70 (middle and old age) 
E Exposure Sleep duration (less than 6 hours compared to normal) 
O Outcome Dementia 

Comment: To get a broader set of result, the initial search terms could be "sleep" AND dementia

Khan, K. S., Kunz, R., Kleijnen, J., & Antes, G. (2003). Systematic reviews to support evidence-based medicine: How to review and apply findings of healthcare research. London: Royal Society of Medicine Press.


Using the SPIDER tool enabled us to search the literature in this exploratory study in a more timely and sensitive manner because of the suitability of the refined components for qualitative and mixed-methods research.  

Here is an example on how to formulate a more specific research question using the PEO formulation:

Topic: First-time parents’ prenatal needs for early parenthood preparation-A systematic review and meta-synthesis of qualitative literature 


SPIDER Elements Example
S Sample First-time parents
PI Phenomenon of interest antenatal education 
D Design Interview/discussion
E Evaluation  experience 
R Research Type  qualitative 

Comment: Depends on the number of results, you may want to draft your initial search as  “first-time parents” AND “parenthood preparation” which is S and PI. The other elements such as D, E and R can be added later on to look for a specific type of study related to the main focus.

Cooke A, Smith D, Booth A. Beyond PICO: The SPIDER tool for qualitative evidence synthesis. Qualitative Health Research 2012;22(10):1435-43. doi: 10.1177/1049732312452938

SPICE was developed in the context of evidence-based librarianship and subsequently promoted by the Joanna Briggs Institute for qualitative systematic reviews

Here is an example on how to formulate a more specific research question using the PEO formulation:

Topic: A systematic review of qualitative evidence of cancer patients’ attitudes to mindfulness 


SPICE Elements Example
S Setting Clinical setting
P Perspective Experiences and perspectives of mindfulness interventions following a cancer diagnosis 
I Interest  Mindfulness and cancer care
C Comparison  control group 
E Evaluation

(1) Coping strategies developed through mindfulness  

(2) Positive outcomes of mindfulness practice  

(3) Challenges with engaging in mindfulness practice  

(4) Group identification and shared experiences 

Comment:  Initial search terms could be mindfulness AND cancer AND diagnos* AND (coping OR outcome OR challeng* OR experience) 

Booth A. Clear and present questions: formulating questions for evidence based practice. Library Hi Tech 2006;24(3):355-68. doi: 10.1108/07378830610692127

ECLIPSE search strategy, which was introduced to handle health management topics.

Here is an example on how to formulate a more specific research question using the PEO formulation:

Topic: Interventions to improve discharge from acute adult mental health inpatient care to the community: systematic review and narrative synthesis 


ECLIPS(E) Elements Example
E Expectation Interventions to improve the discharge procedure from the hospital to the community where rehabilitation will continue.
C Client Acute mental health inpatient
L Location Community.
I Impact Reduced readmission, improved wellbeing, reduced homelessness, improved treatment adherence, accelerated discharge, reduced suicide. 
P Professionals Hospital nurses, community staff, social services.
S Service Community rehabilitation service.

Comment: The initial search terms could be "mental health" AND discharg* AND intervention*

Wildridge, V., & Bell, L. (2002). How CLIP became ECLIPSE: A mnemonic to assist in searching for health policy/management information. Health Information & Libraries Journal, 19(2), 113–115.

SDMO approach for if for methodology systematic reviews where they can be performed to examine any methodological issues relating to the design, conduct and review of research studies and also evidence syntheses. 

Topic: Characteristics of Qualitative Descriptive Studies: A Systematic Review 


SDMO Elements Example
S Studies  
D Data  
M Methods  
O Outcomes  

Munn, Z., Stern, C., Aromataris, E. et al. What kind of systematic review should I conduct? A proposed typology and guidance for systematic reviewers in the medical and health sciences. BMC Med Res Methodol 18, 5 (2018).

CoCoPop Elements Example
Co Condition  
Co Context  
Pop Population  

Munn Z, Moola S, Lisy K, et al. Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. Int J Evid Based Healthc 2015;13(3):147-53. doi: 10.1097/XEB.0000000000000054

PFO Elements Example
P Population  
F Prognostic Factors (or models of interest)  
O Outcome  

Dretzke J, Ensor J, Bayliss S, et al. Methodological issues and recommendations for systematic reviews of prognostic studies: an example from cardiovascular disease. Syst Rev 2014;3:140. doi: 10.1186/2046-4053-3-140 [published Online First: 2014/12/04]