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Evidence Based Practice Tutorial

Ask the Right questions with PICO

PICO is a State of Mind

It helps to get into a mindframe that will help you formulate your question and think deeply about how best to answer it through the research process. There are several ways to formulate a PICO question too, so each question takes a bit of a different form.

Asking the Right Questions

A good question…

  • Focuses on your information needs
  • Identifies crucial search concepts
  • Points you in the direction of potential resources

Form Your Questions







P – Population or Patient or Disease

Characteristics of a population (age, gender, ethnicity, etc) within a specific condition or set of circumstances. Example: Sudanese Refugees

I -Intervention or Exposure

Specific Drug, therapy, or Procedural Intervention

Exposure to certain conditions or risk behavior

Alternative diagnostic tool or procedure

Specific drug or procedural intervention

Specific drug, therapy, or procedural intervention

C – Comparison

Alternative drug, therapy,  or procedural intervention

Absence of certain conditions or risk behavior

Alternative diagnostic tool or procedure

Alternative drug or procedural intervention

Alternative drug, therapy, or procedural intervention

O – Outcome

Management of disease/condition

Development of disease/condition

Effective diagnosis of condition

Prevention of Disease/condition

Occurrence or absence of new condition

T – Time Frame

The time it takes to demonstrate an outcome or the period in which patient are observed. Examplethe six month period following childbirth.


PICO questions are typically used in Nursing and most clinical health research.

Using the COPES (Client-Oriented, Practical Evidence Search) Framework to Ask Evidence-Based Questions

Copes Questions

Client Type and Problem [1]

What you Might Do [2] Alternative Course of Action [3] What you aim to Accomplish [4]

Across:  Four elements of a good question.


DOWN: Five Question Types

Describe the group of clients; be specific about characteristics. Apply a treatment; actions to prevent a problem; measures to assess a problem; client surveys; screening to assess risk alternatives or comparisons of interventions to the methods proposed in column [2]. the outcomes of the treatments from [2] and/or [3]. were there valid measures? Accurate risk estimation, prevented behavior, accurate estimation of need?
Effectiveness If disoriented elderly persons living in residential nursing homes are given reality orientation therapy or validation therapy which will result in better orientation to time, place, and person?
Prevention If sexually active high school students at high risk for pregnancy are exposed to sex education that includes instruction on proper use of birth control methods or Baby-Think-It-Over which group will have knowledge of birth control methods/use birth control methods/have fewer pregnancies?
Assessment If aged residents of a nursing home with alzheimer's or dementia may have depression are administered depression screening tests or a short mental status examination which measure will be the briefest, most inexpensive, valid and reliable test to differentiate between depression and dementia?
Description If family members of persons diagnosed with Aphasia meet for a support group and receive a short client satisfaction questionnaire given to all support group participants   which areas will the clients list as their ares of greasts and least satisfaction?
Risk If those calling a crisis line for a battered women's shelter are administered a risk assessment scale via telephone or are assessed only by the answerer's "practical judgement" without a scale then will the risk scale have a higher reliability and predictive validity regarding future violence?


COPES questions are typically used in Social Work and some other helping professions as a question framework.

PEO Question Framework (for Etiology and Risk reviews)



Characteristics of a population (age, gender, ethnicity, etc) within a specific condition or set of circumstances. Example: Children
Exposure Medical, Behavioral, Occupational or Environmental factors that affect a population. Example:  Traffic-related Pollution
Outcome The result of said exposure on the population. Example:  ADHD diagnosis

SPIDER Question Framework (for Qualitative Reviews)

Sample A segment of a population group--allows for researchers to more deeply consider the sampled nature of Qualitative Research. Example:  Single Dads
Phenomena of Interest Certain behaviors, exposures, decisions, or experiences of interest. Example:  Father involvement programs
Design The theoretical framework used to determine what research methods are appropriate. Example:  focus groups
Evaluation What the researchers assess to determine the impact of the phenomena of interest. Example:  child development
Research Type Three types:  qualitative, quantitative, mixed methods Example:  Qualitative & mixed Methods



ECLIPSE Question Framework (for Policy and Administration Reviews)


Expectation The purpose of the query Example: Looking to improve rehabilitation times after ACL reconstruction surgery. What have others done?
Client Group Who does the query impact Example:  People with reconstructed ACLs
Location What is the setting of the impact Example:  Physical Therapy Clinics
Impact what is the change in the service, if any, which is being looked for? What would constitute success? How is this being measured? Example:  to reduce the number of PT visits post ACL reconstruction
Professionals what qualified staff or individuals are necessary  Example:  Physical Therapists
Service the kinds of services or programs being assessed Example:  exercises, stretches, cryotherapy


CIMO Question Framework (for administration, business, and management)


Context Which individuals, relationships, institutional settings, or wider systems are being studied? Example:  Long-Term care environments
Intervention The effects of what event, action, or activity are being studied? Example:  collective bargaining agreements
Mechanisms What are the mechanisms that explain the relationship between interventions and outcomes? Under what circumstances are these mechanisms activated or not activated? Example:  competitive wage and benefit packages
Outcomes What are the effects of the intervention? How will the outcomes be measured? What are the intended and unintended effects? Example:  decreased turnover in Nursing staff


PICO Question