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Systematic Reviews

2. Develop a Research Question

A well-developed and answerable question is the foundation for any systematic review. This process involves:

  • Systematic review questions typically follow a PICO-format (patient or population, intervention, comparison, and outcome)
  • Using the PICO framework can help team members clarify and refine the scope of their question. For example, if the population is breast cancer patients, is it all breast cancer patients or just a segment of them? 
  • When formulating your research question, you should also consider how it could be answered. If it is not possible to answer your question (the research would be unethical, for example), you'll need to reconsider what you're asking
  • Typically, systematic review protocols include a list of studies that will be included in the review. These studies, known as exemplars, guide the search development but also serve as proof of concept that your question is answerable. If you are unable to find studies to include, you may need to reconsider your question

Other Question Frameworks

PICO is a helpful framework for clinical research questions, but may not be the best for other types of research questions. Did you know there are at least 25 other question frameworks besides variations of PICO?  Frameworks like PEO, SPIDER, SPICE, and ECLIPS can help you formulate a focused research question. The table and example below were created by the Medical University of South Carolina (MUSC) Libraries.


The PEO question framework is useful for qualitative research topics. PEO questions identify three concepts: population, exposure, and outcome.
Research question: What are the daily living experiences of mothers with postnatal depression?

Element Definition Example
Population Who is my question focused on? mothers
Exposure What is the issue I am interested in? postnatal depression
Outcome What, in relation to the issue, do I want to examine? daily living experiences


The SPIDER question framework is useful for qualitative or mixed methods research topics focused on "samples" rather than populations. SPIDER questions identify five concepts: sample, phenomenon of interest, design, evaluation, and research type.

Research question: What are the experiences of young parents in attendance at antenatal education classes?

Element Definition Example
Sample Who is the group of people being studied? young parents
of Interest
What are the reasons for behavior and decisions? attendance at antenatal education classes
Design How has the research been collected (e.g., interview, survey)? interviews
Evaluation What is the outcome being impacted?


Research type What type of research (qualitative or mixed methods)? qualitative studies



The SPICE question framework is useful for qualitative research topics evaluating the outcomes of a service, project, or intervention. SPICE questions identify five concepts: setting, perspective, intervention/exposure/interest, comparison, and evaluation.

Research question: For teenagers in South Carolina, what is the effect of provision of Quit Kits to support smoking cessation on number of successful attempts to give up smoking compared to no support ("cold turkey")?

Element Definition Example
Setting Setting is the context for the question (where). South Carolina
Perspective Perspective is the users, potential users, or stakeholders of the service (for whom). teenagers
Intervention / Exposure Intervention is the action taken for the users, potential users, or stakeholders (what). provision of Quit Kits to support smoking cessation
Comparison Comparison is the alternative actions or outcomes (compared to what).

no support or "cold turkey"

Evaluation Evaluation is the result or measurement that will determine the success of the intervention (what is the result, how well). number of successful attempts to give up smoking with Quit Kits compared to number of successful attempts with no support



The ECLIPSE framework is useful for qualitative research topics investigating the outcomes of a policy or service. ECLIPSE questions identify six concepts: expectation, client group, location, impact, professionals, and service.

Research question: How can I increase access to wireless internet for hospital patients?

Element Definition Example
Expectation What are you looking to improve or change? What is the information going to be used for? to increase access to wireless internet in the hospital
Client group Who is the service or policy aimed at? patients and families
Location Where is the service or policy located? hospitals
Impact What is the change in service or policy that the researcher is investigating? clients have easy access to free internet
Professionals Who is involved in providing or improving the service or policy? IT, hospital administration
Service What kind of service or policy is this? provision of free wireless internet to patients