health research questions and answers

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Formulating a Research Idea

Refining your question, developing your research question, frameworks for research questions.

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Start with a broad topic - it could be a health condition, procedure or tool, a research methodology, or health care policy. Most importantly it should be of interest to you. You can find ideas in text books, medical dictionaries and encyclopedias, review articles, conference proceedings and abstracts, and by checking out the bibliographies in each resource. Also, don't forget that many ideas start by talking with colleagues or professors!

A good research question will meet the FINER criteria developed by Hulley et al (2007). It will be:

Hulley S, Cummings S, Browner W, et al. Designing clinical research. 3rd ed. Philadelphia (PA): Lippincott Williams and Wilkins; 2007.

Why should I formulate a structured research question?

• To point you in a specific direction
• To identify your key/main concepts 
• To help build your literature search strategy
• To improve your information retrieval
• To give you a way of evaluating answers

What characterizes a good question?

• Well-conceptualized
• Well-developed
• Direct and clear
• Includes all components

Where do questions fit into  evidence-based practice ?

• Formulate the question
• Search for the evidence
• Appraise the evidence
• Apply the results
• Evaluate the process

What does an undeveloped question look like?

• "Is there a benefit in starting a program to prevent elderly clients from falls at home?”

What does a well-formulated question look like?

• “Is a fall prevention program more effective than education upon discharge from acute care in decreasing the incidence of falls in elderly clients who live independently at home?” (Lou & Durando, 2008, p. 98)

Applying a framework when developing a research question can help to identify the key concepts and determine inclusion and exclusion criteria.

Example: PICO Question

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• Last Updated: Oct 10, 2024 11:38 AM
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Sample Questions & Answers

The studies referenced here were reported in peer-reviewed publications as systematic reviews, hypothesis tests, or predictive analyses. Although the results are valid for the institutions they represent, they may not be valid for other organizations with different technical capacities, project management expertise, organizational culture, or human and economic resources - all of which may affect cost. In addition, these studies may not contain the full technical details of how health information technology was implemented or how it operates. Thus, these results are best used as general guidelines for determining costs and benefits rather than as absolutes, because they may not hold true for all organizations. Please refer to Chapter 4 of "Costs and Benefits of Health Information Technology," AHRQ Publication No. 06-E006, for additional information on the limitations and conclusions of the studies included in the evidence report.

• I am in a four-person practice. What will the cost of an electronic medical record (EMR) implementation be for me?
• We are a small practice being asked to participate in a regional health information exchange. What are the pros and cons of doing this? What workflow and productivity changes can we expect?
• I want to implement computerized physician order entry (CPOE) in my hospital. What is the cost? What are the caveats?
• We are a small practice interested in improving care effectiveness by implementing an electronic health record (EHR) system. What does the research tell us on whether and how we can succeed?
• We've been asked to implement a computerized physician order entry (CPOE) CPOE system as part of a patient safety initiative. What can we really expect in terms of health benefits from CPOE? 

Question 2. We are a small practice being asked to participate in a regional health information exchange. What are the pros and cons of doing this? What workflow and productivity changes can we expect? Checking Data Exchange and all the boxes under cost/benefits outcomes we get the following:

NOTE: Below is an example screenshot of the search criteria you can use. Perform a search on the database .

The second article describes the cost of implementing a health information exchange. The summary is presented below. Estimated cost is $20,000 for software and $15,000 for interfaces per facility.

• Settings : N/A
• Evaluation Method : Mixed methods were used to define the models and estimate costs. An expert panel defined a functional model for a national health information network. The panel achieved consensus through a modified Delphi method. Estimates for costs were based on data taken from the Santa Barbara County Data Exchange, a regional network designed to exchange health data within Santa Barbara County, CA. Secondary data were taken from the 2000 U.S. Census Bureau and the National Center Health Statistics.
• Description : The model delineates a national health information network that is "achievable and desirable" in five years rather than an "ideal infrastructure." The projects expert panel selected the following functional domains to be critical to a national health information network: inpatient/ outpatient results viewing, Electronic Health Records, computerized provider order entry, electronic claims submission, electronic eligibility verification, secure electronic patient communication, and electronic prescriptions.
• Interoperability : The model assumes a brokered peer-to-peer architecture in which data were exchanged over the internet. Interoperability in the model is supported through software interfaces being implemented to allow different Health IT systems to exchange data.
• Barriers : Costs, complexity of integration of information through software interfaces.
• Costs: Total costs to achieve a national health information network in five years were estimated to be $156 billion dollars in capital costs and $48 billion per year in operating costs.
• Cost of Health IT systems : The total cost to achieve functionality of a model network in five years was estimated to be $103 billion in capital costs. The total costs to construct a brokered peer-to-peer communication network was estimated to be $53 billion in capital costs.
• Cost of Implementation : The model used several system cost estimates. Based on cost data from the Santa Barbara County Data Exchange ($35,000-$55,000 per facility) authors estimated software costs for data exchange to be $20,000 per facility as software becomes standardized and nationally produced. The authors estimated costs to create software interfaces needed to exchange data as $15,000 per system for an easy integration (20% of cases), $45,000 per system for a moderately difficult integration (30% of cases) and $90,000 per system for a difficult integration (50% of cases).
• Long-term Cost : Annual yearly operating costs were estimated to be $27 billion per year to maintain system functionality and $21 billion per year to maintain the brokered peer-to-peer communication network. 
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Defining the Question: Foreground & Background Questions

In order to most appropriately choose an information resource and craft a search strategy, it is necessary to consider what  kind  of question you are asking: a specific, narrow "foreground" question, or a broader background question that will help give context to your research?

Foreground Questions

A "foreground" question in health research is one that is relatively specific, and is usually best addressed by locating primary research evidence. 

Using a structured question framework can help you clearly define the concepts or variables that make up the specific research question. 

 Across most frameworks, you’ll often be considering:

• a who (who was studied - a population or sample)
• a what (what was done or examined - an intervention, an exposure, a policy, a program, a phenomenon)
• a how ([how] did the [what] affect the [who] - an outcome, an effect). 

PICO is the most common framework for developing a clinical research question, but multiple question frameworks exist.

PICO (Problem/Population, Intervention, Comparison, Outcome)

Appropriate for : clinical questions, often addressing the effect of an intervention/therapy/treatment

Example : For adolescents with type II diabetes (P) does the use of telehealth consultations (I) compared to in-person consultations  (C) improve blood sugar control  (O)?

Framing Different Types of Clinical Questions with PICO

Different types of clinical questions are suited to different syntaxes and phrasings, but all will clearly define the PICO elements.  The definitions and frames below may be helpful for organizing your question:

Intervention/Therapy

Questions addressing how a clinical issue, illness, or disability is treated.

"In__________________(P), how does__________________(I) compared to_________________(C) affect______________(O)?"

Questions that address the causes or origin of disease, the factors which produce or predispose toward a certain disease or disorder.

"Are_________________(P), who have_________________(I) compared with those without_________________(C) at_________________risk for/of_________________(O) over_________________(T)?" 

Questions addressing the act or process of identifying or determining the nature and cause of a disease or injury through evaluation.

In_________________(P) are/is_________________(I) compared with_________________(C) more accurate in diagnosing_________________(O)?

Prognosis/Prediction:

Questions addressing the prediction of the course of a disease.

In_________________(P), how does_________________(I) compared to_________________ (C) influence_________________(O)?

Questions addressing how one experiences a phenomenon or why we need to approach practice differently.

"How do_________________(P) with_________________(I) perceive_________________(O)?" 

Adapted from: Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

Beyond PICO: Other Types of Question Frameworks

PICO is a useful framework for clinical research questions, but may not be appropriate for all kinds of reviews.  Also consider:

PEO (Population, Exposure, Outcome)

Appropriate for : describing association between particular exposures/risk factors and outcomes

Example : How do  preparation programs (E) influence the development of teaching competence  (O) among novice nurse educators  (P)?

SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research Type)

Appropriate for : questions of experience or perspectives (questions that may be addressed by qualitative or mixed methods research)

Example : What are the experiences and perspectives (E) of  undergraduate nursing students  (S)  in clinical placements within prison healthcare settings (PI)?

SPICE (Setting, Perspective, Intervention/phenomenon of Interest, Comparison, Evaluation)

Appropriate for : evaluating the outcomes of a service, project, or intervention

Example : What are the impacts and best practices for workplace (S) transition support programs (I) for the retention (E) of newly-hired, new graduate nurses (P)?

PCC (Problem/population, Concept, Context)

Appropriate for : broader (scoping) questions

Example : How do nursing schools  (Context) teach, measure, and maintain nursing students ' (P)  technological literacy  (Concept))throughout their educational programs?

Background Questions

To craft a strong and reasonable foreground research question, it is important to have a firm understanding of the concepts of interest.  As such, it is often necessary to ask background questions, which ask for more general, foundational knowledge about a disorder, disease, patient population, policy issue, etc. 

For example, consider the PICO question outlined above:

"For adolescents with type II diabetes does the use of telehealth consultations compared to in-person consultations  improve blood sugar control ?

To best make sense of the literature that might address this PICO question, you would also need a deep understanding of background questions like:

• What are the unique barriers or challenges related to blood sugar management in adolescents with TII diabetes?
• What are the measures of effective blood sugar control?
• What kinds of interventions would fall under the umbrella of 'telehealth'?
• What are the qualitative differences in patient experience in telehealth versus in-person interactions with healthcare providers?
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• Last Updated: Dec 20, 2024 12:02 PM
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