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Systematic Reviews: How-To in Detail

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) or another defined framework.
  • Using a 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
  • Questions should be Feasible, Interesting, Novel, Ethical, and Relevant (FINER) - see links below for more detail on the FINER criteria
  • 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

Did you know there are at least 25 other question frameworks besides variations of PICO? 

PICO is a helpful framework for clinical research questions, but may not be the best for other types of research questions. Frameworks like PEO, SPIDER, SPICE, and ECLIPSe can help you formulate a focused research question.

The tables and examples 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

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

Eligibility Criteria: Inclusion / Exclusion

A well-defined research question will help generate the list of eligibility criteria so it is clear which studies should be included in or excluded from the project.

Common eligiblity criteria for systematic reviews include:

  • time frame of the outcome measurement
  • definitions for the population
  • study setting
  • geographic locations the studies are conducted in
  • language of the published manuscript
  • study design

The Cochrane Handbook states that inclusion criteria should be broad enough to capture all the relevant variety of publications in which the intervention has been used but narrow enough "to ensure that a meaningful answer can be obtained when studies are considered together"


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