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Evidence-Based Practice: Step 1: Ask

This guide contains resources and guidance to help students learning about evidence-based practice.

Step 1: Ask

 

Your first step in the EBP process is formulating a research question. This is a statement which summarises what you are trying to ask.

You may already have a question in mind from something you've noticed in clinical practice - or if this your first time trying the EBP process you may need to first come up with a question.

This page will show you tips for how to refine your ideas in order to turn them into a research question. 

Preliminary searches

Before formulating a research question or committing to a question, it's best to run some preliminary searches to see what research exists. This will help give you an idea of what kind of question you might like to ask and what answers to expect.

Running preliminary searches (also known as scoping searches) is an important part of the research process as it helps you familiarise yourself with your topic of interest. From looking at the titles and abstracts of relevant papers, you can find out: 

  • What keywords researchers are using to describe your topic
  • What research exists
  • What questions have been answered

Having this knowledge in mind assists when it comes time to build or refine your own question and ensures your question is answerable. You do not want to ask a question where answers don't exist yet. Alternatively, if your question is not focused enough, you will not get a clear answer from your search.

A great database to use for these kinds of preliminary searches is PubMed or Google Scholar.

Have a look at our quick PubMed tutorial below for some searching tips to get you started with running a preliminary search:

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Tips

  • PubMed and Google Scholar are great databases to start searching in because they will try to find relevant papers for you. In Google Scholar there is an algorithm at work. PubMed will automatically add alternative terms and subject headings to your search to help you find useful results.
  • TRIP is a medical search engine and is also a useful resource to help you scope out potential research questions. It contains a variety of filters to help you narrow down to primary and secondary evidence. Access TRIP using the link below.
  • A preliminary search will also help you identify any synonyms/alternative terms you can use for the acquire stage.

Formulating your question

Once you have a topic in mind, it's time to turn that into a focused question. First, think about what kind of question you would like to ask.

Your question can take two forms:

Quantitative

This kind of question is about cause and effect relationships and is looking for a specific answer or outcome. Research methods generally involve sampling and statistics to come to a conclusion about the effect of an intervention.

Qualitative

This kind of question is about seeking understanding or meaning. Research methods generally involve interviews, surveys, observation or analysis of documents or artefacts.

 

A tool which can help you formulate either a quantitative or qualitative question is a mnemonic.

Mnemonics are frameworks which can help you identify what elements need to be present in your question. 

PICO

PICO is the most commonly used mnemonic. It is suitable for quantitative questions where you are investigating cause and effect.

PICO example question

Is (I) hand washing or (C) hand sanitiser more effective in preventing the spread of the (O) common cold amongst (P) school children?

PS

The PS mnemonic is suitable for qualitative questions where you are investigating the meaning of a phenomenon.

PS example question

What are the experiences of (P) nurses in (S) caring for people with diabetes?

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Tips

  • A mnemonic is there as a guide only - don't worry if your question doesn't fit in neatly. The main thing is being able to divide your question into separate concepts.
  • Not every concept needs to be present in your question - for example, it's common to not have a comparison.

Here are some more mnemonics you can use

Remember that you do not have to have a concept for every letter.

Quantitative

PICOT – Population, intervention, comparison, outcome, time factors

e.g. How effective are (I) nicotine patches compared to (C) support groups for (O) smoking cessation in (P) chronic smokers within the (T) first year of quitting?

 

Qualitative

PICo – Population, phenomenon of Interest, context

e.g. What are the experiences of (P) school children undertaking (I) online learning during (Co) lockdown in Australia?

 

PICOS – Population, intervention, comparison, outcome, study design

e.g. In patients with type 2 diabates, what are the main factors which determine patient preference for lifestyle changes rather than metformin for managing blood glucose? 

(P) Type 2 diabetes (I) Lifestyle changes (C) Metformin (O) Blood glucose management (S) Patient Interviews

 

SPIDER – Sample, phenomenon of interest, design, evaluation, research type

e.g. What are barriers to long-term carers utilising respite care programs?

(S) Carers (PI) Utilisation of respite care programs (D) Focus groups (E) Barriers (R) Qualitative

 

SPICE –  Setting, perspective, intervention, comparison, evaluation 

e.g. In rural and remote Australia what are the models of care and factors that have enabled telehealth services to be sustainable?

(S) Rural and remote communities in Australia (P) none (I) telehealth services (C) none (E) models of healthcare and factors

Hot tips

  • A mnemonic is there as a guide only - don't worry if your question doesn't fit in neatly. The main thing is being able to divide your question into separate concepts.
  • Not every concept needs to be present in your question - for example, it's common to not have a comparison.
  • broader concepts may need to be narrowed down when searching, for example be specific about what "models of healthcare" and "factors" are in relation to your question. 

Templates

Prioritising types of evidence

When you search, you will often come across a dozen different studies which can answer your question. How do you know which is the best one to use?

An evidence hierarchy can assist - they rank study types according to strength so you can use them as a "golden rule" to help you decide what the best evidence is to answer a question.

If you know what study types you are looking for, you can also use filters to narrow your search and cut down the results you have to go through - more information on filters are in the acquire stage.

There are few out there which exist including:

Evidence-Based Medicine Pyramid

The evidence at the top is considered considered "stronger" and more reliable as this evidence is synthesised from larger studies.

When searching for evidence, you want to look for strong evidence first so start at the top level and work your way down.

For example, if there isn't a systematic review which answers your question, you could then look for a randomised controlled trial. 

Other evidence hierarchies: