The EBP process is typically used in clinical settings and starts with asking a clinical foreground question, though EBP is being used in a number of fields beyond medicine where additional types of foreground questions can be addressed.
What is a foreground question? Foreground questions ask for specific information, usually focused on a patient, population group, or sample. For example, patient focused foreground questions might seek information about:
Asking an answerable foreground question can be tricky, but there are tools called frameworks that can help.
The PICO framework is the most commonly used tool for framing clinical questions, especially ones related to therapy (intervention) effectiveness. PICO is an acronym where each letter stands for a component in the research. Various components are then combined in a search for information.
P - Patient, Population, or Problem
I - Intervention, Exposure, or Test
C - Comparison Intervention, Exposure, or Test
O - Outcome(s) of interest
Example using the PICO framework
Which Patients/Population/Problem is of interest? pediatric patients with asthma
What Intervention/Exposure/Test? RSV infection (exposure)
What Comparison? None or No infection
What Outcome? Admission to the ICU
The research question could be phrased: In pediatric patients with asthma (P), does RSV infection (I) impact admission to the ICU (O)?
Alternatively, we can start with a research question like the one above, and break it down into its PICO components.
In the 2. Acquire the Information tab on the left side of the page, steps for combining the search concepts from your foreground question into a search strategy are described as well as resources for foreground questions.
If PICO is not a good fit for your foreground question, there are other frameworks that you can explore. Here's a sample of the many frameworks that you can consider and some of the types of questions where they are commonly used.
PCC: Population/Participants, Context, Concept
PCC is often used in scoping review research that typically has a broad scope and is less restrictive in identifying explicit interventions, phenomena, or outcomes of interest.
PEO: Patient/Population, Exposure(s), Outcome
PEO is especially useful when investigating a prognosis or likelihood of developing a condition as a result of a pre-existing condition or exposure.
SPICE: Setting (Where?), Perspective (For whom?), Intervention (What?), Comparison (Compared to what?), Evaluation (With what result?)
SPICE builds on PICO by separating the population concept into two components (setting and perspective) and by replacing the outcome concept with evaluation, which can be seen as incorporating outputs and impact together.
SPIDER: Sample, Phenomenon of Interest, Design, Evaluation, Research Type
SPIDER is often used with qualitative research questions (questions asking about attitudes and experiences). It focuses on study design and samples rather than patients and populations.
No matter how you choose to frame your question - or whether you use a framework or not - thinking through the key concepts and their relationship to each other is an important step in EBP. Asking a foreground type question in a structured way can help with retrieving relevant results. If you'd like to talk through your clinical foreground question with an informationist, contact us at email@example.com.