LibGuides: Health Sciences: PICO Question Model

Background vs Foreground Questions

Background Question

Broad and general. General knowledge about a condition, test, treatment, population, etc.
- Example: “What are some best practices for working with children?”
Can be answered quickly using a textbook, handbook, dictionary, thesaurus, or other basic reference materials
- You can find these resources in OneSearch (library catalog)

Foreground Question

Questions that need specific knowledge to inform clinical decisions or actions.
- “In young children, do distraction techniques during immunization result in lower pain scores when compared to no intervention?”
Can be answered through a wide variety of resources from articles, dissertations, conference proceedings, and other original research publications, as well as systematic reviews, meta-analysis, best practice guidelines, etc.
- You can find these resources in OneSearch but you will probably have better luck using a Health Science specific database.

Background information is the prior knowledge you need to develop a question that needs foreground information.

PICO

PICO is a tool to create a foreground question. It's an abbreviation for...

P = Patient or Problem
I = Interventions
C = Comparisons
O = Outcomes

Using the earlier example question, we can break it down into a PICO question like this:

P = Patient or Problem (young children)
I = Interventions (distractions during immunization)
C = Comparisons (no distractions/standard care)
O = Outcomes (lower pain scores)

You may also hear some people use PICOTT. The two T's stand for:

T = Type of Question
Therapy / Diagnosis / Harm / Prognosis / Prevention

T = Type of Study
Systematic review / RCT / cohort study / case-control

Forming Focused Questions with PICO: Choose a specialty
Check out this guide from the University of North Carolina that gives examples of PICO questions for a variety of specialties.
PICOTT Worksheet
Here's a worksheet from Duke University to walk you through creating a PICOTT question.

Types of PICO Questions

Type or Domain	Explanation	Types of evidence to answer the question
Therapy (Treatment)	Questions about the effectiveness of interventions in improving outcomes in sick patients/patients suffering from some condition. These are the most frequently asked. Among the many treatments offered by clinicians are medications, surgical procedures, exercise, and counseling about lifestyles changes.	Randomised Controlled Trial (RCT)
Prevention	Questions about the effectiveness of an intervention or exposure in preventing morbidity and mortality. Similar to treatment questions. When assessing preventive measures, it is particularly important to evaluate potential harms as well as benefits.	RCT or Prospective Study
Diagnosis	Questions about the ability of a test or procedure to differentiate between those with and without a condition or disease.	RCT or Cohort Study
Prognosis (Forecast)	Questions about the probable cause of a patient's disease or the likelihood that he or she will develop an illness.	Cohort Study and/or Case-Control Series
Etiology (Causation)	Questions about the harmful effect of an intervention or exposure on a patient.	Cohort Study
Meaning	Questions about patients' experiences and concerns.	Qualitative Study

University of Canberra. (April 18, 2019). Evidence-Based Practice in Health: Types of Clinical Question. Retrieved from https://canberra.libguides.com/c.php?g=599346&p=4149723

PICO Tutorials

The first video explains background and foreground questions with a brief explanation of PICO. The second provides an example of a PICOTT question and how to turn that question into search terms.