Posing Well-Built, Answerable, Practice Questions Joanne Yaffe, University of Utah Adapted from Stephanie Baus, Tulane University

PICO Questions Population/Problem Intervention Comparison Outcome

Four Features of a Well-Built Question and Types of Questions Across: Four Elements in a Well- Formulated Question Down: Six Question Types Client Type and Problem How would I describe a group of clients of similar type? What You Might Do Apply a treatment, act to prevent a problem, measure to assess a problem, screen to assess risk, survey or interview clients, Alternate Course of Action What is the main alternative other than in the box to the left, if any? What You Want to Accomplish Outcome of treatment or prevention, valid measure, accurate risk assessment, accurate description of client. Intervention Effectiveness Question Example: If disoriented older people who reside in a nursing home are given reality orientation therapy or validation therapy which will result in better orientation to time, place, and person? Prevention Effectiveness Question Example: If sexually active high school students at high risk for pregnancy are exposed to Baby-Think-It-Over or to lecture material on proper use of birth control which will result in fewer unplanned pregnancies during an academic year?

Assessment of Current Status (Detection) Question Example: If aged residents of a nursing home who may be depressed or have dementia are administered depression screening tests or a short mental status examination which measure will be briefer, less expensive, valid and reliable to discriminate between depression and dementia? Assessment of Risk/Prognosis (Prediction) Example: If crisis line callers to a battered women’s shelter are administered a risk assessment scale by telephone or are assessed by practical judgment unaided by a risk assessment scale Which assessment method will have higher reliability and predictive validity? Description Question (Quantitative) Example: If family members of patients with chronic mental illness, who attend a hospital support group are given a short client satisfaction questionnaire ___________ which will the family members list as their areas of greatest and least satisfaction? Descriptive Question (Qualitative) Example: If elderly persons who experience a stroke are interviewed in depth ___________ what is the experience for them like emotionally and practically? This format from Gibbs (2003) follows Sackett, D. L., Richardson, W. S., Rosenberg, W. & Haynes, R. B. (1997) Evidence-based medicine: How to practice and teach EBM. New York: Churchill Livingstone.

Examples of PICO Questions Generated by Social Work Students: Katherine Moody’s question: If a 45 year old alcoholic woman attends weekly AA meetings or receives individual therapy once a week, which will result in lower incidence of relapse? Amy Simmon’s question: If mothers of newborn babies who have been given up for adoption are surveyed, what will be their levels of depression? Michelle Guidry’s question: Among children who are overweight, what are some of the social problems they may encounter? Niquette Kearney’s question: For mothers of children who die of cancer, what is the emotional experience of grieving like for them?

Research Question PICO Question Identifies specific sample Describes type of client and problem Identifies particular instance of intervention, including what, where, when, how May describe particular type(s) of interventions or ask about “best intervention” Identifies specific measurement instruments Describes intended outcomes, rather than measures

Formulating Intervention or Prevention Effectiveness Questions : a) Compare an intervention to no intervention b) Compare two (or more) interventions c) What is the best intervention? ExamplesClient/ProblemActionAlternateOutcome Mary Christensen’s question: If young women in lower and middle income countries are given empowerment classes or no classeswhich group is more likely to continue their education? Stephanie Warren’s question: Among clients aged 18 to 25 with eating disorders will inpatient therapy or outpatient therapy be more effective in reducing symptoms of anorexia or bulimia? Lindsey Wiley’s question: For adolescents who have witnessed violence what is the best interventionto increase coping skills?

Formulating Assessment of Current Status or Future Risk Questions : a) Compare assessment instrument/procedure to no assessment b) Compare two assessment instruments/procedures c) What is the best assessment instrument/procedure? ExamplesClient/ProblemActionAlternateOutcome Betsy McDougal Gibbs’ question (Gibbs, 2003, p. 215): For preschool children in a medium-sized community will a parent report language screening questionnaire [as opposed to no questionnaire] effectively distinguish between children who need pre-school language services and those who do not? Gibbs, 2003, p. 212: For older people living in a nursing home who many be at risk for falling will the Timed Up & Go Test or the STRATIFY test best predict which elderly persons will fall? Katherine Moody’s question: Among children survivors of sexual assault what is the best risk assessment toolused to predict childhood depression?

Formulating Descriptive (Quantitative) Questions : a) Summarizing characteristics (how much, how many, what percentage, what is the average?) b) Asking about relationships between variables. ExamplesClient/ProblemActionAlternateOutcome Megan Brummer’s question: [If] people living with HIV/AIDS [are surveyed]what percentage seek alternative medical therapies? Heather German’s question: [If] children who have been adopted before or after the age of five [are assessed]will there be any differences in adjustment problems based on age of adoption?

Formulating Descriptive (Qualitative) Questions : a) Require narrative responses b) Suggest in-depth explorations, little known phenomena (how would they describe, what is the process, how do they experience?) ExamplesClient/ProblemActionAlternateOutcome Linsey Wiley’s question: [If] female children whose mothers have died due to violence [are interviewed in depth] what are their experiences during puberty? Matthew Knapp’s question: [If] “out” lesbians over age 60 [are interviewed in depth] how would they describe their perceptions of their visibility within the gay community?