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Meta-analyses

Define the question

Breaking down the question into discrete components can help formulate a good answerable question and also helps in the development of a search strategy.

Well-formulated review questions use a structured format to improve the scientific rigor.

There are various models and frameworks that can be used depending on the nature of the review.

Some of these models and frameworks are shown below.

Type of research question
Models
Disciplines
Clinical questions
 PICO
Variants - PIO, PICOT, PICOS		 Health
Quantitative

PICO & variants PIO, PICOT, PICOS
PIFT

 Health; Social Sciences

Business & Policy; Environment; Ecology
Qualitative

PEO,  PICo
CLIP, ECLIPSE

 Social Sciences
Management
Mixed Methods
(use for either qualitative
or quantitative)

PCC
SPICE
SPIDER
FINER

Health
Social Sciences
Methodology or theory

BeHEMoTH
SDMO

 Health

 

Further reading:

Models and frameworks

The PICO model is a tool widely used to develop answerable questions.

Population, Patient or Problem
 Who are the people being studied or What is the problem being looked at?
What are their characteristics?
Intervention
 What is the treatment or intervention being studied? (treat, diagnose, observe)
Comparison, Control or Comparator
 What is the intervention compared to?
(e.g. other interventions, standard treatment, no treatment)
This can be optional if no comparison applies.
Outcome
 What are the relevant outcomes and how are they measured?

Chapter 5 of the Cochrane Handbook for Systematic Reviews of Interventions has more information on the defining each element of the PICO acronym.

Variants of PICO

PIO

Use when there is no Comparison, Control or Comparator
PICOT

Includes Time from the intervention that outcomes are measured.
PICOS

Includes Study Design e.g. cohorts or randomized controlled trials.

Examples

Question:
 
Does the use of chlorhexidine mouthwash prevent gingivitis and aid in plaque control?
  
Question:
 
Do first year students who attend the library Orientation week sessions perform better on research assessment than non-attending students?
Patient, population or problem
 gingivitis and plaque control  
Patient, population or problem
 first year university students
Intervention
 use of chlorhexidine mouthwash  
Intervention
 attendance of library orientation sessions
Comparison
 those who do not use chlorhexidine mouthwash  
Comparison
 non-attending students
Outcome
 decreased gingivitis and increased plaque control  
Outcome
 good assessment results

Instructional Videos

Tutorial from the Cushing/Whitney Medical Library

 

Tutorial from QUT

 

SPICE, SPIDER, FINER & PCC are models that can be used for both qualitative and quantitative topics.

SPICE
Setting
 Where is the study being undertaken?
Perspective
 For whom? Who are the targets or participants of the study?
Intervention
 What is the change or intervention being studied?
Comparison
 What is the intervention being compared to?
Evaluation
 With what result? How is the result being measured?
Source:
Booth, A. (2006). Clear and present questions: Formulating questions for evidence based practice. Library Hi Tech, 24(3), 355-368. https://doi.org/10.1108/07378830610692127
See Example
SPIDER
Sample
 The group of people being looked at
Phenomenon of Interest
 Looks at the reasons for behaviour and decisions, rather than an intervention.​
Design
 The form of research used, such as interview or survey.​
Evaluation
 The outcome measures.
Research type
 Type of research. e.g. qualitative, quantitative or mixed method
Source:
Cooke, A., Smith, D., & Booth, A. (2012). Beyond PICO: The SPIDER tool for qualitative evidence synthesis. Qualitative Health Research, 22(10), 1435-1443. https://doi.org/10.1177/1049732312452938
See Example

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

 

 

FINER
Feasibility
 What is the feasibility? Focuses on time, scope, resources, expertise, and funding
Interesting
 What is the intrinsic and extrinsic interest in answering a research question?
Novel
 How does it generate new evidence for the current empirical literature?
Ethical
 What are the ethical implications?
Relevant
 What is the clinical relevance of a research question?
Source:
Cummings, S. R., Browner, W. S., & Hulley, S. B. (1988) Conceiving the research question. In S. B. Hulley, & S. R. Cummings SR (Eds), Designing Clinical Research. (pp. 12 - 17). Williams & Wilkins
PCC
Population
 Important characteristics of participants, including age and other qualifying criteria.
Concept
 Use the ideas from your primary questions to determine your concept. The core concept examined by the scoping review should be clearly articulated to guide the scope and breadth of the inquiry. This may include details that pertain to elements that would be detailed in a standard systematic review, such as the "interventions" and/or "phenomena of interest" and/or "outcomes".​
Context
 May include... cultural factors such as geographic location and/or specific racial or gender-based interests. In some cases, context may also encompass details about the specific setting​
Source:
Aromataris E, Munn Z (Editors). (2020). JBI manual for evidence synthesis. Joanna Briggs Institute.  https://doi.org/10.46658/JBIMES-20-01
See Example

The variants of PICO below are adapted to work better with qualitative studies.

PEO
  
PICo
Population and their problems

Who are the users, patients or community being affected? What are their symptoms, age, gender etc.

  
Population

What are the characteristics of the population or patient? What condition or disease are you interested in?
 
Exposure
 Use for a specific exposure (this term is used loosely) such as “witnessed resuscitation” or “domestic violence”  
Interest

The phenomena of interest, related to a defined event, activity, experience or process
 
Outcomes or themes

Are you looking for improvements in pain, responsiveness to treatment, mobility, quality of life, daily living? Usually there will be an element of looking at patient’s experiences.

 
Context

The setting or distinct characteristics
 

 
Source:
Moola, S., Munn, Z., Sears, K., Sfetcu, R., Currie, M., Lisy, K., . . . Mu, P. (2015). Conducting systematic reviews of association (etiology): The Joanna Briggs Institute's approach. International Journal of Evidence-Based Healthcare, 13(3), 163-169. https://doi.org/10.1097/XEB.0000000000000064
  
Source:
Lockwood, C., Munn, Z., & Porritt, K. (2015). Qualitative research synthesis: Methodological guidance for systematic reviewers utilizing meta-aggregation. International Journal of Evidence-Based Healthcare, 13(3), 179-187. https://doi.org/10.1097/XEB.0000000000000062
 

CLIP & ECLIPSE are other types of question frameworks for qualitative studies
CLIP
  
ECLIPSE
Client group
 At whom is the service aimed?  
Expectation
 What do you want the information for (the original ‘I’s)?
Location
 Where is the service sited?  
Client group
 At whom is the service aimed?
Improvement or Information or
Innovation
 What do you want to find out?  
Location
 Where is the service sited?
Professionals
 who is involved in providing/improving the service?  
Impact
 What is the change in the service, if any, which is being looked for? What would constitute success? How is this being measured?
     
Professionals
 Who is involved in providing/improving the service?
     
Service
 Which service are you looking for information? For example, outpatient services, nurse‐led clinics, intermediate care.
Source:
Wildridge, V., & Bell, L. (2002). How CLIP became ECLIPSE: A mnemonic to assist in searching for health policy/management information. Health Information and Libraries Journal, 19(2), 113-115. https://doi.org/10.1046/j.1471-1842.2002.00378.x
PICO
  
PIFT
P
 Population, Problem or Patient  
Product or Process
 What is the product or process category being assessed?
I
 Intervention  
Impacts
 What are the impact(s) of interest?
C
 Comparison, Control or Comparator  
Flows
What are the flow(s) or economic sectors contributing to the impact?
O
Outcome
 		  
Types
What are the types of Life Cycle Assessment of interest?
 
   
Source:
Zumsteg, J. M., Cooper, J. S., & Noon, M. S. (2012). Systematic review checklist: A standardized technique for assessing and reporting reviews of life cycle assessment data. Designing Journal of Industrial Ecology, 16 (S1), S12-S21. https://doi.org/10.1111/j.1530-9290.2012.00476.x
BeHEMoTh
  
SDMO
Be
 Behaviour of interest  
S
 Types of studies
H
 Health context  
D
 Types of Data
E
 Exclusions  
M
 Types of Methods
MoTh
Models or Theories
 		  
O
  Types of Outcome measures
Source:
Booth, C., & Carroll, C. (2015). Systematic searching for theory to inform systematic reviews: is it feasible? Is it desirable? Health Information & Libraries Journal, 32(3), 220-235. https://doi.org/10.1111/hir.12108
 
 
  
Source:

Clarke, M., Oxman, A. D., Paulsen, E., Higgins, J. P., Green, S. (2011). Appendix A: Guide to the contents of a Cochrane Methodology protocol and review. In: J. P. Higgins & S. Green (Eds.). Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). The Cochrane Collaboration. 
https://training.cochrane.org/handbook/archive/v5.1/

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