AN INTRODUCTORY GUIDE TO PUTTING RESEARCH INTO PRACTICE 2. Defining the Research Question

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AN INTRODUCTORY GUIDE TO
PUTTING RESEARCH INTO PRACTICE
2.Defining the ResearchQuestion
KateSpringett & Jackie Campbell
Getting the question right is absolutely crucial to the rest of the research
process.This is obvious as getting the right answer to the wrong
question is going to wasteanawful lot of time and resources.However,
the main problem is not asking the wrong question,but not properly
defining the right question. This article assumes you have identified a
generalarea that you are interested in researching and will give
guidance on how to take that idea and shape it intoa researchable
question.
This process should be the same irrespective of whether you are
searching existing literature for the answer,or preparing to design and
conduct your own research study.This stage is neither simple nor quick.
It can take days,weeks or sometimes months,depending upon the
complexity of the problem,toarriveat a clear,conciseand accurate
question. It is not worth rushing; time spent now will save irritation and
frustration later.
Correspondence to:
Dr KateSpringett,Head of Department of Allied
HealthProfessions,Canterbury Christ Church
University,NorthHolmes Road,Canterbury,Kent,
CT1 1QU.Email:k.springett@canterbury.ac.uk
Professor Jackie Campbell,School of Health,The
University of Northampton,Boughton Green Road,
Northampton NN2 7AL.
E-mail:jackie.campbell@northampton.ac.uk
What is a ResearchQuestion?
When you haveaproblem to solve – a
question for whichananswer is needed –
then you have to do some work to find
that answer.Sometimes this information
is available in the literature; sometimes
you need to start from scratch, as no or
little information exists.
Either way you need to spend a bit of
time deciding what the problem is, what it
is that you really want to find out and
what the nature of the problem is.Turning
this intoanon-biased and precise question
–aResearchQuestion (RQ) – helps in
working through how toanswer it.
If you are doing aliterature review, you
need anRQ; if you want to find out about
the efficacy of an intervention through a
clinical study, you need anRQ; if you want
to explore patients’ perceptions of a
management approach, you need anRQ;
whether your planned work is likely to use
aqualitative or quantitativeapproach, you
need anRQ.
AnRQ acts alsoas an ‘aide memoire’.
It helps you keep focused on your areaof
enquiry, which is particularly helpful
when searching the literatureand if you
find you get sidetracked easily.
The key to defining anRQ is focus.The
end product needs tobea specificquery
that is explicit in what it is looking for.The
process of defining the question is
therefore essentially one of taking a broad
topic area and narrowing it down until you
haveaquestion that canbeanswered fully.

November 2006 PodiatryNow27
Feature
How much focus is required depends to
some extent on how much research you are
intending to do toanswer it.
Given unlimited time and resources,a
question suchas ‘What is the best
management regime for metatarsalgia?’
may beanswerable, but it would take a
long time to researchall possible
treatments,for all possible populations of
patients.In doing so, you would probably
break the question down intobite-sized
chunks suchas ‘How effective is a
conservativeapproachcompared with
surgical intervention for the most
common cause of metatarsalgiain
adults?’. Thesechunks are effectively just
better defined RQs.
Once you have decided upon the RQ,
you can then choose which research
approach (qualitative,quantitative or
both) is most appropriate.
Additionalcomponents included in the
process of focusing the question may
include:1
●the study designs in which you are
interested (e.g. randomised controlled
trials)
●the context in which relevant studies
havebeen undertaken,or whether
thereare factors that will limit its
applicability to the question being
asked
●language restrictions (e.g., English only
- note potential for language bias)
●any date restrictions on the period the
literature review will cover (e.g.,if
updating an existing review).
The PICO approach
One approach to limiting the scope of the
topic areais to use the PICO framework.
Although this approach was developed
around Evidence-Based Medicine, 2and
was therefore designed for clinical studies,
it canbeadapted toany researchcontext.
It is anadapted version that is used here.
P
What is the problem that you havecome across in practiceand need an
answer for?What is the patient group or population of people who are
relevant to the area you need to look into?
Tease this information out; break it into sub-units -
what are you interested in? Pick out key words and
phrases that capture this and turn into questions
I
What do you need to do with your patients/population,or involve
yourself with,to find out the nature of,or answer to,the problem? What
information do you want tocapture? What intervention do you want to
investigate? What is it that you want toassess and diagnose or
evaluate? What is it that you want to observe?
C
Are therecomparisons tobe made,differences to establish?
Is monitoring all that is needed? Do you expect themes or groups of
characteristics to emerge? e.g. from observation? This section may not
be relevant to your plans.
O
What outcome(s) is relevant?What is it that you will be measuring,
observing,assessing?
Keep asking yourself questions to help you identify
and refine what it is that you want/need to find
out.Include the points you arriveat in your
prototype RQ.
Depending upon what you need and plan to do,so
your prototype RQ needs to reflect this.Has your
RQ captured all components so far?
Try writing out your question. After afew days,
does it seem to you tobe the right question? Tell
others your question. Do they understand what you
want to get at?If not,re-wordand refine.
Using comments and returning back to your
problem,have you covered all the points you need in
your prototype RQ?If not,re-wordand refine further.
Does the RQ indicate precisely the required components
without bias?Yes - you have defined your RQ.
Figure 1:Using the PICO approach to
defining a research question.
Ppatient,population,problem
Iintervention or exposure
Ccomparison
Ooutcome
RQ = research question

28PodiatryNow November 2006
Feature
●P: Patient,Population or
Problem
●What are the characteristics of
the patient or population?
●What is the condition or disease
you are interested in?
●I: Intervention or exposure
●What do you want to do with
this patient/population (e.g.
treat,diagnose,observe)?
●C: Comparison
●What is the alternative to the
intervention (e.g. placebo,
different drug, surgery)?
●O: Outcome
●What are the relevant outcomes
(e.g. morbidity,death,
complications)?
Using the PICO approach
Figure 1 is a step-by-step guide, adapted
from Ref 2, to help you refine,define and
focus the problem you havecome across
and need toanswer and to turn it intoan
RQ.Allow time for this development.
Outline examples are given at the end of
this section.
P– patient,population or problem
Starting at the beginning with the contents
of big oval ‘P’and related smaller oval,
capture your thoughts on paper.What is
the nature of the problem you havecome
across and need ananswer for?
For a complex areaor one you cannot
see your way through, some people find
highlighting different written thoughts in
different colours helps, some draw spider
diagrams (mind maps) to show links,
whilst others like cutting and pasting to
show links.
Next,discard written thoughts that
seem irrelevant, and link other thoughts
together; what are the main points, the
key components,or sub-units that strike
you?Try turning these into questions.
Leave what you have written for afew
days, return to it withafresh eyeand
discard those questions that seem wrong
or do not seem to fit in with what you
want to find out.Using the remaining
outline question(s),find out if other
people understand them; if not it’s ‘back
to the drawing board’.
I– intervention or exposure
Moving onto the big oval ‘I’and sub-oval,
takes you to including in your prototype
RQ note of what you must do to find out
what you want to find out.Use the
reading you have done in this area to help
specify what this is.
You may want to look at treatments for
aparticular condition,in whichcase you
will need to state the intervention,
treatment or management approach in
your prototype RQ.
If you plan to evaluate patient data,
there may beanaudit process (e.g.
annual review) that you plan to useand
this needs tobe included within your RQ.
To explore patients’commentaries, your
approach to finding out this information
may be through interview or afocus
group, and this also needs tobe reflected
within your RQ.Whatever you intend,
include this in your question.
C–comparison
OvalC(and sub-oval) asks you to
consider if thereareadditional things you
want or need to include. Do you want to
compare treatments?If so, you will need
to include relevant words/phrases within
your prototype RQ along with the
treatment you planas a comparison. If
thereare no comparisons tobe made, you
will still need to include within your RQ
that you plan to monitor uptake of
services over time,for example.
It may be that you plan to explore
patients’ perceptions around their health,
but need to do this in different contexts
or times of disorder onset; this
information needs including within your
question. It may be that this section is
not relevant to your study at all,in which
case leave it out!
O– outcome
OvalO and sub-ovals encourage you to
include in your RQ what the outcome is
that you will be measuring or exploring. If
centred around a clinical study you may
be interested in outcomes including time
(e.g. time to healing), whether the
condition has resolved, costs of the
interventions,patients’ perceptions of the
benefit of the intervention,etc.
Now you have included all the parts of
your RQ, it is again time to leave what
you have written for at least two days.
Returning withafresh eye,does your RQ
say what you wanted it to say?Try it out
withcolleagues.Do they understand it?If
not, re-wordand refine and you will
arriveat your finalRQ.
Examples
Example 1
General nature/ar eaof pr oblem:We use
phenol for nail matrix ablation,is this
really OK, the best way and the best
substance to use?
P opulation people with ingrowing toe nails
Intervention total or partial nail ablation
using NaOH
Comparison total or partial nail ablation
using phenol
Outcome post op pain, regrowth,healing
rate, satisfaction
RQ: Is sodium hydroxide a viable
alternative to phenol for nail matrix
ablation?
Example 2
General nature/ar eaof pr oblem: with the
NSF for Older People, we need to find a
way of targeting our ‘at-risk’ population.
How can we do this?
P opulation people aged 75 years and over
Intervention annual foot health
monitoring
Comparison no monitoring
Outcome effectiveness of healthcheck
tool for diagnosis of high-risk podiatric
conditions + no professional foot care
RQ: Cananannual foot healthcheck for
the over 75s detect high-riskconditions
that would otherwisebe missed?
Example 3
General nature/ar eaof pr oblem:outcome
measures tend to not tocapture the
impact of RA on patients’ daily lives in a
way that has apatient focus, but there is
limited information in the literatureabout
what it is that worries people withRA as
far as their feet areconcerned. How can
we find this out?
P opulation people withRA
Pr oblem nature of concerns
Intervention interview,focus group
Comparison none, themes describing
nature of concerns expected to develop
Outcome identification of a range of
issues e.g. anxiety, uncertainty,frustration
RQ: what is the nature of concerns
people withRA have relating to their
feet and mobility?
Conclusion
Following a structured process in
developing anRQ means that you do not
miss out stages of thinking. After a while,
this step-by-step method becomes second
natureand you will not realise you are
going through these stages when
developing anRQ.
Nevertheless, you will still need to
allow time for this stage of the research
process.It is an important one as a
focused RQ is essential to the research
that follows.
References
1. BoothA & Fry-SmithA, Developing the
research question. In:Etext on Health
Technology Assessment (HTA)Information
Resources , 2003.
http://www.nlm.nih.gov/nichsr/ehta/chapte
r2.html (last accessed July 2006).
2.Richardson WS & Wilson MC, On questions,
background and foreground. EvidenceBased
HealthcareNewsletter1997; 17:8-9.