Formulate a Question

Using the PICO method can really help with framing a research question. It also helps you see the individual parts of your research that will need coverage in a literature review. 

What is PICO?

PICO is a tool, most often used in health-related research, for distilling the essential components of a research topic into concepts. Finding relevant health-related information is often easier if you break down your research topic by developing a PICO question. Your proposed research question may not have all of the elements of PICO, but will likely have most parts. PICO is an acronym for:

Choose the Best Keywords

Why are keywords important?

By this point in your college career, you have had a chance to search library databases. You understand that you need keywords (not sentences) when you search a database. However, using health science terminology might be new territory.

Natural Language vs. Database Language

Natural language refers to the common way that we speak in everyday life. Database language refers to how a database classifies a concept and is usually very technical. Though most databases are great at matching natural language entered with database terminology, it’s important for you to begin recognizing medical terminology. Some examples include:

Where to Find Synonyms

1. The Internet: Is your search term or concept called anything else? Look it up in an online encyclopedia to find out. For example, in the Wikipedia entry for "hypertension", the synonym high blood pressure is quickly identified in the opening sentence. This is true for most Wikipedia entries for scientific and medical terminology. It is Wikipedia, so exercise caution when using this as a background reading source.
2. Other background sources: You can also easily find synonyms in other background sources, including your lecture notes, textbooks, and print encyclopedias (yes, they still exist!).
3. Use database subject headings: CINAHL, a nursing and allied health database, is great for finding subject headings. If you run a search and find a good article, look at the subject terms listed by the database. Use those terms in subsequent searches. PubMed also has a database of its own search terms called MeSH (medical subject headings). To access MeSH: on PubMed’s homepage select the dropdown box where you see PubMed listed. Choose MeSH instead and enter your natural language term.

Example

1. Start with your research question:
   Can pre-screenings help decrease the risk of cardiac arrest deaths in young athletes?

2. Sort out the major terms. In this case:  
   pre-screenings AND cardiac arrest death AND young athletes

3. Make a list of synonyms and related terms for each of your major terms.

   Synonyms and related terms for the word cardiac arrest death include:

   • sudden cardiac death (SCD)
   • sudden cardiac arrest
   • heart arrest

   Synonyms and related terms for young athletes might include:

   • student athletes
   • high school athletes
   • adolescent athlete
   • youth sports
   • high school sports
   • youth football (or basketball, soccer, etc.)

Build a Search Strategy

Now that you've formulated a research question and developed some keywords, it's time to create a search strategy. Each of the following sections will help you build and properly conduct your search.

Search Operators (AND, OR, & NOT)

These operators can be used in Library databases, but also work really well in Google! They are important for creating efficient, effective searches.

Operator	Purpose	Example Search	Visualization
OR	Expands the search. Used to string synonyms together. Results include all articles with any of the terms used.	Hand washing OR Hand Hygiene (all results including the words "hand washing" as well as all results including the words "hand hygiene")
AND	Narrows the search. All retrieved results must include all terms connected with AND. AND usually combines different concepts together in one search. AND is assumed between words in Google.	Hospital infection AND Antibiotic (only results that include both the terms "hospital infection" and "antibiotic")
NOT	Excludes results with a specific term. Really handy to eliminate unwanted search results.	Antibiotic NOT Penicillin (all results with the term "antibiotic", but excluding those with the term "penicillin")

​Phrase Searching

Use quotation marks to search for phrases. Phrase searching is excellent when the desired result is specificity.

CAUTION! Do NOT use phrase searching in PubMed! It turns off Automatic Term Mapping. Just don't do it!

Google Site Searching

Google site searching can help search across various government websites or can help you better search poorly indexed websites. Site searches should be typed into the browser search bar (where the web address is located). 

Site Searching by URL

• site:URL plus search terms

Site Searching by Domain

Example Search

Let's revisit a research question from earlier in the tutorial and construct some good searches.

It is now time to construct your search strategy. You may choose to organize your thoughts into a chart, as shown below using a modified version of our question from Step 2 as an example:

Does hand washing (I) amongst healthcare workers (P) reduce healthcare facility acquired infections(O)? (No hand washing is the (C).)

The idea here is to combine synonyms and concepts in different ways for multiple searches. Combining your terms should reduce the overall number of searches needed. Example search strategies:

• (Hand washing OR Handwashing OR hand hygiene) AND (nosocomial infections OR cross infection) AND (Health personnel OR Healthcare workers)

• (Hand washing OR Handwashing) AND (nosocomial infections OR cross infection)

• Pretty much any way you can think of to combine your terms is a good idea!