PICOT Research Question

What It Is

PICOT is a mnemonic for developing a research question:

P = Population

I = Intervention

C = Comparison

O = Outcome

T = Time Frame

This structure can be used to prompt the investigator to consider and specify the components of a useful research question. Each component should be linked to something measurable and which will be expanded upon in the research protocol. So the question would be formatted something like this:

In [patients, people] with [characteristics, disease], [intervention, treatment, exposure] will [affect, improve, increase/decrease] rates of [disease, survival, cure, complication] compared to [no intervention, other treatment/intervention, non-exposure/non-treatment] [over time period of follow-up / within time period].

Suppose you wanted to do a study to see if adopting healthier behaviors lowers blood pressure in patients with hypertension?  The question might start this way:

“In patients with hypertension, will engaging in healthy behaviors reduce blood pressure compared to not changing behavior within a year?”

That’s a start that should guide you in refining your question.  Then you might ask, which patients with hypertension?  Stage 1, Stage 2?  Patients with a new diagnosis?  Those whose blood pressure is not controlled by medication?  Which patients do you think are most likely to benefit from the intervention?

What healthy behaviors?  Reducing the amount of sodium in the diet?  Exercising regularly? Learning to manage stress?

The comparison is important too.  Maybe you want to know if adopting healthy behaviors is better than “business as usual.”  Or maybe you want to see if healthy behaviors can reduce the need for blood pressure medication (or reduce prescribed doses of blood pressure medication).

The time frame should be aligned with how the intervention or exposure works to affect the outcome.  If your follow-up is too short, the intervention or exposure won’t have time to affect the outcome and your study would conclude it’s not useful (or harmful) when maybe it is.  On the other hand, too long a time frame likely wastes resources and potentially could allow for too many other factors to interfere with your ability to determine the effect of the intervention or exposure of interest.

After thinking about the components of PICOT (and doing a thorough literature review), you might refine your question to something like:

“In sedentary patients newly diagnosed with stage 1 hypertension, will engaging in an exercise regimen that accumulates ≥150 minutes of aerobic activity every week, compared to remaining sedentary,  reduce blood pressure to ≤130/85 without the need for blood pressure medication within six months?”

I’m betting most people would say this updated research question is more useful than the original question.

Why It’s Important

Clarity around all the components of the PICOT question is crucial for developing a research protocol that can produce good quality evidence.  To a certain extent, any research study can produce evidence.  But you will only make forward progress with good quality evidence.