The document provides guidance on developing research questions for systematic reviews. It discusses identifying gaps in existing literature, generating topic ideas, and developing focused questions using frameworks like PICO. Key points include: - Systematic reviews aim to summarize all evidence on a research question in a transparent, replicable manner. - Developing a clear, answerable research question is the foundation for any systematic review. - Potential topics can come from reviewing literature, expertise, or consulting experts. Gaps in existing knowledge should be identified. - Questions should be feasible, interesting, novel, ethical, and relevant. Frameworks like PICO can help formulate focused questions.

1. Developing a Systematic
Reviews Topic/ Research
Questions
Dr. Buna Bhandari, Ph.D (UNSW,
Australia)
Assistant Professor, Central
Department of Public Health,
Tribhuvan University Institute of
Medicine, Kathmandu, Nepal
Lown Scholar, Department of Global
Health and Population, Harvard T.H.
Chan School of Public Health, USA
Author AID Steward and INASP
Associate

2. Systematic review
▪ A systematic review (SR) is a rigorous and organized method to
synthesize the evidence from multiple studies on a particular
research question or topic.
▪ The purpose of a systematic review is to identify, appraise, and
summarize all available evidence relevant to a specific research
question in a transparent and replicable manner.
▪ It aims to provide a comprehensive overview of academic
literature concerning a particular research question of topic.

4. Steps of SRM

5. Systematic Review Research question/idea
generation

6. Research idea generation
▪The selection of topic is the first step in SRM proposal
development.
▪Topic means an area or issue to be examined
▪Selection of topic for SRM is not an easy task.
▪Vision, imaginative insight plays an important role in this
process
6

7. Sources of SRM research problem
▪ Review of literature
▪ Academic/professional experience
▪ Expert consultation
▪ Good review questions often take time to develop, requiring engagement with not
only the subject area, but with a wide group of stakeholders
7

8. Literature review
Step 1: What is my area of research?
Step 2: What is known so far in this area?
Step 3: What is not known in this area?
Step 4: Which unknowns do I want to focus on in my research?
To reach the third step, you need to do an extensive literature survey.
Gap in Literature

9. Identifying gaps
▪ Consider the following to answer this question:
Why is it important to address a particular unknown or gap?
What contribution will it make to the knowledge or practice in your field?
Would your investigation into a particular unknown be relevant for an academic
journal?
Do you (or your research team) have the knowledge, expertise, equipment,
time, and budget to direct your research to explore this unknown? Do you need
a grant to carry out your research project?

10. Criteria for a good research problem/questions
(FINER)
◻ Feasible(F)
adequate number of subjects
adequate technical expertise
affordable in time and money
manageable in scope
That asks a question that the author team is capable of addressing using the
evidence available
◻ Interesting to the investigator(I): The problem should
be interest of the researcher and be a challenge to them.
◻ Reviews are a significant undertaking and review authors need sufficient
commitment to see the work through to its conclusion
10

11. Good research problem/questions -
FINER
◻ Novel(N)
confirms or refutes previous findings
extends previous findings
provide new findings
A novel review will address a genuine gap in knowledge, so review authors should
be aware of any related or overlapping reviews
◻ Ethical (E)
◻ Relevant (R)
to scientific knowledge
to clinical and health policy
to future research directions.
Involving relevant stakeholders in defining its focus and the questions it will
address;
Writing up the review in such a way as to facilitate the translation of its findings to
inform decisions. 11

12. Research Questions

13. Research question
▪ A research question is a clear and specific question that forms
the basis of systematic research project.
▪ It is ideally worded in the form of an actual question.
▪ Reviewers should be clear to formulate the question based on the
identified gap which can address the important questions and
helps to derive a conclusive evidence
Start with a clearly defined, researchable question, that should
accurately and succinctly sum up the review's line of inquiry.

14. Research question of SRM
A well-developed and answerable question is the foundation for any
systematic review.
A systematic review is an in-depth attempt to answer a specific, focused
question in a methodical way.
Well-formulated questions will guide many aspects of the review process,
including determining eligibility criteria, searching for studies,
collecting data from included studies, structuring the syntheses and
presenting findings

15. 15
RQ
BROAD TOPIC
NARROW TOPIC
FOCUSED
TOPIC

16. Types of questions in SRM
▪ To help in focusing the question and determining the most appropriate type of evidence consider the
type of question.
▪ Is there a study design (eg. Randomized Controlled Trials, Meta-Analysis) that would provide the
best answer.
▪ Is your research question to focus on:
Diagnosis : How to select and interpret diagnostic tests
Intervention/Therapy : How to select treatments to offer patients that do more good than harm
and that are worth the efforts and costs of using them
Prediction/Prognosis : How to estimate the patient’s likely clinical course over time and
anticipate likely complications of disease
Exploration/Etiology : How to identify causes for disease, including genetics

17. Discussion among review team
▪ There are methodological issues to bear in mind, including:
How to determine which questions are most important to answer;
How to engage stakeholders in question formulation;
How to account for changes in focus as the review progresses;
And considerations about how broad (or narrow) a review should be

18. Frameworks
If appropriate, use a framework to help in the development of your research question.
A framework will assist in identifying the important concepts in your question.
A good question will combine several concepts.
Identifying the relevant concepts is crucial to successful development and execution of
your systematic search.
Your research question should provide you with a checklist for the main concepts to be
included in your search strategy.

19. PICO framework
The more you understand your question the more likely you are to obtain
relevant results for your review. There are a number of different
frameworks available.
A technique often used in research for formulating a clinical research
question is the PICO model.
Slightly different versions of this concept are used to search for
quantitative and qualitative reviews.

20. PICO framework
▪Key research questions based on PICO (or other structured
research question) components
▪The structured question will determine the inclusion and
exclusion criteria:
What is the population of interest?
What are the interventions?
What are the outcomes of interest?
What study designs are appropriate?

21. Questions of interest
Effectiveness:
▪ Does the intervention work/not work?
▪ Who does it work/not work for?
Other important questions:
▪ How does the intervention work?
▪ Is the intervention appropriate?
▪ Is the intervention feasible?
▪ Is the intervention and comparison relevant?

22. Stages
▪ The review PICO (planned at the protocol stage) is the PICO on which eligibility of
studies is based (what will be included and what excluded from the review).
▪ The PICO for each synthesis (also planned at the protocol stage) defines the
question that each specific synthesis aims to answer, determining how the synthesis
will be structured, specifying planned comparisons (including intervention and
comparator groups, any grouping of outcome and population subgroups).
▪ The PICO of the included studies (determined at the review stage) is what was
actually investigated in the included studies.

23. For example, if the population is cancer patients, then researchers should decide , is it all cancer patients or just a
segment of them like breast cancer or cervical cancer?
Element Definition Example
Population Who is my question focused on? Women with breast
cancers
Intervention What is the intervention I am
interested in?
Education
Comparison What is the issue I am interested
in?
Without education
intervention
Outcome What, in relation to the issue, do I
want to examine?
Quality of life
Research question: What is the effectiveness of health education in improving quality of life
among women with breast cancers?

24. ▪ There are around at least 25 other question frameworks apart from the PICO.
▪ These frameworks are PEO, SPIDER, SPICE, and ECLIPS that can help to
formulate a focused research question for your systematic review.

25. PEO
▪ The PEO question framework is useful for qualitative research topics.
▪ PEO questions identify three concepts: Population, Exposure, and Outcome
Element Definition Example
Population Who is my question focused on? adults
Exposure What is the issue I am interested in? depression
Outcome
What, in relation to the issue, do I want
to examine?
quality of life
Research question: What is the quality of life of adults with depression?

26. SPIDER
▪ The SPIDER question framework is useful for qualitative or mixed methods research
topics focused on "samples" rather than populations.
▪ SPIDER questions identify five concepts: Sample, Phenomenon of interest,
Design, Evaluation, and Research type
Element Definition Example
Sample Who is the group of people being studied? Mothers
Phenomenon
of Interest
What are the reasons for behavior and decisions? immunization classes
Design
How has the research been collected (e.g., interview,
survey)?
interviews
Evaluation What is the outcome being impacted? experiences
Research type What type of research (qualitative or mixed methods)? Mixed methods
Research question: What are the experiences of mothers in attendance at immunization classes?

27. SPICE
▪ The SPICE question framework is useful for qualitative research topics evaluating the outcomes of a
service, project, or intervention.
▪ SPICE questions identify five concepts: setting, perspective, intervention/exposure/interest,
comparison, and evaluation
Element Definition Example
Setting
Setting is the context for the question
(where).
Nigeria
Perspective
Perspective is the users, potential users, or
stakeholders of the service (for whom).
teenagers
Intervention / Exposure
Intervention is the action taken for the
users, potential users, or stakeholders
(what).
provision of Quit Kits to support smoking
cessation
Comparison
Comparison is the alternative actions or
outcomes (compared to what).
no support
Evaluation
Evaluation is the result or measurement
that will determine the success of the
intervention (what is the result, how well).
number of successful attempts to give up
smoking with Quit Kits compared to number
of successful attempts with no support
Research question: What is the effect of provision of Quit Kits to support smoking cessation on number of successful
attempts to give up smoking compared to no support among teenagers in Nigeria ?

28. ECLIPSE
▪ Similarly, qualitative research topics to investigate the outcomes of a policy or service, the
ECLIPSE framework is useful.
▪ ECLIPSE questions includes six concepts: expectation, client group, location, impact,
professionals, and service
Research question: How can access to telemedicine be
increased for rural patients?
Element Definition Example
Expectation
What are you looking to improve or
change? What is the information
going to be used for?
to increase access to telemedicine
service
Client group Who is the service or policy aimed at? patients and families
Location
Where is the service or policy
located?
Rural areas
Impact
What is the change in service or
policy that the researcher is
investigating?
clients have easy access to
telemedicine services
Professionals
Who is involved in providing or
improving the service or policy?
IT, administration
Service What kind of service or policy is this?
provision of free telemedicine to rural
area patients

29. Examples

31. Research questions
▪ Research questions: what is the relationship between the long-term consumption (>5
yr) of the main food groups defined a priori as whole grains, vegetables, fruits, nuts,
legumes, eggs, poultry, dairy products, fish/seafood, red/processed meat, and
cardiovascular mortality among adults
P- Adults
I – food intake ( highest)
C- No Intake ( lowest intake)
O- cardiovascular mortality

33. Research questions
▪ Research questions: What is the impact of urinary tract infection–targeted ASP on
overall AMR, antimicrobial use in nursing homes (NHs)?
P- Nursing homes
I – Antimicrobial Stewardship Program
C- No ASP
O-Antibiotic resistance

35. Research questions
▪ Research questions: What is the effectiveness of interventions to address transport
and other unintentional injuries among adolescents aged 10–24 years worldwide?
P- Adolescents aged 10–24 years
I – Interventions
C- No Interventions
O- Transport and other injuries

36. Ongoing Systematic Reviews
▪ The effects of lifestyle interventions in mid-life in reducing cardiovascular events at later life : A
Cochrane Review- with team of UNSW Australia
▪ Effects of Beverage consumption and cardiovascular mortality: A Systematic review and Meta
analysis - with team of UNSW Australia_ manuscript under preparation
▪ “Mixed method systematic review of Interventions addressing antimicrobial resistance (AMR)
across one health spectrum in lower- and middle-income countries employing an inter-
disciplinary social-ecological framework”- With Mentee/students

38. Further resources/References
▪ Thomas J, Kneale D, McKenzie JE, Brennan SE, Bhaumik S. Chapter 2: Determining the scope of the review and the questions it will address.
In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of
Interventions version 6.3 (updated February 2022). Cochrane, 2022. Available from www.training.cochrane.org/handbook.
▪ Aromataris E, Munn Z. Chapter 1: JBI Systematic Reviews. In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis. JBI, 2020.
Available from https://synthesismanual.jbi.global.. https://doi.org/10.46658/JBIMES-20-02
▪ Introduction to Systematic Review and Meta-Analysis. Course era online course https://www.coursera.org/learn/systematic-review
▪ https://guides.mclibrary.duke.edu/sysreview/write
▪ https://training.cochrane.org/online-learning/core-software/revman
▪ https://ktdrr.org/resources/sr-resources/tools.htm

39. Contact
email: bhbuna@iom.edu.np
Twitter: bunabh
Linekdin – Buna Bhandari