Formulating the Topic and Research Questions for Systematic Reviews - Dr Carlos Andrade

Learn how to effectively develop your research focus with our comprehensive slides on "Formulating the Topic and Research Questions for Systematic Reviews."
This presentation includes:

1) The importance of well-defined topics and research questions in systematic reviews
2) Steps to identify and refine your research topic
3) Frameworks for developing research questions (e.g., PICO, SPIDER)
4) Techniques for ensuring clarity and specificity in your questions
5) Practical examples of well-formulated research questions
6) Common pitfalls and how to avoid them
7) Tools and resources for topic formulation and question development

Perfect for researchers and practitioners beginning their systematic review journey, these slides provide essential guidance on creating focused and relevant research questions.

Set a strong foundation for your systematic review with expertly crafted topics and questions.

1. SYSTEMATIC REVIEWS
FORMULATING THE TOPIC AND
RESEARCH QUESTIONS
CARLOS ALEXANDRE ANDRADE
PHD CANDIDATE AND RESEARCHER
UNIVERSITY OF DEBRECEN

2. A LITTLE BIT ABOUT ME…
•Graduated in Dentistry at the University of Brasilia-UnB(Brazil)
•Exchange Program at the University of Debrecen (Hungary)
•Post-graduation specialty in Implantology at Aria Institute (Brazil)
•Master’s degree in Dentistry University of Brasilia-UnB(Brazil)
•PhD candidate in Health Sciences at the University of Debrecen (Hungary)
•Association of dental diseases and Diabetes Mellitus
•Failure of dental implants in Diabetes Mellitus
•Burden of Diabetes Mellitus in European Union
•Inequalities in non-communicable diseases in Europe
–Systematic Reviews and Meta-analysis
–Secondary database analysis
–Clinical cohorts and trials

3. HOW TO START A
SYSTEMATIC REVIEW ?
1. Planning
2. Execution
3. Reporting

4. PLANNING
(1) Forming the team
(2) Selecting the topic
(3) Conducting a comprehensive search
for prior Reviews on the chosen subject
(4) Formulating the research question
(5) Organizing information within the
protocol.

5. FORMULATING THE TOPIC
•It might originate from day-to-day finding or issue.
•Recurring patterns, uncertainties, or gaps in knowledge.
•Issues that need evidence-based solutions.
•From previously published evidence needing further exploration or
validation.
•Population needs, educational issues, epidemiological doubts, public
health concerns, or emerging healthcare trends.

6. FORMULATING THE TOPIC
•The process should prioritize topics that are relevant and interesting,
while also addressing a gap in the existing literature.
•Consulting specialists in the field, studying relevant literature
references, and conducting interviews to gain insight into potential
research directions.
•Collaborating with a selected group of researchers can also facilitate a
brainstorming session to refine and shape the main question.
•The topic can be either refined to become more specific or expanded
to encompass a broader scope.

7. FORMULATING THE TOPIC
•Exploring the topic in the current body of evidence and identifying
any knowledge gaps that exist.
•A preliminary literature review is necessary during the study planning
stages to:
–investigate what is known about the topic,
–confirm the need for the project,
–and refine the research topic.

8. FORMULATING THE TOPIC
Identifying a problem that is meaningful and relevant is crucial.
1.Uncover the international evidence: to gather and summarize evidence
from various international sources.
2.Confirm current practice and address any variation: to verify the
effectiveness of current practices or identify and address variations in
practice.
3.Identify areas for future research: to highlight gaps in the current
evidence base and suggest areas where further research is needed.
4.Investigate conflicting results: to resolve discrepancies or conflicts in
the results of previous studies.
5.Produce statements to guide decision-making: to develop evidence-
based recommendations or guidelines to inform decision-making.

9. FORMULATING THE TOPIC
•Initial brainstorming sessions allow researchers to express their
passions, share their experiences, and define their areas of expertise.
•Brainstorm and concept map steps for formulating research question:
1.Identify what types of studies have been done in the past.
2.Unique area that is yet to be investigated or a particular question
that may be worth replicating.
3.Begin to narrow the topic by asking open-ended “how” and
“why” questions.
4.Evaluate the question draft and develop a hypothesis.
5.Write down the final research question.

10. FRAMEWORKS
Help to define and focus
the systematic review topics
by providing a structured
approach, ensuring that
research questions are
specific and well-defined.
Improve the relevance and
rigor of research questions
by setting criteria that
ensure the topics addressed
are significant.
Maintain consistency in
question formulation and
review processes.
Assist in identifying key concepts and
variables, guiding researchers in conducting
detailed literature searches and organizing
relevant studies.
Clearly define the target population and
setting, context, intervention, index test or
phenomenon of interest, comparator or reference
standard, and outcome or treatment decisions
are all essential parts of the research question.

11. FRAMEWORKS
The PICO approach is helpful for the rapid synthesis of clinical questions,
particularly for interventional studies.
Population (P):
Define the study population
considering baseline and
clinical characteristics (age,
sex/gender, race/ethnicity,
medical condition, disease
severity).
Determine inclusion/exclusion
criteria and address potential
selection bias.
Plan the sampling method, setting
(inpatient, ambulatory care,
community, academia), and
recruitment strategies.
Intervention (I):
For experimental designs,
include details on medication
type, dose, route, service
provided, and contextual
factors.
For qualitative studies, focus on
the phenomenon of interest
(behavior, attitude, practice,
experience…).
Define the study methodology
(interview, survey, cohort, case-
control, pre-post) and whether it
is descriptive, correlational, or
causal.
Comparator (C):
Identify what the intervention
is being compared against
(active control, sham,
historical, usual care).
Specify details of comparators
and consider design choices like
masking/blinding.
Discuss potential confounders
and how to measure and handle
them.
Outcomes (O):
Clarify what the study aims to
measure or describe.
Define primary and secondary
outcomes for quantitative studies.
Assess both beneficial outcomes
and potential harms.
Consider temporal aspects
(intervention schedule, evaluation
duration).
Plan for sample size
determination and pre-plan
subgroup and statistical analyses.

13. FRAMEWORKS
•PICO is accepted among scholars as a universal approach for formulating a
research question or planning a search strategy.
•However, it does not apply to most types of evidence.
•Reviewers often attempt to fit their question into the PICO format, even when the
question pertains to diagnostic test accuracy or prognosis.
•This forced alignment with PICO can complicate and confound the review
process.
•Experts in the field have introduced other approaches and frameworks for certain
types of evidence and studies, particularly those commonly used in clinical
settings.

14. FrameworkReview Type Aim Question Format Question Example
PICO Effectiveness
To evaluate the effectiveness of a certain
treatment/practice in terms of its impact on
outcomes
Population, Intervention,
Comparator/s, Outcomes
What is the effectiveness of exercise for
treating depression in adults compared to
no treatment or a comparison treatment?
PEO
Etiology
and/or Risk
To determine the association between particular
exposures/risk factors and outcomes
Population, Exposure, Outcome
Are adults exposed to radon at risk for
developing lung cancer?
CoCoPop
Prevalence
and/or
Incidence
To determine the prevalence and/or incidence
of a certain condition
Condition, Context, Population
What is the prevalence/incidence of
claustrophobia and claustrophobic
reactions in adult patients undergoing
MRI?
PIRD
Diagnostic
Test Accuracy
To determine how well a diagnostic test works
in terms of its sensitivity and specificity for a
particular diagnosis
Population, Index Test, Reference
Test, Diagnosis of Interest
What is the diagnostic test accuracy of
nutritional tools compared to the Patient
Generated Subjective Global Assessment
amongst patients with colorectal cancer to
identify undernutrition?
PFO Prognostic
To determine the overall prognosis for a
condition, the link between specific prognostic
factors and an outcome and/or
prognostic/prediction models and prognostic
tests
Population, Prognostic Factors (or
models of interest), Outcome
In adults with low back pain, what is the
association between individual recovery
expectations and disability outcomes?
PICOC
Economic/Cos
t-effectiveness
To determine the costs associated with a
particular approach/treatment strategy,
particularly in terms of cost effectiveness or
benefit
Population, Intervention,
Comparator/s, Outcomes, Context
What is the cost effectiveness of self-
monitoring of blood glucose in type 2
diabetes mellitus in high income countries?
CPTM Psychometric
To evaluate the psychometric properties of a
certain test, normally to determine how the
reliability and validity of a particular test or
assessment
Construct of interest or the name of
the measurement instrument(s),
Population, Type of measurement
instrument, Measurement properties
What is the reliability, validity,
responsiveness and interpretability of
methods to assess muscle strength in
adults?

15. Framework Review Type Aim Question Format Question Example
SDMO Methodologic
To examine and investigate current
research methods and potentially their
impact on research quality
Types of Studies, Types of Data,
Types of Methods, Outcome
What is the effect of masked (blind) peer
review for quantitative studies in terms
of the study quality as reported in
published reports?
BeHEMoTh Theory/Model
To explore theoretical frameworks and
models relevant to health and behavior
Behavior of interest, Health
context, Exclusions, Models or
Theories
What models or theories explain the
impact of socio-economic factors on
health behavior in adolescents?
PPhTS Qualitative
To investigate experiences, perceptions,
or phenomena in specific contexts
Participants, Central
Phenomenon, Time, Space
What is the experience of undergoing
high technology medical imaging in
adult patients in high income countries?
SPICE
Qualitative: Public
Health
To assess public health interventions and
their impacts
Setting, Perspective,
Intervention, Comparison,
Evaluation
What is the impact of community-based
health interventions on reducing
childhood obesity in urban settings?
SPIDER
Qualitative/Mixed-
Method: Experience and
Views
To understand personal experiences and
views on specific phenomena
Sample, Phenomenon of
Interest, Design, Evaluation,
Research type
What are the experiences of patients
receiving telehealth services compared to
traditional in-person consultations?
CIMO
Qualitative:
Organizational and
Policy Evaluation
To evaluate organizational and policy-
related interventions and their effects
Context, Intervention,
Mechanism, Outcome
How does the implementation of new
workplace wellness programs affect
employee health outcomes in large
organizations?
ECLIPSe
Qualitative: Health Policy
and Management
To explore health policies and
management strategies in various
settings
Expectation, Client group,
Location, Impact, Professionals,
Service
What are the expectations and impacts of
health policy changes on service delivery
in rural health centers?
PCC Scoping
To map out the breadth of literature and
research on a particular concept or
population
Population, Concept, Context
What is the scope of research on the
effectiveness of remote patient
monitoring systems for chronic disease
management?

16. RESEARCH
QUESTION
(1) It should be interesting, answerable,
and innovative.
(2) It should be a clear, focused, and well-
designed
(3) It can arise from previous research or
from a question that emerged in clinical
practice
(4) It should be useful to a broad number
of people

17. Innovative
Ensuring novelty in research topics is crucial.
Undertaking extensive research is justified only if
there are significant updates or advancements that
render previous studies obsolete. Quick literature
reviews, qualitative research such as interviews,
and source verification, to confirm the originality
and relevance of the chosen topic should be
performed.
Focused
Ensure that the topic is not overly broad, as this would
make implementing the systematic review impractical
due to the overwhelming number of related studies that
would need to be assessed. Keep your topic focused
and structured in a manner that facilitates a more direct
path toward uncovering its answer.
Specific
The topic for a systematic review must be
specific, leaving no ambiguity or room for
misinterpretation. However, caution should be
exercised to avoid making it excessively
narrow, as this may lead to difficulties in
locating relevant data.
Answerable
The primary objective of a systematic review is to address
a specific research question comprehensively. If the
chosen topic cannot be effectively answered through the
review process, it undermines the purpose and efficacy of
the entire research. It is imperative to select a topic that is
well-defined and conducive to being addressed through
systematic review methods.

18. Criterion Description
Feasible
-Assess if the project can be realistically executed with available subjects, methodology, time, and
funds.
-Ensure access to necessary people, tools, and data.
-Plan for data collection and project completion within given resources.
-Develop contingency plans for unforeseen issues.
Interesting
-Ensure genuine interest in the research question.
-Interest should drive motivation and academic debate.
Novel
-The research should offer new insights or perspectives.
-Aim to confirm, refute, or expand on existing findings.
-Formulate a clear and specific question to guide the research effectively.
-Avoid contradictions and poorly structured questions.
Ethical
-Obtain clearance from appropriate authorities.
-Minimize harm, protect privacy, maintain confidentiality, and ensure the right to withdraw.
-Avoid deceptive practices.
Relevant
-The question should be of academic and intellectual interest in the chosen field.
-Arise from current issues, literature, or practice.
-Establish a clear purpose in relation to the field (e.g., filling knowledge gaps, analyzing assumptions).

19. Criterion Description
Manageable
- The research should be manageable by the researcher, similar to feasibility but focused on personal
management.
Appropriate
- The research question should be logically and scientifically appropriate for the community and
institution.
Potential
Value and
Publishability
-Aim for significant impact in clinical, community, or policy contexts.
-Should address important health dilemmas and have implications for decision-making.
-Should reduce unnecessary costs and aim for evidence-based change.
Systematic
- Research should follow a structured sequence of steps according to well-defined rules, while allowing
for creative thinking.
Clarity and
specificity
- The research question should be precise, focused, and clear, exactly outlining what it aims to
investigate.
Originality
- While it is not required to be entirely unique, a good research question should address an aspect that
has not been extensively studied, or offer a novel perspective on an existing topic.
Measurability
- The question should be answerable, allowing for measurable outcomes or data that can be analyzed
and interpreted.

20. RESEARCH QUESTION
•Research question identifies the problem to be studied and guides to
the methodology.
•Researchers should be aware that occasionally slight modification of
research questions might be required at a later stage of the study.
•The research question and overall overview objective will dictate the
type of review required.
•The format and wording of research questions are closely linked to the
methodological approach of the study.

21. RESEARCH QUESTION
•In qualitative research, questions are generally open-ended, enabling
free responses to explain a phenomenon.
•Qualitative approaches are best used for discovering answers to ‘why’,
‘how’, or ‘what’ type questions.
– “How do adult smokers adapt to their first year after quitting
smoking?”
– “Which factors in the teaching-learning environment increase
students’ interest in learning?”

22. RESEARCH QUESTION
•Experimental studies using quantitative methods usually ask closed
questions relating to pre-defined variables aimed at establishing a
relationship.
•These studies commonly explore responses to questions asking
‘do(es)’, ‘is(are)’, ‘can’, or ‘should’.
– “Do medical students who are trained on surgical skills models
perform better when performing their first live surgery?”
– “Are Brazilian law professionals who prepare for their law
examination using online guides more likely to pass their licensing
examination on the first attempt?”

23. RESEARCH QUESTION
•Occasionally, researchers find it advantageous to combine aspects of
both research types to draw data from various perspectives; this
creates a mixed methods study.
– “Do students’ experiences of the teaching-learning environment
change during school, and if so, how are these changes related to
the development of self-management skills?”
– “How has remote teaching during the Covid-19 pandemic affected
first-year university students’ assessment scores, help-seeking
behavior, and well-being?”

24. Type of Research
Question
Description Example
Existence
Designed to determine whether a particular phenomenon exists or
to rule out alternative explanations.
Can neonates perceive pain?
Description and Classification
Encompasses statements of uniqueness, focusing on the
characteristics or types of phenomena.
What are the characteristics and types of
neuropathic bladders?
Composition Breaks down a phenomenon into its components or stages.What are the stages of reflux nephropathy?
Relationship Evaluates the relationship between two or more variables.
What is the association between tumor rupture
and recurrence rates in Wilm's tumor?
Descriptive (Comparative)
Compares groups to determine if differences exist between them,
ensuring that all factors except the one in question are the same.
Are germ cell tumors occurring in gonads more
aggressive than those occurring in extragonadal
sites?
Causality Investigates whether a specific cause leads to a particular outcome.
Does deletion of p53 lead to worse outcomes in
patients with neuroblastoma?
Causality (Comparative)
Compares the effects of two different treatments to determine
which is more effective.
Does adding surgical resection improve survival
rates in children with neuroblastoma compared to
chemotherapy alone?
Causality (Comparative
Interactions)
Examines how one cause affects outcomes in the presence or
absence of other conditions or factors.
Does immunotherapy lead to better survival
outcomes in neuroblastoma Stage IV S with an
adverse genetic profile compared to
chemotherapy alone?

25. RESEARCH QUESTION
1.Is the Research question clear?
With so much research available on any given topic,
research questions must be as clear as possible.
2.Is the Research question focused?
Research questions must be specific enough to be well
covered in the space and time available.
3.Is the Research question complex?
Research questions should not be answerable with a simple
“yes” or “no” or by easily found facts. They should, instead,
require both research and analysis on the part of the
researcher.
4.Is the Research question of interest to the researcher
and potentially useful to others?
Is it a new issue or problem that needs to be solved or is it
attempting to shed light on previously researched topic.
5.Is the Research question researchable?
Consider the available time frame and the required
resources.
6. Is the methodology to conduct the research feasible?
Consider necessary resources, time, and expertise are
available to effectively carry out the planned procedures and
if any potential obstacles can be reasonably managed.
7.Is the Research question measurable and will the process
produce data that can be supported or contradicted?
Consider if the question is clearly defined and specific
enough to allow for the collection of quantifiable and
analyzable data that can be used to draw definitive
conclusions.
8.Is the Research question too broad or too narrow?
If a question is too narrow, it may limit the external validity
of the study and broader interest in the results, making it
difficult to seek publication and dissemination. If a question
is too broad, it may affect the internal validity and relevance
of the results by leading to unclear conclusions.
9.Do you understand implications of your research?
Consider whether one achieves to fill gap in knowledge and
how the results of the research have practical implications.

26. Bad examples of research question Good examples of research question
Very narrow: What is the protein-energy malnutrition in schoolchildren in Delhi?
Less narrow: How does the education level of the parents impact protein-energy
malnutrition in schoolchildren of Delhi?
This is too narrow because it can be answered with a simple statistic. Questions that
can be answered with a “yes” or a “no” should also typically be avoided
This question is more specific and will lead to more meaningful research and the
results would provide the opportunity for an argument to be formed
Unfocused: What are the effects of protein-energy malnutrition in schoolchildren in
New Delhi?
More focused: How does protein-energy malnutrition among children affect
academic performance in elementary schoolchildren in Delhi?
This question is so broad that research methodology would be very difficult and the
question is too broad to be discussed in a typical research paper.
This question has a very clear focus for which data can be collected, analyzed, and
discussed
Very objective: How much time do young children in Delhi spend doing physical
activity per day?
More subjective: What is the relationship between physical activity levels and
childhood obesity?
This question may allow the researcher to collect data but does not lend itself to
collecting data that can be used to create a valid argument because the data is just
factual information
This is a more subjective question that may lead to the formation of an argument
based on the results and analysis of the data. It is interesting and relevant too.
Too simple: How are school systems in various schools of Delhi addressing
childhood behavioral problems?
More complex: What are the effects of intervention programs in the elementary
schools on the rate of childhood psychological health among 6th-9th-grade students?
This information can be obtained without the need to collect unique data. The
question could be answered with a simple online search and does not provide an
opportunity for analysis
This question is more complex and requires both investigation and evaluation which
will lead the research to form an argument that may be discussed. It is interesting and
relevant.

28. CONCLUSIONS
The importance of formulating a sound and proper research question can be
summarized in three main motives:
1.Conducting an evidence-based study: Evidence-based studies,
particularly systematic reviews, rely on a research question developed to
specifically address the problem with all required details.
2.Designing search strategy: Formulating a strategy for searching
electronic databases based on a well-defined research question is the
fundamental step for any specific attempt to access the evidence for
educational, clinical, and research purposes.
3.Highlighting the literature gaps: Beyond the study design, a formulated
research question is essential for the literature review to identify and
specify knowledge gaps.

29. HANDS-ON
( H T T P S : / / F O R M S . G L E / A Z E 3
N H I K H T N 9 I X E T 6 )

30. Comparison of academic performance between rural and
urban children receiving parental financial incentives for
good grades
•Population (P): Children (5 – 10 years old) attending
schools located in urban areas.
•Intervention (I): Any monetary incentives provided by
parents to encourage children to achieve good grades in
school.
•Comparison (C): Children (5 – 10 years old) attending
schools located in rural areas.
•Outcome (O): Academic performance will be measured
in terms of grades or scores achieved in school
assessments.
Research question
How does the academic performance of children aged
between 5 and 10 years old in urban areas who receive
financial incentives from their parents for good grades
compare to that of children in rural areas who receive similar
financial support?
Prevalence of unemployed civil engineers in the European
Union from 2000 to 2024
•Condition (Co): Unemployment within the profession of
civil engineering.
•Context (Co): The geographical and political boundaries
of the European Union, considering its member states.
•Population (Pop): Individuals who are qualified civil
engineers within the age range of 18 to 70 years.
Research question
What is the prevalence rate of unemployment among civil
engineers aged 18-70 in the European Union between 2000
and 2024, and how do these rates vary by factors such as age,
country, economic cycles, and industry changes?
1 2
WHAT IS THE BEST RESEARCH QUESTION?

31. Diagnostic test accuracy of rapid oral HIV test compared
to standard blood antibody test amongst individuals with
dry mouth
•Population (P): Patients experiencing xerostomia (dry
mouth) who are being tested for HIV.
•Index Test (I): Rapid HIV diagnostic test that uses an oral
fluid sample.
•Reference Test (R): The conventional method for HIV
diagnosis using a blood sample to detect antibodies.
•Diagnosis of Interest (D): The presence of HIV infection
as confirmed by diagnostic testing.
Research question
In individuals with dry mouth (xerostomia), how does the
diagnostic accuracy of the rapid oral HIV test compare to the
standard blood antibody test in terms of sensitivity,
specificity, positive predictive value, and negative predictive
value for detecting HIV infection?
Explaining the impact of self-perceived health on crime rates
in high-income countries
•Behavior (Be): Includes types and frequencies of crimes such
as violent crime, property crime, and white-collar crime.
•Health context (He): Individuals’ assessments of their own
level of health, including self-reported health status and
perceived well-being.
•Environment (E): High-income countries.
•Models (Mo): Human Capital Theory (suggests that higher
self-perceived health increases the economic opportunities
available to individuals) and Social Control Theory (proposes
that higher self-perceived health strengthens social bonds and
adherence to societal norms).
•Theories (Th): Routine Activities Theory (explains how
changes in health may influence routine activities) Strain
Theory (discusses how lack of health access may lead to
strain).
Research question
What models and theories, such as Social Control Theory, Human
Capital Theory, and Routine Activities Theory, explain the impact
of self-perceived health on crime rates within high-income
countries, and how do these models account for variations in
crime rates across different high-income nations?
3 4
WHAT IS THE BEST RESEARCH QUESTION?

32. QUESTIONS?

33. Thank you for your attention!
Carlos Alexandre Andrade
[email protected]