research question examples in healthcare

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Defining the Question: Foreground & Background Questions

In order to most appropriately choose an information resource and craft a search strategy, it is necessary to consider what  kind  of question you are asking: a specific, narrow "foreground" question, or a broader background question that will help give context to your research?

Foreground Questions

A "foreground" question in health research is one that is relatively specific, and is usually best addressed by locating primary research evidence. 

Using a structured question framework can help you clearly define the concepts or variables that make up the specific research question. 

 Across most frameworks, you’ll often be considering:

• a who (who was studied - a population or sample)
• a what (what was done or examined - an intervention, an exposure, a policy, a program, a phenomenon)
• a how ([how] did the [what] affect the [who] - an outcome, an effect). 

PICO is the most common framework for developing a clinical research question, but multiple question frameworks exist.

PICO (Problem/Population, Intervention, Comparison, Outcome)

Appropriate for : clinical questions, often addressing the effect of an intervention/therapy/treatment

Example : For adolescents with type II diabetes (P) does the use of telehealth consultations (I) compared to in-person consultations  (C) improve blood sugar control  (O)?

Framing Different Types of Clinical Questions with PICO

Different types of clinical questions are suited to different syntaxes and phrasings, but all will clearly define the PICO elements.  The definitions and frames below may be helpful for organizing your question:

Intervention/Therapy

Questions addressing how a clinical issue, illness, or disability is treated.

"In__________________(P), how does__________________(I) compared to_________________(C) affect______________(O)?"

Questions that address the causes or origin of disease, the factors which produce or predispose toward a certain disease or disorder.

"Are_________________(P), who have_________________(I) compared with those without_________________(C) at_________________risk for/of_________________(O) over_________________(T)?" 

Questions addressing the act or process of identifying or determining the nature and cause of a disease or injury through evaluation.

In_________________(P) are/is_________________(I) compared with_________________(C) more accurate in diagnosing_________________(O)?

Prognosis/Prediction:

Questions addressing the prediction of the course of a disease.

In_________________(P), how does_________________(I) compared to_________________ (C) influence_________________(O)?

Questions addressing how one experiences a phenomenon or why we need to approach practice differently.

"How do_________________(P) with_________________(I) perceive_________________(O)?" 

Adapted from: Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

Beyond PICO: Other Types of Question Frameworks

PICO is a useful framework for clinical research questions, but may not be appropriate for all kinds of reviews.  Also consider:

PEO (Population, Exposure, Outcome)

Appropriate for : describing association between particular exposures/risk factors and outcomes

Example : How do  preparation programs (E) influence the development of teaching competence  (O) among novice nurse educators  (P)?

SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research Type)

Appropriate for : questions of experience or perspectives (questions that may be addressed by qualitative or mixed methods research)

Example : What are the experiences and perspectives (E) of  undergraduate nursing students  (S)  in clinical placements within prison healthcare settings (PI)?

SPICE (Setting, Perspective, Intervention/phenomenon of Interest, Comparison, Evaluation)

Appropriate for : evaluating the outcomes of a service, project, or intervention

Example : What are the impacts and best practices for workplace (S) transition support programs (I) for the retention (E) of newly-hired, new graduate nurses (P)?

PCC (Problem/population, Concept, Context)

Appropriate for : broader (scoping) questions

Example : How do nursing schools  (Context) teach, measure, and maintain nursing students ' (P)  technological literacy  (Concept))throughout their educational programs?

Background Questions

To craft a strong and reasonable foreground research question, it is important to have a firm understanding of the concepts of interest.  As such, it is often necessary to ask background questions, which ask for more general, foundational knowledge about a disorder, disease, patient population, policy issue, etc. 

For example, consider the PICO question outlined above:

"For adolescents with type II diabetes does the use of telehealth consultations compared to in-person consultations  improve blood sugar control ?

To best make sense of the literature that might address this PICO question, you would also need a deep understanding of background questions like:

• What are the unique barriers or challenges related to blood sugar management in adolescents with TII diabetes?
• What are the measures of effective blood sugar control?
• What kinds of interventions would fall under the umbrella of 'telehealth'?
• What are the qualitative differences in patient experience in telehealth versus in-person interactions with healthcare providers?
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Examples of Research Questions

Phd in nursing science program, examples of broad clinical research questions include:.

• Does the administration of pain medication at time of surgical incision reduce the need for pain medication twenty-four hours after surgery?
• What maternal factors are associated with obesity in toddlers?
• What elements of a peer support intervention prevent suicide in high school females?
• What is the most accurate and comprehensive way to determine men’s experience of physical assault?
• Is yoga as effective as traditional physical therapy in reducing lymphedema in patients who have had head and neck cancer treatment?
• In the third stage of labor, what is the effect of cord cutting within the first three minutes on placenta separation?
• Do teenagers with Type 1 diabetes who receive phone tweet reminders maintain lower blood sugars than those who do not?
• Do the elderly diagnosed with dementia experience pain?
•  How can siblings’ risk of depression be predicted after the death of a child?
•  How can cachexia be prevented in cancer patients receiving aggressive protocols involving radiation and chemotherapy?

Examples of some general health services research questions are:

• Does the organization of renal transplant nurse coordinators’ responsibilities influence live donor rates?
• What activities of nurse managers are associated with nurse turnover?  30 day readmission rates?
• What effect does the Nurse Faculty Loan program have on the nurse researcher workforce?  What effect would a 20% decrease in funds have?
• How do psychiatric hospital unit designs influence the incidence of patients’ aggression?
• What are Native American patient preferences regarding the timing, location and costs for weight management counseling and how will meeting these preferences influence participation?
•  What predicts registered nurse retention in the US Army?
• How, if at all, are the timing and location of suicide prevention appointments linked to veterans‘ suicide rates?
• What predicts the sustainability of quality improvement programs in operating rooms?
• Do integrated computerized nursing records across points of care improve patient outcomes?
• How many nurse practitioners will the US need in 2020?

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Evidence-Based Research: Phrasing Research Questions

The researchable question.

The first step in doing evidence-based practice research is forming a researchable question. Questions that are too broad or too narrow can make your research difficult, if not impossible.

Clinical example:

• This topic is so broad that you'd have difficulty wading through all of the results.
• This question is so specific that there probably hasn't been anything published on that specific location regarding that specific population.
• Just right : In the NICU, what is the effect of hand washing on infection control compared with hand sanitizers, over 6 months?

Non-clinical example:

• This topic is so broad that you'd have difficulty wading through all of the results.  Also the wording in the question has to be more specific (use synonyms to include all possible versions).  For instance, heart disease is better known in the literature as cardiovascular disease, so search both ways. 
• This question is so specific that there probably hasn't been anything published on that specific location regarding that specific population. It can be only be determined by accessing the electronic medical records in the hospital and finding the rate.
• This question is just right because the variable name like “cardiovascular mortality” are descriptive and reflective of what is found in the literature.  Additionally, there are some control variables included to make sure that even if each group of race had individuals with different ages or different incomes, this would not explain away the differences in cardiovascular mortality impacted by race.

PICOT and other models

PICOT is a mnemonic that helps you remember the key components of a well-focused question. It stands for:

• P = Patient, Population or Problem
• I = Intervention, Prognostic Factor, or Exposure
• C = Comparison (optional)
• O = Outcome

PICOT examples:

Intervention/therapy

In _______(P), what is the effect of _______(I) on ______(O) compared with _______(C) within ________ (T)? 

In the aged population, what is the effect of exercise programs on accidental falls, as compared with no exercise?  

Are ____ (P) who have _______ (I) at ___ (Increased/decreased) risk for/of_______ (O) compared with ______ (P) with/without ______ (C) over _____ (T)?

Are adult smokers with a history of childhood asthma at increased risk of COPD compared to adult smokers with no history of asthma?  

Diagnosis or diagnostic test

Are (is) _________ (I) more accurate in diagnosing ________ (P) compared with ______ (C) for _______ (O)? 

Is the Hemoglobin A1C test more accurate in diagnosing diabetes as compared with fasting blood sugar levels?  

For ________ (P) does the use of ______ (I) reduce the future risk of ________ (O) compared with _________ (C)? 

For people with type 2 diabetes, does zinc supplementation reduce the future risk of foot ulcers compared with placebo?  

Prognosis/Predictions 

Does __________ (I) influence ________ (O) in patients who have _______ (P) over ______ (T)? 

In adults with osteoarthritis, does low vitamin D levels in the bloodstream predict the rate of future hip fractures?  

Meaning 

How do ________ (P) diagnosed with _______ (I) perceive ______ (O) during _____ (T)? 

How do cancer patients diagnosed with alopecia perceive their self-esteem during and after chemotherapy?

Public Health:

PICO(T) is commonly used to formulate research questions, sometimes referred to as ‘PI/ECO’ (Population/participants, Intervention/Exposure, Comparison, Outcome). The PI/ECO structure can be readily amended for different question types ( NHMRC Guidelines, 2019 ). A simple example might be:   

• Population / participants: Non-institutionalized civilian residents of the United States   
• Intervention (or Exposure): Hypertension (or Low Socioeconomic Status)  
• Comparison: Respondents without hypertension   
• Outcomes: Cardiovascular disease or cardiovascular mortality   
• Types of studies: Cross-sectional, Longitudinal

Alternate Models:

• PECO  – Population | Environment | Comparison | Outcome Very similar to PICO but looking at the effect of exposure to something e.g. smoky atmosphere
• SPICE  - Setting | Population | Intervention | Comparison | Evaluation Another variant of PICO but this time including the setting (where? in what context?)
• ECLIPSE  - Expectation | Client group | Location | Impact | Professionals | Service Recommended for health policy/management searches
• SPIDER  – Sample | Phenomenon of Interest | Design | Evaluation | Research Type Developed to create effective search strategies of qualitative and mixed-methods research - more specific than PICO/PECO

Search terms

Once you've developed your question, it's time to find keywords or search terms that you can use in the Library databases to find articles relevant to your question. Remember that each article does not necessarily need to address ALL the aspects of your question.

To learn more about selecting and combining appropriate search terms, please see our guides:

• Keyword Searching: Keyword Search Strategy
• Guide: Keyword Searching: Boolean
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• Next Page: Levels of Evidence Pyramid
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Research Aims, Objectives & Questions

The “Golden Thread” Explained Simply (+ Examples)

By: David Phair (PhD) and Alexandra Shaeffer (PhD) | June 2022

The research aims , objectives and research questions (collectively called the “golden thread”) are arguably the most important thing you need to get right when you’re crafting a research proposal , dissertation or thesis . We receive questions almost every day about this “holy trinity” of research and there’s certainly a lot of confusion out there, so we’ve crafted this post to help you navigate your way through the fog.

Overview: The Golden Thread

• What is the golden thread
• What are research aims ( examples )
• What are research objectives ( examples )
• What are research questions ( examples )
• The importance of alignment in the golden thread

What is the “golden thread”?  

The golden thread simply refers to the collective research aims , research objectives , and research questions for any given project (i.e., a dissertation, thesis, or research paper ). These three elements are bundled together because it’s extremely important that they align with each other, and that the entire research project aligns with them.

Importantly, the golden thread needs to weave its way through the entirety of any research project , from start to end. In other words, it needs to be very clearly defined right at the beginning of the project (the topic ideation and proposal stage) and it needs to inform almost every decision throughout the rest of the project. For example, your research design and methodology will be heavily influenced by the golden thread (we’ll explain this in more detail later), as well as your literature review.

The research aims, objectives and research questions (the golden thread) define the focus and scope ( the delimitations ) of your research project. In other words, they help ringfence your dissertation or thesis to a relatively narrow domain, so that you can “go deep” and really dig into a specific problem or opportunity. They also help keep you on track , as they act as a litmus test for relevance. In other words, if you’re ever unsure whether to include something in your document, simply ask yourself the question, “does this contribute toward my research aims, objectives or questions?”. If it doesn’t, chances are you can drop it.

Alright, enough of the fluffy, conceptual stuff. Let’s get down to business and look at what exactly the research aims, objectives and questions are and outline a few examples to bring these concepts to life.

Research Aims: What are they?

Simply put, the research aim(s) is a statement that reflects the broad overarching goal (s) of the research project. Research aims are fairly high-level (low resolution) as they outline the general direction of the research and what it’s trying to achieve .

Research Aims: Examples  

True to the name, research aims usually start with the wording “this research aims to…”, “this research seeks to…”, and so on. For example:

“This research aims to explore employee experiences of digital transformation in retail HR.”   “This study sets out to assess the interaction between student support and self-care on well-being in engineering graduate students”  

As you can see, these research aims provide a high-level description of what the study is about and what it seeks to achieve. They’re not hyper-specific or action-oriented, but they’re clear about what the study’s focus is and what is being investigated.

Need a helping hand?

Research Objectives: What are they?

The research objectives take the research aims and make them more practical and actionable . In other words, the research objectives showcase the steps that the researcher will take to achieve the research aims.

The research objectives need to be far more specific (higher resolution) and actionable than the research aims. In fact, it’s always a good idea to craft your research objectives using the “SMART” criteria. In other words, they should be specific, measurable, achievable, relevant and time-bound”.

Research Objectives: Examples  

Let’s look at two examples of research objectives. We’ll stick with the topic and research aims we mentioned previously.  

For the digital transformation topic:

To observe the retail HR employees throughout the digital transformation. To assess employee perceptions of digital transformation in retail HR. To identify the barriers and facilitators of digital transformation in retail HR.

And for the student wellness topic:

To determine whether student self-care predicts the well-being score of engineering graduate students. To determine whether student support predicts the well-being score of engineering students. To assess the interaction between student self-care and student support when predicting well-being in engineering graduate students.

  As you can see, these research objectives clearly align with the previously mentioned research aims and effectively translate the low-resolution aims into (comparatively) higher-resolution objectives and action points . They give the research project a clear focus and present something that resembles a research-based “to-do” list.

Research Questions: What are they?

Finally, we arrive at the all-important research questions. The research questions are, as the name suggests, the key questions that your study will seek to answer . Simply put, they are the core purpose of your dissertation, thesis, or research project. You’ll present them at the beginning of your document (either in the introduction chapter or literature review chapter) and you’ll answer them at the end of your document (typically in the discussion and conclusion chapters).  

The research questions will be the driving force throughout the research process. For example, in the literature review chapter, you’ll assess the relevance of any given resource based on whether it helps you move towards answering your research questions. Similarly, your methodology and research design will be heavily influenced by the nature of your research questions. For instance, research questions that are exploratory in nature will usually make use of a qualitative approach, whereas questions that relate to measurement or relationship testing will make use of a quantitative approach.  

Let’s look at some examples of research questions to make this more tangible.

Research Questions: Examples  

Again, we’ll stick with the research aims and research objectives we mentioned previously.  

For the digital transformation topic (which would be qualitative in nature):

How do employees perceive digital transformation in retail HR? What are the barriers and facilitators of digital transformation in retail HR?  

And for the student wellness topic (which would be quantitative in nature):

Does student self-care predict the well-being scores of engineering graduate students? Does student support predict the well-being scores of engineering students? Do student self-care and student support interact when predicting well-being in engineering graduate students?  

You’ll probably notice that there’s quite a formulaic approach to this. In other words, the research questions are basically the research objectives “converted” into question format. While that is true most of the time, it’s not always the case. For example, the first research objective for the digital transformation topic was more or less a step on the path toward the other objectives, and as such, it didn’t warrant its own research question.  

So, don’t rush your research questions and sloppily reword your objectives as questions. Carefully think about what exactly you’re trying to achieve (i.e. your research aim) and the objectives you’ve set out, then craft a set of well-aligned research questions . Also, keep in mind that this can be a somewhat iterative process , where you go back and tweak research objectives and aims to ensure tight alignment throughout the golden thread.

The importance of strong alignment 

Alignment is the keyword here and we have to stress its importance . Simply put, you need to make sure that there is a very tight alignment between all three pieces of the golden thread. If your research aims and research questions don’t align, for example, your project will be pulling in different directions and will lack focus . This is a common problem students face and can cause many headaches (and tears), so be warned.

Take the time to carefully craft your research aims, objectives and research questions before you run off down the research path. Ideally, get your research supervisor/advisor to review and comment on your golden thread before you invest significant time into your project, and certainly before you start collecting data .  

Recap: The golden thread

In this post, we unpacked the golden thread of research, consisting of the research aims , research objectives and research questions . You can jump back to any section using the links below.

As always, feel free to leave a comment below – we always love to hear from you. Also, if you’re interested in 1-on-1 support, take a look at our private coaching service here.

Psst... there’s more!

This post was based on one of our popular Research Bootcamps . If you're working on a research project, you'll definitely want to check this out ...

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39 Comments

Thank you very much for your great effort put. As an Undergraduate taking Demographic Research & Methodology, I’ve been trying so hard to understand clearly what is a Research Question, Research Aim and the Objectives in a research and the relationship between them etc. But as for now I’m thankful that you’ve solved my problem.

Well appreciated. This has helped me greatly in doing my dissertation.

An so delighted with this wonderful information thank you a lot.

so impressive i have benefited a lot looking forward to learn more on research.

I am very happy to have carefully gone through this well researched article.

Infact,I used to be phobia about anything research, because of my poor understanding of the concepts.

Now,I get to know that my research question is the same as my research objective(s) rephrased in question format.

I please I would need a follow up on the subject,as I intends to join the team of researchers. Thanks once again.

Thanks so much. This was really helpful.

I know you pepole have tried to break things into more understandable and easy format. And God bless you. Keep it up

i found this document so useful towards my study in research methods. thanks so much.

This is my 2nd read topic in your course and I should commend the simplified explanations of each part. I’m beginning to understand and absorb the use of each part of a dissertation/thesis. I’ll keep on reading your free course and might be able to avail the training course! Kudos!

Thank you! Better put that my lecture and helped to easily understand the basics which I feel often get brushed over when beginning dissertation work.

This is quite helpful. I like how the Golden thread has been explained and the needed alignment.

This is quite helpful. I really appreciate!

The article made it simple for researcher students to differentiate between three concepts.

Very innovative and educational in approach to conducting research.

I am very impressed with all these terminology, as I am a fresh student for post graduate, I am highly guided and I promised to continue making consultation when the need arise. Thanks a lot.

A very helpful piece. thanks, I really appreciate it .

Very well explained, and it might be helpful to many people like me.

Wish i had found this (and other) resource(s) at the beginning of my PhD journey… not in my writing up year… 😩 Anyways… just a quick question as i’m having some issues ordering my “golden thread”…. does it matter in what order you mention them? i.e., is it always first aims, then objectives, and finally the questions? or can you first mention the research questions and then the aims and objectives?

Thank you for a very simple explanation that builds upon the concepts in a very logical manner. Just prior to this, I read the research hypothesis article, which was equally very good. This met my primary objective.

My secondary objective was to understand the difference between research questions and research hypothesis, and in which context to use which one. However, I am still not clear on this. Can you kindly please guide?

In research, a research question is a clear and specific inquiry that the researcher wants to answer, while a research hypothesis is a tentative statement or prediction about the relationship between variables or the expected outcome of the study. Research questions are broader and guide the overall study, while hypotheses are specific and testable statements used in quantitative research. Research questions identify the problem, while hypotheses provide a focus for testing in the study.

Exactly what I need in this research journey, I look forward to more of your coaching videos.

This helped a lot. Thanks so much for the effort put into explaining it.

What data source in writing dissertation/Thesis requires?

What is data source covers when writing dessertation/thesis

This is quite useful thanks

I’m excited and thankful. I got so much value which will help me progress in my thesis.

where are the locations of the reserch statement, research objective and research question in a reserach paper? Can you write an ouline that defines their places in the researh paper?

Very helpful and important tips on Aims, Objectives and Questions.

Thank you so much for making research aim, research objectives and research question so clear. This will be helpful to me as i continue with my thesis.

Thanks much for this content. I learned a lot. And I am inspired to learn more. I am still struggling with my preparation for dissertation outline/proposal. But I consistently follow contents and tutorials and the new FB of GRAD Coach. Hope to really become confident in writing my dissertation and successfully defend it.

As a researcher and lecturer, I find splitting research goals into research aims, objectives, and questions is unnecessarily bureaucratic and confusing for students. For most biomedical research projects, including ‘real research’, 1-3 research questions will suffice (numbers may differ by discipline).

Awesome! Very important resources and presented in an informative way to easily understand the golden thread. Indeed, thank you so much.

Well explained

The blog article on research aims, objectives, and questions by Grad Coach is a clear and insightful guide that aligns with my experiences in academic research. The article effectively breaks down the often complex concepts of research aims and objectives, providing a straightforward and accessible explanation. Drawing from my own research endeavors, I appreciate the practical tips offered, such as the need for specificity and clarity when formulating research questions. The article serves as a valuable resource for students and researchers, offering a concise roadmap for crafting well-defined research goals and objectives. Whether you’re a novice or an experienced researcher, this article provides practical insights that contribute to the foundational aspects of a successful research endeavor.

A great thanks for you. it is really amazing explanation. I grasp a lot and one step up to research knowledge.

I really found these tips helpful. Thank you very much Grad Coach.

I found this article helpful. Thanks for sharing this.

thank you so much, the explanation and examples are really helpful

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Writing for Healthcare Professionals: Creating a Research Question

• Finding Sources
• Creating a Research Question
• Search Terms
• Search Strategies
• Recording Your Research
• Journal Articles
• Books & Other Sources
• Online Help
• Publisher URL

Choosing a Topic

Sometimes the most difficult part of the research process is choosing a topic.  Here are some tips for selecting a research question that you will enjoy learning about and will ultimately lead to a good grade.

• Read through your assignment.   Professors design an assignment outline for a reason.  Make sure your topic can and will adhere to their requirements and guidelines.
• Choose a topic you are interested in.   If you don't like what you're researching, chances are you won't learn a whole lot or enjoy the process.  And really, what's the point of that?  
• Browse resources that relate to your course work.  Look through a newspaper, magazine, or database for current events or hot topics.  Browsing can spark a lot of great ideas and can help you refine your topic.
• Ask for help!   There is nothing wrong with asking your professor or a librarian to help you brainstorm ideas.

Where to Start

The links below are great places to start in developing a research question.  Browsing current events and hot topics can spark your interest and inspire a topic.

• Alvernia's "Opposing Viewpoints" Collection
• Alvernia's Reference Collection
• Anatomy & Physiology
• Athletic Training Websites
• Google Trends
• Health & Medicine
• Hot Paper Topics
• Hot Topics for Research Papers
• MedLinePlus This link opens in a new window
• National Library of Medicine
• Opposing Viewpoints in Context This link opens in a new window
• Human Diseases
• New York Times
• NPR Research News
• Pew Research Center
• Public Agenda's Programs and Reports

How to Formulate an Answerable Clinical Question

P opulation/patients

I ntervention/indicator

C omparator/control

• P I C O: Formulate an Answerable Question
• Formulating Answerable Clinical Questions

Developing your Research Question

Try asking yourself these questions to help develop a research question:

Topic:  Obesity

Who?  teenagers

What?  consumption of high fat foods

Where?  school cafeterias

Question :  How does the consumption of high fat foods in school cafeterias contribute to teenager obesity?

Topic: Smoke Exposure

Who?   children exposed to smoke

What?   developmental abilities

Question :  How does smoke exposure alter the developmental abilities of children?

Below is worksheet which will help illustrate how a research question develops from a broad topic to a focused question.  This could be a helpful resource for you during the process of creating your research question.

• Creating a Research Question Helps you to write a narrow, focused research question.

Subject Terms to Consider

Below is a list of subjects that often  relate to nursing issues .  Considering these subject terms can help you  develop a topic  or  focus your search .

• Nursing research
• Evidence-based nursing

Helpful Tools

• bubbl.us - Brainstorming Made Simple
• Critical Thinking Model
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• Next: Search Terms >>
• Last Updated: Jan 18, 2024 1:19 PM
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• Research Guides

Public Health

• Defining the Question
• Evidence-Informed Decision Making

Introduction

Identifying key concepts and search terms, frameworks for question formulation.

• Grey Literature
• Appraising Sources
• Writing Literature Reviews

Whether you are practicing evidence-informed decision making or conducting research (e.g. a systematic review), the first step of the process is to clearly define the question or problem in a searchable and answerable format. This step of the process helps you answer the questions:  

• “Who is my target group?
• What is the issue we are dealing with?
• What specifically are we trying to change?”

Source: NCCMT .

Using a framework to develop your question can help to identify the main concepts of your review topic (see further down the page). Whether you use a framework or not, the goal is to identify the main concepts of your question and the synonyms / similar terms that might be used to describe each of those concepts:

Combining search terms with AND or OR:

• Use AND to combine different  main concepts of your search: childhood AND obesity. Narrows results
• Use OR to include similar terms / synonyms (and sometimes antonyms) for a concept: childhood OR adolescence. Fertility OR infertility. Broadens results

Considerations for searching:

It is not always necessary to include all of your main concepts in the search. In some PICO questions, the outcome (O) is implied and does not need to be included. In other cases, any and all outcomes might of interest and so the search strategy can leave this out to keep it open.

Example for the research question: In seniors with dementia, does a falls prevention program, compared to no falls prevention program, result in decreased falls?

• In the following PICO question, the comparator (C) can be left out of the search strategy as there is no great way to search for "not" having the intervention (in contrast to when there is a placebo or an alternate intervention as a comparison)
• Also, the intervention (I) somewhat implies the outcome (O), so the outcome (decreased falls) can be left out of the search strategy
• The main concepts that should be included in this particular search are: seniors (P1), dementia (P2), and falls prevention (I). Keep in mind though that there are different ways of describing these three concepts and so synonyms / similar terms are important to include in the search as well

Applying a framework when developing a question can help to identify the key concepts and determine inclusion and exclusion criteria.

Example: PICO Question

Example: spice question.

Example from: Booth, A., Noyes, J., Flemming, K., Moore, G., Tunçalp, Ö., & Shakibazadeh, E. (2019).  Formulating questions to explore complex interventions within qualitative evidence synthesis . BMJ Global Health, 4(Suppl 1), e001107.

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• Next: Searching Databases >>
• Last Updated: Mar 1, 2024 9:56 AM
• Subjects: Health Sciences , Public Health Sciences
• Tags: public health

HS 390W: Current Health Issues

• Library Guide for HS 390w
• Choosing a topic and developing a research question
• Keywords & Background vs. Foreground Information
• Health Resources (Databases at Cline Library)
• Health Resources (U.S. Government)
• Scholarly/Peer Reviewed
• Key Components of Research Articles
• Requesting an Item the Library Doesn't Have

Current Health Issues, Topics and Trends

Choosing a topic:

There are many places to look for information about current health issues, from newspapers and news stories to scholarly articles, as well as government and non-profit organization websites. Try these websites to look at current health trends:

Government Websites

• American Public Health Association: Topics & Issues
• Health Topics (MedlinePlus)
• Health Topics A to Z (Healthfinder.gov)
• HHS Blog (Department of Health and Human Services) Be sure to look at the categories on the left hand side as well as the most recent tweets .
• Minority Health Topics
• Women's Health: Health Issues
• New York Times: Health Topics

The Who and What of your Question

• Health professionals, religious organization, news outlets
• Who is the author’s desired audience?
• Are they credible?
• Does the author have a bias or agenda?
• What is your topic?
• Is it controversial?
• Is it currently in the news?
• Is there federal policy around it?
• Best practices
• What are the geographic parameters?

Formulating a question

Once you've decided on a topic, think about what questions you want to ask about that topic.  What would you like to know more about?  Thinking about this will help you develop a research question. 

Examples of research questions:

• Does improved nutrition in children impact academic achievement?
• Are teenage drivers more likely to be involved in automobile accidents? 
• Do early intervention programs prevent smoking among teenagers who live in rural areas within the United States?
• Do bicycle seats effect reproductive health in professional cyclists? 
• Are pregnant women from lower socioeconomic backgrounds less likely to use prenatal vitamins?

After you have formulated a research question, you'll want to search a variety of health resource to make sure that there is enough information about your topic for you to complete the assignments. 

Factors to consider when formulating a research question:

• What is the health issue (is it looking at the prevention of a health condition, is it about the treatment of a health condition, etc.?)
• Who is your audience: is it a population, or is it an individual, such as a patient?
• How is the information going to be used by a population or a patient?
• What types of resources should be consulted to answer the complexity of your question? Evidence-based? Peer-reviewed?
• How many resources might be necessary in order to adequately research the topic?
• Searching Worksheet
• << Previous: Library Guide for HS 390w
• Next: Keywords & Background vs. Foreground Information >>
• Last Updated: Nov 9, 2023 12:38 PM
• URL: https://libraryguides.nau.edu/hs390w-current-health-issues

• UNC Libraries
• HSL Subject Research
• Forming Focused Questions with PICO
• PICO Examples

Forming Focused Questions with PICO: PICO Examples

Created by health science librarians.

• PICO's Limitations

Practice Your Skills

Cancer care and peer support, cultural awareness and nursing care, labor & delivery, infection control, nurse educator, nurse practitioner, public health, school nursing.

• Other Question Frameworks

Practice writing out PICO components and then forming a focused question about one of the case studies below. Choose one or several that interest you.

You have read that peer support interventions help individuals and families affected by cancer across the care continuum from prevention through survivorship and end-of-life care. You wonder about the characteristics of peer support programs and how peer support programs have been used to reduce disparities and barriers to care.

Open to check your PICO analysis of the scenario for cancer care.

Nurses in oncology units interact frequently with adults with cancer who do not speak English as their primary language. You are curious whether cultural awareness among nurses improves these patients’ care and participation in the decision-making process.

Open to check your PICO analysis of the scenario for nursing care.

You’re a new nurse on a labor and delivery unit. You’ve noticed that most women give birth in the lithotomy position at the encouragement of their doctors. However, you’re sure you heard in nursing school that other positions are less likely to lead to deliveries with forceps or a vacuum.. or did you? You want to find some literature to back up your claim.

Open to check your PICO analysis of the scenario for labor and delivery.

You work in the Big City Hospital ICU. Your mechanically ventilated patients sometimes contract nosocomial pneumonia, which leads to costly complications. You want to know if raising the head of the bed lowers the chance of the patient contracting pneumonia compared to letting the patient lie flat on their back.

Open to check your PICO analysis of the scenario for the ICU..

In the past few years, your hospital has installed antibacterial foam dispensers on all the nursing units. You’ve had nurses asking you if the foam is just as effective as washing their hands with water and soap.

Open to check your PICO analysis of the scenario for infection control.

Shift change on your busy med-surg unit can be frustrating for you and your coworkers. Report at the nursing station takes up to 30 minutes, by the end of which you’re anxious to see your patients. You read something in a recent ANA newsletter about other hospitals switching to a bedside shift report, and you want to find out if staff liked that style of shift change better.

Open to check your PICO analysis of the scenario in med-surg.

Open to check your pico analysis of the scenario in the nicu..

It’s the last semester of your BSN students’ time in school and they’re excited.. and anxious! They’ve been asking you if they should take the NCLEX right after they graduate or wait for a while after graduation so they can relax and study.

Open to check your PICO analysis of the scenario for nurse educators.

It’s winter at your family practice, and you have a lot of patients coming in with runny noses and general malaise. Brenda, a 35 year old working mother in for a checkup states, "I’m so busy between work and home that I definitely don’t have time to get sick! Can those vitamin C or zinc pills prevent colds?"

Open to check your PICO analysis of the scenario for nurse practitioners.

The main concern for most of your patients coming out of anesthesia in your PACU is pain. You want to explore nursing interventions you can use on top of medication administration to decrease pain. One coworker mentions trying to make the PACU feel less clinical by playing soft music to relax patients.

Open to check your PICO analysis of the scenario for PACU.

You work in a pediatrician’s office and give patients their routine vaccinations. The younger children are often fearful of needles, and some of the staff use toys to distract the patients. You want to know if this technique actually has an effect on the children's pain response.

Open to check your PICO analysis of the scenario for pediatrics.

You work on an inpatient psychiatric unit. One of your patients with chronic schizophrenia, Joe, normally mumbles to himself, but will occasionally speak to others when residents play games together. Noticing this, you say to a coworker that maybe social skills group training sessions would bring out Joe’s conversational skills. Your coworker shakes her head and says "I don’t think so. Joe is in and out of this hospital, he’s a lost cause."

Open to check your PICO analysis of the scenario for psychiatry.

You coordinate health education programs and have been holding seminars for teenagers about STI prevention. You’ve been found that they’re hesitant to open up to you during classes to ask you questions. You’re wondering if recruiting peer educators closer to their age will encourage them to actively participate and get more satisfaction out of the classes.

Open to check your PICO analysis of the scenario for public health.

On your pulmonary unit, many of your COPD patients receive injections of heparin to prevent pulmonary emboli, and patients find the bruises associated with heparin injections unsightly. You’ve had nursing students shadowing you lately, so you’ve been particularly concerned with injection technique. You want to find out if the duration of injection has any effect on the extent of bruising.

Open to check your PICO analysis of the scenario for pulmonary.

You’re a school nurse and one aspect of your job is counseling pregnant teens with the aim of enabling them to complete high school. You’ve even been conducting home visits on top of your normal in-school meetings as part of their preparation-for-motherhood counseling. You want sources to backup the effectiveness of these home visits.

Open to check your PICO analysis of the scenario for school nursing.

A diabetic patient from a nursing home has recently been admitted with a stage III pressure ulcers on his heels. The unit nurses have called you in for a wound consult. You have to choose between standard moist wound therapy and using a wound vac.

Open to check your PICO analysis of the scenario for wound care.

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• Next: Other Question Frameworks >>
• Last Updated: Feb 6, 2024 9:51 AM
• URL: https://guides.lib.unc.edu/pico

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55 research questions about mental health

Last updated

11 March 2024

Reviewed by

Brittany Ferri, PhD, OTR/L

Research in the mental health space helps fill knowledge gaps and create a fuller picture for patients, healthcare professionals, and policymakers. Over time, these efforts result in better quality care and more accessible treatment options for those who need them.

Use this list of mental health research questions to kickstart your next project or assignment and give yourself the best chance of producing successful and fulfilling research.

• Why does mental health research matter?

Mental health research is an essential area of study. It includes any research that focuses on topics related to people’s mental and emotional well-being.

As a complex health topic that, despite the prevalence of mental health conditions, still has an unending number of unanswered questions, the need for thorough research into causes, triggers, and treatment options is clear.

Research into this heavily stigmatized and often misunderstood topic is needed to find better ways to support people struggling with mental health conditions. Understanding what causes them is another crucial area of study, as it enables individuals, companies, and policymakers to make well-informed choices that can help prevent illnesses like anxiety and depression.

• How to choose a strong mental health research topic

As one of the most important parts of beginning a new research project, picking a topic that is intriguing, unique, and in demand is a great way to get the best results from your efforts.

Mental health is a blanket term with many niches and specific areas to explore. But, no matter which direction you choose, follow the tips below to ensure you pick the right topic.

Prioritize your interests and skills

While a big part of research is exploring a new and exciting topic, this exploration is best done within a topic or niche in which you are interested and experienced.

Research is tough, even at the best of times. To combat fatigue and increase your chances of pushing through to the finish line, we recommend choosing a topic that aligns with your personal interests, training, or skill set.

Consider emerging trends

Topical and current research questions are hot commodities because they offer solutions and insights into culturally and socially relevant problems.

Depending on the scope and level of freedom you have with your upcoming research project, choosing a topic that’s trending in your area of study is one way to get support and funding (if you need it).

Not every study can be based on a cutting-edge topic, but this can be a great way to explore a new space and create baseline research data for future studies.

Assess your resources and timeline

Before choosing a super ambitious and exciting research topic, consider your project restrictions.

You’ll need to think about things like your research timeline, access to resources and funding, and expected project scope when deciding how broad your research topic will be. In most cases, it’s better to start small and focus on a specific area of study.

Broad research projects are expensive and labor and resource-intensive. They can take years or even decades to complete. Before biting off more than you can chew, consider your scope and find a research question that fits within it.

Read up on the latest research

Finally, once you have narrowed in on a specific topic, you need to read up on the latest studies and published research. A thorough research assessment is a great way to gain some background context on your chosen topic and stops you from repeating a study design. Using the existing work as your guide, you can explore more specific and niche questions to provide highly beneficial answers and insights.

• Trending research questions for post-secondary students

As a post-secondary student, finding interesting research questions that fit within the scope of your classes or resources can be challenging. But, with a little bit of effort and pre-planning, you can find unique mental health research topics that will meet your class or project requirements.

Examples of research topics for post-secondary students include the following:

How does school-related stress impact a person’s mental health?

To what extent does burnout impact mental health in medical students?

How does chronic school stress impact a student’s physical health?

How does exam season affect the severity of mental health symptoms?

Is mental health counseling effective for students in an acute mental crisis?

• Research questions about anxiety and depression

Anxiety and depression are two of the most commonly spoken about mental health conditions. You might assume that research about these conditions has already been exhausted or that it’s no longer in demand. That’s not the case at all.

According to a 2022 survey by Centers for Disease Control and Prevention (CDC), 12.5% of American adults struggle with regular feelings of worry, nervousness, and anxiety, and 5% struggle with regular feelings of depression. These percentages amount to millions of lives affected, meaning new research into these conditions is essential.

If either of these topics interests you, here are a few trending research questions you could consider:

Does gender play a role in the early diagnosis of anxiety?

How does untreated anxiety impact quality of life?

What are the most common symptoms of anxiety in working professionals aged 20–29?

To what extent do treatment delays impact quality of life in patients with undiagnosed anxiety?

To what extent does stigma affect the quality of care received by people with anxiety?

Here are some examples of research questions about depression:

Does diet play a role in the severity of depression symptoms?

Can people have a genetic predisposition to developing depression?

How common is depression in work-from-home employees?

Does mood journaling help manage depression symptoms?

What role does exercise play in the management of depression symptoms?

• Research questions about personality disorders

Personality disorders are complex mental health conditions tied to a person’s behaviors, sense of self, and how they interact with the world around them. Without a diagnosis and treatment, people with personality disorders are more likely to develop negative coping strategies during periods of stress and adversity, which can impact their quality of life and relationships.

There’s no shortage of specific research questions in this category. Here are some examples of research questions about personality disorders that you could explore:

What environments are more likely to trigger the development of a personality disorder?

What barriers impact access to care for people with personality disorders?

To what extent does undiagnosed borderline personality disorder impact a person’s ability to build relationships?

How does group therapy impact symptom severity in people with schizotypal personality disorder?

What is the treatment compliance rate of people with paranoid personality disorder?

• Research questions about substance use disorders

“Substance use disorders” is a blanket term for treatable behaviors and patterns within a person’s brain that lead them to become dependent on illicit drugs, alcohol, or prescription medications. It’s one of the most stigmatized mental health categories.

The severity of a person’s symptoms and how they impact their ability to participate in their regular daily life can vary significantly from person to person. But, even in less severe cases, people with a substance use disorder display some level of loss of control due to their need to use the substance they are dependent on.

This is an ever-evolving topic where research is in hot demand. Here are some example research questions:

To what extent do meditation practices help with craving management?

How effective are detox centers in treating acute substance use disorder?

Are there genetic factors that increase a person’s chances of developing a substance use disorder?

How prevalent are substance use disorders in immigrant populations?

To what extent do prescription medications play a role in developing substance use disorders?

• Research questions about mental health treatments

Treatments for mental health, pharmaceutical therapies in particular, are a common topic for research and exploration in this space.

Besides the clinical trials required for a drug to receive FDA approval, studies into the efficacy, risks, and patient experiences are essential to better understand mental health therapies.

These types of studies can easily become large in scope, but it’s possible to conduct small cohort research on mental health therapies that can provide helpful insights into the actual experiences of the people receiving these treatments.

Here are some questions you might consider:

What are the long-term effects of electroconvulsive therapy (ECT) for patients with severe depression?

How common is insomnia as a side effect of oral mental health medications?

What are the most common causes of non-compliance for mental health treatments?

How long does it take for patients to report noticeable changes in symptom severity after starting injectable mental health medications?

What issues are most common when weaning a patient off of an anxiety medication?

• Controversial mental health research questions

If you’re interested in exploring more cutting-edge research topics, you might consider one that’s “controversial.”

Depending on your own personal values, you might not think many of these topics are controversial. In the context of the research environment, this depends on the perspectives of your project lead and the desires of your sponsors. These topics may not align with the preferred subject matter.

That being said, that doesn’t make them any less worth exploring. In many cases, it makes them more worthwhile, as they encourage people to ask questions and think critically.

Here are just a few examples of “controversial” mental health research questions:

To what extent do financial crises impact mental health in young adults?

How have climate concerns impacted anxiety levels in young adults?

To what extent do psychotropic drugs help patients struggling with anxiety and depression?

To what extent does political reform impact the mental health of LGBTQ+ people?

What mental health supports should be available for the families of people who opt for medically assisted dying?

• Research questions about socioeconomic factors & mental health

Socioeconomic factors—like where a person grew up, their annual income, the communities they are exposed to, and the amount, type, and quality of mental health resources they have access to—significantly impact overall health.

This is a complex and multifaceted issue. Choosing a research question that addresses these topics can help researchers, experts, and policymakers provide more equitable and accessible care over time.

Examples of questions that tackle socioeconomic factors and mental health include the following:

How does sliding scale pricing for therapy increase retention rates?

What is the average cost to access acute mental health crisis care in [a specific region]?

To what extent does a person’s environment impact their risk of developing a mental health condition?

How does mental health stigma impact early detection of mental health conditions?

To what extent does discrimination affect the mental health of LGBTQ+ people?

• Research questions about the benefits of therapy

Therapy, whether that’s in groups or one-to-one sessions, is one of the most commonly utilized resources for managing mental health conditions. It can help support long-term healing and the development of coping mechanisms.

Yet, despite its popularity, more research is needed to properly understand its benefits and limitations.

Here are some therapy-based questions you could consider to inspire your own research:

In what instances does group therapy benefit people more than solo sessions?

How effective is cognitive behavioral therapy for patients with severe anxiety?

After how many therapy sessions do people report feeling a better sense of self?

Does including meditation reminders during therapy improve patient outcomes?

To what extent has virtual therapy improved access to mental health resources in rural areas?

• Research questions about mental health trends in teens

Adolescents are a particularly interesting group for mental health research due to the prevalence of early-onset mental health symptoms in this age group.

As a time of self-discovery and change, puberty brings plenty of stress, anxiety, and hardships, all of which can contribute to worsening mental health symptoms.

If you’re looking to learn more about how to support this age group with mental health, here are some examples of questions you could explore:

Does parenting style impact anxiety rates in teens?

How early should teenagers receive mental health treatment?

To what extent does cyberbullying impact adolescent mental health?

What are the most common harmful coping mechanisms explored by teens?

How have smartphones affected teenagers’ self-worth and sense of self?

• Research questions about social media and mental health

Social media platforms like TikTok, Instagram, YouTube, Facebook, and X (formerly Twitter) have significantly impacted day-to-day communication. However, despite their numerous benefits and uses, they have also become a significant source of stress, anxiety, and self-worth issues for those who use them.

These platforms have been around for a while now, but research on their impact is still in its infancy. Are you interested in building knowledge about this ever-changing topic? Here are some examples of social media research questions you could consider:

To what extent does TikTok’s mental health content impact people’s perception of their health?

How much non-professional mental health content is created on social media platforms?

How has social media content increased the likelihood of a teen self-identifying themselves with ADHD or autism?

To what extent do social media photoshopped images impact body image and self-worth?

Has social media access increased feelings of anxiety and dread in young adults?

• Mental health research is incredibly important

As you have seen, there are so many unique mental health research questions worth exploring. Which options are piquing your interest?

Whether you are a university student considering your next paper topic or a professional looking to explore a new area of study, mental health is an exciting and ever-changing area of research to get involved with.

Your research will be valuable, no matter how big or small. As a niche area of healthcare still shrouded in stigma, any insights you gain into new ways to support, treat, or identify mental health triggers and trends are a net positive for millions of people worldwide.

Get started today

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Qualitative Research Questions: Gain Powerful Insights + 25 Examples

We review the basics of qualitative research questions, including their key components, how to craft them effectively, & 25 example questions.

Einstein was many things—a physicist, a philosopher, and, undoubtedly, a mastermind. He also had an incredible way with words. His quote, "Everything that can be counted does not necessarily count; everything that counts cannot necessarily be counted," is particularly poignant when it comes to research. 

Some inquiries call for a quantitative approach, for counting and measuring data in order to arrive at general conclusions. Other investigations, like qualitative research, rely on deep exploration and understanding of individual cases in order to develop a greater understanding of the whole. That’s what we’re going to focus on today.

Qualitative research questions focus on the "how" and "why" of things, rather than the "what". They ask about people's experiences and perceptions , and can be used to explore a wide range of topics.

The following article will discuss the basics of qualitative research questions, including their key components, and how to craft them effectively. You'll also find 25 examples of effective qualitative research questions you can use as inspiration for your own studies.

Let’s get started!

What are qualitative research questions, and when are they used?

When researchers set out to conduct a study on a certain topic, their research is chiefly directed by an overarching question . This question provides focus for the study and helps determine what kind of data will be collected.

By starting with a question, we gain parameters and objectives for our line of research. What are we studying? For what purpose? How will we know when we’ve achieved our goals?

Of course, some of these questions can be described as quantitative in nature. When a research question is quantitative, it usually seeks to measure or calculate something in a systematic way.

For example:

• How many people in our town use the library?
• What is the average income of families in our city?
• How much does the average person weigh?

Other research questions, however—and the ones we will be focusing on in this article—are qualitative in nature. Qualitative research questions are open-ended and seek to explore a given topic in-depth.

According to the Australian & New Zealand Journal of Psychiatry , “Qualitative research aims to address questions concerned with developing an understanding of the meaning and experience dimensions of humans’ lives and social worlds.”

This type of research can be used to gain a better understanding of people’s thoughts, feelings and experiences by “addressing questions beyond ‘what works’, towards ‘what works for whom when, how and why, and focusing on intervention improvement rather than accreditation,” states one paper in Neurological Research and Practice .

Qualitative questions often produce rich data that can help researchers develop hypotheses for further quantitative study.

• What are people’s thoughts on the new library?
• How does it feel to be a first-generation student at our school?
• How do people feel about the changes taking place in our town?

As stated by a paper in Human Reproduction , “...‘qualitative’ methods are used to answer questions about experience, meaning, and perspective, most often from the standpoint of the participant. These data are usually not amenable to counting or measuring.”

Both quantitative and qualitative questions have their uses; in fact, they often complement each other. A well-designed research study will include a mix of both types of questions in order to gain a fuller understanding of the topic at hand.

If you would like to recruit unlimited participants for qualitative research for free and only pay for the interview you conduct, try using Respondent  today. 

Crafting qualitative research questions for powerful insights

Now that we have a basic understanding of what qualitative research questions are and when they are used, let’s take a look at how you can begin crafting your own.

According to a study in the International Journal of Qualitative Studies in Education, there is a certain process researchers should follow when crafting their questions, which we’ll explore in more depth.

1. Beginning the process 

Start with a point of interest or curiosity, and pose a draft question or ‘self-question’. What do you want to know about the topic at hand? What is your specific curiosity? You may find it helpful to begin by writing several questions.

For example, if you’re interested in understanding how your customer base feels about a recent change to your product, you might ask: 

• What made you decide to try the new product?
• How do you feel about the change?
• What do you think of the new design/functionality?
• What benefits do you see in the change?

2. Create one overarching, guiding question 

At this point, narrow down the draft questions into one specific question. “Sometimes, these broader research questions are not stated as questions, but rather as goals for the study.”

As an example of this, you might narrow down these three questions: 

into the following question: 

• What are our customers’ thoughts on the recent change to our product?

3. Theoretical framing 

As you read the relevant literature and apply theory to your research, the question should be altered to achieve better outcomes. Experts agree that pursuing a qualitative line of inquiry should open up the possibility for questioning your original theories and altering the conceptual framework with which the research began.

If we continue with the current example, it’s possible you may uncover new data that informs your research and changes your question. For instance, you may discover that customers’ feelings about the change are not just a reaction to the change itself, but also to how it was implemented. In this case, your question would need to reflect this new information: 

• How did customers react to the process of the change, as well as the change itself?

4. Ethical considerations 

A study in the International Journal of Qualitative Studies in Education stresses that ethics are “a central issue when a researcher proposes to study the lives of others, especially marginalized populations.” Consider how your question or inquiry will affect the people it relates to—their lives and their safety. Shape your question to avoid physical, emotional, or mental upset for the focus group.

In analyzing your question from this perspective, if you feel that it may cause harm, you should consider changing the question or ending your research project. Perhaps you’ve discovered that your question encourages harmful or invasive questioning, in which case you should reformulate it.

5. Writing the question 

The actual process of writing the question comes only after considering the above points. The purpose of crafting your research questions is to delve into what your study is specifically about” Remember that qualitative research questions are not trying to find the cause of an effect, but rather to explore the effect itself.

Your questions should be clear, concise, and understandable to those outside of your field. In addition, they should generate rich data. The questions you choose will also depend on the type of research you are conducting: 

• If you’re doing a phenomenological study, your questions might be open-ended, in order to allow participants to share their experiences in their own words.
• If you’re doing a grounded-theory study, your questions might be focused on generating a list of categories or themes.
• If you’re doing ethnography, your questions might be about understanding the culture you’re studying.

Whenyou have well-written questions, it is much easier to develop your research design and collect data that accurately reflects your inquiry.

In writing your questions, it may help you to refer to this simple flowchart process for constructing questions:

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25 examples of expertly crafted qualitative research questions

It's easy enough to cover the theory of writing a qualitative research question, but sometimes it's best if you can see the process in practice. In this section, we'll list 25 examples of B2B and B2C-related qualitative questions.

Let's begin with five questions. We'll show you the question, explain why it's considered qualitative, and then give you an example of how it can be used in research.

1. What is the customer's perception of our company's brand?

Qualitative research questions are often open-ended and invite respondents to share their thoughts and feelings on a subject. This question is qualitative because it seeks customer feedback on the company's brand. 

This question can be used in research to understand how customers feel about the company's branding, what they like and don't like about it, and whether they would recommend it to others.

2. Why do customers buy our product?

This question is also qualitative because it seeks to understand the customer's motivations for purchasing a product. It can be used in research to identify the reasons  customers buy a certain product, what needs or desires the product fulfills for them, and how they feel about the purchase after using the product.

3. How do our customers interact with our products?

Again, this question is qualitative because it seeks to understand customer behavior. In this case, it can be used in research to see how customers use the product, how they interact with it, and what emotions or thoughts the product evokes in them.

4. What are our customers' biggest frustrations with our products?

By seeking to understand customer frustrations, this question is qualitative and can provide valuable insights. It can be used in research to help identify areas in which the company needs to make improvements with its products.

5. How do our customers feel about our customer service?

Rather than asking why customers like or dislike something, this question asks how they feel. This qualitative question can provide insights into customer satisfaction or dissatisfaction with a company. 

This type of question can be used in research to understand what customers think of the company's customer service and whether they feel it meets their needs.

20 more examples to refer to when writing your question

Now that you’re aware of what makes certain questions qualitative, let's move into 20 more examples of qualitative research questions:

• How do your customers react when updates are made to your app interface?
• How do customers feel when they complete their purchase through your ecommerce site?
• What are your customers' main frustrations with your service?
• How do people feel about the quality of your products compared to those of your competitors?
• What motivates customers to refer their friends and family members to your product or service?
• What are the main benefits your customers receive from using your product or service?
• How do people feel when they finish a purchase on your website?
• What are the main motivations behind customer loyalty to your brand?
• How does your app make people feel emotionally?
• For younger generations using your app, how does it make them feel about themselves?
• What reputation do people associate with your brand?
• How inclusive do people find your app?
• In what ways are your customers' experiences unique to them?
• What are the main areas of improvement your customers would like to see in your product or service?
• How do people feel about their interactions with your tech team?
• What are the top five reasons people use your online marketplace?
• How does using your app make people feel in terms of connectedness?
• What emotions do people experience when they're using your product or service?
• Aside from the features of your product, what else about it attracts customers?
• How does your company culture make people feel?

As you can see, these kinds of questions are completely open-ended. In a way, they allow the research and discoveries made along the way to direct the research. The questions are merely a starting point from which to explore.

This video offers tips on how to write good qualitative research questions, produced by Qualitative Research Expert, Kimberly Baker.

Wrap-up: crafting your own qualitative research questions.

Over the course of this article, we've explored what qualitative research questions are, why they matter, and how they should be written. Hopefully you now have a clear understanding of how to craft your own.

Remember, qualitative research questions should always be designed to explore a certain experience or phenomena in-depth, in order to generate powerful insights. As you write your questions, be sure to keep the following in mind:

• Are you being inclusive of all relevant perspectives?
• Are your questions specific enough to generate clear answers?
• Will your questions allow for an in-depth exploration of the topic at hand?
• Do the questions reflect your research goals and objectives?

If you can answer "yes" to all of the questions above, and you've followed the tips for writing qualitative research questions we shared in this article, then you're well on your way to crafting powerful queries that will yield valuable insights.

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Writing Survey Questions

Perhaps the most important part of the survey process is the creation of questions that accurately measure the opinions, experiences and behaviors of the public. Accurate random sampling will be wasted if the information gathered is built on a shaky foundation of ambiguous or biased questions. Creating good measures involves both writing good questions and organizing them to form the questionnaire.

Questionnaire design is a multistage process that requires attention to many details at once. Designing the questionnaire is complicated because surveys can ask about topics in varying degrees of detail, questions can be asked in different ways, and questions asked earlier in a survey may influence how people respond to later questions. Researchers are also often interested in measuring change over time and therefore must be attentive to how opinions or behaviors have been measured in prior surveys.

Surveyors may conduct pilot tests or focus groups in the early stages of questionnaire development in order to better understand how people think about an issue or comprehend a question. Pretesting a survey is an essential step in the questionnaire design process to evaluate how people respond to the overall questionnaire and specific questions, especially when questions are being introduced for the first time.

For many years, surveyors approached questionnaire design as an art, but substantial research over the past forty years has demonstrated that there is a lot of science involved in crafting a good survey questionnaire. Here, we discuss the pitfalls and best practices of designing questionnaires.

Question development

There are several steps involved in developing a survey questionnaire. The first is identifying what topics will be covered in the survey. For Pew Research Center surveys, this involves thinking about what is happening in our nation and the world and what will be relevant to the public, policymakers and the media. We also track opinion on a variety of issues over time so we often ensure that we update these trends on a regular basis to better understand whether people’s opinions are changing.

At Pew Research Center, questionnaire development is a collaborative and iterative process where staff meet to discuss drafts of the questionnaire several times over the course of its development. We frequently test new survey questions ahead of time through qualitative research methods such as  focus groups , cognitive interviews, pretesting (often using an  online, opt-in sample ), or a combination of these approaches. Researchers use insights from this testing to refine questions before they are asked in a production survey, such as on the ATP.

Measuring change over time

Many surveyors want to track changes over time in people’s attitudes, opinions and behaviors. To measure change, questions are asked at two or more points in time. A cross-sectional design surveys different people in the same population at multiple points in time. A panel, such as the ATP, surveys the same people over time. However, it is common for the set of people in survey panels to change over time as new panelists are added and some prior panelists drop out. Many of the questions in Pew Research Center surveys have been asked in prior polls. Asking the same questions at different points in time allows us to report on changes in the overall views of the general public (or a subset of the public, such as registered voters, men or Black Americans), or what we call “trending the data”.

When measuring change over time, it is important to use the same question wording and to be sensitive to where the question is asked in the questionnaire to maintain a similar context as when the question was asked previously (see  question wording  and  question order  for further information). All of our survey reports include a topline questionnaire that provides the exact question wording and sequencing, along with results from the current survey and previous surveys in which we asked the question.

The Center’s transition from conducting U.S. surveys by live telephone interviewing to an online panel (around 2014 to 2020) complicated some opinion trends, but not others. Opinion trends that ask about sensitive topics (e.g., personal finances or attending religious services ) or that elicited volunteered answers (e.g., “neither” or “don’t know”) over the phone tended to show larger differences than other trends when shifting from phone polls to the online ATP. The Center adopted several strategies for coping with changes to data trends that may be related to this change in methodology. If there is evidence suggesting that a change in a trend stems from switching from phone to online measurement, Center reports flag that possibility for readers to try to head off confusion or erroneous conclusions.

Open- and closed-ended questions

One of the most significant decisions that can affect how people answer questions is whether the question is posed as an open-ended question, where respondents provide a response in their own words, or a closed-ended question, where they are asked to choose from a list of answer choices.

For example, in a poll conducted after the 2008 presidential election, people responded very differently to two versions of the question: “What one issue mattered most to you in deciding how you voted for president?” One was closed-ended and the other open-ended. In the closed-ended version, respondents were provided five options and could volunteer an option not on the list.

When explicitly offered the economy as a response, more than half of respondents (58%) chose this answer; only 35% of those who responded to the open-ended version volunteered the economy. Moreover, among those asked the closed-ended version, fewer than one-in-ten (8%) provided a response other than the five they were read. By contrast, fully 43% of those asked the open-ended version provided a response not listed in the closed-ended version of the question. All of the other issues were chosen at least slightly more often when explicitly offered in the closed-ended version than in the open-ended version. (Also see  “High Marks for the Campaign, a High Bar for Obama”  for more information.)

Researchers will sometimes conduct a pilot study using open-ended questions to discover which answers are most common. They will then develop closed-ended questions based off that pilot study that include the most common responses as answer choices. In this way, the questions may better reflect what the public is thinking, how they view a particular issue, or bring certain issues to light that the researchers may not have been aware of.

When asking closed-ended questions, the choice of options provided, how each option is described, the number of response options offered, and the order in which options are read can all influence how people respond. One example of the impact of how categories are defined can be found in a Pew Research Center poll conducted in January 2002. When half of the sample was asked whether it was “more important for President Bush to focus on domestic policy or foreign policy,” 52% chose domestic policy while only 34% said foreign policy. When the category “foreign policy” was narrowed to a specific aspect – “the war on terrorism” – far more people chose it; only 33% chose domestic policy while 52% chose the war on terrorism.

In most circumstances, the number of answer choices should be kept to a relatively small number – just four or perhaps five at most – especially in telephone surveys. Psychological research indicates that people have a hard time keeping more than this number of choices in mind at one time. When the question is asking about an objective fact and/or demographics, such as the religious affiliation of the respondent, more categories can be used. In fact, they are encouraged to ensure inclusivity. For example, Pew Research Center’s standard religion questions include more than 12 different categories, beginning with the most common affiliations (Protestant and Catholic). Most respondents have no trouble with this question because they can expect to see their religious group within that list in a self-administered survey.

In addition to the number and choice of response options offered, the order of answer categories can influence how people respond to closed-ended questions. Research suggests that in telephone surveys respondents more frequently choose items heard later in a list (a “recency effect”), and in self-administered surveys, they tend to choose items at the top of the list (a “primacy” effect).

Because of concerns about the effects of category order on responses to closed-ended questions, many sets of response options in Pew Research Center’s surveys are programmed to be randomized to ensure that the options are not asked in the same order for each respondent. Rotating or randomizing means that questions or items in a list are not asked in the same order to each respondent. Answers to questions are sometimes affected by questions that precede them. By presenting questions in a different order to each respondent, we ensure that each question gets asked in the same context as every other question the same number of times (e.g., first, last or any position in between). This does not eliminate the potential impact of previous questions on the current question, but it does ensure that this bias is spread randomly across all of the questions or items in the list. For instance, in the example discussed above about what issue mattered most in people’s vote, the order of the five issues in the closed-ended version of the question was randomized so that no one issue appeared early or late in the list for all respondents. Randomization of response items does not eliminate order effects, but it does ensure that this type of bias is spread randomly.

Questions with ordinal response categories – those with an underlying order (e.g., excellent, good, only fair, poor OR very favorable, mostly favorable, mostly unfavorable, very unfavorable) – are generally not randomized because the order of the categories conveys important information to help respondents answer the question. Generally, these types of scales should be presented in order so respondents can easily place their responses along the continuum, but the order can be reversed for some respondents. For example, in one of Pew Research Center’s questions about abortion, half of the sample is asked whether abortion should be “legal in all cases, legal in most cases, illegal in most cases, illegal in all cases,” while the other half of the sample is asked the same question with the response categories read in reverse order, starting with “illegal in all cases.” Again, reversing the order does not eliminate the recency effect but distributes it randomly across the population.

Question wording

The choice of words and phrases in a question is critical in expressing the meaning and intent of the question to the respondent and ensuring that all respondents interpret the question the same way. Even small wording differences can substantially affect the answers people provide.

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An example of a wording difference that had a significant impact on responses comes from a January 2003 Pew Research Center survey. When people were asked whether they would “favor or oppose taking military action in Iraq to end Saddam Hussein’s rule,” 68% said they favored military action while 25% said they opposed military action. However, when asked whether they would “favor or oppose taking military action in Iraq to end Saddam Hussein’s rule  even if it meant that U.S. forces might suffer thousands of casualties, ” responses were dramatically different; only 43% said they favored military action, while 48% said they opposed it. The introduction of U.S. casualties altered the context of the question and influenced whether people favored or opposed military action in Iraq.

There has been a substantial amount of research to gauge the impact of different ways of asking questions and how to minimize differences in the way respondents interpret what is being asked. The issues related to question wording are more numerous than can be treated adequately in this short space, but below are a few of the important things to consider:

First, it is important to ask questions that are clear and specific and that each respondent will be able to answer. If a question is open-ended, it should be evident to respondents that they can answer in their own words and what type of response they should provide (an issue or problem, a month, number of days, etc.). Closed-ended questions should include all reasonable responses (i.e., the list of options is exhaustive) and the response categories should not overlap (i.e., response options should be mutually exclusive). Further, it is important to discern when it is best to use forced-choice close-ended questions (often denoted with a radio button in online surveys) versus “select-all-that-apply” lists (or check-all boxes). A 2019 Center study found that forced-choice questions tend to yield more accurate responses, especially for sensitive questions.  Based on that research, the Center generally avoids using select-all-that-apply questions.

It is also important to ask only one question at a time. Questions that ask respondents to evaluate more than one concept (known as double-barreled questions) – such as “How much confidence do you have in President Obama to handle domestic and foreign policy?” – are difficult for respondents to answer and often lead to responses that are difficult to interpret. In this example, it would be more effective to ask two separate questions, one about domestic policy and another about foreign policy.

In general, questions that use simple and concrete language are more easily understood by respondents. It is especially important to consider the education level of the survey population when thinking about how easy it will be for respondents to interpret and answer a question. Double negatives (e.g., do you favor or oppose  not  allowing gays and lesbians to legally marry) or unfamiliar abbreviations or jargon (e.g., ANWR instead of Arctic National Wildlife Refuge) can result in respondent confusion and should be avoided.

Similarly, it is important to consider whether certain words may be viewed as biased or potentially offensive to some respondents, as well as the emotional reaction that some words may provoke. For example, in a 2005 Pew Research Center survey, 51% of respondents said they favored “making it legal for doctors to give terminally ill patients the means to end their lives,” but only 44% said they favored “making it legal for doctors to assist terminally ill patients in committing suicide.” Although both versions of the question are asking about the same thing, the reaction of respondents was different. In another example, respondents have reacted differently to questions using the word “welfare” as opposed to the more generic “assistance to the poor.” Several experiments have shown that there is much greater public support for expanding “assistance to the poor” than for expanding “welfare.”

We often write two versions of a question and ask half of the survey sample one version of the question and the other half the second version. Thus, we say we have two  forms  of the questionnaire. Respondents are assigned randomly to receive either form, so we can assume that the two groups of respondents are essentially identical. On questions where two versions are used, significant differences in the answers between the two forms tell us that the difference is a result of the way we worded the two versions.

One of the most common formats used in survey questions is the “agree-disagree” format. In this type of question, respondents are asked whether they agree or disagree with a particular statement. Research has shown that, compared with the better educated and better informed, less educated and less informed respondents have a greater tendency to agree with such statements. This is sometimes called an “acquiescence bias” (since some kinds of respondents are more likely to acquiesce to the assertion than are others). This behavior is even more pronounced when there’s an interviewer present, rather than when the survey is self-administered. A better practice is to offer respondents a choice between alternative statements. A Pew Research Center experiment with one of its routinely asked values questions illustrates the difference that question format can make. Not only does the forced choice format yield a very different result overall from the agree-disagree format, but the pattern of answers between respondents with more or less formal education also tends to be very different.

One other challenge in developing questionnaires is what is called “social desirability bias.” People have a natural tendency to want to be accepted and liked, and this may lead people to provide inaccurate answers to questions that deal with sensitive subjects. Research has shown that respondents understate alcohol and drug use, tax evasion and racial bias. They also may overstate church attendance, charitable contributions and the likelihood that they will vote in an election. Researchers attempt to account for this potential bias in crafting questions about these topics. For instance, when Pew Research Center surveys ask about past voting behavior, it is important to note that circumstances may have prevented the respondent from voting: “In the 2012 presidential election between Barack Obama and Mitt Romney, did things come up that kept you from voting, or did you happen to vote?” The choice of response options can also make it easier for people to be honest. For example, a question about church attendance might include three of six response options that indicate infrequent attendance. Research has also shown that social desirability bias can be greater when an interviewer is present (e.g., telephone and face-to-face surveys) than when respondents complete the survey themselves (e.g., paper and web surveys).

Lastly, because slight modifications in question wording can affect responses, identical question wording should be used when the intention is to compare results to those from earlier surveys. Similarly, because question wording and responses can vary based on the mode used to survey respondents, researchers should carefully evaluate the likely effects on trend measurements if a different survey mode will be used to assess change in opinion over time.

Question order

Once the survey questions are developed, particular attention should be paid to how they are ordered in the questionnaire. Surveyors must be attentive to how questions early in a questionnaire may have unintended effects on how respondents answer subsequent questions. Researchers have demonstrated that the order in which questions are asked can influence how people respond; earlier questions can unintentionally provide context for the questions that follow (these effects are called “order effects”).

One kind of order effect can be seen in responses to open-ended questions. Pew Research Center surveys generally ask open-ended questions about national problems, opinions about leaders and similar topics near the beginning of the questionnaire. If closed-ended questions that relate to the topic are placed before the open-ended question, respondents are much more likely to mention concepts or considerations raised in those earlier questions when responding to the open-ended question.

For closed-ended opinion questions, there are two main types of order effects: contrast effects ( where the order results in greater differences in responses), and assimilation effects (where responses are more similar as a result of their order).

An example of a contrast effect can be seen in a Pew Research Center poll conducted in October 2003, a dozen years before same-sex marriage was legalized in the U.S. That poll found that people were more likely to favor allowing gays and lesbians to enter into legal agreements that give them the same rights as married couples when this question was asked after one about whether they favored or opposed allowing gays and lesbians to marry (45% favored legal agreements when asked after the marriage question, but 37% favored legal agreements without the immediate preceding context of a question about same-sex marriage). Responses to the question about same-sex marriage, meanwhile, were not significantly affected by its placement before or after the legal agreements question.

Another experiment embedded in a December 2008 Pew Research Center poll also resulted in a contrast effect. When people were asked “All in all, are you satisfied or dissatisfied with the way things are going in this country today?” immediately after having been asked “Do you approve or disapprove of the way George W. Bush is handling his job as president?”; 88% said they were dissatisfied, compared with only 78% without the context of the prior question.

Responses to presidential approval remained relatively unchanged whether national satisfaction was asked before or after it. A similar finding occurred in December 2004 when both satisfaction and presidential approval were much higher (57% were dissatisfied when Bush approval was asked first vs. 51% when general satisfaction was asked first).

Several studies also have shown that asking a more specific question before a more general question (e.g., asking about happiness with one’s marriage before asking about one’s overall happiness) can result in a contrast effect. Although some exceptions have been found, people tend to avoid redundancy by excluding the more specific question from the general rating.

Assimilation effects occur when responses to two questions are more consistent or closer together because of their placement in the questionnaire. We found an example of an assimilation effect in a Pew Research Center poll conducted in November 2008 when we asked whether Republican leaders should work with Obama or stand up to him on important issues and whether Democratic leaders should work with Republican leaders or stand up to them on important issues. People were more likely to say that Republican leaders should work with Obama when the question was preceded by the one asking what Democratic leaders should do in working with Republican leaders (81% vs. 66%). However, when people were first asked about Republican leaders working with Obama, fewer said that Democratic leaders should work with Republican leaders (71% vs. 82%).

The order questions are asked is of particular importance when tracking trends over time. As a result, care should be taken to ensure that the context is similar each time a question is asked. Modifying the context of the question could call into question any observed changes over time (see  measuring change over time  for more information).

A questionnaire, like a conversation, should be grouped by topic and unfold in a logical order. It is often helpful to begin the survey with simple questions that respondents will find interesting and engaging. Throughout the survey, an effort should be made to keep the survey interesting and not overburden respondents with several difficult questions right after one another. Demographic questions such as income, education or age should not be asked near the beginning of a survey unless they are needed to determine eligibility for the survey or for routing respondents through particular sections of the questionnaire. Even then, it is best to precede such items with more interesting and engaging questions. One virtue of survey panels like the ATP is that demographic questions usually only need to be asked once a year, not in each survey.

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Technology as a Tool for Improving Patient Safety

Introduction .

In the past several decades, technological advances have opened new possibilities for improving patient safety. Using technology to digitize healthcare processes has the potential to increase standardization and efficiency of clinical workflows and to reduce errors and cost across all healthcare settings. 1 However, if technological approaches are designed or implemented poorly, the burden on clinicians can increase. For example, overburdened clinicians can experience alert fatigue and fail to respond to notifications. This can lead to more medical errors. As a testament to the significance of this topic in recent years, several government agencies [(e.g. the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare and Medicaid services (CMS)] have developed resources to help healthcare organizations integrate technology, such as the Safety Assurance Factors for EHR Resilience (SAFER) guides developed by the Office of the National Coordinator for Health Information Technology (ONC). 2,3,4  However, there is some evidence that these resources have not been widely used.5 Recently, the Centers for Medicare & Medicaid Services (CMS) started requiring hospitals to use the SAFER guides as part of the FY 2022 Hospital Inpatient Prospective Payment Systems (IPPS), which should raise awareness and uptake of the guides. 6

During 2022, research into technological approaches was a major theme of articles on PSNet. Researchers reviewed all relevant articles on PSNet and consulted with Dr. A Jay Holmgren, PhD, and Dr. Susan McBride, PhD, subject matter experts in health IT and its role in patient safety. Key topics and themes are highlighted below.  

Clinical Decision Support  

The most prominent focus in the 2022 research on technology, based on the number of articles published on PSNet, was related to clinical decision support (CDS) tools. CDS provides clinicians, patients, and other individuals with relevant data (e.g. patient-specific information), purposefully filtered and delivered through a variety of formats and channels, to improve and enhance care. 7   

Computerized Patient Order Entry  

One of the main applications of CDS is in computerized patient order entry (CPOE), which is the process used by clinicians to enter and send treatment instructions via a computer application. 8 While the change from paper to electronic order entry itself can reduce errors (e.g., due to unclear handwriting or manual copy errors), research in 2022 showed that there is room for improvement in order entry systems, as well as some promising novel approaches. 

Two studies looked at the frequency of and reasons for medication errors in the absence of CDS and CPOE and demonstrated that there was a clear patient safety need. One study found that most medication errors occurred during the ordering or prescribing stage, and both this study and the other study found that the most common medication error was incorrect dose. Ongoing research, such as the AHRQ Medication Safety Measure Development project, aims to develop and validate measure specifications for wrong-patient, wrong-dose, wrong-medication, wrong-route, and wrong-frequency medication orders within EHR systems, in order to better understand and capture health IT safety events.9 Errors of this type could be avoided or at least reduced through the use of effective CPOE and CDS systems. However, even when CPOE and CDS are in place, errors can still occur and even be caused by the systems themselves. One study reviewed duplicate medication orders and found that 20% of duplicate orders resulted from technological issues, including alerts being overridden, alerts not firing, and automation issues (e.g., prefilled fields). A case study last year Illustrated one of the technological issues, in this case a manual keystroke error, that can lead to a safety event. A pharmacist mistakenly set the start date for a medication to the following year rather than the following day , which the CPOE system failed to flag. The authors recommended various alerts and coding changes in the system to prevent this particular error in the future.  

There were also studies in 2022 that showed successful outcomes of well-implemented CPOE systems. One in-depth pre-post, mixed-methods study showed that a fully implemented CPOE system significantly reduced specific serious and commonly occurring prescribing and procedural errors. The authors also presented evidence that it was cost-effective and detailed implementation lessons learned drawn from the qualitative data collected for the study. A specific CPOE function that demonstrated statistically significant improvement in 2022 was automatic deprescribing of medication orders and communication of the relevant information to pharmacies. Deprescribing is the planned and supervised process of dose reduction or stopping of a medication that is no longer beneficial or could be causing harm. That study showed an immediate and sustained 78% increase in successful discontinuations after implementation of the software. A second study on the same functionality determined that currently only one third to one half of medications are e-prescribed, and the study proposed that e-prescribing should be expanded to increase the impact of the deprescribing software. It should be noted, however, that the systems were not perfect and that a small percentage of medications were unintentionally cancelled. Finally, an algorithm to detect patients in need of follow-up after test results was developed and implemented in another study . The algorithm showed some process improvements, but outcome measures were not reported. 

Usability  

Usability of CDS systems was a large focus of research in 2022. Poorly designed systems that do not fit into existing workflows lead to frustrated users and increase the potential for errors. For example, if users are required to enter data in multiple places or prompted to enter data that are not available to them, they could find ways to work around the system or even cease to use it, increasing the potential for patient safety errors. The documentation burden is already very high on U.S. clinicians, 10 so it is important that novel technological approaches do not add to this burden but, if possible, alleviate it by offering a high level of usability and interoperability.  

One study used human-factored design in creating a CDS to diagnose pulmonary embolism in the Emergency Department and then surveyed clinician users about their experiences using the tool. Despite respondents giving the tool high usability ratings and reporting that the CDS was valuable, actual use of the tool was low. Based on the feedback from users, the authors proposed some changes to increase uptake, but both users and authors mentioned the challenges that arise when trying to change the existing workflow of clinicians without increasing their burden. Another study gathered qualitative feedback from clinicians on a theoretical CDS system for diagnosing neurological issues in the Emergency Department. In this study too, many clinicians saw the potential value in the CDS tool but had concerns about workflow integration and whether it would impact their ability to make clinical decisions. Finally, one study developed a dashboard to display various risk factors for multiple hospital-acquired infections and gathered feedback from users. The users generally found the dashboard useful and easy to learn, and they also provided valuable feedback on color scales, location, and types of data displayed. All of these studies show that attention to end user needs and preferences is necessary for successful implementation of CDS.  However, the recent market consolidation in Electronic Health Record vendors may have an impact on the amount of user feedback gathered and integrated into CDS systems. Larger vendors may have more resources to devote to improving the usability and design of CDS, or their near monopolies in the market may not provide an incentive to innovate further. 11 More research is needed as this trend continues.  

Alerts and Alarms 

Alerts and alarms are an important part of most CDS systems, as they can prompt clinicians with important and timely information during the treatment process. However, these alerts and alarms must be accurate and useful to elicit an appropriate response. The tradeoff between increased safety due to alerts and clinician alert fatigue is an important balance to strike. 12

Many studies in 2022 looked at clinician responses to medication-related alerts, including override and modification rates. Several of the studies found a high alert override rate but questioned the validity of using override rates alone as a marker of CDS effectiveness and usability. For example, one study looked at drug allergy alerts and found that although 44.8% of alerts were overridden, only 9.3% of those were inappropriately overridden, and very few overrides led to an adverse allergic reaction. A study on “do not give” alerts found that clinicians modified their orders to comply with alert recommendations after 78% of alerts but only cancelled orders after 26% of alerts. A scoping review looked at drug-drug interaction alerts and found similar results, including high override rates and the need for more data on why alerts are overridden. These findings are supported by another study that found that the underlying drug value sets triggering drug-drug interaction alerts are often inconsistent, leading to many inappropriate alerts that are then appropriately overridden by clinicians. These studies suggest that while a certain number of overrides should be expected, the underlying criteria for alert systems should be designed and regularly reviewed with specificity and sensitivity in mind. This will increase the frequency of appropriate alerts that foster indicated clinical action and reduce alert fatigue. 

There also seems to be variability in the effectiveness of alert systems across sites. One study looked at an alert to add an item to the problem list if a clinician placed an order for a medication that was not indicated based on the patient’s chart. The study found about 90% accuracy in alerts across two sites but a wide difference in the frequency of appropriate action between the sites (83% and 47%). This suggests that contextual factors at each site, such as culture and organizational processes, may impact success as much as the technology itself.  

A different study looked at the psychology of dismissing alerts using log data and found that dismissing alerts becomes habitual and that the habit is self-reinforcing over time. Furthermore, nearly three quarters of alerts were dismissed within 3 seconds. This indicates how challenging it can be to change or disrupt alert habits once they are formed. 

Artificial Intelligence and Machine Learning  

In recent years, one of the largest areas of burgeoning technology in healthcare has been artificial intelligence (AI) and machine learning. AI and machine learning use algorithms to absorb large amounts of historical and real-time data and then predict outcomes and recommend treatment options as new data are entered by clinicians. Research in 2022 showed that these techniques are starting to be integrated into EHR and CDS systems, but challenges remain. A full discussion of this topic is beyond the scope of this review. Here we limit the discussion to several patient-safety-focused resources posted on PSNet in 2022.  

One of the promising aspects of AI is its ability to improve CDS processes and clinician workflow overall. For example, one study last year looked at using machine learning to improve and filter CDS alerts. They found that the software could reduce alert volume by 54% while maintaining high precision. Reducing alert volume has the potential to alleviate alert fatigue and habitual overriding. Another topic explored in a scoping review was the use of AI to reduce adverse drug events. While only a few studies reviewed implementation in a clinical setting (most evaluated algorithm technical performance), several promising uses were found for AI systems that predict risk of an adverse drug event, which would facilitate early detection and mitigate negative effects.  

Despite enthusiasm for and promising applications of AI, implementation is slow. One of the challenges facing implementation is the variable quality of the systems. For example, a commonly used sepsis detection model was recently found to have very low sensitivity. 13 Algorithms also drift over time as new data are integrated, and this can affect performance, particularly during and after large disturbances like the COVID-19 pandemic. 14 There is also emerging research about the impact of AI algorithms on racial and ethnic biases in healthcare; at the time of publication of this essay, an AHRQ EPC was conducting a review of evidence on the topic. 15  These examples highlight the fact that AI is not a “set it and forget it” application; it requires monitoring and customization from a dedicated resource to ensure that the algorithms perform well over time. A related challenge is the lack of a strong business case for using high-quality AI. Because of this, many health systems choose to use out-of-the-box AI algorithms, which may be of poor quality overall (or are unsuited to particular settings) and may also be “black box” algorithms (i.e., not customizable by the health system because the vendor will not allow access to the underlying code). 16 The variable quality and the lack of transparency may cause mistrust by clinicians and overall aversion to AI interventions.  

In an attempt to address these concerns, one article in 2022 detailed best practices for AI implementation in health systems, focusing on the business case. Best practices include using AI to address a priority problem for the health system rather than treating it as an end itself. Additionally, testing the AI using the health system’s patients and data to demonstrate applicability and accuracy for that setting, confirming that the AI can provide a return on investment, and ensuring that the AI can be implemented easily and efficiently are also important. Another white paper described a human-factors and ergonomics framework for developing AI in order to improve the implementation within healthcare systems, teams, and workflows. The federal government and international organizations have also published AI guidelines, focusing on increasing trustworthiness (National Artificial Intelligence Initiative) 17 and ensuring ethical governance (World Health Organization). 18   

Conclusion and Next Steps 

As highlighted in this review, the scope and complexity of technology and its application in healthcare can be intimidating for healthcare systems to approach and implement. Researchers last year thus created a framework that health systems can use to assess their digital maturity and guide their plans for further integration.  

The field would benefit from more research in several areas in upcoming years. First and foremost, high-quality prospective outcome studies are needed to validate the effectiveness of the new technologies. Second, more work is needed on system usability, how the systems are integrated into workflows, and how they affect the documentation burden placed on clinicians. For CDS specifically, more focus is needed on patient-centered CDS (PC CDS), which supports patient-centered care by helping clinicians and patients make the best decisions given each individual’s circumstances and preferences. 19 AHRQ is already leading efforts in this field with their CDS Innovation Collaborative project. 20 Finally, as it becomes more common to incorporate EHR scribes to ease the documentation burden, research on their impact on patient safety will be needed, especially in relation to new technological approaches. For example, when a scribe encounters a CDS alert, do they alert the clinician in all cases? 

In addition to the approaches mentioned in this article, other emerging technologies in early stages of development hold theoretical promise for improving patient safety. One prominent example is “computer vision,” which uses cameras and AI to gather and process data on what physically happens in healthcare settings beyond what is captured in EHR data, 21 including being able to detect immediately that a patient fell in their room. 22  

As technology continues to expand and improve, researchers, clinicians, and health systems must be mindful of potential stumbling blocks that could impede progress and threaten patient safety. However, technology presents a wide array of opportunities to make healthcare more integrated, efficient, and safe.  

• Cohen CC, Powell K, Dick AW, et al. The Association Between Nursing Home Information Technology Maturity and Urinary Tract Infection Among Long-Term Residents . J Appl Gerontol . 2022;41(7):1695-1701. doi: 10.1177/07334648221082024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9232878/
• https://www.healthit.gov/topic/safety/safer-guides
• https://cds.ahrq.gov/cdsconnect/repository
• https://www.cms.gov/about-cms/obrhi
• McBride S, Makar E, Ross A, et al. Determining awareness of the SAFER guides among nurse informaticists. J Inform Nurs. 2021;6(4). https://library.ania.org/ania/articles/713/view
• Sittig DF, Sengstack P, Singh H. Guidelines for US hospitals and clinicians on assessment of electronic health record safety using SAFER guides. J ama . 2022;327:719-720.
• https://library.ahima.org/doc?oid=300027#.Y-6RhXbMKHt
• https://www.healthit.gov/faq/what-computerized-provider-order-entry#:~:text=Computerized%20provider%20order%20entry%20(CPOE,paper%2C%20fax%2C%20or%20telephone
• https://digital.ahrq.gov/2018-year-review/research-spotlights/leveragin…
• Holmgren AJ, Downing NL, Bates DW, et al. Assessment of electronic health record use between US and non-US health systems. JAMA Intern Med. 2021;181:251-259. https://doi.org/10.1001/jamainternmed.2020.7071
• Holmgren AJ, Apathy NC. Trends in US hospital electronic health record vendor market concentration, 2012–2021. J Gen Intern Med. 2022. https://link.springer.com/article/10.1007/s11606-022-07917-3#citeas
• Co Z, Holmgren AJ, Classen DC, et al. The tradeoffs between safety and alert fatigue: data from a national evaluation of hospital medication-related clinical decision support. J Am Med Inform Assoc. 2020;27:1252-1258. https://pubmed.ncbi.nlm.nih.gov/32620948/
• Wong A, Otles E, Donnelly JP, et al. External validation of a widely implemented proprietary sepsis prediction model in hospitalized patients. JAMA Intern Med. 2021;181:1065-1070. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2781307
• Parikh RB, Zhang Y, Kolla L, et al. Performance drift in a mortality prediction algorithm among patients with cancer during the SARS-CoV-2 pandemic. J Am Med Inform Assoc. 2022;30:348-354. https://academic.oup.com/jamia/advance-article/doi/10.1093/jamia/ocac221/6835770?login=false
• https://effectivehealthcare.ahrq.gov/products/racial-disparities-health…
• https://www.statnews.com/2022/05/24/market-failure-preventing-efficient-diffusion-health-care-ai-software/
• https://www.ai.gov/strategic-pillars/advancing-trustworthy-ai/
• Ethics and governance of artificial intelligence for health (WHO guidance). Geneva: World Health Organization; 2021. https://www.who.int/publications/i/item/9789240029200
• Dullabh P, Sandberg SF, Heaney-Huls K, et al. Challenges and opportunities for advancing patient-centered clinical decision support: findings from a horizon scan. J Am Med Inform Assoc. 2022: 29(7):1233-1243. doi: 10.1093/jamia/ocac059. PMID: 35534996; PMCID: PMC9196686.
• https://cds.ahrq.gov/cdsic
• Yeung S, Downing NL, Fei-Fei L, et al. Bedside computer vision: moving artificial intelligence from driver assistance to patient safety. N Engl J Med. 2018;387:1271-1273. https://www.nejm.org/doi/10.1056/NEJMp1716891
• Espinosa R, Ponce H, Gutiérrez S, et al. A vision-based approach for fall detection using multiple cameras and convolutional neural networks: a case study using the UP-Fall detection dataset. Comput Biol Med. 2019;115:103520. https://doi.org/10.1016/j.compbiomed.2019.103520

This project was funded under contract number 75Q80119C00004 from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. The authors are solely responsible for this report’s contents, findings, and conclusions, which do not necessarily represent the views of AHRQ. Readers should not interpret any statement in this report as an official position of AHRQ or of the U.S. Department of Health and Human Services. None of the authors has any affiliation or financial involvement that conflicts with the material presented in this report. View AHRQ Disclaimers

Perspective

Perspectives on Safety

Annual Perspective

Patient Safety Innovations

Suicide Prevention in an Emergency Department Population: ED-SAFE

WebM&M Cases

The Retrievals. August 9, 2023

Agent of change. August 1, 2018

Amid lack of accountability for bias in maternity care, a California family seeks justice. August 16, 2023

Mirror, Mirror on the Wall: An Update on the Quality of American Health Care Through the Patient's Lens. April 12, 2006

Improving patient safety by shifting power from health professionals to patients. October 25, 2023

Patient Safety Primers

Discharge Planning and Transitions of Care

Medicines-related harm in the elderly post-hospital discharge. March 27, 2019

Emergency department crowding: the canary in the health care system. November 3, 2021

Advancing Patient Safety: Reviews From the Agency for Healthcare Research and Quality's Making Healthcare Safer III Report. September 2, 2020

Exploring Alternatives To Malpractice Litigation. January 15, 2014

Making Healthcare Safer III. March 18, 2020

Special Section: Patient Safety. May 24, 2006

The Science of Simulation in Healthcare: Defining and Developing Clinical Expertise. November 19, 2008

Compendium of Strategies to Prevent HAIs in Acute Care Hospitals 2014. September 1, 2014

Quality, Safety, and Noninterpretive Skills. November 11, 2015

Patient Safety. November 21, 2018

Ambulatory Safety Nets to Reduce Missed and Delayed Diagnoses of Cancer

Remote response team and customized alert settings help improve management of sepsis.

Using sociotechnical theory to understand medication safety work in primary care and prescribers' use of clinical decision support: a qualitative study. May 24, 2023

Human factors and safety analysis methods used in the design and redesign of electronic medication management systems: a systematic review. May 17, 2023

Journal Article

Reducing hospital harm: establishing a command centre to foster situational awareness.

The potential for leveraging machine learning to filter medication alerts. May 4, 2022

Improving the specificity of drug-drug interaction alerts: can it be done? April 6, 2022

A qualitative study of prescribing errors among multi-professional prescribers within an e-prescribing system. December 23, 2020

The tradeoffs between safety and alert fatigue: data from a national evaluation of hospital medication-related clinical decision support. July 29, 2020

Assessment of health information technology-related outpatient diagnostic delays in the US Veterans Affairs health care system: a qualitative study of aggregated root cause analysis data. July 22, 2020

Reducing drug prescription errors and adverse drug events by application of a probabilistic, machine-learning based clinical decision support system in an inpatient setting. August 21, 2019

Improving medication-related clinical decision support. March 7, 2018

The frequency of inappropriate nonformulary medication alert overrides in the inpatient setting. April 6, 2016

The effect of provider characteristics on the responses to medication-related decision support alerts. July 15, 2015

Best practices: an electronic drug alert program to improve safety in an accountable care environment. July 1, 2015

Impact of computerized physician order entry alerts on prescribing in older patients. March 25, 2015

Differences of reasons for alert overrides on contraindicated co-prescriptions by admitting department. December 17, 2014

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