Step 1: Frame Your Clinical Question

The first step in the evidence-based practice (EBP) process is to identify the clinical problem or question for which you are seeking evidence. Asking a focused and relevant question about your client's situation will inform your search. One widely used approach to frame a clinical question is known as PICO, which stands for

Population Intervention Comparison Outcome

The PICO elements are as follows:

Population: What are the characteristics and/or condition of the group? This may include specific diagnoses, ages, or severity levels (e.g., autism spectrum disorder, mild hearing loss).
Intervention: What is the screening, assessment, treatment, or service delivery model that you are considering (e.g., instrumental swallowing assessment, high-intensity treatment, hearing aids)?
Comparison: What is the main alternative to the intervention, assessment, or screening approach (e.g., placebo, different technique, different amount of treatment)? Note: In some situations, you may not have a specific comparison in your PICO question.
Outcome: What do you want to accomplish, measure, or improve (e.g., upgraded diet level, more intelligible speech, better hearing in background noise)?

Once you've identified the population, intervention, comparison, and outcome for your situation, you can establish your PICO question.

There is no one "correct" way to construct a PICO question. Your clinical question should include elements specific to each client's unique circumstances and values.

Population	Intervention	Comparison	Outcome	Example PICO Question
Children with severe to profound hearing loss	Cochlear implants	Hearing aids	Speech and language development	For children with severe to profound hearing loss, what is the effect of cochlear implants compared with hearing aids on speech and language development?
Young adult with a stroke	Cognitive rehab	Not applicable	Return to work	What is the effect of cognitive rehabilitation on vocational outcomes in individuals who experience a stroke?

Sometimes, you have a clinical situation that may have more than one PICO question. Write them all down to tackle one search at a time. Your clinical question(s) should be specific enough to guide your search—but not too specific that you are unable to find any evidence.