Systematic Review: Frameworks

This guide presents tools and advice for conducting systematic reviews.

Frameworks

Choosing a Framework

Key to your research is the framework you choose for your Review. Frameworks can be used to both develop your research question and your search strategy. As you can see from Figure 1 below, frameworks can differ across disciplines and across question types. When developing your question, write out your framework and add concepts from your question in the appropriate framework element. When you are happy that everything is accounted for, state your question using all the elements you have developed.

Please refer to the individual tabs above for more information on some of the more commonly used frameworks.

This list is not exhaustive.

Type of Research Question	Framework	Discipline
Clinical	PICO (and variants)	Health
Quantitative	PEO, PICO (and variants)	Health, Social Sciences, Business, etc.
Qualitative	PEO, PICo, ECLIPSe, SPICE, SPiDER, PerSPEcTiF	Social Sciences, Business, Health, etc.
Mixed Methods	SPICE, SPiDER	Health, Social Sciences
Methodological or Theoretical	BeHEMoTh	Health

Figure 1. Table of commonly used research frameworks. (adapted from City University of London: https://libguides.city.ac.uk/systematic-reviews/formulate-your-question)

The PICO Framework

The PICO question framework is very heavily used in Systematic Reviews and is effective at answering quantitative questions.

PICO identifies four concepts:

P:	Patient problem or Population	Characteristics of the patient; condition or disease being investigated.
I:	Intervention	What do we do to them; what are they exposed to?
C:	Comparison (if there is one)	What is the alternative to the intervention/exposure? (optional)
O:	Outcome(s)	What are the desired outcomes of the intervention?

Figure 1. The structure of the PICO framework. Click image for a larger version.

More Information

Samson, D. and Schoelles, K. M. (2012) 'Chapter 2: medical tests guidance (2) developing the topic and structuring systematic reviews of medical tests: utility of PICOTS, analytic frameworks, decision trees, and other frameworks', J Gen Intern Med, 27 Suppl 1(Suppl 1), pp. S11-9, NLM. Available at: https://doi.org/10.1007/s11606-012-2007-7

The PICOT Framework

Substantially similar to the PICO framework, the PICOT framework incorporates a time limitation for the collection of data.

PICOT identifies five concepts:

P:	Patient problem or Population	Characteristics of the patient; condition or disease being investigated.
I:	Intervention	What do we do to them: what are they exposed to?
C:	Comparison (if there is one)	What is the alternative to the intervention/exposure? (optional)
O:	Outcome(s)	What are the desired outcomes of the intervention?
T:	Time	Time period for data collection.

Figure 1. Structure of the PICOT Search tool. Click image for larger version.

More Information

Samson, D. and Schoelles, K. M. (2012) 'Chapter 2: medical tests guidance (2) developing the topic and structuring systematic reviews of medical tests: utility of PICOTS, analytic frameworks, decision trees, and other frameworks', J Gen Intern Med, 27 Suppl 1(Suppl 1), pp. S11-9, NLM. Available at: https://doi.org/10.1007/s11606-012-2007-7

The PEO Framework

PEO is used for qualitative focused systematic reviews

PEO identifies three concepts:

P:	Population	Who are you studying? Infants? Males who are between the ages of 55 and 60? Adolescent females?
E:	Exposure	What is your population exposed to? Baby aspirin? Soy supplements? Peanuts?
O:	Outcome	What is the result of the exposure on your population? Lowered risk for heart attacks? Food allergies? Increased menstrual cramps?

Figure 1. The structure of the PEO framework. Click image for a larger version.

More Information

Elsevier Author Services (2023) Clinical Questions: PICO and PEO Research. Available at: https://scientific-publishing.webshop.elsevier.com/research-process/clinical-questions-pico-and-peo-research/#What_is_a_PEO_Question

The PCC Framework

PCC is often used in Scoping Reviews

PCC identifies three concepts:

P:	Population or participants	Important characteristics of participants, including age and other qualifying criteria.
C:	Concept	interventions/programmes and outcomes assessed.
C:	Context	Context may encompass details about the specific location, timeframe, environment, etc..

Figure 1. The structure of the PCC framework. Click image for a larger version.

More Information

Aromataris, E. and Riitano, D. (2014) 'Systematic reviews: constructing a search strategy and searching for evidence', AJN The American Journal of Nursing, 114(5), pp. 49-56. Available at: https://doi.org/10.1097/01.NAJ.0000446779.99522.f6.

The SPiDER Framework

SPiDER is frequently used for Qualitative Reviews.

SPiDER identifies five concepts:

S:	Sample	The group you are studying.
Pi:	Phenomenon of interest	The topic of research or intervention.
D:	Design	Techniques used to gather qualitative data. (i.e.: focus group, interviews, observations, etc..)
E:	Evaluation	The outcome of the study.
R:	Research type	What kind of qualitative study? (i.e.: phenomenology, ethnography, grounded theory, case study, etc..)

Figure 1: The structure of the SPiDER search tool. Click the image for a larger version.

More Information

The SPICE Framework

The SPICE framework is useful when the research question is concerned with Evidence-Based Practice.

SPICE identifies five concepts:

S:	Setting	Where?
P:	Perspective	For whom?
I:	Intervention	What?
C:	Comparison	Compared with what?
E:	Evaluation	With what result?

Figure 1. The structure of the SPICE framework. Click image for a larger version.

More Information

The BeHEMoTh Framework

BeHEMoTH is a framework that can be used to investigate questions about theory.

BeHEMoTh identifies four concepts:

Be:	Behaviour of interest	Way population or patient interacts with health context, for example access for a service, compliance, attitude to policy.
H:	Health context	i.e.: the service, policy, programme or intervention.
E:	Exclusions	To exclude non-theoretical/technical models (depends on volume).
MoTh:	Models or Theories	Operationalized as a generic ‘model* or theor* or concept* or framework*’ strategy together with named models or theories if required.

Figure 1. The structure of the BeHEMoTh framework. Click image for a larger version.

More Information

Booth, A. and Carroll, C. (2015) 'Systematic searching for theory to inform systematic reviews: is it feasible? Is it desirable?', Health Information & Libraries Journal, 32(3), pp. 220-235, Available at: https://doi.org/10.1111/hir.12108

The ECLIPSe Framework

The ECLIPSe framework is useful for qualitative research topics investigating the outcomes of a policy or service.

ECLIPSe identifies six concepts:

E:	Expectation	What are you looking to improve or change? What is the information going to be used for?
C:	Client group	Who is the service or policy aimed at?
L:	Location	Where is the service or policy located?
I:	Impact	What is the change in service or policy that the researcher is investigating?
P:	Professionals	Who is involved in providing or improving the service or policy?
Se:	Service	What kind of service or policy is this?

Figure 1. The structure of the ECLIPSe framework. Click image for a larger version.

More Information

Wildridge, V. and Bell, L. (2002) 'How CLIP became ECLIPSE: a mnemonic to assist in searching for health policy/ management information', Health Info Libr J, 19(2), pp. 113-5, NLM. Available at: https://doi.org/10.1046/j.1471-1842.2002.00378.x .

The PerSPEcTiF Framework

PerSPEcTiF is a framework designed specifically for exploring complex interventions within qualitative evidence synthesis.

PerSPEcTiF identifies seven concepts:

Per:	Perspective	Whose perspective are you interested in? How are you defining this population?
S:	Setting	Where is your phenomenon of interest taking place? (geographical location or service location)
P:	Phenomenon of interest	Which situation, issue, event or activity are you investigating?
E:	Environment	Relevant aspects of the environment in which the phenomenon is experienced. (Staffing, transport, facilities, access to services, etc.)
C:	Comparison	Which situation, issue, event, or activity are you comparing your problem or phenomenon of interest with? (optional)
Ti:	Time/Timing	What is the duration of the problem or phenomenon you are observing?
F:	Findings	Which of your population's perceptions and experiences are you focusing on? How are you measuring these?

Figure 1. The structure of the PerSPECiF framework. Click image for a larger version.

More Information

Andrew, B., Jane, N., Kate, F., Graham, M., Özge, T. and Elham, S. (2019) 'Formulating questions to explore complex interventions within qualitative evidence synthesis', BMJ Global Health, 4(Suppl 1), pp. e001107. Available at: http://dx.doi.org/10.1136/bmjgh-2018-001107.

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