3.3.7 Determining the review question

Developing a qualitative systematic review question is a critical initial step that sets the direction for the entire review (Lockwood et al. 2015). The question is the foundation upon which the entire systematic review is built and provides a structure for the review process, guiding the literature search, selection of studies, data extraction and data analysis. A well-crafted question ensures that the review yields meaningful and relevant results.

Developing a systematic review question should address a need for evidence-based knowledge within a specific domain of inquiry. This need is often driven by the desire to synthesise and consolidate the available evidence to inform decision-making, policy development or clinical practice. This need can be related to practice areas associated with high costs, poor outcomes or where there is wide variation in practice.

The review question should articulate this need clearly, guiding the systematic review to ensure a comprehensive and rigorous examination of the topic. In essence, the question serves as the linchpin that connects the existing knowledge gaps with the pursuit of a detailed understanding. This ensures the review is purposeful and yields valuable results.

There are several ways in which a review question can be developed and there is not one approach that it advocated over another. Questions can be presented as a single question or a primary question with one or more secondary questions, with the questions being either broad or narrow and specific. The review team should consider how their choice of question will influence the review, such as its impact on data extraction or synthesis, and provide a description of these considerations in the relevant sections.

Review questions typically follow a structured framework. This ensures that the question is formulated precisely, focused and aligned with the review objectives. In JBI qualitative systematic reviews, the PICo (Population, Phenomenon of Interest, Context) framework guides the development of the review question (Lockwood et al. 2015).

• (P) Population/Participants: This component specifies the group or individuals that the review focuses on. This can be a particular demographic or a group sharing certain characteristics or experiences.

• (I) Phenomenon of interest: This component specifies the central subject of interest, which is the core focus of the review. It defines what is being examined or the main concept that the researchers want to understand better through the review. Depending on the research question, the phenomenon can take various forms. It can be:

  • a particular condition (e.g. chronic pain management in elderly patients)

  • a social phenomenon (e.g. stigmatisation of mental illness in adolescents)

  • a healthcare intervention (e.g. mindfulness-based stress reduction programs)

  • a specific behaviour (e.g. adherence to medication regimens among type 2 diabetes patients)

  • an experience (e.g. experiences of cancer survivors during their treatment journey)

  • or any other aspect that is central to the inquiry.

• (Co) Context: This component refers to the specific setting or circumstances in which the research or phenomenon of interest occurs or is being studied. The context provides situational information that helps to frame and understand the phenomenon under investigation. Context can encompass a range of factors, including geographical location, time, cultural or socio-economic factors, specific settings (e.g. healthcare institutions, educational settings, workplaces) and any other relevant circumstances.

In qualitative systematic reviews, the review question plays a crucial role in shaping the inclusion and exclusion criteria and subsequently, the development of the search strategy. The review question guides the review process and helps define the scope of the review. Using the PROGRESS-Plus framework during question formulation can help teams determine whether there are equity-related dimensions that need to be specified within the question (O’Neill et al. 2014).

Examples of well-constructed review questions are provided below.

Example 1

What are the experiences of children and young adults living with juvenile idiopathic arthritis (JIA)? (Min et al. 2022)

• Population: Children and young adults, defined as under 21 years old diagnosed with JIA.

• Phenomenon of interest: Experiences of living with JIA; experiences broadly defined as physical and/or psychosocial, physical manifestations, psychological reactions, financial burden and disease complications.

• Context: any country, independent of the location (e.g. home, clinic, hospital, community).

Example 2

What were the experiences of women who smoked tobacco during pregnancy or postnatally (or both) concerning healthcare professional interactions with them about their smoking, when such interactions occurred during contact for prenatal or postnatal healthcare in any healthcare setting? (Small et al. 2023)

• Population: Women who smoked tobacco during pregnancy or postnatally (or both).

• Phenomenon of interest: Experiences of interactions with healthcare professionals about their smoking.

• Context: Contact for prenatal or postnatal healthcare in any healthcare setting.

Example 3

What are the experiences of bridging students who are enrolled in or have completed a post-licensure practical nurse (PLPN) to registered nurse (RN) bridging program? (McCloskey et al. 2023)

The review sub-questions are:

1. What motivates PLPNs to enrol in PLPN to RN bridging programs?

2. What academic supports help students successfully complete PLPN to RN bridging programs?

3. What causes PLPN attrition from RN bridging programs?

   • Population: Students who are enrolled in or have completed a PLPN to RN bridging program.

   • Phenomenon of interest: Experiences, including their views, understandings or impressions of being enrolled in the program.

   • Context: PLPN to RN bridging programs in any setting.

Example 4

What are the perceptions and practices of community members relating to trachoma in Africa? (Tanywe, Green & Fernandez 2022)

• Population: Community members.

• Phenomenon of interest: Perceptions and practices relating to trachoma.

• Context: Africa.

Example 5

What are the postpartum experiences of women and birthing people, their partners and their families during COVID-19? (Macdonald et al. 2023)

• Population: Women, birthing people, their partners and their families.

• Phenomenon of interest: Postpartum experiences.

• Context: COVID-19.

Additional aspects to consider when developing the review question in a qualitative systematic review include:

Relevance: The question should be relevant to the research area, addressing a specific issue or gap in the existing literature. It should further the understanding of a meaningful and important topic.

Scope: Consider the scope of the question. Is it broad or narrow in focus? The scope should align with the review objectives and available resources. Avoid overly broad or unmanageable questions. In particular, consider whether it is meaningful to conduct the review with a global or universal perspective or whether it is important to explore the experiences more specifically of a particular group or context (Hannes & Harden 2011).

Clarity: Ensure that the question is clear and concise and avoids ambiguity or vagueness.

Alignment: Ensure the question aligns with the objectives and scope of the review.

Knowledge user relevance: Consider the relevance of the question to knowledge users, such as policymakers, clinicians or patients. Will the review findings be useful and applicable to these groups? Does the question consider equity, diversity and inclusion?