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With your PICO question set, the next step is deciding on the best methodological approach to answer it. Each methodology has its own strengths, for example:

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PICO in hand – and fuelled by a strong coffee – next you will need to go through each piece of literature multiple times. Start with the abstract, then the full text, and then further in-depth readings as often as required.

Whether you’re talking to policymakers, media, or the general public, your readers will only be scraping the surface of a subject you have been immersed in for months. So, keep your language straightforward, and avoid jargon and abbreviations. And if you are planning to share your findings more broadly with the public, seek out support from communications professionals who can help you translate your research into everyday language and share it on the appropriate channels.

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This is where the magic happens: it’s time to synthesise the vast volumes of information you have gathered and make meaning from it. You will have defined a method of analysis to do this when setting out your protocol, informed by the type of review. A meta-analysis may work best for quantitative data. Whereas for qualitative data, you may be looking at thematic synthesis or meta-ethnography. The skills to distil these findings into a coherent review with valid conclusions are hard-won over many years of academic training and professional research experience.

For example, the HRB’s recent review of research on the health effects of community water fluoridation asked: What is the impact on the systemic health (O) of the human population (P) for those exposed to artificially fluoridated water between 0.4 and 1.5 ppm (I), compared with non-fluoridated water (less than 0.3 ppm) (C)?

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If you imagine that producing an evidence review means hundreds of hours buried in literature… you’re right! To find all relevant research, you must do an extensive search of at least two (and usually many more) bibliographical databases, trawl relevant sources for grey literature (material produced outside conventional publishing channels), and carefully scan citations in the texts you consult for breadcrumbs towards additional research.

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The next step is to thoroughly evaluate and assess the quality of the data you have gathered. There is a range of tried and tested ‘risk of bias’ tools for evaluating the quality of the included research studies. However, bias in your data is not the only way that it can creep into your review – the reviewers themselves need to leave preconceptions at the door and follow where the evidence takes them. One way to keep this bias at bay is to have at least two researchers assess the quality of the research papers and accuracy of the data in parallel, but independently, reconciling any disagreements along the way.

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When formulating your PICO question, simultaneously doing an initial scope of the literature will ensure there is sufficient material available for a robust answer.

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With your review completed, it’s time to share it. While we researchers may dream of our reports being read cover to cover, the reality is that most readers are short on time and need to see the key findings at a glance. This means a clear, concise and accurate executive summary is essential.

Web-based software such as Eppi-Reviewer can help you manage the data you gather (abstracts, full texts, inclusions, exclusions and their reasons, and data to prepare PRISMA flow charts). And an electronic reference management system such as Zotero or EndNote is indispensable to keep tabs on all literature and enable seamless referencing in your final evidence review.

Good healthcare policy must be based on high-quality evidence. But policymakers must often make decisions in fields where they may lack specialist expertise. So, how do they know what evidence to look for, and how to assess it?

After identifying the relevant literature, it’s time to dig out the data you need from the studies to answer your PICO question. When developing your protocol, you will have created a data extraction form. This specifies the information you need to extract from each research paper, allowing you to gather the data for your review in a structured way, ready for evaluation.

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Defining a clear question is the essential first step in producing a quality evidence review so you can get the answers you need. By using what is known as a PICO format, you can translate a free-form enquiry from a policymaker into a structured research question. PICO stands for:

Once you have selected the methodology, you should draw up a protocol and timeline detailing your PICO question, methodology and approach to analysis, and the process to be followed by the research team.

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The HRB Evidence Centre conducts such reviews for the Department of Health in diverse areas including community water fluoridation, electronic cigarettes, and assisted living for older people. Next, we explore seven key steps in the process.

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