Using PICO To Build an Evaluation Question

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PICO1 is a framework that can help evaluators and programs develop a concise but rigorous evaluation question. A PICO question can tell you in just a few words what you aim to learn from an evaluation.
PICO stands for—

Target POPULATION that will participate in the intervention and evaluation

INTERVENTION to be evaluated

COMPARISON that will be used to see if the intervention makes a difference

OUTCOMES you expect the intervention to achieve

Why the PICO Framework Is Helpful

The PICO framework can help your team develop an evaluation question that contains the key components of a rigorous evaluation. One of these key components is having a strong theory behind what your program is trying to achieve. By including the Population, Intervention, Comparison and Outcomes into the evaluation question, PICO can help your team think through through the following questions:

  • Is the Intervention a good fit for the target Population?
  • Is the Intervention likely to produce these Outcomes?
  • Will the Comparison help us understand whether it was the Intervention –or possibly something else–that produced the Outcomes?

PICO helps teams develop an evaluation question with standard components and identify an appropriate evaluation design by determining the comparison that will be used. A PICO question includes key information about your evaluation in a short summary, making it a useful format to share with others.

EXAMPLES

Do families participating in home visiting (P) that meet regularly with parent mentors (I) keep more home visiting appointments and stay in the program longer (O) than families who do not meet with parent mentors (C)?

Population: Families participating in home visiting services
Intervention: Home visiting services that include meeting regularly with parent mentors
Comparison: Families that receive home visiting services but don’t meet with parent mentors
Outcomes: Increased retention and dosage (i.e., families stay in the program longer and keep more appointments)

Do women who are pregnant with their first child (P) who receive home visiting services (I) experience better birth outcomes (O) compared with pregnant women who gave birth at the clinic before home visiting was implemented (C)?

Population: Women pregnant with their first child
Intervention: Home visiting services
Comparison: Pregnant women who gave birth at the clinic before the program was implemented
Outcomes: Birth outcomes (e.g. birth weight, gestational age)

How TEI Supports Grantees in Using the PICO Framework

TEI has initial discussions with each Tribal Home Visiting Program grantee about the PICO format during the program planning phase. The discussions typically include program staff, evaluators, advisory board members, and other program partners. TEI often helps facilitate a discussion about what the team wants the program to do, whom it should serve, and what it can accomplish. The team also begins to think about what type of comparison might work for their evaluation and be appropriate for their community.

Later, grantees refine their thinking until they have a feasible evaluation question using the PICO format that reflects the interests of the community and meets the grant requirements. This process typically involves gathering input from a community advisory board, elders, or tribal leaders. Grantees then develop a one-page summary of the evaluation design, measures, data collection plan, and analysis. Next, they move on to develop a full evaluation plan. TEI supports grantees throughout this process as determined by local need and interest.

RESOURCES

Learn how the PICO approach has been applied in the Children’s Bureau’s Permanency Innovation Initiative: The PII Approach: Building Implementation and Evaluation Capacity in Child Welfare – (PDF, 1.2mb)

View materials from a presentation on how TEI has used PICO to help grantees develop evaluation questions:

Develop a PICO question for two evaluation scenarios in this exercise: TEI Exercise: Developing a PICO Question – (Word, 22kb)

FOOTNOTE

[1] Testa, M., & Poertner, J. (Eds.). (2010). Fostering accountability: Using evidence to guide and improve child welfare policy. New York, NY: Oxford University Press.