Wednesday, August 30, 2023

An In-Depth Examination of the PEO Framework in Health-Related Research



Serving as a complementary tool to the well-established PICO and PICOTS frameworks, the PEO framework offers a specialized and robust strategy for formulating research questions in the context of evidence-based practice, specifically in qualitative research. This in-depth analysis aims to thoroughly dissect the PEO framework, covering its foundational principles, historical context, essential concepts, practical applications, and critical evaluations.


 Key Terms and Concepts

The PEO framework is an acronym representing three core components—Population, Exposure, and Outcome—that guide the construction of research questions in qualitative studies (Cooke et al., 2012). Each component is defined as follows:

- Population: This term refers to the particular group under investigation, characterized by specific attributes such as age, gender, or medical condition.

- Exposure: This component signifies the factor or intervention being examined, often taking the form of a behavior or environmental condition rather than a medical treatment.

- Outcome: This aspect captures the effects or impacts of the exposure on the population, focusing primarily on experiential outcomes like perceptions, experiences, or quality of life.

 Historical Context

 Origins and Evolution

Initially conceived as a supplement to the PICO framework, which was tailored for quantitative research inquiries, the PEO framework was developed to cater specifically to qualitative research. It accommodates the often expansive and experiential outcomes evaluated in such studies (Smith, 2010).

 Key Milestones

Over the years, the PEO framework has garnered attention for its utility in addressing the distinctive challenges of qualitative research, notably in fields such as nursing and social sciences. Noteworthy professional organizations, including the Joanna Briggs Institute, have formally endorsed the PEO framework for its application in evidence-based qualitative research (Porritt et al., 2014).

 Key Concepts and Theories

 The Utility of PEO in Qualitative Research

The PEO framework is especially advantageous for qualitative research projects, as it places a strong emphasis on experiential and often intangible outcomes. This unique focus enables researchers to delve into complex phenomena that are not easily captured by quantitative metrics (Polit & Beck, 2018).

 Influence of PEO on Research Rigor

The careful construction of a research question via the PEO framework serves as a foundational element for the study's design, methodology, and objectives. This rigorous approach significantly enhances the quality of evidence generated (Methley et al., 2014).


 Real-World Implementations

The PEO framework has proven to be widely applicable across various sectors of health science research. For example, it has been employed to explore the lived experiences of individuals with chronic conditions, thereby yielding invaluable insights for patient care (McKenzie & Crouch, 2020).

 Case Studies

A landmark study that utilized the PEO framework aimed to investigate the experiences of diabetic patients in managing their condition. The research question was framed as follows: "How does self-monitoring of blood glucose levels impact the quality of life among adult diabetic patients?" This study offered a detailed understanding of the psychological and emotional dimensions involved in diabetes management.

 Critical Analysis

 Debates and Controversies

Though the PEO framework is widely lauded for its applicability in qualitative research, debates continue over its suitability for diverse qualitative methodologies, such as phenomenology and ethnography (Flemming, 2010).

 Critiques and Limitations

Despite its merits, the PEO framework has its limitations. It may not be optimal for addressing certain types of qualitative research questions that involve complex cultural or systemic factors. These research questions may necessitate a more nuanced approach (Booth, 2016).

 Future Trends and Research

 Emerging Directions

Incorporating patient-reported outcomes into the PEO framework is an evolving trend, signaling a shift towards more patient-centered research (Calvert et al., 2019).

 Open Questions

An ongoing area of investigation concerns the adaptation of the PEO framework for use in mixed-methods research, which merges both qualitative and quantitative research approaches (Pluye & Hong, 2014).


In summary, the PEO framework is a seminal instrument for crafting research questions in qualitative health science studies. While it is not devoid of limitations and remains a subject of scholarly debate, its merits in systematically addressing complex, experiential research questions are undeniable. Further refinement and adaptation of the PEO framework will likely contribute to advancements in evidence-based healthcare practices.


Booth, A. (2016). "Clear and present questions: Formulating questions for evidence-based practice," Library Hi Tech.

Calvert, M., Kyte, D., Mercieca-Bebber, R., Slade, A., Chan, A. W., & King, M. T. (2019). "Guidelines for inclusion of patient-reported outcomes in clinical trial protocols: The SPIRIT-PRO extension," JAMA.

Cooke, A., Smith, D., & Booth, A. (2012). "Beyond PICO: The SPIDER tool for qualitative evidence synthesis," Qualitative Health Research.

Flemming, K. (2010). "Synthesis of qualitative research and evidence-based nursing," British Journal of Nursing.

McKenzie, J. E., & Crouch, M. (2020). "Exploring the lived experiences of individuals with chronic conditions: A case study," International Journal of Nursing Studies.

Methley, A. M., Campbell, S., Chew-Graham, C., McNally, R., & Cheraghi-Sohi, S. (2014). "PICO, PICOS, and SPIDER: A comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews," BMC Health Services Research.

Pluye, P., & Hong, Q. N. (2014). "Combining the power of stories and the power of numbers: Mixed methods research and mixed studies reviews," Annual Review of Public Health.

Polit, D. F., & Beck, C. T. (2018). "Essentials of nursing research: Appraising evidence for nursing practice," Lippincott Williams & Wilkins.

Porritt, K., Gomersall, J., & Lockwood, C. (2014). "JBI’s systematic reviews: Study selection and critical appraisal," American Journal of Nursing.

Smith, V. (2010). "Beyond evidence-based medicine: A critique of the orthodox approach to the development of clinical guidelines," International Journal of Nursing Studies.