4 The Practice Question 73prescribing and administering pain medication. Evidence identified for back-
ground questions often provides a large number of studies with diverse popula-
tions, settings, and interventions.
Foreground questions yield specific knowledge that informs decisions or actions
and generally compare two or more specific interventions. In some instances,
the information gained from background questions can be used to develop
foreground questions. The following is an example of a foreground question: Is
behavioral contracting or mutual goal setting more effective in improving the
chronic-pain experience for adult patients enrolled in outpatient rehabilitation
with a history of substance abuse? Foreground questions produce a refined, lim-
ited body of evidence specific to the EBP question. In this example, a narrow pa-
tient population is added (adults enrolled in outpatient rehabilitation with a his-
tory of substance abuse), the nature of pain specified (chronic), and intervention
comparison identified (mutual goal setting versus behavioral contracting).
One important point to note is that when an EBP team is asking a background
question, the evidence review can become complex. As a result, it may be helpful
to organize the EBP project by breaking down the components of the problem
into an appropriate number of foreground questions. To do this, the team could
create questions that relate to each of the components identified. For example, if
the problem is high fall rates in older inpatients, the background question could
be, What are the best practices in fall prevention for older patients? An appropri-
ate foreground question could be, Which practice is more effective in reducing
fall-related injury in older adults: bed alarms or hourly rounding?
Figure 4.1 depicts the relationship between background and foreground ques-
tions. Teams with little experience with a topic or condition will have more back-
ground questions (A), whereas teams with more experience with the condition
will generally have more foreground questions (C). Often, EBP teams will benefit
from a thorough understanding of the background of an issue before diving into
the more specific foreground issues (DiCenso, Guyatt, & Ciliska, 2005). As their
understanding and experience with the topic or issue deepens, they move into
more focused foreground questions (B).