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Health & Medical: BREAD - selecting health information

A collection of information resources and guidance for Health & Medical students

What is BREAD?

Selecting information

BREAD is a thinking tool designed to help you select appropriate, high quality information for your studies and clinical practice. It was developed specifically with health students in mind. BREAD stands for:

  • Bias
  • Relevance
  • Evidence
  • Author
  • Date

It is NOT a checklist, but it offers 5 things to think about when you select the information you wish to use, cite and rely on.

See the video below or a piece from the Nursing Times website: Nurses must consider which information to use and trust for a quick overview, and the rest of this page for a bit more information.

Bias, Relevance, Evidence, Author, Date

Thinking about BREAD

BREAD is simply an acronym for 5 things to think about when you select information. Bias. Relevance. Evidence. Author. Date. It is not a checklist, and you don't have to think about them in any particular order - BREAD just seemed like a better name than BEARD or DEBAR!

Thinking about these things is part of critical thinking - asking questions about the sources of information that we use, and asking questions about what we believe and understand.

A cross-section of a loaf of fresh bread

Bias

Bias - is there balance?

Bias is a viewpoint or attitude that can affect the information an author or organisation produces. This means that Bias and Author are closely linked.

Everyone has biases, so I am definitely not saying that you should not use biased information! But you should think about what impact bias might have. For example, think about whether the person or organisation responsible for information is likely to make money from the information they provide? Or is an author making a political point, and perhaps twisting the facts slightly to fit this point?

Think - why?

Bias is probably the hardest of the five points in BREAD. Perhaps the easiest way to think about it is this - WHY was this information produced? If it was created to persuade the reader to spend money or to support a particular cause, then it is more likely to be biased, and may not present the whole picture of a topic or issue. If you find a source that you are fairly sure is biased, but you will want to use it, perhaps you could find another source and compare the two - where do they agree and disagree?

Relevance

Relevance - do I need this?

There is a LOT of information available. So before you even think about how good a piece of information is, it's worth thinking about whether it is relevant at all. There are three things to think about with regard to relevance:

  • Content
  • Context
  • Level

Either watch this short video, or read the text below it for more about these things.

Content

What is it about? The clearer you are about what you need to read about, the easier it is to work out if the content of a book, a journal article or something else is relevant. For example, your topic could be blood pressure, but this covers lots of different things. What are you really looking for? How to carry out observations of a person's blood pressure? The long-term impact of high blood pressure? Drugs relating to managing blood pressure? Each of these would probably lead you to different books or articles or websites.

Also consider that you don't necessarily need to read the whole of a source of information. For example, you might not need to read the whole of the book ABC of Autism. Perhaps one chapter, such as Chapter 13 on 'Gender and autism', is all you need.

Context

In health and medical care, context is important. Sometimes, information might not be relevant because of context. An article might focus on acute care in a hospital, but you need to consider community-based care, which may take a different approach and involve a different set of professionals.The information doesn't have to be FROM your specific context, whether that is prehospital, the operating department, maternity or something else, but it has to be RELEVANT to it.

A patient or service user might also provide some context. Is information on the impact of a particular drug during pregnancy relevant to a cis-male service user? Probably not.

Level

This is about who the information was written for. Tutors often suggest using "academic" sources of information. This means information that was written for students, professionals and researchers. It will have a lot more depth and detail than information written for the general public. If information is not at the right level, it will not provide the quality and scope of information that you are expected to learn and to write about.

Evidence

Evidence - how do they know?

This one is possibly the last of the five to think about, because you have to start looking at your information source in a bit more detail. The question here is whether they offer any evidence for the things they are claiming or stating. This might be references to other sources, it might be data from their research, it might be specific observations from their experience. But they should in some way indicate HOW they know the things they claim to know.

Often, the source of evidence will be statistics. But be careful! Always look at statistics and ask yourself whether the stats really mean what the author says they do. Take this chart as an example:

A chart labelled "People wearing gloves compared to people falling over in the street over a period of eight months". Two sets of bars show that the numbers for each of these things go up and down at the same time.

It seems to suggest that there is a link between two things - people wearing gloves and people falling over in the street. But gloves do not really make people fall over! There might be a link, but it is not the gloves, it is cold weather - people wrap up more warmly, and also the streets might by icy, causing people to fall. Also, there is no indication of what the numbers actually are (a percentage? a total? people per thousand?), which is always a worrying sign with statistics!

Author

Author - Who wrote it?

With any piece of information, think about who created it. This might be an organisation such as NICE, or it might be a named person or group. Think about who they are, and what relevant knowledge or experience they may have. 

With books and journal articles, there's often a short piece of information about the authors, which helps you learn a bit more about them. Sometimes, though, you might need to use Google (or another search engine) to find out a bit more. Don't just rely on an author or organisation's website - what do other people say about them?

The video below offers a short introduction to the sorts of questions you can ask about the author.

Date

Is it up to Date?

In health and medical care, information can change quickly. Researchers and health professionals learn more about disease, therapy, drugs and so on all the time. The law also changes - something which was OK a few years ago might now be illegal. It is therefore important to work out when a source was written or updated. This page, for example, has a Last Updated date right at the bottom, which would allow you to see how up-to-date we keep it.

Old information isn't necessarily bad, but it is good to be know how old the information is. If you are selecting between three different sources of information which all look good, you might opt for the most recent one, as that should reflect more changes in the law, guidelines and research than older sources.