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Biomedical subjects

Mark Avis

Publications and source records attributed to Mark Avis.

12 recordsLinked to original sources
PubMed2006

Evaluating a community-based walking intervention for hypertensive older people in Taiwan: a randomized controlled trial.

OBJECTIVE: To study the effect of a community-based walking intervention on blood pressure among older people. METHOD: The study design was a randomized controlled trial conducted in a rural area of Taiwan between October 2002 and June 2003. A total of 202 participants aged 60 years and over with mild to moderate hypertension was recruited. Participants randomized to the intervention group (n=102) received a six-month community-based walking intervention based on self-efficacy theory. A public health nurse provided both face-to-face and telephone support designed to assist participants to increase their walking. Control group participants (n=100) received usual primary health care. Primary outcome was change in systolic blood pressure and secondary outcomes were exercise self-efficacy, self-reported walking and diastolic blood pressure. RESULTS: At six-month follow-up the mean change in systolic blood pressure was a decrease of 15.4 mmHg and 8.4 mmHg in the intervention and control group, respectively. The difference in mean change between the two groups was -7.0 mmHg (95% CI, -11.5 to -2.5 mmHg, p=0.002). Improvement in exercise self-efficacy scores was greater among intervention group participants (mean difference 1.23, 95% CI, 0.5 to 2.0, p=0.001). Intervention group participants were more likely to report walking more (p<0.0005) but no differences were observed in diastolic blood pressure (p=0.19). CONCLUSIONS: Among hypertensive older people, a six-month community-based walking intervention was effective in increasing their exercise self-efficacy and reducing systolic blood pressure.

Age Factors↗
PubMed2006

Why do women participate in the English cervical cancer screening programme?

The vast majority of women in England attend for cervical cancer screening. Conventional economic theorising fails to explain why and its predictions are inconsistent with the evidence. Using questionnaire data, we analyse directly motivations for screening attendance. We conclude that regular attendance at screening is driven primarily by a search for reassurance, a sense of duty and herd signalling. It is evident that recognisable sub-groups of attenders exist, in which the configurations of motivational factors differ. Being motivated to attend by physicians is less significant that is widely supposed and is more frequently associated with irregular attendance.

Adult↗
PubMed2006

Testing the construct validity of willingness to pay valuations using objective information about risk and health benefit.

This paper describes an experiment to test the construct validity of contingent valuation, by eliciting women's valuations for the NHS cervical cancer screening programme. It is known that, owing to low levels of knowledge of cancer and screening in the general population, women both over-estimate the risk of disease and the efficacy of screening. The study is constructed as a randomised experiment, in which one group is provided with accurate information about cervical cancer screening, whilst the other is not. The first hypothesis supporting construct validity, that controls who perceive greater benefits from screening will offer higher valuations, is substantiated. Both groups are then provided with objective information on an improvement to the screening programme, and are asked to value the improvement as an increment to their original valuations. The second hypothesis supporting construct validity, that controls who perceive the benefits of the programme to be high already will offer lower incremental valuations, is also substantiated.

Adult↗
PubMed2006

Evidence for practice, epistemology, and critical reflection.

Evidence-based practice (EBP) has become a critical concept for ethical, accountable professional nursing practice. However, critical analysis of the concept suggests that EBP overemphasizes the value of scientific evidence while underplaying the role of clinical judgement and individual nursing expertise. This paper explores the empiricist position that valid evidence is the basis for all knowledge claims. We argue against the positivist idea that science should be regarded as the only credible means for generating evidence on which to base knowledge claims. We propose that the process of critically reflecting on evidence is a fundamental feature of empirical epistemology. We suggest that critical reflection on evidence derived from science, arts and humanities and, in particular, nursing practice experience can provide a sound basis for knowledge claims. While we do not attempt to define what counts as evidence, it is argued that there is much to be gained by making the processes of critical reflection explicit, and that it can make a valid contribution to expert nursing practice, without recourse to irreducible concepts such as intuition.

Art↗
PubMed2006

Introducing HPV triage into the English cervical cancer screening program: consequences for participation.

OBJECTIVE: To predict the likely impact of adding human papillomavirus (HPV) triage for minor abnormalities on participation in the English cervical cancer screening program. METHOD: Contingent valuations of the existing Pap program and a possible HPV-augmented screening program, obtained from questionnaires completed by 1141 women in east-central England. RESULTS: The value of participating in Pap screening was negatively associated with age, positively associated with educational level, and positively associated with the level of household income. Higher levels of worry about cervical cancer were associated with higher valuations of screening. Adding HPV-based triage to the Pap program lowered the value of screening participation for only two women, whereas for the sample as a whole, it increased the average valuation by about 47 percent. Supposedly-negative characteristics of HPV testing, when described, were expected to trigger psychosocial concerns in respondents and thereby give rise to significant decreases in valuations of participating in a Pap-plus-HPV program. For most women, however, such information changed their valuations of participation in screening little, if at all. CONCLUSIONS: Accepting the proposition that higher contingent valuations indicate stronger behavioural preferences, our results offer insubstantial grounds for believing that the inclusion of HPV triage would detrimentally affect participation in Pap screening for cervical cancer.

Adult↗
PubMed2004

Analysing interpretation and reinterpreting analysis: exploring the logic of critical reflection.

This paper examines the distinction that is sometimes drawn between analysis and interpretation in the context of qualitative research, and the processes of critical analysis that underpin reflective practice. The authors consider the complementary logical processes involved in analysis and interpretation, and propose a cycle of reductive, inductive and hypothetico-deductive testing that is both rational and creative. The authors argue that the goal of critical reflection and qualitative data analysis is not to produce knowledge that can be justified in terms of 'correspondence' to 'reality'. Instead we propose a pragmatic, coherence view of knowledge that emphasizes the centrality of dialogue with texts, evidence, beliefs and practice. We conclude that evidence and belief are inextricably linked and that combined processes of reductive, inductive and hypothetico-deductive logic need to be used in a transparent manner to establish the credibility of an interpretation. Although there is no clear demarcation between what is found and what is constructed, a commitment to coherence is the basis of a pragmatic theory of knowledge.

Data Interpretation, Statistical↗
PubMed2003

Human papillomavirus and the value of screening: young women's knowledge of cervical cancer.

The study reports a questionnaire survey of female university students intended (1) to delineate their knowledge of cervical cancer and screening, and (2) to impute their valuation of the introduction of human papillomavirus (HPV) testing. It was found that almost 80% of respondents thought cervical cancer was a leading cause of cancer death amongst women. Most subjects consistently over-estimated the incidence of cervical cancer, consistent with the social amplification hypothesis. The major risk factors were accurately identified by the majority, although family history was emphasized to a degree unwarranted by epidemiological evidence. Subjects' knowledge of the screening programme was accurate in some respects, but not in others, e.g. the majority under-estimated the abnormality rate and over-estimated the age at which abnormalities typically occurred. Subjects placed a premium on the increased accuracy which HPV testing might potentially offer, predictable from their beliefs about the performance of the existing screening programme. Policy makers can be reassured that female university students appear unconcerned about undergoing a test for a sexually transmitted disease, although their beliefs about cervical cancer and the power of screening are distorted, and their enthusiasm for HPV testing relates to an, as yet, unconfirmed belief in its accuracy.

Adolescent↗
PubMed2003

Do we need methodological theory to do qualitative research?

Positivism is frequently used to stand for the epistemological assumption that empirical science based on principles of verificationism, objectivity, and reproducibility is the foundation of all genuine knowledge. Qualitative researchers sometimes feel obliged to provide methodological alternatives to positivism that recognize their different ethical, ontological, and epistemological commitments and have provided three theories: phenomenology, grounded theory, and ethnography. The author argues that positivism was a doomed attempt to define empirical foundations for knowledge through a rigorous separation of theory and evidence; offers a pragmatic, coherent view of knowledge; and suggests that rigorous, rational empirical investigation does not need methodological theory. Therefore, qualitative methodological theory is unnecessary and counterproductive because it hinders critical reflection on the relation between methodological theory and empirical evidence.

Empirical Research↗
PubMed2002

Meta-analysis: the glass eye of evidence-based practice?

Meta-analysis was developed as a technique for combining the results of many different quantitative studies: it is often used to produce quantitative estimates of causal relations and/or association between variables. Meta-analysis is sometimes regarded as a central component of evidence-based practice. We draw attention to an incompatibility in the epistemology and methods of reasoning in quantitative meta-analysis and the epistemology and reasoning implicit in expert practice. We argue that this may be because the common perception of meta-analysis appeals to truth as correspondence; we suggest that rejecting the naive realism that underpins truth as correspondence allows meta-analysis to be understood in terms of truth as coherence. We can then develop an account of meta-analysis that does not depend upon reduction to a mathematical procedure but is an attempt to maximise coherence in beliefs about what works that is consistent with clinical reasoning in expert practice.

Decision Making↗
PubMed2002

Psychosocial and economic aspects of a trial of management of mild and borderline cervical abnormalities (TOMBOLA).

TOMBOLA is a randomized controlled trial to determine (a) the most effective and efficient management strategy for women with borderline or mildly dyskaryotic cervical smear results, and (b) the most appropriate treatment for women with abnormalities detected following colposcopy. This paper outlines the trial's psychosocial and economic protocol, and explains how TOMBOLA can provide detailed evidence on the psychosocial and economic impact of alternative management options and follow-up. This protocol has been developed in parallel with the clinical protocol, thereby offering the opportunity for the development of a type-specific outcome measure and detailed piloting of all instruments. The multi-disciplinary approach to TOMBOLA allows the combination of clinical outcomes with both generic and specific psychosocial and health-related quality of life measures. The convergent validity between these measures will be assessed, with a view to developing a specific utility index for the future assessment of cervical screening modalities.

Journal Article↗
PubMed1999

Evaluation of a project providing community palliative care support to nursing homes.

This paper reports an evaluation of a 3-year pilot community care project to extend 'hospice standards' of palliative care to nursing home residents in Nottingham. The evaluation involved two questionnaire surveys of all matrons of nursing homes with registered palliative care beds (39 and 43 matrons, respectively) and 35 interviews with a sample of local stakeholders selected to give a range of views regarding the project's impact. The interview sample included nursing home matrons (10) and care staff (7); nursing home residents and their relatives (4); community nurses (3); members of the Health Authority and Social Services (6); and local palliative care experts (5). Other sources of data included referral forms, evaluation of training sessions and a reflective account given by the project coordinator. The analysis used descriptive statistics to summarize the quantitative data and an iterative procedure to generate themes from the qualitative data. The overall perception of the project's impact was that it had helped to overcome the barriers that exist between NHS services and the independent sector. By providing assistance with individual care and access to specialist advice, equipment and training, the project was thought to have decreased the isolation experienced by staff and residents and improved equity of access to specialist palliative care for nursing home residents. Although it was widely agreed that the nursing home is an appropriate setting for palliative care, concern was expressed about the quality of care that can be given with mostly unqualified care staff. Ongoing needs for training and liaison between nursing homes and specialist palliative care services were identified.

Journal Article↗