At the heart of the programme is a commitment to work with patients, rather than on them.
Introduction to The Third Gap
The Third Gap team is a group of researchers who aim to work with patients, rather than about them, on topics of concern to those who use health services and the general public. The name of the team derives from the two gaps in translation from research to clinical practice (Cooksey D. A review of UK health research funding. London: HM Treasury, 2006). The first translation gap was in the translation of ideas from research into the development of new products and therapies, and the second gap was the uptake of evidence based treatments in routine clinical practice. We argue that there is a third translational gap, from routine clinical practice into acceptance and uptake by patients and carers. Hence the team is called the Third Gap to reflect our interest in the ways in which evidence based treatments and management strategies are used – or not – in patients’ everyday lives, and in the ways in which research evidence is used and understood by members of the public. The team’s work consists of several separate strands.
The strand which is concerned with the use of treatments takes the perspective of the lay person as well as the professionals treating them, because we recognise that lay and professional perspectives often diverge, and person-centred care requires an understanding of the former. In particular, we conceptualise the resources available (or not available) to people in managing their own health and illness as including a range of pharmaceutical and non-pharmaceutical treatments, as well as social and other resources. . Lay people may draw on a wide range of resources, which are differentially available to them depending on their social and material context, which may or may not be professionally recommended or sanctioned. To be effective, professional advice needs to engage with patients’ own self-management and self-care strategies. Similarly, the implementation of new research findings depends on appropriate take up by patients, and relevance to their own situations.
Most of the Third Gap team employ qualitative research methods, as in general these are necessary for understanding patient perspectives, social processes and patient-professional communication. We have expertise in a range of primary and secondary qualitative methods including interviews, focus groups, analysis of consultations, secondary analysis and the synthesis of qualitative research. We provide advice on qualitative research to colleagues, and are involved in qualitative process evaluations in several clinical trials.
The Third Gap also includes the PenCLAHRC Patient and Public Involvement team whose aim has been to embed meaningful patient and public involvement throughout PenCLAHRC. This includes involving the public as both users and producers of research knowledge. The strategy has been delivered in collaboration with the Peninsula Public Involvement Group, also known as PenPIG, an advisory group led and made up of members of the public, patients and carers. Its aim is to advise PenCLAHRC on all aspects of user involvement. In addition to serving on the PenCLAHRC management board and the stakeholder group which prioritises research projects, members of PenPIG have contributed to a wide variety of activities. These include developing the on-line research question generation tool, contributing to the writing of funding proposals, supporting user involvement in ongoing research projects, presenting conference papers, and teaching medical and other students.
Several members of the Third Gap team are sociologists, and our work also contributes to the sociological literature. In general, we wish to understand the experience of receiving health care in its social context and to move beyond individual behaviour in considering the development of interventions.
Members of the Third Gap team: Professor Nicky Britten, Kade Beeson, Kate Boddy, Linda Dumchen (Secretary), Dr Julia Frost, Dr Ruth Gwernan-Jones, Dr Janet Heaton, Dr Kristin Liabo, Dr Kath Maguire, Dr Lucy Moore, Helen Burchmore, Dr Barbara Wider, Weyinmi Demeyin.