title: A narrative synthesis of factors that affect women speaking up about early warning signs and symptoms of pre-eclampsia and responses of healthcare staff.
abstract: One of the challenges for treating pre-eclampsia and preventing further deterioration is determining how best to enable early detection. If women or their partners and families are able to raise early warnings about potential signs and symptoms of pre-eclampsia in pregnancy, birth and in the postnatal period, women may be able to receive earlier intervention to prevent severe pre-eclampsia from developing. The aim of this study was to improve understanding of factors affecting the ability of women to recognise symptoms and signs of pre-eclampsia/eclampsia and seek appropriate medical help and factors affecting health care professionals' responses to women and their families who 'speak up' about early warning signs and symptoms.
  
  
  
  A narrative synthesis was conducted of evidence relevant to address the research question. The following electronic data bases were searched for qualitative studies which met inclusion criteria from January 1980 to April 2016; Medline, CINAHL, HMIC, PsycINFO, Embase, BNI, ASSIA, Scopus, Maternity and Infant Care, Web of Science, Google Scholar, Cochrane, JBI and IBSS with the support of an Information Service Consultant.
  
  
  
  Following thematic analysis, three themes were identified; 1: Women's understanding and knowledge of pre-eclampsia/eclampsia; 2: Factors affecting help seeking behaviour from perspectives of women and their families'; 3: Factors affecting staff response. There was widespread lack of knowledge and understanding of signs and symptoms of pre-eclampsia/eclampsia among women and their families, with some women not exhibiting signs and symptoms of pre-eclampsia or unable to distinguish them from 'normal' pregnancy changes.
  
  
  
  Women and their families not only need to be made aware of signs and symptoms of pre-eclampsia/eclampsia but also require information on the most effective ways to seek urgent medical assessment and care. Some women did not experience prodromal signs and symptoms, which raises concerns about how women and families can detect early onset, and is an issue which needs further exploration. There is very limited research exploring clinical staff response to women who raise concerns about their health when experiencing symptoms and signs of pre-eclampsia/eclampsia with further research needed if safety and quality of care are to be improved.
authors.affiliation: King's College London, Division of Women's Health, Faculty of Life Sciences and Medicine, London, UK. Wendy.carter@kcl.ac.uk.|King's College London, Women's Health Academic Centre, King's Health Partners, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, London, UK. Wendy.carter@kcl.ac.uk.
authors.forename: Wendy
authors.identifier: 0000-0002-6961-7370
authors.initials: W
authors.lastname: Carter
authors.affiliation: King's College London, Florence Nightingale Faculty of Nursing and Midwifery, London, UK.
authors.forename: Debra
authors.initials: D
authors.lastname: Bick
authors.affiliation: King's College London, Division of Women's Health, Faculty of Life Sciences and Medicine, London, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Mackintosh
authors.affiliation: King's College London, Division of Women's Health, Faculty of Life Sciences and Medicine, London, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Sandall
mesh_terms: D005260:Female; D014943:Global Health; D000066505:Help-Seeking Behavior; D006801:Humans; D033262:Narration; D011225:Pre-Eclampsia / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D011247:Pregnancy; D015995:Prevalence; D036301:Qualitative Research
keywords: Help seeking; Midwives; Narrative synthesis review; Pre-eclampsia