A qualitative study of factors which influence help seeking by women who develop pre-eclampsia and the response of health care workers.

Student thesis: Doctoral ThesisDoctor of Philosophy


Pre-eclampsia is a disorder of pregnancy, where delay in diagnosis and management of warning signs can lead to serious morbidity and mortality for women and their infants.
The aim of this study was to understand factors that influenced women’s help seeking about early warning signs and symptoms, and health care workers’ response to women’s concerns.
Design and Methods
Candidacy theory and street level bureaucracy (SLB) informed the analytical approach to the study.
The principles of a narrative approach were used to explore the experiences of 23 women who had pre-eclampsia, 5 family members, 17 health care workers, and 5 representatives of service user groups. Purposive heterogeneity sampling was used to select participants.
Themes associated with help-seeking among women and families included: level of knowledge and understanding, perception of signs and symptoms, self-monitoring, making trade-offs and organisational constraints. All women classed as low risk at pregnancy booking were unhappy about the lack of information they were offered on pre-eclampsia. Women classified as high risk women often felt they had too much information. Candidacy theory illuminated how women negotiated their care using knowledge, previous experience and self-monitoring.
Themes identified from health care workers included; information sharing, difficulty of diagnosing pre-eclampsia, responsibility and self-monitoring, clinical need versus clinical availability, and relationships and continuity of care. Individualised care was often compromised as frontline healthcare providers made choices while struggling to meet both the organisation and the individual service user needs, which resonates with Street level bureaucracy theory.
Conclusion and implications for practice, policy and future research
Women and their families need individualised information on signs and symptoms of pre-eclampsia to facilitate help seeking for which healthcare workers need additional training.
Not all women experience signs and symptoms of pre-eclampsia, highlighting the importance of regular antenatal appointments and the importance of telling women why their blood pressure is monitored. Women often used self-monitoring and this needs further research.
Date of Award2018
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorJane Sandall (Supervisor), Nicola Mackintosh (Supervisor) & Debra Bick (Supervisor)

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