Dorien Brouwer

111 Motivational interviewing to support lifestyle behavior change PART 2 Background After a ischemic stroke or TIA patients have an increased risk of recurrent stroke and cardiovascular events. [1, 2] In addition to adequate treatment of risk factors like hypertension and hypercholesterolemia, many guidelines recommend lifestyle behavior change such as regular physical exercise, healthy diet, stop smoking and no excessive use of alcohol to reduce this risk. [3-5] In patients with coronary artery disease, the benefits of lifestyle management on vascular risk factors as well as the risk of vascular death and myocardial infarction have been demonstrated. However, the majority of people with cardiovascular disease fail to sustain lifestyle modification in the long-term. [6, 7] Therefore a lifestyle intervention supporting patients in changing health behavior could be an effective way to reduce stroke recurrence. At present, only inconsistent data and data of varying quality are available on interventions to support patients in health-related behavior change after TIA or ischemic stroke. [8, 9] These interventions varied from personal education, exercise or lifestyle classes, motivational counselling (not specified), telephone support, home visits and interviews. [10] The heterogeneity in applied interventions with regards to content, intensity, behavior focused on and duration makes comparing complex. Follow-up rates are often low and patients experience physical barriers such as fatigue or pain, lack of knowledge and social support, and cognitive problems. [11-15] Roger’s revised Protection Motivation Theory (PMT) [16] describes socio-cognitive factors that play a role in individual’s motivation to change or not to change health-related behavior. This theory assumes that behavior change is a consequence of behavioral intention to change. [17] One of the factors that plays an important role in this process is perceived self-efficacy. In our previous study [18] we found that self-efficacy (a person’s confidence to carry out behavior necessary to reach a desired goal) was the strongest determinant of intention to stop smoking, increase physical activity and improve healthy diet. Self-efficacy has been found to be a powerful predictor of intention to change in other cardiovascular studies. [19-23] It has a direct effect on health-related behavior, is the strongest predictor of health-related behavior change [23, 24] and an important precondition for successful self- management. [21, 25] Hence increasing self-efficacy could be a way to support health-related behavior change in patients with TIA or ischemic stroke. A promising method to support behavior change by increasing self-efficacy and self- management is motivational interviewing. Motivational interviewing is defined as a client- centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. It is designed to strengthen personal motivation for and