Dorien Brouwer

121 Motivational interviewing to support lifestyle behavior change PART 2 Table 5: Behavior change after six months in patients with high or low self-efficacy Self-efficacy Control n (%) Intervention n (%) p Quit smoking (n= 11) Low 0 (0) 2 (50) 0.04 (n= 14) High 4 (44) 0 (20) 0.08 More physical activity (n= 45) Low 10 (48) 7 (29) 0.20 (n= 41) High 10 (48) 11 (55) 0.63 Healthy diet (n= 44) Low 3 (15) 4 (17) 0.89 (n= 41) High 3 (13) 1 (6) 0.42 Discussion Our results do not support the effectiveness of motivational interviewing in supporting lifestyle behavior change after TIA or minor ischemic stroke. The overall lifestyle behavior change in our study was high and might be explained by the key role of specialized nurses in both groups. Only three published studies focused on the effects of motivational interviewing on health-related behavior after TIA or ischemic stroke. Two of these studies were small and showed promising effects on physical activity, dietary behavior, blood pressure and self- efficacy. [36, 37] In line with our results, a recent randomized controlled trial in 386 stroke patients found no effect on blood pressure or cholesterol levels, but medication adherence was significantly higher in the intervention group. [35] Usual care after discharge by a general practitioner or at a designated stroke clinic was supplemented with 4 face to face or telephone motivational interviewing sessions in 9 months. A recent review of motivational interviewing on lifestyle modification in patients with cardiovascular diseases showed that motivational interviewing was more effective than usual care on changing smoking habits and physical activity. [45] Motivational interviewing did not differ from usual care in changing dietary behavior. [45] Although no overall effect of motivational interviewing on life style behavior change could be found in our study, there might be an effect on smoking behavior. After three months 50% of the patients in the intervention group stopped smoking compared to 33% in the control group (data in supplemental file). This trend did not sustain after six months. Earlier studies showed that motivational interviewing was particularly effective when conversations were short and repeated. [29] The conversations in our study were short but possibly not repeated often enough and as a consequence the effect of the intervention on smoking behavior did not sustain.