Dorien Brouwer

137 behavior future interventions should consist of education on health-related behavior, guidelines and strategies for change in order to influence response-efficacy and intention to change. Interventions should also focus on patients and their relatives and make use of patient group contacts to increase social support. Self-management approaches to increase patients’ self-efficacy should also be a part of these interventions. Nurses should play a key role in the intervention. Special attention should be given to anxious patients, depressed patients, elderly patients and patients with a vascular history. Interventions to support patients after TIA or ischemic stroke should focus more on factors on which patients indicate the need of guidance and should provide support in every stage of change which could be supported by e-health solutions. These interventions should start as soon as possible after the ischemic stroke or TIA and, to prevent patients missing appointments, continue during the rehabilitation process or at home. It should take place in an accessible setting, preferably close to the patient’s home. Such an integrated program in which the hospital, rehabilitation institutions and general practitioner work together should be developed and tested. Conclusion The behavior change process after ischemic stroke or TIA is complex. We showed that stroke patients felt no urgency to change and experienced barriers for health-related behavior change such as fatigue, pain, mood and mobility problems which distinguishes them from other vascular patients. Nevertheless, we were able to identify factors that could help in developing an intervention. We demonstrated that self-efficacy, fear and response efficacy play a role in intention to change. Patients identified knowledge and social support as important factors for behavior change, which provides opportunities in supporting patients in health-related behavior change. Our RCT showed that as yet there is insufficient evidence to advocate the use of motivational interviewing, but the value of this technique needs further study. We also showed that the best time to start interventions is probably as soon as possible after the TIA or stroke. In these interventions nurses should play a key role. Our findings may help to develop and test targeted and efficacious interventions to support patients in health-related behavior change in order to reduce the recurrence risk and improve quality of life of after a TIA or ischemic stroke.