Dorien Brouwer

144 framed by the Protection Motivation Theory and Transtheoretical Model. This study showed that these patients understand what constitutes a healthy lifestyle, but seem unable to adequately appraise their own health-related behavior. More than half of the patients were satisfied with their lifestyle and felt no urgency to change. In this study, self-efficacy was the most important determinant for health-related behavior change. It was reported by patients both as barrier and facilitator. Most of the patients stated that they did not need support or already received support in changing health behavior. Patients indicated knowledge, guidelines and social support as most needed to facilitate behavior change and to preserve a healthy lifestyle. This study suggests that increasing knowledge on lifestyle risk factors for ischemic stroke and improving self-efficacy may be important targets for lifestyle interventions after ischemic stroke. As self-efficacy appeared to play an important role we aimed to describe levels of self-efficacy of health-related behavior change and identify correlates of self-efficacy in patients with ischemic stroke or TIA. This study is described in Chapter 1.3 . In this study, 92 patients with TIA or ischemic stroke completed questionnaires on self-efficacy for health-related behavior change and fear, social support and depressive symptoms. Patients reported high self-efficacy scores for health-related behavior change. Age, vascular history, more depressive symptoms, higher BMI, less physical activity, and fear were correlates of low self-efficacy levels. These patients deserve extra attention in interventions supporting behavior change after TIA or ischemic stroke. Additionally, we studied the optimal timing of an intervention to support health-related behavior change after TIA or ischemic stroke by studying the determinants of intention to change over time in Chapter 1.4 . We studied differences between these determinants at baseline, six weeks and three months after TIA or ischemic stroke. Fear was significantly higher at baseline than at three months and started to decrease after six weeks. No change in self-efficacy or response efficacy was found. Since fear significantly decreased over time after TIA or ischemic stroke and self-efficacy and response efficacy scores remained high, the optimal timing to start an intervention to support patients in health-related behavior change after TIA or ischemic stroke seems directly after the stroke or TIA. The second part of this thesis focuses on supporting patients in health-related behavior change after TIA or minor ischemic stroke. Chapter 2.1 describes a review on health education in patients with recent stroke or TIA. It shows that patients’ basic knowledge of their disease and associated risk factors is not sufficient. Knowledge appeared to be a necessary factor for inducing change, but the process of modification of risk factors is a multistaged and complex one, requiring the right attitude, motivation and capacity to change behavior. We suggest that health education on stroke should start during the acute phase, and should be continued after discharge, and preferably be provided by the same persons. No specific method of health education is superior, although the individual and repetitive, active methods seem more successful. The