Dorien Brouwer

145 information should be patient-centred, interactive, personalized, flexible and repetitive. It should create opportunities to apply the new knowledge that leads to attitude changes. Nurse practitioners could combine vascular care coordination with promoting self- management or other cognitive behavioral approaches to induce healthy lifestyle. They could also pay attention to patients’ relatives, who play an important role in inducing and promoting healthy lifestyle behaviors in patients. This part ends with a randomized controlled open label phase II trial with blinded endpoint assessment in which we studied the effects of motivational interviewing to encourage health-related behavior change after TIA or ischemic stroke. We describe this study in Chapter 2.2. We included 136 patients (of whom 68 were assigned to the intervention group). The intervention consisted of three 15-minute visits in three months by a motivational interviewing trained nurse practitioner. Patients in the control group received standard consultation after one and three months by a nurse practitioner. Our results did not support the effectiveness of motivational interviewing in supporting health-related behavior change after TIA or minor ischemic stroke. The strong support in the control group, the timing and duration of the intervention, and cognitive problems may partially explain the lack of effect of motivational interviewing in this study. However, the overall health-related behavior change was high and might be explained by the key role of specialized nurses in both groups. In Chapter 3 , I conclude that 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. 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 evaluate 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. Future research should focus on interventions modifying the determinants of health-related behavior change after TIA or ischemic stroke. These interventions should consist of education for patient and relatives, self-management approaches and special attention should be given to anxious patients, depressed patients, elderly patients and patients with a vascular history.