Dorien Brouwer

21 Determinants of intention to change health-related behavior and actual change PART 1 Background In contrast to the established effectiveness of pharmacological and surgical treatment for prevention of ischemic stroke recurrence, little is known about the importance of change in health-related behavior after TIA or ischemic stroke. The strong epidemiological association between health-related behaviors, such as physical inactivity, smoking, and unhealthy diet and the incidence of stroke, and their adverse impact on other vascular conditions suggest that it is reasonable to extrapolate the results from primary prevention studies to secondary prevention after TIA or ischemic stroke. [1-13] Moreover, healthy lifestyle is known to improve vascular risk factors, for instance, modest weight loss in the obese can improve control of hypertension and hyperglycemia. Hence, interventions promoting healthy behavior may be an effective way to reduce stroke recurrence. Only limited and inconsistent data are available on the effect of lifestyle modification on both traditional vascular and lifestyle risk factors for recurrent stroke, and there are no large randomized controlled trials on lifestyle modification and prevention of stroke recurrence. [14-18]. 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. [19-21] However, these results can probably not be directly extrapolated to patients with TIA or ischemic stroke as these patients are generally older, and often experience cognitive and functional impairments, which may influence their health-related behavior. Various disease-related and sociocognitive factors might influence health-related behavior. Roger’s revised Protection Motivation Theory (PMT) [22] describes sociocognitive factors that play a role in individual’s motivation to change or not to change health-related behavior (Figure 1). Similar to other models including the Health Belief Model, Theory of Planned Behavior and the transtheoretical model, this theory assumes that behavior change is a consequence of behavioral intention to change. [23] An intention to change only develops when a threat is perceived and a coping response is available.