Dorien Brouwer

23 Determinants of intention to change health-related behavior and actual change PART 1 Methods We conducted a prospective cohort study. Patients were eligible for inclusion if they were 18 years or older and had a clinical diagnosis of TIA, including amaurosis fugax, or minor ischemic stroke and a modified Rankin Scale score of 3 or less. The modified Rankin Scale (mRS) is a commonly used scale for measuring the degree of disability or dependence in the daily activities of people who have suffered a stroke. Scores on the mRS range from 0 (no symptoms at all) to 5 (severe disability); for statistical purposes, death has a score of 6. [27] Patients were excluded if they were discharged to a nursing home, were not Dutch- speaking or had severe aphasia. Patients were recruited in the first week after admission to the stroke unit or TIA outpatient clinic. All patients received routine general lifestyle advice including regular physical exercise, healthy diet, and advice against smoking as part of standard care at baseline. At baseline, we recorded data on clinical features of TIA or ischemic stroke, quantification of stroke severity according to the National Institutes of Health stroke scale (NIHSS) [28] , demographic data, vascular risk factors and history, and use of medication. Patients were assessed at enrollment, and at 3 months thereafter. The initial assessment included self-reported questionnaires on sociocognitive determinants. Furthermore, all patients underwent a cognitive assessment. The questionnaires include the following: · Severity, assessed with a single item: ‘Getting another stroke would be a very bad thing to happen to me’, scored on a scale ranging from 1 (definitely not) to 5 (definitely yes). · Susceptibility, assessed with a 5-point scale ranging from definitely will not (0) to definitely will (5) get another stroke. [29] · Fear, measured with 8 questions. Patients were asked on a scale of 1 to 5 how nervous they are when thinking of getting another stroke, how upset they get, depressed or jittery, if their heart beats faster, and if they feel uneasy or anxious. [30] · Response-efficacy, assessed with the following statement: ‘For me, regular physical activity will reduce my chances of getting another stroke’ (1 = strongly disagree; 5 = strongly agree). Similar questions were asked for dietary change and smoking cessation. [29, 30]