Dorien Brouwer

31 Determinants of intention to change health-related behavior and actual change PART 1 The lack of spontaneous health-related behavior change in our study stresses the importance of an intervention supporting this behavior change after TIA or ischemic stroke. A second limitation is that only 87% of our patients completed the follow-up, and IPAQ-S and Food frequency questionnaire were not completed in all patients, probably because of the length and difficulty of these questionnaires. However, comparison of the excluded patients with the study population showed no significant differences with regard to age, sex, cognitive and functional impairment. Finally, all questions on behavioral intention, sociocognitive determinants and health-related behavior are filled in by patients themselves. Therefore, the answers might be socially approved. The determinants of intention to change health-related behavior were mainly coping factors. Self-efficacy was the strongest determinant of intention to stop smoking, increase physical activity and improve healthy diet. Self-efficacy appeared a convincing and powerful predictor of intentions in other cardiovascular studies. [49-51] It has also been found to have a direct effect on health-related behavior and is the strongest predictor of health- related behavior change. [51, 52]. Self-efficacy can be developed by mastery experiences (successes build a robust belief in one’s personal efficacy), vicarious models (rolemodels), social persuasion (social support) and psychological and emotional arousal. [53] Interventions which aim to improve self-efficacy should be based on these factors. There is growing evidence that self-management approaches are effective in increasing self-efficacy [54] . As far as we know only a few studies focused on improving self-efficacy or self-management in patients with TIA or ischemic stroke [55-58] , but we found only one study which focused on self-efficacy for health behavior change. [59] Motivational interviewing can be used to help patients exercise more, lose weight, reduce problematic substance use and boost self-efficacy in their ability to make health-related behavior changes. Therefore it might be a promising method and can be incorporated in future self-management programs or other health-related behavior change interventions. [60]