Dorien Brouwer

32 PART 1 Chapter 1.1 Response efficacy may be an important determinant as behavior change is hard to accomplish and patients are only willing to change when they believe that making the change is effective in reducing the risk of another events. Fear was the only perceived threat factor that influenced intention to change. As far as we know, fear has not been studied in relation to intention to change health-related behavior in patients with TIA or stroke before. Fear can be a strong influencing and uncontrollable factor, which can lead to the intention to change. Otherwise fear can work counterproductive, as it can lead to avoidance or lead to denial based forms of coping. Earlier research showed that fear may be a motivator for action, but is insufficient to have this effect on its own. A meta-analysis has shown a significant interaction between threat (fear) and efficacy, such that threat only had a motivating effect when high efficacy is present. [61] Conclusion In conclusion, we found that self-efficacy, response-efficacy, and fear were determinants of intention to change health-related behavior after TIA or ischemic stroke, with self-efficacy as the strongest predictor. Practice implications At present, little is known about promoting health-related behavior change after TIA or ischemic stroke. Our study provides insight in determinants that may influence intention to change health-related behavior. Future studies should focus on factors that explain the gap between intention to change and actual change in health-related behavior and should focus on interventions that have the ability to influence these determinants. In daily practice, the determinants of intention to change health-related behavior in patients with TIA or ischemic stroke should be taken into account by physicians promoting health-related behavior change in these group of patients.