Dorien Brouwer

42 Chapter 1.2 PART 1 At present, it is unclear how patients judge their own lifestyle after TIA or ischemic stroke, which facilitating factors and barriers for health-related behavior change are experienced, and which support patients desire to support health-related behavior change. Hence, we explored patients’ perspectives on health-related behavior change and support in health-related behavior change after TIA or minor ischemic stroke in a qualitative study with in-depth, semi-structured interviews. Methods We conducted a descriptive qualitative study with in-depth, semi-structured interviews. Patients were eligible for inclusion if they were 18 years or older and had a clinical diagnosis of TIA 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). [21] Patients were recruited in the first week after admission to the stroke unit. Eighteen patients with TIA or ischemic stroke were interviewed. All patients received verbal routine general lifestyle advice including regular physical exercise, healthy diet, and advice to stop smoking as part of standard care of the neurologist. We recorded data on quantification of stroke severity according to the National Institutes of Health stroke scale (NIHSS) [22] , demographic data, education and BMI. Interviews All 18 patients underwent an in-depth interviews of 60 minutes taken by MdJ. Seventeen patients were interviewed at home and one in the hospital. Interviews were audiotaped, transcribed and thematically analyzed by MdJ and DBG. Interviews followed a scheme that addressed patients’ assessment of their own lifestyle, barriers and facilitators of health- related behavior change framed by the Protection Motivation Theory and desired support in the behavior change process (Table 1). Patients were asked to describe a healthy lifestyle and to compare it with their own lifestyle. After that patients were asked if they had changed their lifestyle after the TIA or ischemic stroke and which barriers and facilitating factors they experienced. Questions were asked about the lifestyle factors of smoking, exercise, (healthy) diet and alcohol consumption, and the motivation to change or not to change the lifestyle. Finally, they were asked what type of support they need when changing their lifestyle and what could help to maintain a healthy lifestyle.