Dorien Brouwer

51 Patient perspectives on health-related behavior change PART 1 Besides knowledge, social support has been indicated as most needed to change behavior. In line with this result social support has been found as important factor for changing physical activity after stroke in many other studies. [18, 25-30] Low self-efficacy appeared to be the strongest barrier for behavior change after TIA or ischemic stroke. Self-efficacy has been found to have a direct effect on health-related behavior and is the strongest predictor of health-related behavior change. [31] In our previous study, [32] we found that self-efficacy was the strongest determinant of intention to stop smoking, increase physical activity and improve healthy diet. Self-efficacy was a powerful predictor of intention to change in other cardiovascular studies. [33-37] Therefore self-efficacy can be seen as a barrier and facilitator as patients in our study mentioned. Response efficacy and fear were also named as facilitating factors. In line with our results, earlier studies in cardiovascular and stroke patients showed response efficacy and fear as determinants of health behavior change. [38, 39] Fear of a recurrent stroke is often present [40-44] and leads to a motivation to make changes to promote patients’ health in order to avoid a new stroke. [40] In our previous study fear of recurrence and response efficacy were also determinants of intention to change health behavior after TIA or ischemic stroke. [20] To the best of our knowledge there are no other studies focussing on fear and response efficacy in relation to actual health- related behavior change in patients with TIA or ischemic stroke. The results of our study show that patients after TIA or ischemic stroke often feel no urgency to change. Patients may not have enough knowledge to properly assess their lifestyle and severity of stroke recurrence. Stroke patients are known to have a low awareness of risk factors for stroke. However, patients indicated to have sufficient knowledge and most patients indicated that they did not need support. When patients felt the need to change, they indicated knowledge as the most necessary factor for changing health-related behaviors and felt the need to knowmore about guidelines. Several patients mentioned fear as a facilitator for health-related behavior change. However, this fear will increase if patients have sufficient knowledge to estimate the severity. Besides knowledge, self-efficacy appeared to play an important role. When patients are convinced of the importance of behavioral change and have enough knowledge of the guidelines, self- confidence is needed to proceed to actual change. Response efficacy was also mentioned as a facilitator of health-behavior change. It 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 other events. Lack of knowledge can also play a role in this determinant. If patients are not aware of the effects of health- related behavior change, they will be less likely to change. In our earlier study we found a gap between intention and actual change. Patients had the intention to change and high self-efficacy and fear were present, but there was no actual change. Possibly these patients