Dorien Brouwer

52 Chapter 1.2 PART 1 did not know how to change their lifestyle, as patients in our present study mentioned knowledge and guidelines as the most needed factor to health-related behavior change and to preserve a healthy lifestyle. However, knowledge is not sufficient to adopt a healthy lifestyle, because other barriers to behavioral change often overrule the advice. [11,37] If there is sufficient knowledge but self-efficacy is low, it will be difficult to proceed to actual change. Only two studies focused on knowledge in relation to health-behavior change in patients with ischemic stroke. Both studies found no difference in behavioral change in lifestyle. [15, 38] Next to self-efficacy, action planning and action control are crucial to bridge the gap between intentions to change behavior and actual behavior change and behavior maintenance. Action planning means that it is important to make a detailed mental representation of “when”, “where” and “how” an intended behavioral action has to be performed. Action control is a self-regulatory process of self-monitoring one’s own behavior, awareness of the intended behavior, and the effort one makes in performing the intended behavior. [34] Therefore interventions focusing not only on increasing self-efficacy and self-management, but also on action planning and action control can possibly bridge the intention behavior gap in these patients. Strength of this study is that patients were interviewed at home in their own environment. Therefore social desirability does not seem to play a large role in this study. Another strength is the qualitative aspect of this study. As far as we know patients’ perspectives on determinants of health-related behavior change after ischemic stroke have not been studied qualitatively before. Since many discussion points returned and were comparable between patients saturation was reached, and the sample of 18 patients seems to have been taken properly. This study has also some limitations. Patients do not seem to adequately appraise their lifestyle. We cannot be sure how much this judgment differs from the actual lifestyle of the patients as we have not assessed their actual health-related behavior. We should have assessed their actual lifestyle more thorough. When patients think they have a healthy lifestyle a conversation about changing health behavior can be difficult. Therefore it possibly would be better to use questionnaires to assess their lifestyle first. Another limitation is the use of semi-structured interviews. Although the interview was as open as possible, sometimes the interviewer did a suggestion which gave the patient a direction, because some issues had to be addressed. On the other hand, some determinants, like “perceived severity” were still not discussed much. The short time between the ischemic stroke or TIA and the interview has advantages and limitations. On the one hand, patients just experienced their ischemic stroke or TIA and made decisions about their behavior change. On the other hand some patients did not think about their health behavior yet at the time of the interview and were mainly focused on recovering.