Dorien Brouwer

61 Self-efficacy for health-related behavior change PART 1 Background The modification of health behavior is an important part of cardiovascular disease risk management. Secondary prevention programs focusing on lifestyle modification, such as cardiac rehabilitation have positive effects on health outcomes. However, for patients with stroke or TIA (defined by Easton et al., 2009 as brief episodes of neurological dysfunction resulting from focal cerebral ischemia not associated with permanent cerebral infarction), insufficient data are available on the effect of lifestyle modification and current guidelines were drawn on data extrapolated from epidemiological studies or cardiac rehabilitation. [1-7] Moreover, studies have shown that the majority of people with cardiovascular disease fail to sustain lifestyle modification in the long-term. The social cognitive theory describes how cognitive, behavioral, personal and environmental factors determine behavior and motivation. [8, 9] One of the factors that play a central role in this process is perceived self-efficacy. Self-efficacy (a person’s confidence to carry out behavior necessary to reach a desired goal) is an important precondition for successful self-management. [10, 11] In our previous study [12] we found that self-efficacy was the strongest determinant of intention to stop smoking, increase physical activity and improve healthy diet. Self-efficacy was also a powerful predictor of intention to change in other cardiovascular studies. [10, 13-16] It has been found to have a direct effect on health-related behavior and is the strongest predictor of health-related behavior change. [15, 17] Hence, increasing self-efficacy could be a way to support health-related behavior change in patients with TIA or ischemic stroke. Modulation of self-efficacy has proven to be effective in changing health-related behavior in patients with overweight and in healthy individuals of different ages [11-18] and is for example possible by means of self- management interventions. There is growing evidence that these self-management approaches are effective in increasing self-efficacy. [18] The literature on ‘self-management’ after stroke is limited. Nevertheless a systematic meta-review based on 13 systematic reviews which studies core elements of self-management support including problem solving, decision making, and goal setting found high quality evidence that therapy rehabilitation incorporating these elements delivered soon after a stroke improves ADL and extended ADL and reduces the risk of dependence and mortality. As far as we know there is no clear evidence how to improve self-management for behavior change in stroke patients. At present also little is known about correlates of self-efficacy for health- related behavior change in patients with stroke or TIA and it may be different from other vascular conditions, as stroke patients are generally older and often have cognitive and/or functional impairment. Studies on self-efficacy in patients with TIA or ischemic stroke have shown that patients with high self-efficacy report significantly fewer depressive symptoms, were more likely to meet exercise recommendations,were younger, and not overweight. [19-