Dorien Brouwer

62 Chapter 1.3 PART 1 22] However, these studies did not focus on health-related behavior change. In patients with cardiovascular diseases, diabetes and smoking were related to low levels of self-efficacy. [16] It is unknown yet if diabetes and smoking are associated with self-efficacy in patients with TIA or ischemic stroke as well. Self-efficacy can be developed by mastery experiences (successes build a robust belief in one’s personal efficacy), vicarious models (rolemodels), social persuasion (social support) and psychological and emotional arousal. [11] Social support is therefore an important requirement for health-related behavior change by adequate self-management. [11, 23] Social support is known to influence physical activity after stroke, but it is unclear whether it has a role in improving self-efficacy. [24-26] On the other hand, fear and depression can also affect self-efficacy and are often present after stroke. [27, 28] An earlier study showed that fear was independently associated with intention to change health-related behavior [13] and depression is known to influence health behavior change in myocardial infarction patients. At present, it is unclear how to support patients in changing health-related behavior after TIA or ischemic stroke. Insight in the correlates of self-efficacy can be helpful by developing interventions to increase self-efficacy and thereby support patients with TIA or minor ischemic stroke with health-related behavior change and to select patient groups on which the interventions should be focused. In this study, we aimed to describe levels of self-efficacy of health-related behavior change and identify correlates of self-efficacy in patients with ischemic stroke or TIA. Methods All patients included in the present study participated in the DECIDE study. Detailed methods of the DECIDE study have been described earlier. [12] In short, DECIDE was a prospective study on determinants of intention to change health-related behavior and actual change in patients with TIA or ischemic stroke. Patients of 18 years or older with a clinical diagnosis of TIA, including amaurosis fugax, or minor ischemic stroke with a modified Rankin Scale score (mRS) 2 or less were included during admission on the stroke unit or outpatient clinic. Baseline data We recorded data on clinical features of TIA or ischemic stroke, quantification of stroke severity according to the National Institutes of Health stroke scale [29] (NIHSS, a 15-item scale with scores that range from 0 to 42 and higher values indicating greater severity), demographic data, vascular risk factors and history, weight, length, BMI and use of medication. Patient were assessed at baseline (directly after inclusion) and three months