Dorien Brouwer

68 Chapter 1.3 PART 1 Discussion and conclusion In this study, we found that patients with recent TIA or ischemic stroke report high self- efficacy scores for health-related behavior change. Older patients, and those with vascular history, more depressive symptoms scores, higher BMI, less physical activity and increased fear had lower levels of self-efficacy for health-related behavior change. Of these prognostic factors, depressive symptoms and BMI were the strongest (Table 4). This is one of the first studies that assessed correlates of self-efficacy for health-related behavior change in patients with TIA an minor ischemic stroke. Self-efficacy for behavior change appeared to be high in our patients as earlier studies using the same self-efficacy scale [16, 31, 32] found comparable total self-efficacy scores, but disaggregated self-efficacy scores were lower. In line with our results, two other studies showed that patients with high self-efficacy had significantly less depressive symptoms [19-21] , were more likely to meet exercise recommendations [21, 22, 32] were younger, and not overweight. [16, 22] In studies with patients with vascular disease (coronary heart disease, cerebrovascular disease or peripheral artery disease) having diabetes and smoking were significantly associated with lower levels of self-efficacy in contrast to our results. [16, 32] We found only one study in which vascular history as determinant of self-efficacy for health-related behavior change was studied in patients with vascular diseases. In this cross-sectional study with 236 patients, no association between vascular history and self-efficacy was found. [16] As far as we know, fear has not been studied in relation to self-efficacy for health-related behavior change in patients with TIA or ischemic stroke or other vascular diseases. Earlier studies in general populations showed a significant interaction between threat (fear) and self-efficacy, such that threat only had an motivating effect when high efficacy is present. [40] The association between low self-efficacy scores for behavior change and depressive symptoms has also been earlier described in general populations. [41, 42] Social support is considered to be an important requirement of health-related behavior change by adequate self-management, [11, 23] but in our study we found no relation between social support and self-efficacy. A strength of our study is that we collected detailed information on potential correlates of self-efficacy. This included both patient characteristics and correlatesof health-related behavior change. Our study also has some limitations. First, we studied patients for a relatively short period of time after their TIA or minor ischemic stroke. In this period, patients possibly did not adequately appraise their situation. On one hand this effect may not be very strong, because self-efficacy did not change over a period of three months. On the other hand patients often rehabilitate in the first months after discharge. The positive feed-back and support in this period can provide a boosting effect on self-efficacy. Second, self-efficacy for health-related behavior change appeared to be high in patients with TIA