Dorien Brouwer

69 Self-efficacy for health-related behavior change PART 1 or minor ischemic stroke. The self-efficacy scale used in our study has only been applied in three earlier studies in patients with symptomatic vascular diseases (cerebrovascular disease, abdominal aortic aneurysm, or peripheral arterial disease). In these studies, total self-efficacy was comparable to our findings, but disaggregated self-efficacy scores were lower. [16, 31, 32] Furthermore, social desirability bias during questionnaire completion may also have played a role as self-efficacy is high in these patients where our earlier study showed that most patients do not actually change their behavior, due to the intention-behavior gap. [12, 43] Sol et al. described how subsequent underestimation of the difficulty of self-management of vascular risk can be another explanation for high self-efficacy scores. [31] The questions seem simple, causing high scores while the tasks are very difficult. We analyzed several correlates in this study which can lead to type 1 errors. Also it cannot be completely excluded that our results were affected by possible confounders. Although for instance the lowmRs and NIHSS suggests that these patients are mildly or not impaired, factors such as fatigue, visual loss or inactivity can affect the relation between physical activity and self-efficacy as well. There was also a small (but not significant difference) in cognition between patients with high-self efficacy and low self-efficacy. However in linear regression analysis (adjusted for age, data not shown) we found no significant relation between self-efficacy and cognition. The results of our study suggest that vulnerable patients have lower self-efficacy scores. Older patients often experience more physical discomfort that may result in feeling less confident. Also vascular history or depressive symptoms can affect the patients’ perception of their physical and mental capability, resulting in low self-efficacy. Patients with higher fear had lower self-efficacy levels. In contrast to our study, a meta-analysis of fear studied in different populations and different behaviors has shown a significant interaction between threat (fear) and efficacy, in these studies threat only had a motivating effect when high efficacy is present. [40] Possibly, fear results in counterproductive behavior in our patients, and leads to avoidance or denial based forms of coping, explaining the association with low self-efficacy. We expected social support to play a role in building self-efficacy, as it plays a role in self-management. However we found no relation between social support and self-efficacy. Possibly social support influences self- management in an different kind than by improving self-efficacy. For example the effect of old age, vascular history and fear on self-efficacy can be so intense that the social support patients experience cannot compensate the effects of these correlates.