Dorien Brouwer

70 Chapter 1.3 PART 1 At present, the mechanism of building self-efficacy is not completely clear. On the one hand, factors as vascular history, age, depressive symptoms and fear can influence self- efficacy. On the other hand, self-efficacy may influence these factors as well. For example, lack of confidence and low self-efficacy can possibly lead to less control of health-related related behavior resulting in overweight, less physical activity and continuing smoking. Vice versa, being overweight, less physical active or not being able to quit smoking can also affect the sense of control over one’s life with consequently low self-efficacy. Self-efficacy is an important precondition for behavior change. Therefore, increasing self-efficacy could be a way to support health behavior change in patients with TIA or ischemic stroke. As far as we know, a few studies focused on improving self-efficacy or self-management in patients with TIA or ischemic stroke, [44-47] but we identified only one study which focused on self-efficacy for health-related behavior change. [31] In this study self-efficacy for healthy food and physical exercise improved by the nursing intervention. As 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] these self-management programs should be built on these factors. Motivational interviewing can also be used to help patients exercise more, lose weight, reduce problematic substance use and stimulate self-efficacy in their ability to make health-related behavior changes. [48] Our study provides insight in self-efficacy and factors associated with self-efficacy in patients with a recent TIA or minor ischemic stroke. Future studies should focus on interventions that can influence self-efficacy and should focus on the effects of supporting these patients in health-related behavior change by increasing self-efficacy. In the development of interventions to support patients in health behavior change after TIA or ischemic stroke the correlates of self-efficacy can be taken into account. Patients of older age, vascular history, more depressive symptoms scores, low physical activity, higher BMI and increased fear deserve additional attention in these programs, for example by extra visits or more intense support. Self-efficacy can be easily measured and could provide an early and direct indication of patients capability to change and the intensity of support needed. Therefore, a tailored self-management program using motivational interviewing could be a very promising method to support patients in health-related behavior change after TIA or ischemic stroke.