Dorien Brouwer

77 Changes in determinants of health-related behavior over time PART 1 Introduction Modification of health behavior after TIA or ischemic stroke including smoking cessation, healthy diet and increased physical activity is considered important and strongly recommended in many guidelines. [1-3] However, at present little is known about effective interventions to support patients in this health-related behavior change. [4, 5] Not only is the available data inconsistent and of varying quality, but the heterogeneity in applied interventions with regards to content, intensity and behavior focussed on makes comparing difficult. Interventions included personal education, exercise or lifestyle classes, motivational counselling (not specified), telephone support, home visits and interviews [6] , but follow-up rates are low and patients experience lack of knowledge and social support, pain and fatigue and other barriers. [7-11] Insight in determinants of lifestyle behavior change and optimal timing of the intervention is essential to develop a successful intervention to support health-related behavior change. [12-15] The Protection Motivation Theory to examine determinants of lifestyle behavior change after TIA or ischemic stroke has shown to be an useful model for predicting health- protective intentions and behavior changes in other conditions, such as diabetes, coronary heart disease, and breast cancer. [16] We earlier found that response efficacy (the believe that lifestyle change can reduce the risk of recurrent stroke), self-efficacy (patients confidence to carry out behavior necessary to reach a desired goal) and fear were determinants of intention to change health-related behavior after TIA or ischemic stroke. Self-efficacy was the strongest determinant of intention to stop smoking, increase physical activity and improve healthy diet. [17] Both response efficacy and self-efficacy were associated with intention to change health behavior in other cardiovascular studies [18-20] . At present, there are no studies focusing on change of these determinants over time after TIA or ischemic stroke. As these determinants probably vary over time, there may be a window of opportunity to start a health-related behavior supporting intervention. [21] In order to get insight in the timing to start an intervention supporting health-related behavior change after TIA or ischemic stroke, we aimed to assess the determinants of intention to change over time (fear, response efficacy and self-efficacy) in patients with recent TIA or ischemic stroke. Methods All patients included in the present study participated in the DECIDE study (Determinants of intention to change health-related behavior and actual change in patient with TIA or minor ischemic stroke). Detailed methods of the DECIDE study have been described earlier. [17] In short, DECIDE was a prospective study on determinants of intention to change