Dorien Brouwer

78 Chapter 1.4 PART 1 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 (mRS) score of 2 or less were included during admission on the stroke unit or outpatient clinic. Patients were excluded if they were discharged to a nursing home, were not Dutch-speaking or had severe aphasia. Patients were recruited in the first week after admission to the stroke unit or TIA outpatient clinic. All patients received routine general lifestyle advice including regular physical exercise, healthy diet, and advice against smoking as part of standard care at baseline. The study was approved by national and local institutional ethical review boards and written informed consent was obtained from all patients. The investigation conforms with the principles outlined in the Declaration of Helsinki. As earlier described in the DECIDE study patients were assessed at baseline (directly after inclusion), at six weeks and three months after inclusion. [17] The assessment included self-reported questionnaires on self-efficacy, fear, response-efficacy, and health-related behavior. Patients completed the following questionnaires: · Self-efficacy was measured with the self-efficacy scale, a 9-item scale with scores that range from 1 to 5. [22] Higher values indicate more confidence to carry out the behavior necessary to reach the desired goal. Cronbach’s α of the self-efficacy questionnaire was 0.75. This scale has been used successfully before in vascular patients. [19, 23-25] · Fear was assessed with 8 questions. Patients were asked on a scale of 1 to 5 how nervous they are when thinking of getting another stroke, how upset they get, depressed or jittery, if their heart beats faster, an if they feel uneasy or anxious. [26] · Response-efficacy, assessed with the following statement: ‘For me, regular physical activity will reduce my chances of getting another stroke’ (1 = strongly disagree; 5 = strongly agree). Similar questions were asked for dietary change and smoking cessation. [26, 27]