Strategies to Promote Self-Efficacy After Stroke May Help Manage Blood Pressure

Woman having blood pressure taken
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Having positive health beliefs—specifically, the perception that you can protect yourself from having another stroke—is linked to lower blood pressure among stroke survivors, especially women, according to a new study led by researchers at NYU School of Global Public Health. The findings are published in a spotlight issue on psychosocial factors in the Journal of the American Heart Association.

High blood pressure is strongly associated with an increased risk of stroke, including the risk of having a second stroke. While blood pressure can be modified through lifestyle changes or medication, many adults have difficulty controlling it.

There is growing recognition that positive beliefs about one’s health can play a role in cardiovascular health. This study sought to understand whether positive health beliefs can promote lower blood pressure among stroke survivors, many of whom need to control their blood pressure in order to reduce the risk of having another stroke. 

Using data from the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) study, a randomized controlled trial of 552 stroke patients in four New York City hospitals, the research examined the link between positive health beliefs and blood pressure reduction one year following a stroke.

Prior to being discharged from the hospital, patients were asked whether they agreed with the following statement: “I can protect myself against having a stroke.” More than three quarters of the study’s participants agreed. 

“This perception that you can protect yourself from another stroke reflects the construct of self-efficacy, or a belief in one’s ability to achieve a specific outcome,” said Emily Goldmann, clinical assistant professor of epidemiology at NYU School of Global Public Health and the study’s lead author.

The researchers followed up with the study participants a year after being discharged from the hospital to assess their blood pressure. They found that those who believed they could protect themselves from having a stroke had a 5.6 mm Hg greater reduction in blood pressure than those who did not, which represents a clinically significant difference.

After additional analyses, the researchers found that female stroke survivors who had positive health beliefs were especially likely to have lower blood pressure a year later; this finding was not statistically significant in men. Female patients who did not feel they could protect themselves from having another stroke had, on average, a slight increase in blood pressure.

“In this study, we found an association between self-efficacy and reduced blood pressure, which is consistent with previous studies linking positive psychological states to better health outcomes in the context of cardiovascular disease and stroke,” said Goldmann. “Targeted strategies to improve health beliefs after stroke may be an important component to include in risk factor management among stroke survivors.”

In addition to Goldmann, study authors include Rachelle Jacoby, Erica Finfer, Nina S. Parikh, and Eric T. Roberts of NYU School of Global Public Health; Noa Appleton of NYU Langone Health; and Bernadette Boden‐Albala of the University of California, Irvine. The research was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health (P50NS049060).

About the NYU School of Global Public Health
At the NYU School of Global Public Health (NYU GPH), we are preparing the next generation of public health pioneers with the critical thinking skills, acumen, and entrepreneurial approaches necessary to reinvent the public health paradigm. Devoted to employing a nontraditional, interdisciplinary model, NYU GPH aims to improve health worldwide through a unique blend of global public health studies, research, and practice. The School is located in the heart of New York City and extends to NYU's global network on six continents. Innovation is at the core of our ambitious approach, thinking and teaching. For more, visit: http://publichealth.nyu.edu/