Women's Belief That They Can Prevent Stroke Correlates With Greater Reductions in Blood Pressure

Data from the DESERVE study (NCT01836354), published in a special issue of the Journal of the American Heart Association, show a correlation between self-efficacy and reduced systolic blood pressure (SBP) in women. Self-efficacy was measured by agreement with the statement "I can protect myself against having a stroke," and blood pressure (BP) was measured before discharge and at 12-month follow up. 

After adjusting for elevated baseline BP, age, sex, race/ethnicity, marital status, physical activity, number of chronic disease diagnoses, and whether or not participants had received a trial of skills-based education, those with vs without self-efficacy had a 5.6 mm Hg greater mean SBP reduction (P<.05). Greater mean decreases for those with vs without self-efficacy were also seen in women (9.8 mm Hg; 95% CI, 2.3-17.2 mm Hg; P=.010), those less than age 65 (7.2 mm Hg; 95% CI, 0.2–14.3 mm Hg; P=0.045), and those who had been randomly assigned to receive usual care rather than the trial skills-based intervention (7.2 mm Hg; 95% CI, 0.0-14.3 mm Hg; P=0.049). No significant interactions between self-efficacy and age, sex, ethnicity, or trial intervention were seen in this analysis. 

In sensitivity analysis, however, with baseline SBP as a covariate instead of elevated baseline BP, the association between self-efficacy and SBP reduction was lessened. The strongest association remained when comparing SBP reduction in women with vs without self-efficacy (5.3 mm Hg; 95% CI, −0.2 to 10.8 mm Hg; P=0.057). In this analysis there was a small interaction between self-efficacy and sex (P=0.064). 

Study author Emily Goldmann of the NYU School of Global Public Health noted that positive effects of self-efficacy and physical activity on SBP reduction were independent of one another. This suggests self-efficacy in and of itself may reduce risk rather than simply acting via an increase on physical activity.

Goldmann said, "Our study suggests that asking individuals about their beliefs regarding whether or not they can prevent a secondary stroke can help guide physicians in stroke prevention efforts. For individuals with low or no self-efficacy, efforts to improve that may be helpful, and for those with feelings of self-efficacy (75% of our cohort), physicians may be able to harness that to encourage and improve prevention efforts."

This analysis used data from 453 participants, mean age 62, of varying ethnicities (nonHispanic white, 29.1%; non‐ispanic black, 32.2%; and Hispanic, 32.7%) and approximately equal numbers of men and women.