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BACKGROUND: International students frequently face difficulties that are specific to the typical college experience, in addition to facing other factors of acculturative stress, including cultural differences, language barriers, and comfortability in accommodation. AIM: The study aims to measure the prevalence of acculturative stress among first-year international students enrolled at Faculty of Medicine in an Egyptian University and aims to reveal the factors that are associated with acculturative stress in these students. METHODOLOGY: A cross-sectional study was conducted on 422 international students in the academic year 2021-2022, using the Acculturative Stress Scale for International Students (ASSIS). The factors associated with acculturative stress were examined using the following criteria: comfort in accommodation, student adjustment to college, language proficiency, and academic pressure. RESULTS: This study showed that 28.7% of the international students were "above the warning sign" of acculturative stress (above 109). The major stressors of acculturative stress among international students were the non-specific concerns, homesickness, and perceived discrimination, while the least reported stressors were fear and guilt. International students who scored in the "above the warning sign" in the (ASSIS) were mostly females (35.3%) and non-Arab students (37.8%). Having a friend or a family member living in Egypt significantly reduced the level of acculturative stress. Moreover, the ASSIS total score showed a negative correlation with the scores for overall language proficiency, comfort in accommodation, academic adjustment, and student adjustment to college. CONCLUSION: Acculturative stress among the studied groups is influenced by several factors, including nationality, English and Arabic language proficiency, academic adjustment, and comfort of living. That being said, the most significant stressor is the country of origin, which is defined in terms of nationality or language proficiency. Consequently, resources that ensure the sustainability and growth of international students throughout their educational process must be made available to a multicultural environment in order to support and retain those students. CLINICAL TRIAL NUMBER: Not applicable.

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This chapter provides an overview of how international students in the United States used media and interpersonal channels to communicate with family, friends, and each other during the COVID-19 pandemic. The chapter starts by discussing the challenges of international students during the health pandemic. It then provides a review of the role of media during a crisis. Factors influencing media use during the COVID-19 crisis include culture, personality, and time spent in a foreign country. Finally, the chapter ends by providing suggestions for how universities can better equip their international offices to deal with international students during challenging times such as the COVID-19 pandemic.

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Objective: Although there are many international college students in the state of Georgia, few studies have been conducted on how social determinants affect their health outcomes and academic success. This study examined the effects of social determinants on the health outcomes and academic success of international college students in Georgia. Participants: Participants were international college students (n = 136) in Georgia. Methods: A mixed methods cross-sectional design was used for the study. Results: The lack of access to sufficient funds caused study participants to experience anxiety (39.0%), depression (20.6%), and stress (52.9%). Cultural differences (16.9%), lack of access to health care (15.4%), transportation (14.7%), poor housing (7.4%), and financial insecurity (54.5%) affected study participant health outcomes and academic success. Conclusion: Addressing financial insecurity, the lack of access to health care, poor housing, transportation issues, and cultural differences experienced by international college students in Georgia, is crucial to their health outcomes and academic success.

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Background: Depression, anxiety, and stress are the commonly encountered mental health conditions among medical students. Overseas environment may add additional burden to the existing environment. However, comparison of the rate and associated factors of depression, anxiety, stress among domestic and overseas students has not been attempted in Bangladesh. We aimed to assess the rate and associated factors of depression, anxiety, stress among domestic and overseas medical students in the country. Methods: This cross-sectional study was conducted among 360 undergraduate medical students in 2021. Data were collected by self-reporting instruments by a stratified random sampling method by the Depression, Anxiety, and Stress Scale-21 scale. Bivariable and multivariable binary logistic regression analyses were done by computing crude odds ratio and adjusted odds ratio with 95% confidence interval to identify the associated factors. Results: Among the 360 undergraduate medical students, 181 were domestic and 179 overseas ones. 44.8% of domestic students reported depressive symptoms, 45.3% reported anxiety symptoms, and 33.1% reported stress. On the other hand, half of overseas students experienced depression (50.3%) and anxiety (52.5%), and 41.3% experienced stress. Female medical students were found vulnerable for developing depression, anxiety, and stress than males. Conclusions: The study revealed higher rates of depression, anxiety, and stress among overseas undergraduate medical students enrolled in a private medical school of Bangladesh. Private medical college authorities could consider special services for overseas students to ensure adequate psychosocial support.

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BACKGROUND: International students account for a significant proportion of medical graduates Australia-wide, and most opting to remain in Australia for their first year of practice (Internship). Hence, understanding this particular demographic's perspectives is crucial for curriculum and workforce planning. Despite this, very few studies have addressed this demographic, and none have explored the impact of the COVID-19 pandemic on international medical students specifically. AIM: A qualitative design was used to explore the perspectives of final-year international medical students at an Australian medical school as they prepared for transition to internship during the COVID-19 pandemic. METHODS: Participants engaged in a semi-structured interview about the pandemic's personal and professional implications. The data were analysed using inductive thematic analysis. RESULTS: Seven out of 34 final-year international medical students at the University of Adelaide participated. The main themes identified were that isolation was magnified, institutional support was lacking and that uncertainty was challenging. The pandemic did not deter participants from pursuing an Australian internship, as Australia was considered a desirable place for internship compared to their home countries. CONCLUSIONS: While the COVID-19 pandemic exacerbated the situation, many of the challenges identified by international students already existed. Issues such as social isolation, racial discrimination, financial hardship and lack of institutional support have been prevalent for decades. Insights from this study reveal a need to improve the medical school experience. Australian Universities have a responsibility to ensure fair treatment of international students by training faculty, implementing support programmes and ensuring an inclusive and culturally safe learning environment.

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The COVID-19 pandemic in 2020 caused unexpected and unprecedented disruptions worldwide. University students, especially international students, underwent unique challenges during this volatile era. This secondary quantitative data analysis study aimed to investigate the experiences, stress, adjustment, and ways of coping of university students during the COVID-19 pandemic. Data from 112 international university students and 112 domestic American university students were included in the statistical analyses. The differences in Student Adaptation to College Questionnaire (SACQ), Ways of Coping Questionnaire (WAYS), COVID-19-related questionnaire, and Perceived Stress Scale (PSS) between international and domestic students were analyzed using independent samples t-tests. Multiple regression models predicting PSS by SACQ, WAYS, and COVID-19-related questionnaire subscales were estimated for international and domestic students separately. The results showed that international students and American students did not report significant differences in their university adjustment, usage of coping strategy, and perceived stress level during the peak of the pandemic. Additionally, American students reported more factors impacting their perceived stress than international students. Implications of the findings as well as limitations and future directions were discussed.

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Introduction: In the aftermath of the COVID-19 pandemic, the reintegration of Chinese international student returnees intersects with China's critical effort to combat a significant brain drain of highly skilled talents, highlighting an unprecedented psychological battleground. This convergence underscores the urgent need for nuanced research to navigate the uncharted territory of their mental health. Methods: Employing Bayesian analysis supported by Markov Chain Monte Carlo (MCMC) algorithms, this study examined depression prevalence and associated factors among 1,014 Chinese returnees. The sample comprised 44.87% male participants (455), 51.58% female participants (523), and 3.55% identifying as "Others" (36), with an age distribution of 61.74% aged 18-30 (626), 28.80% aged 31-40 (292), and 9.47% aged 41-50 (96). The mean age of participants was 29.6 years, ranging from 18 to 50 years. PHQ-9 diagnoses revealed alarming levels of depression, with 47.9% exhibiting a moderately severe degree of depressive disorder. Results: Our findings highlight the intricate interplay between identity clusters- "homestayers" (those leaning towards a Chinese cultural identity), "navigators" (those with a bicultural identity), and "wayfarers" (those leaning towards a foreign cultural identity)-and the likelihood of depression. Specifically, homestayers showed a clear and strong negative association, navigators demonstrated a positive association, and wayfarers had a positive yet unclear correlation with depression levels. Furthermore, acculturation, age, and gender showed no significant effects, whereas education mildly mitigated depression. Discussion: Based on these findings, we suggest the implementation of better-tailored mental health support and policies to facilitate smoother reintegration.

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As the preeminent mobile social media platform in Mainland China, WeChat's meteoric expansion has revolutionized the dynamics of interpersonal communication and the modalities of mutual interaction among individuals. Despite the escalating significance of mobile social media in the cross-cultural adaptation of international students, existing scholarly works have largely neglected the underlying relationship between psychological motivations, excessive WeChat use, academic performance, and sociocultural adaptation of these students. Anchored in uses and gratifications theory and cross-cultural adaptation paradigm, the primary objectives of this study are to devise a theoretical model and to scrutinize differential psychological motivations propelling international students' WeChat usage, its association with excessive WeChat use, and impacts on academic performance and sociocultural adjustment. The proposed model undergoes meticulous evaluation through data amassed online from 598 Chinese international students studying in Germany. Sequential analytical techniques, especially Confirmatory Factor Analysis and Structural Equation Modeling, were employed to elucidate the dynamic interplay among key variables. The final results validate the path effect suggesting that both hedonic and social motivations are positive predictors of excessive WeChat use. Moreover, excessive WeChat use is negatively correlated with academic performance and sociocultural adjustment. However, utilitarian motivation is not significantly related to excessive WeChat use. By demystifying the driving factors and consequences of excessive WeChat use, these findings not only accentuate the pivotal role of mobile social media in the cross-cultural adaptation of international students but also enrich the theoretical landscape and enhance the strategic approaches for educators and academic institutions.

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This research project expands on previous studies to analyze the institutional image from the perspective of higher education students in Singapore. The work builds on extensive prior research and examines the impact of the recent pandemic and lockdowns in Asia, which have increased Singapore's popularity as a study destination for Asian students, particularly from China. Known as the Garden City and one of Asia's wealthiest cities, Singapore has grown significantly due to foreign direct investment and its strategic location near Malaysia and Indonesia. This study aims to identify institutional and city image dimensions in higher education, focusing on three of Singapore's six publicly funded universities. The critical factors examined include Institutional Image, Economic Image, Social Image, Environmental Image, Perceived Educational Quality, and Satisfaction and Loyalty. These factors are crucial for Singapore's goal to become an innovation and talent powerhouse by 2030, aligning with national scientific and technological advancement plans. The research also explores how Singapore competes with traditional study destinations like the USA, Britain, and Australia.

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Purpose: Understanding patient's preferences is important to delivering good quality services. Patients' feedback provides healthcare providers with valuable information about the services provided. The increasing number of international students enrolling in Hungarian Universities raises the need to ensure the quality of services meets international students' requirements, which includes healthcare. This study aimed to assess service quality in the University Health Center (UHC) from the international student's point of view to be used to improve the quality of services. Methods: This cross-sectional study was conducted at the university health center. We used a mixed methods approach to collect both quantitative and qualitative data. We used the importance-performance analysis (IPA) for quantitative analysis to understand expectations and perceptions in service research. The qualitative analysis was conducted from responses to reflection questions. The qualitative data were then analyzed using thematic analysis. Results: 437 international students participated in the study, but only 402 (91.99%) were analysed. The gaps between the importance and performance of service quality were negative in all dimensions (P-value < 0.001). This suggests that there is an unmet need for student expectations and university health center performance. From the Importance factor, the highest and lowest were related to safety (4.54 ± 0.56) and efficiency (4.31 ± 0.66) dimensions. The Performance factor's highest and lowest mean scores were also related to safety (4.22 ± 0.72) and efficiency (3.91 ± 0.87), respectively. From qualitative analysis, there are two major themes several secondary themes from the thematic analysis of free-text responses were identified. Conclusion: The importance and performance analysis could provide useful information to university policymakers about university health center service quality. There is a need for improvement and obviating the importance-performance gaps, especially in the efficiency dimension. Decision-makers can use the IPA analysis results to allocate limited resources more effectively, giving special attention to possible organizational weaknesses for further direction.

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BACKGROUND: International student education has become an important part of higher education and an important symbol to measure the level of higher education. To change the traditional teaching model, here we introduced a combination of Case-Based Learning (CBL)and Flipped Classroom (FC) into the pathophysiology course for international students. This study aimed to explore whether the active learning ability and critical thinking ability of international students can be improved, based on this new teaching model, improving the innovation ability of teachers' team and students' attitude to the reform. METHODS: The two chapters of Cardiac Insufficiency and Apoptosis in Pathophysiology are designed as a CBL + FC teaching method. Distribute the Self-assessment Scale on Active Learning and Critical Thinking (SSACT) and satisfaction questionnaire to international students to evaluate teaching reform based on CBL + FC. RESULTS: Compared with the traditional classroom, the online flipped classroom based on CBL has significantly improved the learning enthusiasm, as these students are required to independently complete literature review, actively participate in classroom teaching, learn to use multiple learning strategies, and collaborate with other students to complete PowerPoint (PPT)production. At the same time, the students' ability to raise problems and solve problems has been greatly improved by analyzing clinical cases; By consulting the literature, the theoretical knowledge learned can be better applied to clinical analysis. The results of the satisfaction survey also show that international students are more likely to accept the flipped classroom teaching mode. CONCLUSIONS: This teaching mode will stimulate the learning motivation of international students, enhance teaching attraction and increase teaching interaction; At the same time, the CBL + FC teaching method can strengthen the evaluation of international students' in and out of class and online learning, enhance students' active learning ability and critical thinking ability, promote the development of personalized learning, and integrate with international medical education.

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Introduction: The current systematic review aimed to examine the relationship between acculturative stress (AS) and psychological outcomes in international students to determine the role AS may play in predicting the mental health of international students. Methods: The studies included in the current systematic review and meta-analysis had considered AS and its impact on psychological outcomes among international students studying abroad. After checking the studies found in our primary search through the scientific databases in terms of our eligibility criteria, 29 studies were included, of which 26 were eligible for a meta-analysis (total N = 7,247). Results: Meta-analysis indicated a moderate mean correlation of AS with psychological outcomes like depression, life satisfaction, quality of life, vocational outcome expectations, drinking behaviors, resilience, health promotion behavior, psychological adjustment, psychological distress, negative affect, and mental health symptoms (r = 0.39) and depression (r = 0.41), respectively. Discussion: The review of studies revealed a robust relationship between AS and increased negative psychological outcomes such as depression, psychological distress, and general stress, as well as decreased positive psychological outcomes such as psychological adjustment, mental health, life satisfaction, and quality of life.

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This study acknowledges the growing importance of international student mobility and examines the relational well-being of international students at Hohai University in Nanjing, China. Understanding the complexities of interactions among international students is essential for their well-being and the university's overall success, since this tendency continues to increase. By examining the distinct possibilities and problems faced by international students at Hohai University and considering elements including cultural distinctiveness, the campus environment, interpersonal dynamics, and support networks, the study fills a research void. For this purpose, 150 international students at Hohai University participated in semi-structured interviews and 10 participants participated in unstructured interviews as part of the mixed-methods approach to obtain in-depth information. Hence, the descriptive data were analyzed using SPSS and qualitative analyses were performed using NVIVO. According to preliminary findings derived from quantitative data, important results emphasize the significant impact of homesickness (0.143, T value: 5.931) and the positive correlation of relational well-being (0.146), highlighting their significance. The effect of the language barrier is also significant (0.125, T value: 4.378), whereas loneliness has little bearing (0.011, T value: 0.847). Additionally, the highest concern of the international students (M = 8.35; SD = 1.43) was making connections with local students. Additionally, (M = 8.21; SD = 1.15) international students favored Hohai University, which provided a welcoming atmosphere for intercultural dialogue. The Foreign Student Office, social events, cultural exchange programs, counseling services, and peer support networks are just a few examples of the support structures and networks crucial to international students' general well-being. At the same time, the cultural hurdles, including the language barrier and loneliness, seemed to be the challenge. The study concludes by shedding light on the relational well-being of international students at Hohai University and highlighting the importance of community-building and supporting actions. The results provide insightful information that will help the institution better respond to the particular difficulties that international students encounter, creating a more welcoming and stimulating atmosphere. This study establishes the foundation for further research in comparable contexts and advances our understanding of relational well-being in the context of experiences for overseas students.

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PURPOSE: Examine the predictors of food security and perceived stress among international students. DESIGN: Cross-sectional Design. SETTINGS: A public university in the Southwest United States. SUBJECTS: Sample size of Seventy-three participants (≥18 years). MEASURES: Self-report measures of food insecurity and perceived stress. The U.S. Department of Agriculture (USDA) Adult Food Security Survey Module (AFSSM) to assess food security status, and the Perceived Stress Scale (PSS-10) questionnaire to evaluate stress levels. ANALYSIS: Logistic regression was performed to identify predictors of food security and perceived stress. RESULTS: Duration of stay in the U.S. was a predictor of food security status, while gender was a predictor of perceived stress. International students in the U.S. for less than a year had a lower chance of being food secure [OR (95% CI) = 0.22 (0.05 - 0.74)]. Female international students had a lower chance of experiencing low perceived stress [OR (95% CI) = 0.07 (0.00 - 0.51)]. CONCLUSION: In supporting international students, targeted nutrition and stress management interventions should be emphasized, particularly for females and those who recently moved to the U.S.

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This study investigated the effects of mindfulness training on alleviating fear of the COVID-19 epidemic among international students in China during the academic year 2020. The training group participants (N = 41) and the control group participants (N = 44) were surveyed pre-and post-training with the two English questionnaires: The Five-Facet Mindfulness Questionnaire (FFMQ) and the fear of the COVID-19 scale (FCV-19S). The results showed that, regarding the relationship between the two main variables in the study, mindfulness is related negatively to the COVID-19 epidemic. Moreover, compared to the control group, results showed that individuals in the training group demonstrated significant improvements in mindfulness levels and decreased Fear of COVID-19. Thus, findings suggest that a short online mindfulness meditation training may reduce fear of the COVID-19 epidemic.

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With the rapid development of network technology, cross-regional on-line higher education is becoming one of the mainstream directions of distance education development. The effectiveness of on-line studying is significantly influenced by the level of learning engagement, and research on this topic can help learners by providing them with process-oriented learning support and targeted teaching interventions. Using the example of on-line Science and Technology Chinese Course for preparatory international students at four universities in China, this study collected self-reported data from 463 students using a survey method. The questionnaire was divided into two parts: the on-line studying engagement scale and the factors influencing on-line studying engagement. Descriptive statistical analysis and differential testing were conducted on the data using SPSS software, and the structural validity of the questionnaire was tested using AMOS software. With the assistance of Smart PLS, a model of the influencing factors of on-line studying engagement was constructed to explore the relationship between on-line studying engagement and its influencing factors. The study found that: The overall level of engagement in on line studying for preparatory international students is above average. In demographic factors, apart from gender, all other variables have a significant impact on on-line studying. Student-level factors will have a more significant positive impact on the degree of on-line studying engagement of preparatory international students. Among them, academic self-efficacy, basic psychological needs satisfaction, the difficulty of the on-line course, and completion of the assignment have a significant positive effect. The influence of teacher-level factors on behavioral engagement and emotional engagement is stronger than that of student-level factors. However, the emotional support of teacher-level factors, the on-line environment of environmental-level factors, and the perceived usefulness of technology of teacher-level factors have a certain negative impact on engagement in online studying. According to the research results, this paper puts forward the optimization strategies of accelerating the update frequency of Chinese learning materials, strengthening the input of on-line emotional support, and holding language learning activities with cultural characteristics. This study makes an in-depth analysis of the influencing factors of preparatory international students' on-line Chinese studying engagement, and puts forward the optimization strategies to improve the quality of on-line studying, to provide theoretical and practical reference for the development of cross-regional on-line higher education.

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BACKGROUND: Chinese international students (CIS) in the United States may face unique mental health challenges that are often overlooked in discussions about mainstream college student needs. OBJECTIVE: This study aims to investigate the predictors of mental health (MH) professional help-seeking intentions among CIS at a large public Midwestern university, as well as the obstacles that hinder their use of professional MH services. METHODS: The study used quantitative and qualitative approaches to gather data on CIS' help-seeking attitudes. Quantitative analysis focused on the association between specific factors and help-seeking intentions. Qualitative coding of open-ended questions provided additional insights into obstacles and suggestions for improving mental health support. RESULTS: The study identified several factors influencing the mental health help-seeking intentions of Chinese international students. Two primary negative predictors were a preference for emotional self-control and concerns about the questionable quality of treatment. Conversely, having previous experience with professional mental health services, both in China and the United States, was found to be a positive predictor of help-seeking intentions. Additionally, qualitative analysis of open-ended responses revealed further obstacles to seeking help and provided useful suggestions for enhancing mental health support for Chinese international students in college settings. CONCLUSIONS: The study identifies key factors that influence CIS' attitudes toward seeking professional mental health services. Understanding these factors can help in developing strategies to better support the mental health of CIS in college settings. LIMITATIONS: Several limitations must be acknowledged in this study. The cross-sectional design limits the ability to draw causal inferences from the data. Additionally, the sample may not be fully representative of the broader population of Chinese international students, which may affect the generalizability of the findings. Self-reported data may also introduce response biases. Future research should consider longitudinal approaches and a more diverse sample to validate and expand on these findings.

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Objectives: This study was aimed at examining the relationship between acculturation strategies and both psychological and socio-cultural adjustment, while concurrently assessing the moderating role of perceived second language proficiency. The premise was that proficiency in the host country's language could potentially facilitate successful acculturative outcomes. Method: We used self-report measures to collect data on a sample of 237 international students in Los Angeles. A General Linear Model was applied for data analyses. Results: Overall, integration emerged as the most adaptive acculturation strategy, whereas marginalization was identified as the least adaptive. Noteworthy, moderating effects were observed in the relationships between marginalization and life satisfaction, integration and socio-cultural adjustment, assimilation and psychological problems, as well as socio-cultural adjustment. Conclusions: Our findings lend support to the Integration Hypothesis, highlighting that adopting integration is associated with superior adaptive outcomes, also pointing out that the pattern of associations between acculturation strategies and both psychological and socio-cultural adjustment could fluctuate depending on the level of perceived second language proficiency.

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BACKGROUND: The COVID-19 pandemic led to significant lifestyle changes and uncertainties, triggering a secondary wave of mental health issues in society. University students are especially susceptible to mental disorders. International students are considered more vulnerable due to limited emotional and financial support from their families and difficulties accessing community support. Hence, we conducted a longitudinal analysis to compare depressive symptoms among international students before and during the pandemic. METHODS: Data from depression screenings conducted at the University of Tsukuba in 2019 and 2020 were utilized. We included all students enrolled in 2019 who underwent health check-ups in both 2019 and 2020. Participants completed the Patient Health Questionnaire-9 (PHQ-9), enabling a comparison of item scores between domestic and international students. Psychopathological network analysis was employed to examine relationships among the items. RESULTS: Prior to the pandemic, international students generally exhibited relatively good mental health compared with domestic students. During the 2020 pandemic, no significant difference was observed, but international students tended to demonstrate better mental health. However, network analysis revealed intergroup variations in the relationships among PHQ-9 items, with concentration problems and suicidal thoughts being more prominent among international students. CONCLUSION: This study's findings suggest that young people studying abroad experience mental health crises similar to their domestic counterparts. Nevertheless, the patterns of these crises may differ between the two groups.

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(1) Background: International students with sufficient health literacy are better equipped to respond to public health emergencies and reduce any unintentional harm that may occur during such events. This study aims to assess the current status of health literacy among international students and investigate the factors that influence health literacy. (2) Methods: A cross-sectional study was conducted in Tokyo on international university students using a questionnaire consisting of the Communicative and Critical Health Literacy and eHealth Literacy Scales. The study analyzed 205 valid responses. Descriptive statistics were utilized to assess the level of health literacy, and linear regression was used to identify the association of socio-demographic characteristics and disease status with health and e-health literacy. (3) Results: Health literacy and e-health literacy were low in 48.29% and 47.29% of international students, respectively. The mean scores of CCHL items ranged from 3.13 to 3.26, while the mean scores of eHEALS items ranged from 3.33 to 3.49. Both health literacy and e-health literacy were better with unmarried status (p = 0.015), and e-health literacy was worse with higher age (p = 0.007). (4) Conclusions: Overall, international students' health literacy and e-health literacy were at intermediate levels, with considerable room for improvement, and affected by certain student attributes.