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AIM: This study aims to investigate international students' perspectives on service quality and analyse factors contributing to the perceived service quality of the university health centre. BACKGROUND: International students are at increased risk of experiencing poor mental health, isolation from families and cultures, language barriers, financial stress and academic pressures. It is important that universities support international students to enable them to complete their degrees and reach their desired level of achievement and performance. One of the supports required by international students is the availability of healthcare services. Therefore, improving the quality of services to meet international students' requirements, including healthcare services, is essential. METHODS: A three-phase exploratory sequential mixed methods design was used. Phase 1 aims to explore international students' perceptions of primary healthcare quality by conducting in-depth interviews and focus group discussions. Data were analysed using thematic analysis. Phase 2 is to form questionnaire items based on the results of the qualitative study. The questionnaire is subject to pilot testing to measure validity and reliability. Phase 3 analyses factors influencing international students' perceived primary healthcare service quality. Multiple regression was used to analyse factors contributing to the perceived service quality of international students. FINDINGS: The qualitative strand revealed five major themes representing the study participants' thoughts about the quality of services in the university healthcare context. Perceived quality attributes identified in this study were primarily empathy, equity, effectiveness, efficiency and safety. The quantitative strand found that 35.57% of participants consider the perceived quality of the centre as good. The highest and lowest service quality attributes were related to safety and efficiency, with a score of 21.12 ± 3.58 and 19.57 ± 4.34, respectively. The multiple linear regression analyses showed that PhD students from Health Faculty and Scholarship awardees were significantly associated with the perceived quality of healthcare services. Thus, the university management needs to improve service quality considering the diversity of international students' socio-demographic characteristics.

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BACKGROUND: The international education sector is important not only to Australian society, but also to the national economy. There are growing concerns about the potential wellbeing challenges facing international students in their host country, owing to acculturative stress; including loneliness, isolation and experiences of racism. Risks include poor mental health and decreased likelihood to access support due to stigma, language and cultural barriers, not knowing where to seek help, and poor mental health knowledge. METHODS: This study explored students' perceptions of their accommodation, subjective wellbeing (through the Personal Wellbeing Index, ['PWI']), mental health help-seeking and individual engagement with evidence-based everyday health promotion actions (informed by the '5 Ways to Wellbeing' model) through an online survey (N = 375) and three online focus groups (N = 19). A mixed-methods approach using descriptive statistics, ANOVA, regression analysis and thematic analysis, were used. RESULTS: The PWI of international students in the survey was observed to be substantially lower (M = 60.7) than that reported for the Australian population (M = 77.5). Accommodation impacted on wellbeing (loneliness, belonging, connectedness) in a number of different ways including through location, safety, and shared accommodation. In terms of help-seeking, international students noted a number of barriers to accessing support for mental health: cost of accessing support, language and cultural barriers, lack of information on where to find support and stigma. CONCLUSIONS: In the discussion, implications of the findings are considered, including that more could be done to shape policy and practice in service and facility provision around wellbeing, connectedness, and help-seeking for mental health support of international students.

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From the earliest studies of soft power in International Relations, the importance of educational exchanges has been well-established. Studies of international education in the context of Canadian soft power often draw on cases from the higher education sector. This article argues that greater attention should be paid to the K-12 level, especially as budgetary pressures in Ontario's education system are leading school boards to rapidly expand their international student recruitment efforts. Although this is not an example of intentional soft power projection, it nevertheless represents an important reminder that subnational actors may accidentally become paradiplomats whose actions have consequences on the international level. Further, this case reveals the importance of paying attention to actors typically overlooked by IR scholarship. Drawing on Joseph Nye's theory of soft power and in conversation with prior research on international education as a mechanism of soft power projection, this article traces the thread between budgetary pressures in Ontario school boards and the broader context of soft power projection.

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The role of higher education in the foreign policy of states has been increasing significantly in order to generate soft power. Nevertheless, the literature on the educational aspect of soft power has yet to be systematically reviewed. Therefore, this systematic review is conducted to delineate and analyze the major studies in the field of international higher education which indicates education as a soft power resource for a country. To identify the multiple and contrary arguments on the topic, this study reviewed 48 peer-reviewed articles published from 2001 to 2022. The data collected from the reviewed papers are organized into five sub-sections outlined in the results sections. The contradictions in the literature are examined within the sub-sections in order to understand the various perspectives on education as a resource of soft power. Through analyzing the data mentioned in the results section, this study provides a framework of the essential conditions to harness education as a soft power resource. Furthermore, this review also suggests prospects for future research in this area.

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In recent years, the number of medical students seeking international opportunities has grown. To satisfy these demands, collaborative international programs have been developed. However, the benefits of these programs are limited as they employ an international medical education (IME) approach where only the students are exchanged. In this commentary, we discuss the current models of IME and propose a paradigm shift to a transnational approach wherein the student, faculty, and curriculum are exchanged allowing for increased integration and awareness of cultural and educational approaches to treatment that can be retained and incorporated into future practice to advance healthcare across the globe.

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The Philippines is one of the major labor exporters for health care workers in the world and occupational therapists are the second most likely professionals behind nurses to work in "greener pastures" overseas. This phenomenological study describes the migration experiences of Philippine-trained occupational therapists working in high-income, Anglophone countries. Researchers conducted online interview for 15 participants who were previously/currently unemployed/underemployed. Following an inductive approach to qualitative data analysis, themes were drawn from the migrant therapists' lived experiences. Four themes describe the migration experiences of Filipino occupational therapists: (a) realities of being an occupational therapist in the Philippines, (b) contradictions faced by Filipino occupational therapists upon migration, (c) when the pastures overseas are not greener, and (d) when the pastures overseas are indeed greener. The study contributes to the labor migration discourse in occupational therapy and the critical examination of the idea of "greener pastures."

The Migration and Deskilling of Filipino Occupational TherapistsThis study provides stories of Filipino occupational therapists who were underemployed as they migrated to developed and English-speaking countries. We interviewed 15 people online to explore their experiences of migration, being underemployed, and working in a foreign country with a different culture of working. Results of the study revealed four ideas: (a) reality of being an occupational therapist in the Philippines, (b) contradictions faced by Filipino occupational therapists upon migration, (c) barriers faced by migrant occupational therapists, and (d) successes experienced by migrant occupational therapists. This study contributes to the ongoing research on occupational therapy, labor migration, and overseas Filipino workers.

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Culture is inescapable in education, incorporating cross-cultural dialogue and serving as the foundation of Chinese foreign education (CIE). This study aims to investigate, from the standpoint of intercultural communication, the impact of sports on the development of a positive psychological climate in CIE. The study employed quantitative and qualitative methods, collected data through tests, classroom observation, and interviews, and conducted a quasi-experimental comparison of the experimental group learning CIE and culture curriculum and the control group learning traditional language skills curriculum. This study determined that the experimental group's cross-cultural attitude improved more rapidly after the systematic study of cultural courses, which plays a more significant influence in fostering a positive psychological climate in CIE. In addition, the study indicated that culture is transmitted through language and that cultural elements play an essential role in language acquisition. In addition, most learners of a second language originate from nations and areas with different cultural backgrounds than the target language. Comparing one's culture with students and determining the most effective cross-cultural communication strategies are essential for teaching.(AU)

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The learning adaptability of international students is pivotal to the success of sustainable international higher education development. The purpose of this study was to explore what factors affect the learning adaptability of international students in China through structural equation modelling and mediation analysis. The data collected through a questionnaire from the overseas students were analysed, and the reliability and validity were also tested. The findings show that the influencing factors that affect learning adaptability of international students in China comprise seven variables: learning attitude, motivation to study abroad, learning ability, language proficiency, learning environment, teaching management and social relations. In addition, when language proficiency is used as the mediating variable, the motivation to study abroad has a significant positive impact on learning attitudes, with an influence coefficient of 0.185 and an effect proportion of 35%, which is a partial mediator. When social relationships are used as the mediating variable, study abroad motivation has a significant positive impact on learning attitude, with an influence coefficient of 0.058, which is completely mediating.

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This paper investigates international students' confidence as a base for imminent tertiary education decisions. International students are a highly sought-after commodity, particularly during and after a global pandemic when the income streams of tertiary education providers are limited. In-depth interviews were conducted with students who sought guidance towards an international study experience to explore the guiding research questions, (1) how does confidence impact tertiary education decisions of international students and (2) what is the relationship between confidence and time to make a tertiary education decision? Set within the context of the international tertiary education industry of Australia, the original contribution stems from identifying that guidance towards an international study experience is affected by confidence in; guidance counselors, the brand name of the university, and the tertiary education decision itself. The identified confidence characteristics in this study have an inverse relationship with the length of time taken for the students' decision-making process. This leads to swifter finalizations of tertiary education decisions by students increasing returns on education providers' admission activities.

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Globally, scholarships for international higher education play a critical role in human capital development. While substantial research has documented the benefits such scholarships provide for individuals, their impact on the creation of pathways for social change remains under-researched. This paper bridges this gap by examining the extent to which a government scholarship for international education has created pathways for social change in Kazakhstan. Data were collected through interviews with 67 scholarship alumni. Drawing on Dassin et al.'s (2018) framework for pathways to social change, the findings reveal that international education fosters social change in Kazakhstan in four ways. First, the scholarship program develops local talent and builds agents of change. Second, it widens access to international education, particularly for individuals from marginalized communities, who would otherwise lack access owing to their scarce financial resources. Third, the program develops alumni's cosmopolitan and intercultural competencies and strengthens international collaborations. Finally, it creates associations and groups through which alumni can collectively contribute to society. The findings highlight that while the interviewed alumni foster strong patriotic feelings and are determined to contribute to the prosperity of their country, underdeveloped industries, economic volatility, and top-down bureaucracy in workplaces limit their potential contributions to social changes. These findings may help policymakers and administrators to reconsider and improve on the design and structure of scholarship programs.

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International education activities suddenly halted due to the COVID-19 pandemic, severely disrupting student mobility and academic learning. Many educational institutions have delivered programs to students through digital devices globally rather than in situ. Such a shift presents a unique opportunity to assess the impact of online and hybrid education for international students. This qualitative study interviewed 30 international students who had arrived on campus and shared their first-year university transition experiences during the pandemic. The analysis shows that spatial and temporal circumstances created two scenarios and thus resulted in different first-year university experiences. Although all students were dissatisfied with online learning, studying at a distance in different time zones was particularly detrimental to international students' mental and physical health. The (im)mobile environments led to mismatches in expectations, roles, activities, and realities, negatively affecting student learning and adjustment. This study highlights the complex international transition issues and offers implications for sustainable online and hybrid-learning practices in the educational system.

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Due to the worldwide travel restrictions caused by the 2019 coronavirus disease pandemic, many universities and students lost opportunities to engage in international exchange over the past 2 years. Teleconferencing systems have thus been developed to compensate for severe travel restrictions. Kansai Medical University in Japan and Vilnius University in Lithuania have a collaborative research and academic relationship. The two universities have been conducting an online joint international surgery lecture series for the medical students of both universities. Fifteen lectures were given from October 2021 to May 2022. The lectures focused on gastrointestinal surgery, gastroenterology, radiology, pathology, genetics, laboratory medicine, and organ transplantation. A survey of the attendees indicated that they were generally interested in the content and satisfied with attending this lecture series. Our efforts were successful in providing Japanese and Lithuanian medical students with the opportunity to engage in international exchange through lectures held in each other's countries.

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To understand the impact of the international Master's programmes offered at the Institute of Development Policy (University of Antwerp), a theory-based evaluation was undertaken. In the first phase, a Theory of Change (ToC) was elaborated, distinguishing between three levels of impact (individual, organisational and societal), four learning dimensions (knowledge, skills, attitudes and networks) and five implicit pathways (change agent, social network, widening access, academic diversity, international understanding). Given the multifaceted and vague nature of the 'impact' concept under study, we selected an international, gender-balanced, multi-sectoral team of alumni researchers who fostered inclusiveness of different perspectives, at the same time capitalising on their depth of understanding, having gone through the study experience themselves. A mixed-methods approach was adopted to validate the ToC, combining a Most Significant Change approach, categorisation and text analysis of 101 alumni impact stories. Our findings demonstrate the importance of the three levels of impact and four learning dimensions in capturing graduate impact. While the impact stories confirmed the dominant 'change agent' pathway, they also hinted at the importance of hybrid complementary configurations of pathways to fully grasp how impact materialises.

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As the third-largest export industry, international education occupies an important place in the Australian economy and society. Employing Bacchi's "What is the Problem Represented to be" (WPR) approach, this paper critically analyses four key policies pertaining to international students in Australia since the 1990s. Drawing upon theorising of the globalisation of international education policy, we uncover contestation and problem representation in discourses around the economisation of education and of international students' experiences. The findings reveal multiple discourses of the problematisation of diversity at play, including a "pivot" towards protection of international students' rights as consumers and as potential future citizens, and increased attention to the intrinsic value of international students as people, and not simply as economic agents. The findings have implications for other national contexts, in which international students contribute to the economic viability of education, and in which internationalisation of education in universities has the capacity to foster enhanced cross-cultural understanding.

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During school closures prompted by the Covid-19 pandemic, educational technology (EdTech) was often used to continue educational provision. In this article, we consider EdTech effectiveness using a holistic framework, and synthesise findings from 10 primary research studies of EdTech interventions conducted in low- and middle-income countries during the pandemic. The framework includes five main lenses: learning outcomes, enhancing equity, implementation context, cost and affordability, and alignment and scale. While in-person schooling has largely resumed, there continues to be further integration of EdTech into education systems globally. This analysis provides evidence-based insights and highlights knowledge gaps to shape holistic analysis of both EdTech mainstreaming and future research into the effective use of EdTech to strengthen learning.

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The Russian-born American psychologist Bronfenbrenner's bioecological perspective on human development is an ideal framework for understanding how individuals negotiate the dynamic environment and their own identities in international and intercultural education settings. However, a review of the current literature shows that most studies either adopted the earlier version of the theory (i.e., the ecological systems theory) or inadequately presented the most recent developments of the bioecological model (i.e., the process-person-context-time model). The construct of proximal processes-the primary mechanisms producing human development according to Bronfenbrenner-has seldom been explored in depth, which means the true value of bioecological theory is largely underrepresented in international and intercultural education research. This article first presents a review of studies that adopt Bronfenbrenner's theory and then offers future directions for the scope and design of international and intercultural education research.

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Background: The use of international telemedicine conferences for doctor-to-doctor education has increased following the coronavirus disease 2019 pandemic to ensure health and safety. Previous studies have shown that administrative tasks are an obstacle to promoting international telemedicine conferences but have not identified the type of system needed to alleviate this burden. Objective: The Asia-Pacific Advanced Network Medical Working Group (APAN-MWG) is an international telemedicine network that includes 1171 medical institutions and 3653 members as of July 21, 2021. The APAN-MWG has supported international telemedicine conferences since 2005 and implemented a program management system in 2014. The present study explores the conference organizers' tasks and evaluates the APAN-MWG management system through a survey of organizers. Methods: We developed a system called med-hok for managing conference programs, international medical institutions, and their members. We investigated all event programs using the med-hok system from June 3, 2015 to July 21, 2021. The target samples included 64 conference programs in 12 series hosted by 13 program organizers. The effectiveness of the system was evaluated using a four-point Likert scale (very good, good, poor, and very poor). The User Experience Questionnaire (UEQ) was used to assess user experience. Results: The survey response rate of the program organizers, who hosted 11 different program series in 7 Asian countries, was 92% (12/13). The administrative tasks for managing the programs were primarily handled by physicians (67%, 8/12), followed by technicians (17%, 2/12). The average program scope encompassed 7 countries, 10 institutions, and 44 members. The largest program comprised 194 members from 49 institutions in 25 countries and was managed by two physicians and one technician. Most program organizers (8/12, 67%) indicated that verifying member information was the most burdensome aspect of organizing teleconferences. Over 90% of respondents positively evaluated med-hok in the following areas: "Confirmation of institution information," "Confirmation of member information," "Confirmation of technical information," "Maintaining the latest status of the program," "Announcing and publicizing the event," and "Formatting and correcting misspellings." They rated user experience positively for all aspects (attractiveness: 1.22; practical quality: 1.42; and hedonic quality: 1.24). Conclusions: Many tasks of organizing casual international telemedicine conferences are handled by physicians and technicians with no operating funds or staff, unlike those in large academic conferences. The proposed system was found to help program organizers manage participants and communicate information effectively. These findings suggest that international telemedicine networks should implement an administrative support system to conduct program operations efficiently.

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Female Community Health Volunteers (FCHV) in Nepal have identified lack of appropriate training as a barrier to involvement in the COVID 19 response. With more than 50,000 FCHVs serving rural areas of Nepal, they are instrumental in healthcare and are a major source of information delivery to those with the most limited health-care access in Nepal. This communication describes an innovative training programme to rapidly equip FCHVs with knowledge on COVID 19 response. The ongoing programme leverages partnerships between local municipalities and a local community-based organisation and has rapidly trained more than 300 FCHVs across four districts with a population of 1,000,000, and has plans to expand the training across the country. This training programme is a key example of how local partnerships can be utilised for digital training of FCHVs in remote parts of Nepal and leveraged to strengthen response capacity during the pandemic.

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The agency of international students has long been neglected and undertheorised, though recent literature indicates that this has started to change. This paper systematically reviews 51 studies that address student agency in international higher education. Focusing on research published in the last two decades (2000-2020), the review draws on studies that foreground student voices, or international students' perspectives, rather than the perspectives of teachers, administrators or policymakers. A detailed discussion of how international student agency is positioned in the literature found that agency appears as either: a research object, as part of a theoretical or conceptual framework, or an emergent finding. Furthermore, our analysis suggests that the term "agency" is often used as a buzzword rather than as a fleshed-out concept. Thus, drawing on this initial analysis, the review synthesises varying but overlapping conceptualisations of international student agency in the literature into an integrative framework. Implications for future research are drawn, based on our findings about the understudied populations and methodological limitations in the literature. Supplementary Information: The online version contains supplementary material available at 10.1007/s10734-022-00952-3.