Exploring the challenges and opportunities for improving the health and wellbeing of international students: Perspectives of professional staff at an Australian University.

International students typically face a range of challenges from the time they leave their home country, which includes the need to adapt to a new culture and norms and to a new educational landscape. Due to their unfamiliarity with local culture and language barrier, the stress of adjustment often leads them to feel lonely, socially isolated and homesick. However, the Social Identity Model of Identity Change (SIMIC) model suggests that during life transitions, an individual’s group memberships and associated social identities can buffer people from these negative effects of life change.This thesis presents three studies that explore the contribution of social identity change to the academic performance, retention, mental health and well-being of international students who have left their home country and moved to Australia to pursue tertiary education. To explore the relevance of SIMIC for international students’ transition to studying overseas, the first study reports the findings from semi-structured interviews conducted with 15 international students attending an Australian university. Thematic analysis undertaken provided support for the relevance of SIMIC’s new group membership and maintained group membership pathways in the transition, and revealed a number of associated factors that acted as either facilitators (e.g., a host family that supported community integration) or barriers (e.g., experiencing culture shock) to successful adjustment in the face of social identity change.The second study is a longitudinal investigation of 210 international students studying in a Foundation Year programme in a large Australian university across three time points over the course of one year. Consistent with SIMIC, this found that social identity variables predicted (a) higher academic performance, (b) better mental health and (c) better well-being outcomes. Maintained group membership also indirectly improved student retention across time.The final study builds on the previous two to explore the feasibility of a four-module manualized program, Groups 4 Health for International Students (G4H-IS), adapted from the evidence based intervention Groups 4 Health and developed specifically for international students to increase social connectedness by building group-based social identifications through an in-vivo group experience. The G4H-IS program was delivered to a group of international students (N=123) from an international college. New group membership and maintained group membership resulted in reduction in depression, improved life satisfaction and self-esteem over time. However, there was limited evidence that G4H-IS directly affected these outcomes. Nevertheless, feedback from facilitators and participants pointed to ways in which the program might be improved before conducting further trials.Together, the various components of the present thesis point to the ways in which social identity mechanisms impact on identity change in the course of the life transition that international students undergo when moving overseas to study. Findings from the three studies corroborate previous research in showing how maintained and new group membership support health and well-being outcomes, and this thesis provides novel insights into the capacity for these processes to also affect academic performance and drop out. Theoretical and practical implications are discussed, as well as directions for future research.

This study sought to explore the challenges and opportunities for improving the health and wellbeing of international students through in-depth interviews with 21 international students at an Australian University. Interviews explored 1) conceptualisation of health and wellbeing, 2) perceptionsof the most significant health and wellbeing issues for international students, and 3) the barriers to international students accessing campus-based services for health and wellbeing concerns. Almost all international students viewed health and wellbeing as a state encompassing both physical and mental/emotional health. Key challenges included mental health, lack of social support, academic stressors, financial pressures, and accommodation concerns. Barriers to accessing university support services included cultural stigma, language barriers, waiting periods to access services, and not knowing how or where to access support within the university. The implications of these findings and suggested strategies for improving the health and wellbeing of international students are discussed.


 
 
 International student mobility has been increasingly subject to turbulences in politics, culture, economics, natural disasters, and public health. The new decade has witnessed an unprecedented disruption to international student flows and welfare as a consequence of the COVID-19 outbreak. COVID-19 has laid bare how fragile the current transactional higher education model is, in Australia and in other major destination countries like the United States, United Kingdom, Canada and New Zealand. This health crisis hitting international education presents a range of challenges for host universities. In such a fallout, the connection between university communities and international students is more critical than ever. This connection is vital not only to university’s operations and recovery but more importantly, to international students’ learning and wellbeing. This in turn will have longer term impacts on host countries’ and universities’ sustainable international recruitment and reputation as a study destination. Therefore, it is timely to reflect on how we view and conceptualize the way we engage and work with international students. This article presents a new frame for conceptualizing the teaching, learning, and engagement for international students, which emphasizes people-to-people empathy and people-to-people connections.
 
 
 
 Conceptualize Student Connection Through Formal and Informal Curriculum
 Dis/connection has been argued to play “an important role in shaping international students’ wellbeing, performance and life trajectories” (Tran & Gomes, 2017, p. 1). Therefore, it is important to frame international student connectedness not only within the context of formal teaching and learning on campus, but also in a broader setting, taking into account the dynamic, diverse, and fluid features of transnational mobility.
 Some of the primary dimensions of international student connection vital to their academic and social experience and wellbeing have been identified as:
 • Connection with the content and process of teaching and learning• Bonding between host teachers and international students• Engagement with the university communities• Interaction between domestic and international students and among international peers• Integration into relevant social and professional networks, the host community, and the host society• Connection with family and home communities• Online and digital connection
 Based on interviews with around 400 international students, teachers, and international student support staff across different research projects, I identified four main principles underpinning effective engagement and support for international students. Most participants stressed the importance of understanding international students’ study purposes, needs, expectations, and characteristics in the first place in order to meaningfully and productively engage with and cater for this cohort (Tran, 2013). Second, effective teaching of and engagement with international students is based on understanding not only their academic needs but also other aspects that are interlinked with their academic performance, including pastoral care needs, mental health, employment, accommodation, finance, life plans, and aspirations. Third, a sense of belonging to the content of teaching and learning and the pedagogy used by teachers is essential to international students’ engagement with the classroom community. In this regard, connection is intimately linked to international students being included and valued intellectually and culturally in teaching and learning, and in being treated as partners (Green, 2019; Tran, 2013) rather than ‘others’ in the curriculum. Fourth, to position international students as truly an integral component of campus communities, it is essential to develop explicit approaches to engage them not only academically and interculturally, but also mentally and emotionally, especially during hard-hitting crises in international education such as the 2019–2020 COVID-19 outbreak, the 2003 SARS epidemic, and the 2001 September 11 attacks.
 Productive Connectedness
 The lack of engagement between international and domestic students is often identified as a primary area for improvement for universities that host international students, especially in Anglophone countries (Leask, 2009). While international education is supposed to strengthen people-to-people connections and enrich human interactions, ironically it is this lack of connection with the local community, including local students, that international students feel most dissatisfied about in their international education experience. To support and optimize the learning and wellbeing of international students, productive connectedness is essential. Productive connectedness is not simply providing the mere conditions for interaction between domestic and international peers (Tran & Pham, 2016). These conditions alone cannot ensure meaningful and real connectedness but can just lead to artificial or surface engagement between international students and the host communities. Productive connectedness is centered around creating real opportunities for international and local students to not only increase their mutual understandings, but importantly also to reciprocally learn from the encounter of differences and share, negotiate, and contribute to building knowledge, cultural experiences, and skills on a more equal basis. In this regard, productive connectedness is integral to optimizing teaching and learning for international students.
 Teaching and Learning for International Students
 Over the past 15 years, I and my colleagues have undertaken various research on conceptualizing the teaching and learning process for international students, an evolving and dynamic field of scholarship (Tran, 2011; Tran, 2013a, 2013b; Tran & Nguyen, 2015; Tran & Gomes, 2017; Tran & Pham, 2016). Figure 1 summarizes the six interrelated dimensions of teaching and learning for international students emerging from our research: connecting, accommodating, reciprocating, integrating, “relationalizing,” and empathy.
 
 Connecting
 It is critical in effective teaching and learning for international students that conditions are provided to engage them intellectually, culturally, socially, and affectively. Curriculum, pedagogies, and assessment activities should aim at supporting international students to make transnational knowledge, skills, experience, and culture, as well as people-to-people connections (Tran, 2013).
 Accommodating
 Effective teaching and learning for international students cannot be achieved without an effort to understand their purposes to undertake international education, their cultural and educational backgrounds, their characteristics, their identities, and their aspirations. Good teaching and learning practices in international education are often built on educators’ capacities to tailor their curriculum and pedagogies to cater to international students based on an understanding of their study purposes, backgrounds, and identities.
 Reciprocating
 Reciprocal learning and teaching is integral to international education (Tran, 2011). It is centered around positioning international students as co-constructors of knowledge and educators as reciprocal co-learners (Tran, 2013b). It refers to extending beyond mutual understanding and respect for diversity, to validate and reciprocally learn from diverse resources, experiences, and encounters of differences that international classrooms can offer. This is vital to making international students feel included and valued as an integral part of the curriculum and the university community.
 Integrating
 Integrating refers to the purposeful incorporation of international examples, case studies, materials, and perspectives into the curriculum. Strategies to diversify the teaching and learning content and pedagogies are closely connected with de- Westernizing the curriculum and moving away from Euro-centric content (Tran, 2013a). Integrating contributes to enriching students’ global awareness, world mindfulness, and intercultural competence, which are central to internationalizing student experience and outcomes.
 “Relationalizing”
 “Relationalizing” is crucial in assisting domestic and international students to develop open-minded and ethno-relative perspectives. Engaging students in a comparing–contrasting and reflexive process about professional practices, prior experiences, and cultural norms in different countries represents a critical step in assisting them to develop multiple frames of reference and build capacities to relationally learn from richly varied perspectives and experiences that an international classroom can offer.
 Empathy
 International students’ sense of belonging to the classroom and university community significantly depends on the empathy local teachers and students display toward them. Teachers can develop activities that enable students to develop an understanding and empathy toward what it feels like to be an international student in an unfamiliar academic and social environment, studying in a language that is not their mother tongue. One of the teacher-participants in our research shared an activity she used to help all students develop empathy:I asked for volunteers, I’d speak to them in English and they had to answer in their language. The group had to try and figure out from their body language and tone of voice what they were actually saying to me...But what I try and make them understand that part of the reason we’re doing that, not in English, is because it’s like excluding the local students and it’s making them look like foreigners and to understand the challenge.
 Conclusion
 Effective practices in engaging, teachin

International students comprise an increasingly larger proportion of higher education students globally. Empirical evidence about the health and well-being of these students is, however, limited. We sought to examine the health and well-being of international students, primarily from Asian countries, attending the University of Tasmania, Australia, using domestic students as a comparison group. Ethics approval was given to invite (via email) all currently enrolled students to participate in the study by completing a pilot-tested, online survey. The survey was completed by 382 international students (response rate = 8.9%) and 1013 domestic students (9.2%). Independent samples t-tests, analysis of variance (ANOVA) and chi-square tests were used for bivariate comparisons between international and domestic students, and between subgroups of international students. Regression models were used to examine the associations between student status (international vs. domestic) and health outcomes, controlling for demographic and enrolment variables. International students, particularly male students, were found to be at increased risk of several adverse health outcomes while also being less likely to seek help for mental health and related problems. The findings indicate the need for accessible, targeted, culturally-sensitive health promotion and early intervention programs.

Overall, 13 individual semi-structured in-depth interviews were conducted with 13 international students at an Australian university, aiming to understand the views and experiences of international students with regard to their sexual health and wellbeing. The interviews were analysed thematically, generating four themes. Participants had a varied understanding of sexual consent, which often included concerns about the practicalities of saying 'no' to unwanted sexual interactions and misinformation about the effect of reporting sexual misconduct on their privacy and visa status. Cultural and familial taboos were often inherited, but many participants described an evolution of personal views and attitudes regarding topics such as sex before marriage and same-sex relationships, which had occurred since moving to Australia. Participants expressed that they received large amounts of information about sexual health, but often lacked the skills to navigate that information and access relevant support. These data, along with participants' suggestions for future support and education, are important for understanding the complex experiences of international students at Australian universities, and should be considered when implementing future sexual health education and support programs.

This research aims to explore the acculturative stressors experienced by Chinese international students in the UK and investigates their views on intercultural mentoring programs offered at UK universities. To achieve these objectives, the study utilizes primarily qualitative data gathered from 12 semi-structured interviews, exploring Chinese international students’ wellbeing and their perceptions about intercultural mentoring programs. The findings indicate that the wellbeing of Chinese international students was influenced by a range of macro and micro acculturative stressors, including academic integration, language barriers, social integration, and the COVID-19 pandemic. Contrary to expectations, the study reveals that perceived cultural differences between China and the UK, as well as homesickness, were not the main sources of stress for Chinese international students. Regarding intercultural mentoring programs, this research finds that their introduction by UK universities represents a positive effort to enhance intercultural competence and overall wellbeing of international students. Nevertheless, the research has identified four main issues requiring consideration: mentor qualifications, limited mentor availability, effective mentor-mentee pairing, and ethical challenges.

Background Concerns have been raised that international students are at high risk of poor mental health and wellbeing. Aims The aim of this study was to systematically review the literature on the mental health and wellbeing of international students in Australia. Methods A literature search was conducted using CINAHL, MEDLINE, PsycINFO, and Academic Search Complete using EBSCOhost interface for articles published from 2000. A pre-determined set of eligibility criteria was used to screen articles and eligible articles were quality appraised using the Mixed Methods Appraisal Tool. Due to considerable heterogeneity, the data was narratively analysed, considering the statistical significance and the text narratives. Nineteen studies (N = 19) met the inclusion criteria. Results Mental health issues experienced by international students included anxiety (2.4-43%, N = 5), depression (3.6-38.3%, N = 6), psychological stress/distress (31.6-54%, N = 9) and gambling problems (3.3-50.7%, N = 3). Factors affecting student wellbeing included loneliness/isolation (60-65%, N = 4), work/financial difficulties (15.4-95%, N = 4) and discrimination/safety concerns (9-50%, N = 3). Other factors affecting students included cross-cultural transition experiences, language difficulties, social interaction, university belonging, technology difficulties, self-harm, use of counselling services and mental health literacy. Conclusion International students in Australia experience various issues affecting their mental health and wellbeing. More effort needs to be made to better support students.

The COVID-19 pandemic's global impact has been profound, particularly for vulnerable populations, such as asylum seekers, refugees, and immigrants. Likewise, international students, who fall under the immigrant category umbrella, have faced considerable challenges throughout the pandemic. This study aimed to identify insights for enhancing Japanese international students' health and well-being by investigating how epidemic prevention policies implemented by schools and the government influenced changes in their lifestyles during the post-pandemic era. Semi-structured interviews were conducted and inductive thematic analysis performed using NVivo software, to investigate the lifestyle changes of 20 (8 male and 12 female) international students (mean age: 31.5 years) at Hiroshima University, Japan, during the post-pandemic era. The analysis revealed alterations in lifestyle habits and interpersonal relationships in the aftermath of the pandemic, with most international students continuing to practice some of the epidemic prevention and health behaviors they had adopted during the pandemic, including handwashing (n = 10), mask-wearing (n = 12), and physical distancing (n = 4), as a matter of habit. However, some of these epidemic prevention and health behaviors have not persisted as habits after the pandemic. However, there has been an increased emphasis on maintaining family relationships (n = 5). Addressing language and information dissemination barriers that international students may encounter when accessing medical services, and providing them with employment guidance and support more suited to their current situation, are conducive to enhancing their health and well-being. Additionally, enhancing international students' public awareness is crucial for safeguarding their health and preparing them for potential future public health emergencies.

BackgroundUniversities are increasingly recognised as institutions where health and wellbeing can be promoted to maximise academic outcomes, career transitions, and lifelong positive health behaviours. There is concern about the mental health of university students and other factors which affect academic outcomes particularly for subgroups such as international students. There are few cohort studies of the breadth of issues that can impact on mental health and academic outcomes for both local and international students. We conducted a baseline prevalence survey of students at a large Australian university covering health, academic, and social determinants of wellbeing. The purpose was to inform the university’s new student health and wellbeing framework with a view to follow-up to determine predictors of mental ill-health and academic outcomes in the subsequent year. In this paper we present the baseline prevalence data and report on selected mental health and health care access issues for local and international students.MethodsThe entire university population as of April 2019 of over 56,375 students aged 18 or above were invited to complete the online survey. Questions explored eight domains: demographic characteristics, general health and wellbeing, mental health, risk taking behaviours, psychosocial stressors, learning and academic factors, social and cultural environment, and awareness of and access to health and wellbeing services. Records of academic results were also accessed and matched with survey data for a large subset of students providing consent.ResultsFourteen thousand eight hundred eighty (26.4%) students commenced our survey and were representative of the entire student population on demographic characteristics. Three quarters were aged between 18 to 25 years and one third were international students. Eighty-five percent consented to access of their academic records. Similar proportions of local and international students experienced symptoms of a depression or anxiety disorder, however international students were less aware of and less likely to access available health services both inside and external to the university. We also reported on the prevalence of: general lifestyle factors (diet, exercise, amount of daily sleep); risk-taking behaviours (including alcohol, tobacco and other drug use; unprotected sexual activity); psychosocial stressors (financial, intimate partner violence, discrimination, academic stressors, acculturative stress); subjects failed; resilience; social supports; social media use; and health services accessed online.ConclusionsThis rigorous and comprehensive examination of the health status of local and international students in an Australian university student population establishes the prevalence of mental health issues and other psychosocial determinants of health and wellbeing, along with academic performance. This study will inform a university-wide student wellbeing framework to guide health and wellbeing promotion and is a baseline for a 12-month follow-up of the cohort in 2020 during the COVID-19 pandemic.

Background/Aim: The COVID-19 pandemic has had a significant negative impact globally, causing prolonged stress, isolation, and health and mental health challenges. International students in Canada were particularly vulnerable due to being far from home, facing language barriers, lacking support networks, and dealing with academic and financial stress, which led to increased mental health issues and reduced well-being for this group. This current study examined the effects of belongingness on well-being of international students in Canada during pandemic COVID-19. The aim of this quantitative study was to: (a) examine the relationships among belonging, perceived stress, acculturation stress, and well-being. (b) explore the potential moderating effect of perceived stress and acculturation stress on the relationship between feelings of belonging and well-being. Materials and Methods: 186 international students were recruited in the universities in Canada to complete the online informed consent form, and the online questionnaires, including the World Health Organization Five, the Satisfaction with Life Scale, the General Belongingness Scale, the UCLA Loneliness Scale, the Perceived Stress Scale, the Acculturative Stress Scale and the demographic information. Participants took about 40 minutes and were given either one bonus mark or $10 Amazon gift card. Results: Correlational analyses revealed that well-being was positively correlated with belonging, with acceptance belonging, and significantly negatively associated with rejection belonging, loneliness, perceived stress, and acculturation stress. Belonging and acceptance belonging positively predicted well-being. A mediational model indicated that perceived and acculturation stress mediate the link between belongingness and psychological well-being. Conclusions: The findings revealed that belonging is a positive predictor to well-being and highlight the need for prevention efforts to help international students reduce loneliness, perceived stress and acculturation stress, and increase acceptance belonging which could improve life satisfaction and well-being of international students in Canada during COVID-19.

BackgroundThere are growing concerns about the mental health of university students in Australia and internationally, with universities, governments and other stakeholders actively developing new policies and practices. Previous research suggests that many students experience poor mental health while at university, and that the risk may be heightened for international students. Mental health-related knowledge, attitudes and behaviours are modifiable determinants of mental health and thus suitable targets for intervention. This study assessed the mental health-related knowledge, stigmatising attitudes, helping behaviours, and self-reported experiences of mental health problems in the student population of a large multi-campus Australian university, and conducted a comparative assessment of international and domestic students.MethodsParticipants were 883 international and 2,852 domestic students (overall response rate 7.1%) who completed an anonymous voluntary online survey that was sent to all enrolled students in July 2019 (n = ~ 52,341). Various measures of mental health-related knowledge, attitudes and helping behaviours were assessed. A comparative analysis of international and domestic students was conducted, including adjustment for age and sex.ResultsOverall, there was evidence of improvements in mental health-related knowledge, attitudes and behaviours relative to previous studies, including higher depression recognition, intentions to seek help, and reported help-seeking behaviour. Comparative analysis indicated that international students scored predominantly lower on a range of indicators (e.g., depression recognition, awareness of evidence-based forms of help); however, differences were narrower difference between the two groups compared to what has been reported previously. Finally, some indicators were more favourable among international students, such as higher help-seeking intentions, and lower prevalence of self-reported mental health problems compared to domestic students.ConclusionThough there were some important differences between domestic and international students in this study, differences were narrower than observed in previous studies. Study findings are informing the on-going implementation and refinement of this university’s student mental health strategy, and may be used to inform evolving policy and practice in the university sector.

Migration for educational purposes has become a defining feature of global higher education systems, with several universities in the global north, including the United Kingdom (UK), accounting for millions of students who migrate across borders to pursue academic qualifications and broaden their opportunities. However, there is a rising concern among these students that they are at risk of mental health issues due to migration-related causes. Therefore, this study aimed to systematically review the literature on the mental health and well-being of international students in the United Kingdom. A literature search was conducted using eleven databases - APA Psyc Articles, ASSIA, APA, Psycinfo, CINAHL, MEDLINE, PubMed, Scopus, British Nursing Index, AMED, Google Scholar, Web of Science - for articles published from 2010. A pre-determined set of eligibility criteria was used to screen articles, and eligible articles were quality appraised using the JBI critical appraisal check tool. Due to considerable heterogeneity, the data was narratively analysed, considering statistical significance and the text narratives. Four studies (N = 4) met the inclusion criteria. Five Major factors were found contributing to mental health outcomes in international students included cultural adjustment, language barriers, support, social networks and stigma. The study showed that international students in the UK experience mental health issues and poor well-being linked to migration. Thus, universities need to recognise the causes and make efforts to support international students better.

A representative sample of undergraduate and postgraduate international students at a large Australian university (n=979, 64% females) completed a mail-back survey of their health and wellbeing. Most students evaluated their current and previous physical and mental health positively. Health-related risk practices such as unprotected sexual activity, drug use, smoking and gambling, were reported by few students. There was little change in health or risk behaviours since coming to Australia and few changes that were health compromising. Few demographic or situational variables, including age and gender, had a significant impact on students' wellbeing. This study has revealed that few international students find the experience of studying in an overseas country detrimental to their wellbeing. Nevertheless, for those students who encounter difficulties or are at increased risk of health-compromising outcomes, we must ensure better delivery of health promotion education, and access to, and use of, available counselling and health services.

While universities closed, implementing remote teaching and learning in response to COVID-19, this change significantly impacted the lives of graduate students, given their exposure to unique and diverse experiences. It thus has become essential to understand the possible differences in regard to the pandemic's impact on international and domestic students. The aim of this study was to explore the consequences of the challenges posed by COVID-19 on doctoral students' wellbeing in Russia. The study surveyed 4454 doctoral students across 249 Russian public universities. The challenges posed by COVID-19 negatively affected international doctoral students' learning experience (β= -0.269, p<0.001); students' satisfaction with supervision (β= -0.098, p<0.001); dissertation experience (β= -0.039, p<0.001); and doctoral program satisfaction (β= -0.034, p<0.001). Furthermore, the challenges posed by COVID-19 affected domestic doctoral students' learning experience (β=-0.368, p<0.001); students' satisfaction with supervision (β=-0.194, p<0.001) and doctoral program satisfaction (β=-0.034, p<0.001). However, the influence of the challenges posed by COVID-19 on communication frequency was relatively positive for both international (β=0.060, p<0.001) and domestic students (β=0.021, p<0.001), and dissertation experience (β=0.061, p<0.001) was also positive for only domestic students. Furthermore, controlled factors comprising field of study (β=-0.033, p<0.001); year of study (β=0.127, p<0.001); and university region (β=-0.056, p<0.001) influenced the effect of the challenges posed by COVID-19 on international doctoral students. The COVID-19 challenges had the greatest impact on the wellbeing of international students. Furthermore, both international and domestic students' communication frequency with their supervisors underwent a relatively positive impact (which implies no effect on both categories of students). Furthermore, the challenges posed by COVID-19 had no effect on domestic students' dissertation experiences. Finally, among the controlled variables, field of study, year of study, and university region were discovered to be significant factors in relation to the challenges posed by COVID-19 for international students.

Political developments play a central role in shaping international education experiences, and the mental health of international students. This chapter systematically explores how political developments in home and host nations often influence international student experiences in ways which affect students’ well-being; while also considering the role of economic changes and technological advancements, from a psychological perspective. Specifically, Pacheco discusses how twenty-first-century geopolitics, technological advancements, and economic trends can act as manipulators of international student stress across three specific domains: transitional stress (i.e. adjustment, rejection), social stress (i.e. support networks, identity) and life stress (i.e. financial, familial, emotional distress). The dynamics of geopolitics in home and host environments are also explored, as each context may present unique challenges and barriers to the positive mental health of international students. Drawing attention to the well-established knowledge concerning international student well-being, and highlighting a lack of knowledge where the experiences of individuals sojourning from regions experiencing political conflict are concerned, Pacheco ultimately argues it is necessary to consider the impact both macro level and micro level political shifts have on international students’ mental health, as this population is dually susceptible to stress but is often overlooked. As context to this argument, this chapter also places a special emphasis on the Middle East and North Africa (MENA) region, as this region not only harbours the fast-growing outwardly mobile student population but also currently faces the greatest proportion of political unrest.