Health literacy by migration region and gender: association with healthcare perception among students

Health literacy (HL) is the ability to access, understand, evaluate, and apply health information for well-being. However, comparisons between domestic and international students remain limited. This study aims to investigate HL among Japanese and international university students in Japan and explore the factors that influence it. This cross-sectional study used both the English and Japanese versions of the 47-item European Health Literacy Survey Questionnaire (HLS-EU-Q47). Using convenience sampling, a total of 1366 university students across six regions in Japan who provided informed consent participated in this self-administered, online-based survey. Descriptive statistics, t-tests, ANOVA and multiple regression were conducted as appropriate at a 0.05 alpha level using JMP statistical software (version 17.0.0). The results revealed that 60 % and 32 % of participants had inadequate and problematic HL, respectively, indicating that 92 % of all students had limited HL. International students exhibited better HL than Japanese university students (p < 0.0001), a difference that remained after adjusting for sociodemographic and educational factors (β = 3.39, 95 % confidence interval = 2.83 - 3.95, p < 0.0001). The competency of "appraising" within the healthcare domain presented the greatest challenge for international students, whereas "understanding" within the disease prevention domain was most difficult for Japanese students. Furthermore, the results indicated a strong association between HL and sociodemographic factors such as age, level of study, marital status, and religious affiliation. In contrast, health literacy showed an inverse association with economic status, program of study and parental education level. There was an observable trend between improved Japanese language proficiency and improved HL among international students. International students in Japan demonstrated better HL than Japanese university students. Educational institutions must take a more proactive role in fostering HL for all students through general health education and peer-to-peer programs to create a more informed, healthy, and productive student community.

(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.

Background – The World Health Organization has adopted a definition of Health literacy that reflects the health promotion orientation as the cognitive and social skills that determine the motivation and ability of individuals to access understand and use information in ways that promote and maintain good health. Researches had shown that individuals with lower health literacy are more likely to engage in negative health behaviors and college students are prone in the engagement of this risky behavior. These international college students are required to embrace themselves into a new country, which involves a change in their habits, life conditions that may influence their health and lifestyle behaviors. Objective – the aim of this study was to assess the prevalence of functional health literacy and examined its association with health promotion behaviors and to assess whether health literacy contributes, through mediation to socio-demographic characteristic in health promotion behavior. Methods - An on-line cross-sectional survey was conducted in a convenience sample of (N=240) International college students in Taipei aged 18 years and older. The survey included socio-demographic section, Health literacy and health promotion behavior evaluation. Health literacy was measured by self-report instrument using the validate Medical Term Recognition Test (METER) and the health promotion behavior was measured by the Health-Promoting Lifestyles Profile II (HPLP II). Two step Hierarchical multiple regression analysis was used to assess for evidence of mediation. Results- It was found that 43.3 % of participants had functional health literacy level, 40 % and 16.3% had marginal and low health literacy level respectively. The overall health-promoting behavior scores among these students were moderate, indicating an engagement in health promotion behavior. International students scored highest on interpersonal relations but lower on stress management subscales. Bivariate analysis indicated the significant association of gender, language, educational level, ethnicity and income toward health literacy score. Risk of having limitation in health literacy had been found in female, participants with English not as a first language, low educational level, being Asian and Hispanic/Latino, and low income. Male students engaged more in physical activities than did female students. Students with English as their first language reported higher score of psychosocial practice of interpersonal relations. European students presented highest score in nutrition and African students the lowest in this subscale. Students with higher monthly income reported slightly higher score in the overall health promotion behavior. The hierarchical multiple regression analyses indicated that, age, gender, educational level, and language, tended to have direct rather indirect effects through intermediate factor of health literacy on health promotion behavior. Health literacy is a significant predictor to the overall health promoting behavior, and for health responsibility, nutrition and interpersonal relations subscales. Discussion - This study shown the relationship of health literacy and health promotion behavior. These results provide evidence that there is still a proportion of limited health literacy among international college students in Taiwan and health literacy is a significant predictor of health related behavior. The results encourage efforts to monitor health literacy in the young population and evaluate its association with the engagement in health promotion behavior. Keywords: Functional health literacy, health promotion behavior, international college students.

In our previous study, international university students showed a significantly higher dental caries morbidity rate than domestic students. On the other hand, the periodontal health status of international university students has not been clarified yet. In this study, we compared the periodontal health status of international and domestic university students in Japan. We conducted a retrospective review of the clinical data of the university students that visited a dental clinic in the division for health service promotion at a university in Tokyo for screening between April 2017 and March 2019. Bleeding on probing (BOP), calculus deposition and probing pocket depth (PPD) were investigated. The records of 231 university students (79 international and 152 domestic university students) were analyzed; 84.8% of international students were from Asian countries (n = 67). The international university students showed a higher percentage of BOP than domestic students (49.4% and 34.2%, respectively: p < 0.05) and they showed more extensive calculus deposition (calculus grading score [CGS]) than domestic university students (1.68 and 1.43, respectively: p < 0.01), despite no significant difference in PPD. The current study shows that international university students have poorer periodontal health than domestic students in Japan, even though the result might include many uncertainties and possible biases. To prevent severe periodontitis in the future, regular checkups and thorough oral health care are essential for the university students, especially those from foreign countries.

The number of Japan's international students has rapidly increased in the last decade. This study examines the relationship between menstrual abnormalities in cycle and symptoms, stress level, and lifestyle of female international students in Japan across three time periods, namely pre-arrival, difficult, and current time periods. A cross-sectional design was employed, and data were collected through a self-administered questionnaire, including the menstrual distress questionnaire (MDQ), between December 2022 and February 2023. The questionnaire was distributed to 56 female international students from two universities in Japan, and a total of 29 valid responses were collected. We found varying menstrual cycle abnormalities and severity of menstrual symptoms across three time periods, with the difficult period after arrival in Japan displaying the highest symptom severity. Higher stress levels were significantly associated with more severe menstrual symptoms. Lifestyle habits such as alcohol consumption were also linked to menstrual symptoms. The current study emphasizes the importance of providing menstrual education, support, and resources to address international students' unique challenges in managing their menstrual health while studying abroad. By promoting awareness, education, and access to healthcare services, universities may contribute to international students' well-being and academic success.

PurposePrevious research has indicated that university students experienced substantial mental health issues during the global COVID-19 pandemic, but few studies have considered changes relative to pre-pandemic levels across population groups. Hence, the aim of this study was to compare changes in mental health and associated stressors across the pandemic for international and local university students studying in Australia.MethodsIn a cohort of 4407 university students, we assessed depression (Patient Health Questionnaire 2), anxiety (Generalized Anxiety Disorder-2), social support (Medical Outcomes Study—Social Support Survey), inability to afford food, fear of partner, and experiences of discrimination, both pre-pandemic (April–May 2019) and during the pandemic (September–October 2020). Change in prevalence between local and international students were estimated with logistic regression, adjusting for baseline factors.ResultsCompared to local students, international students experienced an increase in probable major depression (odds ratio (OR) 1.43, 95% Confidence Interval (CI) 1.23, 1.66), low social support (OR 2.63, 95% CI 2.23, 3.11), inability to afford food (OR 5.21, 95% CI 3.97, 6.83) race-based discrimination (OR 2.21, 95% CI 1.82, 2.68) and fear of partner (OR 3.46, 95% CI 2.26, 5.13). Interaction analyses indicated that these issues were more likely to be experienced by students living outside their country of origin, inclusive of international students based in Australia (depression p value interaction term 0.02).ConclusionThe pandemic had a substantial negative impact on international students, particularly those living outside of their country of origin during the pandemic. The inequalities exacerbated by the pandemic were present prior to the pandemic and are likely to continue post-pandemic without action. Interventions to build the supports for international students need to be urgently explored.

Funding Acknowledgements Icelandic Nurses" Assoc., Landspitali Univ Hosp., Icelandic Reg Dev Instit, Univ of Akureyri, Akureyri Hosp, OnBehalf KRANS Background Sufficient health literacy (HL) is vital for patients to effectively manage their chronic disease. There are indications that around 50% of the public have limited HL, which can lead to difficulties in self-care, such as medication adherence and lifestyle management. In order to develop effective patient education for patients with coronary heart disease (CHD) and support their self-care, more knowledge is needed on their HL. This is one of the first studies on HL in Iceland and the first on HL in the cardiac patient population. Purpose To describe HL and related factors in patients, 6 months after hospital admission for their CHD. Methods Data was collected from patients with questionnaires (in 2018-2019), six months following an acute or elective treatment for their CHD. Patients answered the European Health Literacy Survey Questionnaire- short version (HLS-EU-Q16), a 16 items instruments with scores ranges from zero (low/no HL) to 16 (high HL). A score of 0 to 8 is considered an indicator of "insufficient" HL, a score from 9 to 12 as "limited" health literacy, and a score of 13 or more as "sufficient" HL. Data on educational needs (on 19 CHD related topics), disease-related knowledge (CADE-Q SV), general (mental and physical) health (SF-12V2) and self-care (SC-CHDI) were collected from patients as background data. Results Preliminary data analysis shows that patients (N = 376, mean age 65 (SD 8.9), 80% male, 30% with basic education only) had a mean HL score of 13.7 (SD 2.5). Sufficient HL was observed in 71.7% of patients, limited HL in 24.5% and 3.8% had insufficient HL. Health literacy was inversely associated with educational needs (odds ratio (OR) 0.58 (0.35;0.98). An increase in HL level was associated with an increase in knowledge (OR 1.13 (0.01; 1.26), self-care maintenance (OR 1.03 (1.01; 1.06), self-care confidence (OR 1.03 (1.01; 1.04) and mental health (OR 1.02 (1.01;1.04). Conclusions The health literacy of patients in this study is satisfactory. Their HL is associated with their disease-related knowledge, educational needs, confidence, mental health and self-care maintenance. HL should be assessed when planning patient education for patients with CHD and the education tailored to individual needs.

Sense of security during COVID-19 isolation improved with better health literacy – A cross-sectional study

Individual preparedness for large-scale earthquakes is essential for safety and security in Japan, where earthquakes frequently occur. Foreign residents in Japan face barriers to gathering disaster information, and international students are likely to be more vulnerable to the effects of earthquakes due to the shorter duration of their stay in Japan. However, no studies have been conducted on international students' individual preparedness for large-scale earthquakes in Japan. This study aimed to investigate individual preparedness for large-scale earthquakes among international students in Japan. This cross-sectional study was conducted from May to August 2023 among 360 international students aged ≥20 years enrolled at seven Japanese-language educational institutions in Osaka, Kyoto, and Hyogo prefectures. Of these, 120 (33.3%) agreed to participate in the mail surveys. Students with invalid answers were excluded and 114 (31.7%) were included in the analysis. The information obtained using a self-administered questionnaire included participants' characteristics, methods used to collect information on individual preparedness for large-scale earthquakes (information sources and languages), and individual preparedness for large-scale earthquakes. Many international students had not implemented safety measures at home and lacked information about safety confirmation, evacuation sites and routes, items to wear during evacuation, items to take in case of evacuation, or items to stockpile at home. In particular, approximately half of the participants lacked knowledge about nearby evacuation sites, and only 37.7% had confirmed their evacuation routes to nearby evacuation sites. Only 32.5% had prepared bags containing emergency items to take in case of an evacuation, and most had not packed the items, even though they were stocked at home. In addition, only 8.8% had stockpiled radios and emergency portable toilets at home. It is necessary to promote individual preparedness for large-scale earthquakes among international students in Japan.

Purpose – The purpose of this paper is to analyze the influences of different variables on the dietary adjustment process of international university students. More specifically, the authors investigate how ethnocentrism, perceived risk, and external influences affect their adjustment processes by considering three different temporal stages and exploring adjustment in relation to dietary practices. Design/methodology/approach – After performing an in-depth review of the relevant literature, a structural equation analysis is conducted. This analysis relies on data from a sample of 139 international students enrolled in a Spanish university. Findings – The results reveal that ethnocentrism is significant only in the second stage of the adjustment process. The level of perceived risk decreases during the adjustment process but also depends on the features international students have in common with the host culture; in contrast, external influences are important in all stages. Research limitations/implications – International students should not be treated the same way during different stages of their adjustment. For example, during the first stage, the focus should be on minimizing their perceived risk and guaranteeing a safe environment in which they feel comfortable with buying. The role of the media and the training of salespeople should be highlighted in the second stage of adjustment. Practical implications – The dietary adjustment for this group of short-term migrants is different than other groups, which tend to return to their country of origin. In contrast, international university students try to assimilate the host culture and be part of it. Social implications – In the context of consumption, because international university students are influenced by all constructs detailed in this study, it is necessary to formulate a specific approach for each stage. Originality/value – This research evidences how there is a great opportunity for diverse operators (e.g. universities, food retail chains) to influence the consumption habits of international university students, because they are more receptive than other migrant groups.

Previous research has focused on how students adapt to the host country during study abroad. However, less is known about how these experiences influence students’ social engagement upon returning home. This study explores how Japanese students’ social interactions abroad influence their relationships with international students in Japan after their return. Using a qualitative approach based on grounded theory, semi-structured interviews were conducted with 24 Japanese students who had studied abroad for one academic year. The findings suggest that social interactions abroad facilitate recategorization, a process in which individuals redefine group boundaries and develop a broader shared identity. This process was influenced by four key factors: language and social skills, motivation, opportunities, and perceived fit. Through this process, Japanese students expanded their group boundaries and formed a shared identity with international students in Japan as individuals with study abroad experience. As a result, they developed more positive attitudes toward international students, heightened empathy, and a stronger motivation to engage with and help international students. These findings indicate that recategorization can occur through the formation of a new social identity based on shared experiences rather than direct intergroup contact, highlighting the long-term impact of study abroad on students’ intercultural engagement. This study underscores Japanese students’ tendency to identify with international students in Japan rather than with host nationals upon their return.

Background: The number of international students enrolled in universities in Japan is increasing. To provide better oral care services for international students, we have to understand their oral environment and dental health behaviors. However, few studies have investigated the oral health status of international university students. The object of the present study was to clarify the current oral status of international university students. Methods: The subjects were students who visited the dental department at the University of Tokyo’s Health Services Center between April 2012 and March 2013. Our medical records were reviewed with regard to the following items: attributes (nationality, gender, and age); chief complaint (reason for visit); history of dental treatment; mean number of decayed (D), missing (M) or filled (F) teeth as a single (DMFT) index; degree of calculus deposition; gingival condition; and oral hygiene status. Results: The records of 554 university students (138 international and 416 non-international students) were analyzed; 88.4% of the 138 international students were from Asian countries (n = 122), of which 47.1% were from China and 10.9% from Korea, followed by North America (5.8%), Europe (4.3%), and Africa (1.5%). Although no significant differences were found regarding the history of dental treatment between international and non-international students (49.3% and 48.8%, respectively), international students had a significantly higher dental caries morbidity rate (60.1%) than non-international students (49.0%). The international students showed a significantly higher DMFT value compared with the non-international students: 5.0 and 4.0 per individual, respectively. Severe calculus deposition was observed in international students compared with non-international students (51.9% and 31.7%, respectively). Conclusions: The international university students had poorer oral health status than the non-international students, even though the result might include many uncertainties and possible biases.

Caregiver health literacy (HL) in patients' transition from hospital to home care is an important factor for good results. This cross-sectional study included 89 patient-informal caregiver dyads in Brazil. Data were collected using a sociodemographic questionnaire and the European Health Literacy Survey Questionnaire short-short form. Data were analyzed using descriptive statistics, univariate analyses, and a binary logistic regression model. The caregivers' average age was 48 ± 13.48years, and 73.0% of them were female. It was found that 6.7% of the caregivers had inadequate HL, 61.8% had problematic HL, and 31.4% had sufficient HL. Being a healthcare professional was significantly associated with sufficient HL (P= 0.016). Furthermore, healthcare workers had more years of schooling than other caregivers (15.3 ± 4.6 vs. 11.2 ± 4.6; P= 0.013). For every 1-year increase in caregiver age, there was a decrease of 0.041 points on the European Health Literacy Survey Questionnaire short-short form. Being a healthcare professional, increased HL scores by 11.4%. Key findings showed that caregivers with higher HL were typically younger, male, better educated, and more likely to be healthcare professionals. These caregivers managed patients with lower dependence on daily activities, while those with lower HL, mainly females, cared for patients with higher dependence. The study highlights the need for targeted interventions and public policies to enhance HL among caregivers, particularly to improve outcomes for patients with complex needs.

Commentary: COVID‐19 Pandemic and Higher Education: International Mobility and Students’ Social Protection

Beyond the tip of the iceberg: Health literacy in older people.