Acculturation and health behaviors among international students: A qualitative approach

Health-Related Behaviours of Foreign Students Studying in Poland and Their Determinants: A Mixed-Methods Study

Educational migration benefits students and receiving countries, but universities are challenged to meet a variety of needs, such as cultural adaptation and changes in health behaviours such as dietary habits. This study aimed to assess the health-related behaviours, encompassing dietary/eating habits, among international students in Poland, while also elucidating the factors influencing these behaviours. The study consisted of two phases: (phase 1) cross-sectional research among 231 foreign students using the Fantastic Lifestyle Questionnaire (FLQ); and (phase 2) focus group interviews with 15 international students. The study was conducted in accordance with STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) and COREQ (COnsolidated criteria for REporting Qualitative research) Checklists. It was shown that the respondents highly value health. Students' health-related behaviours are related to their financial situation, health condition, self-assessment of their lifestyle, the importance attached to being healthy, and their country of origin. The qualitative analysis allowed us to identify (1) the barriers related to the exhibiting of health-related behaviours, (2) expectations of foreign students regarding the exhibiting of health-related behaviours, (3) changes in the health-related behaviours, and (4) factors facilitating the exhibiting of health-related behaviours. There is a need for inter-university cooperation on a strategy to promote health-promoting behaviours of foreign students studying in Poland.

International tertiary education students experienced difficulties in dietary transitions in Australia: A qualitative study

ISSUE ADDRESSED

More attention to the diet and nutritional status of international students in Australian universities is indicated. This qualitative research aimed to provide an in-depth understanding of dietary changes among international students after they arrived in Australia.

METHODS

Semi-structured interviews were conducted with international students from China and India who were studying at a large urban Australian university. An approach of interpretative phenomenological analysis was employed for coding and data analysis.

RESULTS

A total of 14 interviews were included. International students were able to consume more international foods, dairy products and animal proteins in Australia as a result of increased exposure to a larger variety of these foods compared with their home countries. However, they experienced some difficulties in eating vegetables and authentic traditional foods due to limited availability and higher prices in Australia. It was challenging for these students to live independently and cook for themselves for the first time and with a limited food budget and time, but many students improved their cooking skills over time. Less frequent main meals with more snacking sessions were reported. Weight fluctuations were commonly experienced and craving for traditional foods no longer accessible may negatively impact mental health.

CONCLUSIONS

International students adapted to the Australian food environment but believed the food choices available did not meet their food preferences or perhaps nutritional requirements.

SO WHAT

Some intervention from universities and/or government may be needed to ease the barriers to consumption of affordable and desirable meals in a time-saving manner for international students.

Health behavior changes associated with weight gain among first-year international students studying at an American university

Objectives: To characterize the health behaviors and outcomes of first-year international students (FYIS) studying in the U.S. Participants and methods: Three different cohorts of FYIS from a large midwestern university in the U.S. completed three laboratory visits between August and March. The study began in 2017 and ended in March 2020. Anthropometrics, acculturative stress, eating behaviors, sleep, physical activity, and eating habits were assessed. Results: Fifty-four students completed the study. Females had a significant increase in percent body fat (p = .036) and a decrease in sleep quality (p = .006) at the final visit vs. baseline, and uncontrolled (p = .006) and emotional (p < .001) eating behaviors were higher. FYIS who gained more than the median 1.2 kg over the study period experienced higher acculturative stress (p = .004) and a decline in sleep quality (p = .003). Conclusion: Reducing acculturative stress and improving sleep quality should be explored as interventions to protect against undesirable changes in adiposity among FYIS.

Differences in Overweight or Obesity, Changes in Dietary Habits after Studying Abroad and Sleep Quality by Acculturative Degree among Asian Foreign Students: A Cross Sectional Pilot Study

The number of foreign students is increasing worldwide, and they suffer from acculturation to different environments or cultures. This pilot study examined the difference in overweight or obesity, changes in dietary habits after studying abroad and sleep quality according to acculturative degree among 225 Asian foreign students in South Korea. Most subjects (61.8%) experienced a low acculturative degree. The change in dietary habits after studying abroad showed a significant difference according to the acculturative degree (p < 0.001); however, there were no differences observed in sleep quality (p = 0.090) and prevalence of overweight or obesity according to acculturative degree (p = 0.101). Interestingly, a difference in the risk for being overweight or obese by sleep quality after being stratified into groups according to acculturative degree was observed. Among the groups with a low acculturative degree, subjects reporting poor sleep quality had a 2.875-fold (95% CI = 1.167−7.080) higher risk of being overweight or obese than those reporting good sleep quality. However, the risk of being overweight or obese was not different among the high acculturative group regardless of their sleep quality. The results showed that the degree of acculturation could influence the risk of being overweight or obese according to sleep quality among Asian foreign students.

The Relationship Between International Students' Health Perceptions and Their Healthy Lifestyle Behaviors

This study was carried out to examine the relationship between international students' health perceptions and their healthy lifestyle behaviors. This descriptive and relational study was conducted with 216 international students studying at a university in Turkey. Study data were collected using the descriptive information form, the Perception of Health Scale (PHS) and the Health-Promoting Lifestyle Profile II (HPLP-II). Data were evaluated using descriptive statistics and Pearson correlation analysis. It was determined that the health perception and healthy lifestyle behaviors of the international students involved in this study were moderately positive. The study found a weak and positive relationship between PHS and the physical activity, nutrition and stress management subdimensions of HPLP, while a moderate positive relationship was identified between PHS and the spiritual growth and interpersonal relations subdimensions of HPLP. No relationship was observed between PHS and the health responsibility subdimension of HPLP. The fact that students have a positive perception of health reflects positively on their healthy lifestyle behaviors. It is important to disseminate education programs aimed at improving the health perception and healthy lifestyle behaviors of international students within the university.

Regular Taekwondo Training Affects Mood State and Sociality but Not Cognitive Function among International Students in South Korea

We aimed to investigate the effect of Taekwondo training on physical fitness, mood, sociality, and cognitive function among international students in South Korea. We randomly assigned 24 international students to a control group (CG, n = 12) and experimental group (EG, n = 12). The EG performed Taekwondo training for 16 weeks, while the CG did not train. Each participant underwent a physical fitness test and sociability questionnaire before and after the intervention. We also examined changes in mood state and cognitive function, using the Korean version of the Profile of Mood State-Brief (K-POMS-B), and the Stroop Color and Word test, respectively. Regarding the physical fitness variables, sit-and-reach records in the EG significantly increased after intervention (p < 0.05). In the sub-variable of K-POMS-B, Vigor-Activity scores significantly increased (p < 0.05) after intervention, while the Fatigue-Inertia scores significantly decreased in the EG (p < 0.05). Furthermore, in the EG, peer relationship scores, a sub-variable of sociability, significantly decreased after intervention (p < 0.05). These findings suggest that Taekwondo training can not only improve flexibility among physical fitness factors, but can also be effective in improving the mood state and sociality of international students.

Food access, dietary acculturation, and food insecurity among international tertiary education students: A scoping review

The number of international students within tertiary education facilities continues to increase globally, but the challenges for this population in achieving a healthy diet in an unfamiliar environment receives insufficient attention. This scoping review aimed to synthesize current literature that investigated dietary changes and food security status of this student population. We followed a five-stage methodological framework developed by Arksey and O'Malley. Six electronic databases were searched. All types of research methods, including qualitative, quantitative, and mixed methods, were considered for inclusion. This review included 30 articles reporting dietary changes and 12 articles reporting food insecurity in international students. The students were able to explore novel foods in their host country without totally abandoning their original diet, thus developing a hybrid diet. Dietary habits oscillated between the new and traditional dietary cultures with many students consuming foods from their new food environment but less so in the long term. Changes in diet may contribute to weight change and some negative health impacts, but none of the included studies investigated the effects on academic performance. Additionally, international students appeared to be more vulnerable to food insecurity, but the contributing factors and impacts of this issue were insufficiently researched. International students often experienced dietary acculturation and faced more challenges in food security than their domestic peers. More specific support should be provided by tertiary institutions and governments to international students including regular culturally appropriate nutrition education programs.

Assessment of Dietary Acculturation in East Asian Populations: A Scoping Review

East Asian immigrants face multiple challenges upon arrival in their destination country, including an increased risk of future diabetes and cardiovascular disease development. The adoption of food and eating patterns of their host country (i.e., dietary acculturation) may contribute to this increased disease risk. To effectively examine the dietary acculturation-disease risk relationship in East Asian immigrants, sensitive tools are necessary; however, there has been no systematic review of the methods used to assess dietary acculturation in this population. A systematic scoping review of the literature was undertaken to address this gap. A systematic search was conducted in December 2019 and returned a total of 6140 papers. Manuscripts were screened independently by 2 reviewers, resulting in the final inclusion of 30 papers reporting on 27 studies. Robust measures of dietary acculturation were lacking, with only 6 studies using validated tools. Most studies used self-reported cross-sectional surveys to determine how the individual's diet had changed since immigrating, with responses provided on Likert scales. Only 3 quantitative longitudinal studies used prospective measures of diet change, through serial food-frequency questionnaires. Qualitative studies explored dietary acculturation and factors influencing change in diet through semi-structured interviews and focus groups.  This review found there is no consensus in the literature on how to most effectively measure the magnitude and process of dietary acculturation in East Asian populations. There is a need for robust, longitudinal, and mixed-method study designs to address the lack of evidence and develop more comprehensive tools measuring dietary acculturation. Improving the assessment methods used to measure dietary acculturation is critical in helping to monitor the impact of interventions or policies aimed at reducing diet-related disease risk in East Asian immigrant populations.

Lifestyle Practices, Satisfaction with Life and the Level of Perceived Stress of Polish and Foreign Medical Students Studying in Poland

The adaptation of foreign students to a new country can be complicated due to different cultural values, language barriers and the way university courses are structured. The aim of the study was to analyze the lifestyle practices, satisfaction with life and the level of perceived stress of Polish and foreign students studying various medical disciplines in Poland with regard to chosen sociodemographic characteristics. The study included 231 foreign and 213 Polish students (n = 444) taking different medical disciplines at the medical university in eastern Poland. Three research tools were used: Fantastic Lifestyle Questionnaire (FLQ), Satisfaction with Life Scale (SWLS), Perceived Stress Scale (PSS-10). Additionally, students' sociodemographic data was collected. Two-factor analysis of variance (ANOVA) was performed and correlations between variables were also examined. Our research indicated that Polish students obtained higher results in FLQ than foreign students. It also demonstrated a significantly higher level of stress among Polish students in comparison to foreign students. The self-assessment of their health condition, lifestyle, and rank associated to being healthy correlated with FLQ, SWLS and PSS-10. The present research can aid the development of support programs for foreign students so that the cultural adaptation processes would more positively influence their lifestyle and an education environment.

Knowledge, Attitude and Practices (KAP) towards Diet and Health among International Students in Dublin: A Cross-Sectional Study

International students may have difficulties in dietary acculturation. This study aimed to evaluate the knowledge, attitude and practices (KAP) of diet and health during the acculturation of international students. A cross-sectional survey was conducted among a convenience sample of 473 international students in Dublin. Knowledge, attitude and practices towards diet and health were evaluated by a questionnaire with open- and closed-ended questions. It was found that 45.3% of participants had a broad concept of a healthy diet, while few knew its specific contents. Furthermore, 75.3% of participants could explain the term functional food, and among them, 62.1% knew the appropriate definition of functional food. Participants who perceived their health very good and excellent were more likely to believe that their health status was determined by their own control. The consumption rate of functional food varied among regions and South and Central America students had the highest usage rate (44.5%) and Asian students had the highest daily usage rate (52.7%). Participants who were younger, single, from African and South and Central American countries, or who were in Ireland for less than one year were more likely to report dietary change after immigration. In conclusion, insufficient knowledge and self-perception towards diet and health as well as unhealthily dietary changes exist among international students living in Dublin.

Eating habits and dietary acculturation effects among international college students in the United States

Although the United States rates as the top host country for international students in the world, the impact of dietary acculturation on their health status is poorly understood. This study used a qualitative approach to gain an in-depth understanding of the factors related to dietary acculturation among international students in U.S. universities. Ten focus groups, of which eight were in two Midwestern U.S. universities and two in a Southern U.S. university (n = 44), were studied. Participants were international, college-aged students enrolled in U.S. universities. Grounded theory method was used for data analysis to develop themes relevant to dietary changes and factors related to dietary acculturation based on the participants' perspectives and experiences. The results showed that most of the participants faced various dietary challenges and health consequences in the United States. Access to food, religious orientation, time constraints, campus environment, and healthcare access were the main factors influencing student diets. A majority of the students reported weight gain due to eating larger portions, unstructured mealtimes, and frequent snacking. Some students reported that they do not eat fruits and vegetables in the United States because they believe that these foods are not fresh, genetically modified, and may contain pesticides. The majority of participants reported taking unprescribed dietary supplements since moving to the United States. Students who transitioned to the typical American diet reported weight gain, increased fatigue, abdominal discomfort, and other health consequences. Universities should seek to develop policies and programs aimed to reduce the impact of acculturation in order to improve the experience of international students in the United States.

Acculturation and health behaviors among older Chinese immigrants in the United States: A qualitative descriptive study

Older immigrants tend to experience rapid deterioration in health after immigration. Changes in health behaviors over the course of acculturation are considered attributable factors. However, much remains unknown when it comes to acculturation experiences and health behaviors among older immigrants. This study explored acculturation in three domains (behavioral, cognitive, and identificational) and described how each domain of acculturation could influence various health behaviors among community-dwelling older Chinese immigrants in the United States. In this qualitative descriptive study, trained bilingual interviewers conducted in-depth individual interviews with 24 participants in the greater Los Angeles area. Acculturation experiences emerged from qualitative content analysis, such as high dependence on Chinese behavioral patterns and intraethnic networks and limited intergroup interactions (behavioral acculturation), strong maintenance of Chinese cultural values and some American cultural learning (cognitive acculturation), and strong identification with Chinese ethnicity (identificational acculturation). Behavioral acculturation and cognitive acculturation may influence various health behaviors, including eating/diet, exercise, chronic disease, and mental health management. By recognizing the unique acculturation experiences, interventions could be developed to promote healthy behaviors in achieving optimal health in this population.

Acculturative stress and binge drinking among international students in the United States: Resilience and vulnerability approaches

Objective: While international students frequently face behavioral health risks due to the stress of adjusting to new cultures, many demonstrate effective coping skills that minimize negative outcomes. The current study tested the mediating effects of resilience and mental health on the relationship between acculturative stress and binge drinking. Participants: International students (N = 322) in the United States. Methods: A cross-sectional design using both online and paper-based survey was implemented. Structural equation modeling was conducted to test the hypothesized mediation model. Results: The results showed good model fit, with resilience mediating the relationship between acculturative stress and binge drinking in the conceptual model. Conclusions: Behavioral health problems and needs of international students are prevalent themes in social work practice; this study, therefore, has practical implications for U.S. colleges and universities as they make decisions about programs and services.

The moderating role of acculturation mode on the relationship between depressive symptoms and health-related quality of life among international students in Korea

We examined the moderating role of acculturation mode on the relationship between depressive symptoms and health-related quality of life (HRQoL) in international students. This cross-sectional study enrolled a convenience sample of 147 international students at a university in Korea. Participants' overall HRQoL was moderate (mean = 57.2 of 80). The main and interaction effects of depressive symptoms and selected acculturation modes explained 39.9% of the variance in HRQoL. For all acculturation modes except the integration mode, as depressive symptom scores increased, HRQoL decreased. Specifically, at high depressive symptoms levels, participants with the marginalization, separation, and assimilation modes had worse HRQoL than did the integration mode, while HRQoL was similar for all acculturation modes at low depressive symptom levels. These findings suggest that future prospective intervention strategies should be considered for not only depressive symptoms levels, but also for different acculturation modes to enhance HRQoL in this population.

Binge drinking among male medical students in Viet Nam: a qualitative exploration of norms

Alcohol is a commonly used substance among Vietnamese medical students, especially males. Vietnamese male medical students drink more alcohol, report more intentions to binge drink, and experience more alcohol-related problems than females. As medical students' alcohol consumption may influence their attitudes and medical practice relating to alcohol counseling and prevention, research about the cultural and drinking norms underlying the drinking behavior of Vietnamese male medical students is warranted. This study aims to explore the norms underlying drinking behavior of Vietnamese male medical students. A qualitative study including 32 in-depth interviews with Vietnamese male medical students at a medical university. Thematic analysis was used to analyze the data. This study found Vietnamese male medical students considered alcohol consumption as a way to show their masculinity and become accepted by groups. Given these beliefs and adherence to norms, they followed rules to force others to consume more alcohol or be intoxicated in drinking occasions among medical students. This study showed the importance of gender and group norms in influencing Vietnamese male medical students' alcohol consumption. These norms should be considered in future research and interventions addressing alcohol use among this target population.

University Students' Self-Rated Health and Use of Health Services: A Secondary Analysis

BACKGROUND

University students belonging to various ethnic groups have specific health needs that influence their self-rated health and health service use.

PURPOSE

To examine which determinants of health serve as key predictors of self-rated health and health service use in a sample of ethnically diverse undergraduate students.

METHODS

Data were abstracted from the 2012 Maritime Undergraduate Student Sexual Health Services Survey (N = 10,512). Logistic regression was used to explore the predictors of self-rated health and use of university-based health services according to ethnicity.

RESULTS

Social support (Caucasian: odds ratio (OR) = 1.018; 95% confidence interval (CI) [1.008, 1.028]; African: OR = 1.890; 95% CI [1.022, 1.160]; Other: OR = 1.096; 95% CI [1.023, 1.175]), and depression risk (Caucasian: OR = .899; 95% CI [.844, .914]; Indigenous: OR = .904; 95% CI [.844, .969]; Asian: OR = .894; 95% CI [.839, .953]; Multiracial: OR = .892; 95% CI [.812, .980]) were the most frequent predictors of self-rated health across the different ethnic groups; while year of study (Caucasian: OR = 1.855; 95% CI [1.764, 1.952]; African: OR = 2.979; 95% CI [2.068, 4.291]; Indigenous OR = 1.828; 95% CI [1.371, 2.436]; Asian: OR = 1.457; 95% CI [1.818, 1.797]; Middle Eastern: OR = 1.602; 95% CI [1.088, 2.359]; Other: OR = 1.485; 95% CI [1.093, 2.018]; Multiracial: OR = 2.064; 95% CI [1.533, 2.778]) was found to be the most significant predictor of health service use.

CONCLUSION

Findings from this research shed light on the various factors that impact university students belonging to different ethnic groups, their health, and their access to healthcare that addresses their distinct health needs. Nurses can advocate for the development of health promotion and illness prevention strategies that target the needs of the diverse student population.