Health Survey for Foreign Students in the United States

Introduction

One of the important factors that affect higher education in the United States is the rapid increase in the international student population. This growth has led to an interest in studies on socialization, academic performance, and health outcomes of foreign students studying in the US. According to the definition of the Institute of International Education [IIE] (2016), an international student is “anyone studying in the US on a non-immigrant, temporary visa that allows for academic coursework.” There is a general consensus in the academic literature that foreign students studying in the US face specific cultural, social, mental, and psychological challenges.

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Center for Mental Health in Schools at UCLA (2013), Yeoh, Le, and Doan (2013), Telbis, Helgeson, and Kingsbury (2014), as well as Wu, Garza, and Guzman (2015) agree that a significant number of foreign students experience culture shock, lack of social support, frustration and even hostility towards the host country, as well as negative mental health implications, and problems with physical and psychological health.

Therefore, the questions arise about how international students can integrate into the American social and educational environment and whether their physical, psychological, social, and spiritual needs are adequately met. Hence, there is a need to conduct research that would provide an insight into dynamics and factors that affect the health and wellbeing of international students in the US.

The aim of the current paper is to develop and use a health survey to gather and analyze the information about the state of health and health outcomes of foreign students studying in the US, determine whether their health needs are adequately met, identify barriers to maintaining their physical, mental, social, and spiritual health and recommend measures that can be taken to ensure positive health outcomes among foreign students. The following section contains the background of the survey topic, epidemiological data about target populations, and rationale behind the need to investigate issues pertaining to the mental, social, physical, and spiritual health of foreign students.

Epidemiological Data

The population of international students in the US is rapidly growing. Since the late 1940s, the US has received more international students than any other host country (IIE, 2016). For example, while there were 690 and 720 thousand foreign students studying in the US in 2010 and 2011 respectively (Wu et al., 2015), in 2015, there were nearly 975 thousand foreign students studying in the US (IIE, 2016). Students from China comprise 30 percent of all international students studying in the US public and private higher education institutions. India, South Korea, Saudi Arabia, and Canada account for 13.6, 6.5, 6.1, and 2.8 percent of foreign students respectively. Nearly 60 percent of all foreign students come from China and the five aforementioned countries (IIE, 2016).

Other countries that generate a significant inflow of international students to the US include Brazil, Taiwan, Japan, Vietnam, Turkey, and Mexico (Wu et al., 2015). In total, foreign students comprise nearly five percent of all the student population in the US (IIE, 2016). Therefore, there is a diverse and significant range of foreign students receiving education in the US higher education institutions. Taking into consideration a significant number of foreign students in the US, their mental, social, physical, and spiritual health can be considered a valid public health concern. Therefore, there is a need to study determinants and distribution of health-related events to control diseases and other health problems among international students.

Health Issues of International Students

There is a wide range of health issues arising during international students’ stay in the US, spanning across all the major health domains and including physical, mental, social, and spiritual issues. For the purpose of this paper, there is a need to define what physical, mental, social, and spiritual health domains include in the context of the current study.

Physical. Physical health includes such components as physical activity, nutrition, and diet, any form of substance abuse, access to health care, as well as rest and sleep. Therefore, the health survey should include targeted questions that would help to identify barriers that international students encounter in maintaining physical health. For example, in regard to physical activity, the survey will seek to determine whether foreign students:

  • (a) have opportunities to engage in regular physical exercises and leisure physical activity;
  • (b) have access to a well-balanced diet;
  • (c) are exposed to alcohol and substance abuse;
  • (d) get sufficient rest and sleep;
  • (e) have access to health care services.

Mental. Mental health includes psychological and emotional well-being and determines how a student can handle stress, make decisions, and interact with others. A survey should seek to identify whether foreign students are faced with racism and prejudice that result in stress, depression, anxiety, and other mental health problems or are subject to other influences that negatively affect their thinking, mood, and behavior.

The survey will seek to find out whether pulling away from familiar people and usual activities – something that all foreign students experience when going abroad - can provoke mental health symptoms in students. Additionally, since weak physical health (substance abuse, eating or sleeping too little or too much) is related to mental health, which can impair one’s social health, relevant physical health factors should be addressed as well.

Social. Social health includes the student’s ability to develop and maintain satisfactory interpersonal relationships with others. Social health implies the ability to respond adequately to different situations, react appropriately to the actions of others, and adapt comfortably to different social settings. Additionally, the domain of social health includes establishing a sense of identity, maintaining an adequate level of self-esteem, possessing strong communication skills, and the ability to make friends, build social networks, and reach out to people of different ethnicity.

Factors that can impair foreign students’ social life include poor physical and mental health, poor communicative skills, and personal characteristics such as being selfish, vindictive, or withdrawn. Therefore, a survey should address the aforementioned issues to evaluate students’ social health.

Spiritual. Aspects of spiritual health that a survey should address include easiness or difficulty of maintaining the religious identity and practicing one’s religion. A person maintaining strong spiritual health is more like to deal with life situations in a positive manner or demonstrate greater resilience. Reading spiritual literature, prayer and meditation are among the most commonly met spiritual practices. Hence, the survey should address these issues.

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Literature Review

This part reviews the existing research pertaining to the issue of health among international students. It includes the most recent findings of the health of international students and factors that impact their well-being.

Han, Han, Luo, Jacobs, and Jean-Baptiste (2013) conducted a mental health survey among 130 Chinese international students at Yale University. The authors reported the following findings.

  1. First, 45 and 29 percent of students reported symptoms of depression and anxiety respectively.
  2. Second, 27 percent of students were not aware that counseling and mental health services were available on campus.
  3. Third, higher rates of anxiety and depression symptoms were associated with the lack of regular physical activity, poor relationship with one’s advisor, and poor perceived health outcomes.

Han et al. (2013) reached the conclusion that the mental health of Chinese international students can be improved by enhancing accessibility and increasing the awareness of students regarding counseling and mental health services and making an effort to improve relationships between students and their advisors.

Lee (2014) states that upon arrival in a new country, most international students experience a culture shock and go through the adjustment process. The author explains that compared to domestic students, foreign students encounter such specific challenges as homesickness, unfamiliar educational system, separation from the loved ones, discrimination, acculturative stress, and language barrier. As a result, they frequently experience feelings of sadness, confusion, insecurity, and frustration.

Lee (2014) notes that current literature provides very limited recommendations for foreign students in terms of overcoming their difficulties. The author believes that international students can better adjust to the realities of a host country by focusing on three areas such as developing social relationships, overcoming the language barrier, and pursuing ways to adjust to the local culture.

Moloney-Egnatios, Mielke, Trinh, and Young (2014) state that the needs of international students require higher education institutions to provide quality support services and initiatives to support the international student population. The authors conducted studies to assess the needs of international students in the US and Netherlands and provided recommendations on developing community integration strategies for foreign students. Moloney-Egnatios et al. (2014) reported the following findings.

  1. First, effective integration of international students involves networking with the local community and other domestic and international students, building a life outside of one’s student role, having a dedicated contact person to provide support after arriving at a host country, training faculty to facilitate the integration of foreign students, organizing events where international and domestic students can socialize, and providing on-going psychological support.
  2. Second, personal connections and one-to-one interactions are considered highly important at all stages of students’ lives.
  3. Finally, practicing welcome committee programs that would welcome new students and show how to do basic things, such as finding grocery shops and good food, arranging insurance, and opening bank accounts, was found effective.

Wu et al. (2015) conducted a qualitative study to investigate the challenges that international students face in the US in terms of their adjustment to college and a new socio-cultural setting. The authors found that foreign students experience academic, social, and cultural barriers. For example, in the academic setting, international students are not always able to reach their full potential due to the language barrier, different expectations from professors, and cultural differences. Social barriers that foreign students experience include loneliness and social isolation, awkwardness in social interactions, and difficulties with making friends with domestic students.

Some of the cultural barriers to integrating international students into local social life include culture shock, discrimination, prejudice, and marginalization in classes and social events (Wu et al., 2015). The authors recommended several adjustment strategies to help international students to adapt to a new academic and social setting. These strategies include the utilization of college resources such as service centers and counseling services for international students, involving them in campus activities, providing language support, and using students’ organizations to provide foreign students with an opportunity to understand and adjust to the US culture and improve their language and communicative skills.

Therefore, as the literature review has demonstrated, international students encounter specific challenges and barriers to maintaining healthy mental and social life. Hence, it is important for colleges, faculty, and student organizations to reach out to international students and help them to adjust to the new culture and academic setting. However, the review demonstrates that literature on barriers to staying physically and spiritually healthy by international students is scarce.

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Methodology

This chapter describes the chosen research methodology – survey, and the data collection procedure. The chosen research methodology in the form of a semi-structured survey for generating data is suitable for the needs of the research and identifying barriers that the international students in the US face as they strive to maintain their mental, physical, social, and spiritual health. In the current study, the sample group size of twenty-five foreign students can be considered adequate for conducting a study on the research topic. Study participants are going to be selected on the basis of the following criteria:

  • (a) international students studying in the US;
  • (b) awareness of the study purpose;
  • (c) interest to participate in the research;
  • (d) agreement to complete the survey.

The study participants will be friends and acquaintances who have agreed to fill in the survey. All the sample group members will be informed about the nature of the study and measures to maintain confidentiality. When study participants complete their surveys, generated responses will be systematized and analyzed to examine the barriers that foreign students encounter as they strive to maintain good health.

 

The following are the research questions this study will seek to answer:

  1. Are the health needs of international students adequately met in the US?
  2. What are the barriers that foreign students encounter as they strive to maintain their physical, mental, social, and spiritual health?
  3. What measures and initiatives can be taken to ensure better health outcomes among foreign students studying in the US?

In the current study, the independent variable is the status of a foreign student studying in the US. The dependent variables include students’ physical, social, mental, and spiritual health. The aforementioned dependent variables have been selected since they encompass all the major domains of international students’ health and allow evaluating their health outcomes fully and adequately.

The survey was developed on the basis of sample surveys and by referring to questions in surveys and interviews available in previously conducted studies (including those reviewed in the Literature Review section) by Moloney-Egnatios et al. (2014), Han et al. (2013), Talebloo and Baki (2013), Telbis et al. (2014), and Wu et al. (2015). The survey questions were developed and grouped to evoke responses that would help to answer research questions and generate sufficient information to analyze all four dependent variables (physical, mental, social, and spiritual health).

Addressing the Competencies

In order to maximize benefits that can be derived from conducting a survey, its questions will be formulated in a way that would help to address the following four competencies: social determinants of health, diversity and social justice, program planning and design, and community assessment.

Social Determinants of Health

The survey will seek to determine the impact of social determinants of health, such as social inclusion/exclusion, housing, access to healthy food products, socio-economic status, participation in orientation programs and enhancement activities conducted by higher educational institutions-recipients of international students, length of stay in the host country, previous experience of living abroad, and availability of internship and employment opportunities, among other factors. The survey questions will be formulated in a way that evokes responses providing an insight into the role of the aforementioned determinants in the lives of international students.

Other specific social determinants (related to international students’ health outcomes) addressed in the survey include community and social context students are living in, as well as access to healthcare, socio-economic conditions (social support, availability of resources, social environment), and attitudes and social norms (prejudice, discrimination, racism, presumed bias) within the communities and campuses where foreign students reside and study.

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Diversity and Social Justice

The principles of social justice and respect for diversity will be adhered to by targeting a broad pool of international students of different countries of origin and ethnic groups. For instance, in order to make a sample group of study participants more representative, the invitation to participate in the survey will be provided to all international students, making the opportunity to participate equally available to all foreign students regardless of their ethnicity, citizenship, socioeconomic status, and year of enrollment. Tapping into a wider base of students will allow generalizing the study findings to a wider base of international students.

The survey will investigate whether current dynamics that affect the health of foreign students are governed by the principles of social justice. For example, according to John Rawls’ theory of social justice, the social order or society can be considered just when resources are distributed fairly and the needs and interests of all, including minorities, are given equal consideration (John, 2014). Therefore, the survey will ask targeted questions to find out whether the principles of fairness and equality are equally maintained when addressing the health needs of domestic and foreign students.

Program Planning and Design

The survey will be divided into different parts by themes. For example, there will be groups of questions about housing, participation in orientation programs, etc. to collect responses on specific topics pertinent to the health needs of foreign students. As a means for generating data, the survey will be structured in a way that facilitates data collection across all four targeted health domains: physical, social, cultural, and spiritual. Survey findings will be used to propose measures and develop recommendations for more successful and effective integration of international students into the host country in terms of preserving their health and achieving positive health outcomes.

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Community Assessment

The survey will seek to determine how much impact the communities where international students reside have on these students’ health. For example, communities will be assessed according to several aspects.

  1. First, the survey will seek to determine whether higher education institutions offer orientation programs, counseling, and other services that may affect the health of foreign students.
  2. Second, the survey will ask questions to find out whether there are student organizations on campuses that offer activities that may affect students’ wellbeing.
  3. Third, the survey will ask whether higher education institutions offer socialization-focused enhancement activities that may affect students’ health.
  4. Finally, the survey will assess whether there are racial bias and discrimination within the communities in which international students study.
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