Factors Associated With Quality Of Life In International Medical Students

Introduction:Over the years, the reasons for crossing countries or cultures have evolved fromtrade to seeking refuge from one’s poverty or war-struck country or merely justholidaying. Moving from one’s country to another in pursuit for better education hasalso existed for decades of years. In this paper, the focus shall be particularly onindividuals who have crossed cultures for the latter reason. International students arespecial strata of people who face many challenges of college education and living in aforeign land. For whatever reason individuals choose to study abroad; whether it bebecause of been a recipient of scholarships offered by developed countries in effort toestablish mutual relationships with the under-developed. Others seek better educationopportunities offered outside their countries’ borders and for others it’s merely thedesire to experience the other cultures. The bottom-line is that living outside yourcountry has its challenges and benifitsand this paper looks into the factors that influencethe subjective quality of life among international medical students.Objective:The aim of this study is to evaluate the self-rated quality of life of internationalmedical students and to identify factors that might have associated with self-ratedquality of life. Globally there are few studies on the relationship betweensocio-demographic variables and self-rated quality of life among international students.Furthermore particularly to the setting of the People’s Republic of China (PRC), noresearch could be identified on this subject and hence the purpose of this paper was tobridge that gap. The findings from this paper may not only be applicable to PRC but toother settings as socio-demographic variables studied in this paper such as age, genderand level of study are universal to students regardless of whether they are domestic or international, medical or non-medical. Therefore results from this paper may prove to beuseful in guiding school officials in the establishment and evaluation of programs,activities and services targeting students in general.Methods:Participants in this study were recruited from Dalian Medical University’sInternational College and were invited to fill in a questionnaire on socio-demographicvariables and quality of life; hence the geographical cluster sampling was deployed.Questions on the Quality of life were adapted as they were from the WHOQOL-BREFquestionnaire from World Health Organization. Participation was voluntary andanonymous.Data collected was entered into Statistical Package for Social Science (SPSS)version16template and descriptive tests were run to estimate the distribution ofsocio-demographic factors among the international medical students. ANOVAs, t-testsand Chi-square tests were done to test relationship between variables.Results:Descriptive dataThe sample was composed of n=373international medical students, and there weren=214(57.4%) students with Asian background and n=159(42.6%) with Non-Asianbackground. The sex distribution of the group was males at n=199(53.4%) andfemales at n=174(46.6%). The age of the subjects ranged from17to32years withmode of20and mean age of21(S.D:2.124). The setting in the university, where thestudy was made, was compulsory living within school campus, therefore97.3%of thesubjects lived within school dormitories and only2.7%lived off-campus. As for thenationality of the subjects’ friends, majority of them (83.9%) indicated that most of theirfriends are of international origin too. Only10.7%of the subjects had equal distributionof both domestic and international students.2.1%had most of their friends as ofChinese origin and3.2%reported that they had no friends. Interestingly41.3%of thestudy population expressed that they found it difficult to make friends with Chinese.Language barrier was listed as the top main challenge at33%rate andfood/accommodation followed at11.3%, then teaching/testing style at11%. Culturaldifferences, being homesick, adapting to new subject/course and financial issues wereamong the least challenges at4.8,4,3.8,3.5percentage respectively.Quality of lifeMajority of the students rated their QoL at either ‘good’ or ‘very good’ at50.1% and16.6%respectively. The same pattern was found within the Asian and Non-Asiangroups with major representatives at ‘good’ and ‘very good’ QoL.Domain ScoresThe highest domain score within the study sample was found in the SocialRelationship domain, followed by the Psychological, Environment and Physical healthdomains. Non-Asians had better scores in the Psychological and Social Relationshipdomains than Asian students and it was the other way round in the Physical health andEnvironment domains. Males had better scores in all domains even though the gap wasnot that much. Over-24students and2ndyears had better scores in the Psychologicaldomain than other age groups.Between variables associationOrigin, sex, age and level of study were not statistically related to quality of lifeamong international medical students. There were statistically reliable relationship(P<0.05) between (Physical Domain and origin, age, Level of oral Chinese),(Psychological domain and Availability of close friends),(Social relationship domainand availability of close friends, level of social support, level of oral Chinese) and(Environment domain and origin, communication with family, level of social support).Origin was associated with communication with family, visiting home, level of socialsupport and accepting bodily appearance. Sex was statistically related to BMI,communication with family, satisfaction with health and experiencing negative feelings.Age and level of study had statistical relationship with visiting home and level of socialsupport. Lodging arrangement was statistically associated with level of social support,sleep and having enough money.Discussion:Socio-demographic variables47.2%and48%of the students, who had roommates, shared the same country oforigin and religious beliefs respectively. Interestingly51.5%of the group who sharedwith a roommate also rated their relationship with roommate as either close or veryclose. The possible reasoning behind this observation could be that religion and comingfrom the same country has some effect on the quality or depth of the relationships.Familiar religious background and country of origin provide a platform for easiercommunication because of the shared cultural beliefs, principles, values commonamongst communities and religious groups. Further research would be recommended toexplore this relationship further. Friendships among international medical students were skewed towards fellowinternationals as evidenced by the83.9%coverage. There could many possiblereasoning for this tendency; one of the reasoning could be interpersonal attraction due tosimilar experiences or easier communications amongst the international because of thecommon English language. The other possible contributing factor could be the limitedinteractions between locals and internationals, as they attend classes separately due todifferent medium of instruction. Chinese students are taught in Chinese andinternational students in English. Besides this, other informal or extra-curricularactivities for students are done separately for Chinese and internationals.In the study sample there was not much gap between the two categories of monthlyspending, with ‘under1000CYN’ at48.5%and ‘over1000CYN’ at51.5%. In regardto this variable there was some interesting results as there were49students whosespending was more than2500CYN and within this group the highest amount spent permonth was10000CYN. In the setting of China, these amounts are on the extreme endsbecause food and other commodities within school premises are relatively affordable,with a plate of food costing at least6Yuan. The researcher’s attention was captured bythis peculiar group and hence led to further analysis of these49students. Their qualityof life was in the same line as that of the sample population with majority (n=32) fallingwithin either ‘good’ or ‘very good’. Despite being on the upper end, as far monthlyspending,8out of the49students felt that they didn’t have enough money to meet theirneeds, unfortunately investigations on family’s economic background was not capturedin the questionnaire. Therefore hypothesis could not be made of the relationshipbetween family’s economic background and students’ rate of spending. A hunch couldbe drawn of the possibility of students’ spending money as a coping strategy and furtherresearch is needed to investigate the variables that influence high spending amongstinternational students. Questions like are they using spending as coping strategy need tobe answered.Quality of Life(a) QoL score and analysisThe quality of life for international medical students in this study was generallygood and this was in agreement with other studies. According to Maslow’s theorywhich places people’s needs in kind of a ladder, where one has to meet the basic needsbefore ascending to the higher needs. The highest domain score for the study populationwas in the social relationship, followed closely by the psychological domain; both of these are in the3rdlevel of human needs according to Maslow’s hierarchy of needs.(b) Domain scoresThe highest domain score was in social relationship. Possible contribution to thiscould be high number of students (79.6%) who indicated that they had close friendswithin school premises and having their main friends as fellow international eased thecommunication barrier and hence their social needs are met. Other contributingobservations from the results of this study are the fact that59%of students were sharing,51.5%indicated close/very close relations with roommate and53%were satisfied withtheir personal relationships. All these are in the social realm and hence the high score inthe social domain score.(c) Relation between QoL&factorsQuality of life was statistically associated with relationship with roommate,communication with family and level of oral Chinese. Level of Oral Chinese determineshow an individual is able to be heard and understood in their environment, therefore themore one feels confident to communicate the better that individual will fit in theirenvironment and hence their quality of life is affected positively. Forming morerelationships with the local enhances an international’s quality of life and in the settingof China, due to the fact that majority of the local people speak only Chinese language,the better one is on the language the better off they are in interacting with locals.The psychological domain was found to be statistically associated with availabilityof close friends. The explanations to these observations could that having close friends,provides an atmosphere of mutual understanding and social belonging which areassociated with mental and psychological well-being. Social relationship wasstatistically associated with availability of close friends, level of social support and levelof oral Chinese. All these variables are in the social realm hence affect the social needsof an individual.In all the domains year1student had the lowest domain scores, despite the findingsof no statistically proven relationship between Level of study and WHOQOL-BREFdomain scores. These could be due to what the cross-cultural shock model calls thebottoming out resulting from cultural maladjustment. The study was done at the end ofthe semester, hence probably the honeymoon stage for year1students had subsided andthey have begun to long for the familiar. Further studies are needed to explain thisphenomenon further. Conclusion:The principal goal of this cross-sectional study was to identify factors that areassociated with subjective QoL status in the international medical undergraduatestudents in the context of China. The findings despite being limited in the scope ofcausal relations or explorative features provided some baseline data for universitieshosting international students and for educators. It may assist in the design ofintervention programs that target international students and bettering their lives asinternationals. Fostering of supportive campus environment may assist internationalstudents to forge strong connections with domestic students. Organizing extra-curricularactivities that involve both domestic and international students, especially in the casewhereby there is limited interaction between the two in classroom settings could assistin the formation of relationships between the two groups of students. Orientationscourses for new students which include cultural issues, basic communication skills andaccepted social norms may prove to be helpful in filling in the gaps betweenexpectations and experiences of international students. Sharing students of the sameorigin and religious affiliations could foster better relationships amongst students andhence affect their QoL positively.Further researches on other factors besides socio-demographic variables need to beexplored in order find out the other contributing factors to the good self-rated QoLamong international medical students in China. Factors like personality traits, copingstrategies etc need to be explored.