
==== Front
Nurs Open
Nurs Open
10.1002/(ISSN)2054-1058
NOP2
Nursing Open
2054-1058
John Wiley and Sons Inc. Hoboken

10.1002/nop2.70030
NOP270030
NOP-2023-Aug-1565.R1
Empirical Research Mixed Methods
Empirical Research Mixed Methods
International students' perspectives on factors impacting psychological well‐being and early help‐seeking behaviours in undergraduate nursing programs
Abdelkader et al.
Abdelkader Amany https://orcid.org/0000-0003-1261-4256
1 a.abdelkader@federation.edu.au

Joseph Bindu https://orcid.org/0000-0002-2872-1892
1
Anish Ligi 1
Kaur Muskandeep 1
Bourke Sharon 2
Hayes Claire https://orcid.org/0000-0003-2908-9304
3
Thong Matthew 3
Plummer Virginia https://orcid.org/0000-0003-3214-6904
1
Jacob Sini 3
1 Institute of Health and Wellbeing, Collaborative Evaluation Research Centre Federation University Australia Ballarat Victoria Australia
2 School of Nursing and Midwifery LaTrobe University Melbourne Victoria Australia
3 Faculty of Medicine, Nursing and Health Sciences Monash University Frankston Victoria Australia
* Correspondence
Amany Abdelkader, Institute of Health and Wellbeing, Collaborative Evaluation Research Centre, Federation University Australia, 72‐100 Clyde Road, Ballarat, VIC, Australia.
Email: a.abdelkader@federation.edu.au

10 9 2024
9 2024
11 9 10.1002/nop2.v11.9 e7003025 2 2024
25 8 2023
28 8 2024
© 2024 The Author(s). Nursing Open published by John Wiley & Sons Ltd.
https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Abstract

Background

Studying in a foreign country can be accompanied by challenges, including difficulty understanding the curriculum, culture shock, and a new language. These additional challenges place international students at risk and predispose them to developing mental health problems compared to domestic student.

Aims

This study explores psychological well‐being and help‐seeking behaviours of international nursing students who commenced their program onshore or in a remote learning capacity.

Materials & Methods

This paper reports the findings of the mixed‐methods study. Research was conducted among international students enrolled in the Bachelor of Nursing programs across multiple campuses at two Victorian universities in 2022. Data was collected using a survey questionnaire with open‐response questions and incorporated a validated Student Stress Survey.

Results

Findings indicated that international students require support financially and to settle in Australia upon arrival. Participants highlighted that they require additional support to keep up with academic workloads and require further academic support tailored for international students. There was no patient or public contribution in the design, conduct, analysis or preparation of this manuscript.

Discussion & Conclusion

Participants highlighted that they require additional support to keep up with academic workloads and require further academic support tailored for international students. There was no patient or public contribution in the design, conduct, analysis or preparation of this manuscript.

Australia
help seeking behaviours
international student experience
international student wellbeing
mixed‐methods
source-schema-version-number2.0
cover-dateSeptember 2024
details-of-publishers-convertorConverter:WILEY_ML3GV2_TO_JATSPMC version:6.4.8 mode:remove_FC converted:10.09.2024
Abdelkader, A. , Joseph, B. , Anish, L. , Kaur, M. , Bourke, S. , Hayes, C. , Thong, M. , Plummer, V. , & Jacob, S. (2024). International students' perspectives on factors impacting psychological well‐being and early help‐seeking behaviours in undergraduate nursing programs. Nursing Open, 11 , e70030. 10.1002/nop2.70030
==== Body
pmc1 INTRODUCTION

In 2017, Orygen, the National Centre of Excellence in Youth Mental Health released a report, ‘Under the Radar—The mental health of Australian university students to examine the prevalence of mental ill‐health and help‐seeking behaviours in Australian university students (Orygen, 2017). The study confirms that university students’ mental health is an area of concern. The most recent 2021 census data, identified that 1.2 million Australians aged 15 years and over were undertaking some form of tertiary education (Australian Bureau of Statistics, 2022a), equating to 9.7% of the population aged 15 years or above. Evidence also suggests that 27.5% of Australians aged 15–24 years have higher rates of mental or behavioural health conditions (Australian Bureau of Statistics, 2022b).

Research suggests that undergraduate students are at a greater risk of psychological distress than those not studying as this is a period of transition when mental ill‐health is likely to develop (Browne et al., 2017; Kumar, 2011; Kumar, 2019). Factors contributing to this increased risk include academic and financial pressures, isolation and loneliness (Browne et al., 2017), academic performance (Grimmond et al., 2020), family functioning and housing conditions (Hakami, 2018) and food insecurity (Hattangadi et al., 2019). Evidence also highlights the increased incidence of mental ill‐health in undergraduate nursing students (Labrague et al., 2018), most recently exacerbated by the COVID‐19 pandemic (Jardon & Choi, 2022; Kells & Mathis, 2022).

There has been a dramatic increase in international student numbers in Australia over the last 20 years with numbers doubling since 2001 (Universities Australia, 2020). In 2022, international students contributed over $29 billion to Australia's economy (Universities Australia, 2023). The benefits of studying overseas include exposure to a foreign culture, broader educational opportunities compared to their home country in some instances and more career opportunities (Ammigan & Jones, 2018). However, studying in a foreign country can be accompanied by additional challenges, such as difficulty understanding the curriculum, culture shock, and a new language (Ammigan & Jones, 2018).

These additional challenges place international students at a higher risk of vulnerability and predispose them to developing mental health problems compared to domestic students (Forbes‐Mewett & Sawyer, 2011; Orygen, 2017). A large‐scale study conducted across the United States (US), United Kingdom (UK) and Australia demonstrated that international students often avoid counselling services, even though mental health‐related issues are common in this group (Li & Carroll, 2017). The above study also highlighted those students from non‐English speaking homes and backgrounds, particularly, East and Southeast Asian students, tended to be less socially connected in the host country and therefore were more vulnerable to mental health problems such as anxiety and depression, which impacted their studies. This finding is particularly important as data depicts that the majority of international students who arrive in Australia are from China and India, making up 39% of arrivals up to March, 2023 (Department of Education, 2023). Similarly, Aguiniga et al. (2016) found that international students tend to demonstrate low help‐seeking behaviours. Perhaps the underlying reason why international students are hesitant in accessing these services is due to cultural differences as previously reported (Atherton & Cornwall, 2022). However, Atherton and Cornwall (2022) focused on Chinese international students in New Zealand and no such study has been conducted in Australia for comparison. The consequences of poor mental health and well‐being and the lack of confidence for seeking help among international students can be distressing and may impact student retention and success. During the COVID‐19 pandemic, international students who commenced their studies while still overseas were allowed by the Australian Government to enter flexible learning arrangements and continue online or via remote learning for CRICOS‐registered courses (Tertiary Education Quality and Standards Agency, 2022). However, the challenges encountered during the pandemic and how international students were impacted while studying offshore, onshore and online are not explored and understood. Therefore, this study explores the psychological well‐being and help‐seeking behaviours of international nursing students who commenced their program onshore or in a remote learning capacity during the COVID‐19 pandemic.

2 OBJECTIVES

The aim of the study is to explore the mental ill‐health and help‐seeking behaviours of international undergraduate nursing students at two Australian Universities.

Objectives are to identify: The factors impacting psychological health and wellbeing,

Early help‐seeking behaviours of international students enrolled in Bachelor of Nursing (BN) programs.

3 METHODS

3.1 Study design

This study was conducted among the international students enrolled in the BN programs across multiple campuses at two Victorian universities from July 2022 to December 2022. This paper reports the qualitative and quantitative findings of the mixed‐methods study. The quantitative data was collected using a survey questionnaire with open‐response questions designed in Qualtrics™, refer to Appendix SI. The survey collected demographic data and incorporated a modified form of the validated Student Stress Survey evaluated by Mohamed Arip et al. (2015), which included a series of questions relating to particular situations. Participants were asked to indicate which response described their experiences during the semester. Responses included ‘never, somewhat frequent (1–2 days per week), frequent (3–5 days per week), and always’. The Student Stress Survey was slightly modified to exclude a few questions that were not applicable to the research objectives of this study. The Student Stress Survey, containing 30 items demonstrated high reliability (Cronbach's alpha = 0.99). The survey also included a number of open‐response questions. The collection period incorporated 17‐weeks from the commencement of the second semester of 2022 to the day of the release of results in December, 2022, with two reminder emails sent to students inviting them to participate in the survey. The survey was reviewed by all researchers involved with the study with one researcher experienced in survey design and use of the Qualtrics™ platform.

3.2 Sample population and recruitment

International students who were above 18 years of age and enrolled in the undergraduate BN program either on‐shore or off‐shore location at the commencement of semester 1, 2022 were included in the study. All other students were excluded from the study. An email invitation was sent to all students enrolled in the BN at both universities by the Program Support and International Student Advisory service. Advertisements were placed around campuses on Learning Management System (Moodle™) pages and advertised by the international coordinators at international student information sessions. The email and advertisement included a link to the plain language information statement and a QR code linking to the Qualtrics survey. Consent was implied by the participants clicking on the link and undertaking the survey. Participation in the study was voluntary and it was made clear that participants could withdraw at any time without discrimination or prejudice.

3.3 Data analysis

Descriptive analysis was used to describe the study population and background demographics and expressed in percentages. Thematic analysis was conducted by four researchers to identify, analyse and report emerging themes from the data from the open questions (Braun & Clarke, 2021).

4 RESULTS

4.1 Demographics

The survey was conducted across all campuses of two Australian Universities (total five campuses) using Qualtrics™ software and was open to students for one semester. Across both universities, a total of 59 responses were received, and three responses were automatically excluded from completing the questionnaire on the basis of age selection criteria (< 18 years of age). The majority of responses were received from students in the age group of 18–23 years, 78.6% (n = 44). Students enrolled in the first year accounted for nearly 48% (n = 25) of the total participants. Female students made up the majority of the sample group, 73.6% (n = 39). Out of 18 responses to the question regarding nationality, 44.4% (n = 8) students classified India as their home country followed by Hong Kong (n = 2). Thirty‐three (62.3%) students reported being onshore at the commencement of semester 1, 2022. Twenty‐seven students reported already having social connections such as friends or family in Australia before arrival. A total of 21 responses were gained for English language proficiency with the majority of students (n = 16) reporting fluent knowledge of the English language. Between both universities, 87% (n = 47) of students reported being aware of the campus support services however only 37 students reported utilizing the services. Twenty‐seven of these students reported positive experiences from the university‐organized peer mentorship programs.

Participants were asked about the resources available to them that were already aware of upon commencement of their program. A word cloud has been used to demonstrate how often participants reported particular service or resources (Figure 1). Participants identified the International student support services as the most known upon commencement, followed by counselling and mental health services. Academic support services such as those offered by the library, the learning skills advisors and the student academic support unit featured prominently in participant responses.

FIGURE 1 Word cloud highlighting resources participants were aware of (Created by https://wordart.com 09/02/2023).

4.2 Themes emerged from the open‐response questions

4.2.1 Services participants thought would be of benefit to them

When participants were asked what other services/resources would be of benefit to them, the majority (56%) responded that in their opinion, they would have benefited from receiving assistance with their transition to university in Australia. International students' responses to transitioning to Australian universities appeared to be more related to their needs to initially settle and cope, especially with academic workload, seeking help, and financial insecurities. Four main areas for assistance were identified: Help‐seeking, Support, Career options and Workload.

4.2.2 Help seeking

Although many participants (P) were aware that there were supports available for international students, some of them were hesitant to utilize available services:“Coming to a new country and settling down is quite a challenge, we know about all the resources available, but still are hesitant to access these services…” [P10]

Another participant stated that being shy made it difficult to socialize:“I am a shy person so it was really hard to socialise with other students especially domestic students as it was a little bit intimidating at first…” [P5]

4.2.3 Support

There were a number of services identified by students that would have been of support for them. Participants reported that additional community support was required to familiarize themselves with services that could help with settling in the country including: transport, medical and mobile services. For example, a participant stated:“General information on opening bank accounts, finding a mobile service provider, how the public transport system works etc., MyGov and IHI number1 and ATO [Australian Taxation Office] links. If information was available in one webpage [and/or] document then it would have made figuring these out much easier.”[P16]

Need for peer support and social groups were also reported to help and guide international students in understanding Australian academic requirements which may have been different to their home country.“A group of seniors who can tell us in layman's language about how the study goes and how is the environment. What all to study and how to study.”[P11]

However, there were some participants who also responded that they failed to use the available peer mentorship program but suggested having dedicated international student clubs or mentoring programs would have been beneficial.“I did not use the peer mentorship program to help transition to University. In my opinion, a dedicated nursing club or an international student nursing club should also be formed…who can guide them really well.” [P13]

“International students to be mentored to settle well in Australia…“[P6]

An additional orientation day for international students was also identified in the response.“An extra day of orientation specific for international students…” [P8]

4.2.4 Career options

Some participants reported that assistance with finding part‐time jobs would have been valuable for them. They indicated that guidance and need for information on finding jobs post degree also would be helpful which might have been challenging for many international students.“…guidance/info regarding part‐time job opportunities…” [P8]

Concerns about getting jobs post‐degree was also noticed in the responses and participants expressed requiring more advice and support.“Getting job after finishing the degree is hard part for international students and some advice on that will be helpful…” [P32]

“I want someone from university to help second year student's particularly for career options available to them after degree completion…” [P4]

4.2.5 Workload

There was an increased level of workload and anxiety reported by study participants as they reported that work‐life balance was affected due to the intensity of studying.“…I'm doing BN and I have 3 weeks of classes. I didn't sign up for this. I didn't know that my classes would be for 3 weeks. It is too much information at once.” [P3]

“5 days of class, trying to work and catch up with life, It's been really hard.” [P3]

Participants were provided opportunities for further feedback or comments based on their experience of transitioning to university in Australia. Four main themes emerged were: Academic workload requirements, Disappointment/dissatisfaction, Perceived discrimination and Financial stressors.

4.2.5.1 Students' perception of academic workload requirements

Participants reported the impacts of worrying about assessment deadlines which significantly affected their mental health. They felt stressed and anxious and experienced sleeplessness especially when there were a few submission dates close together:“…feel stressed, anxious, and lack of sleep, which is impacting on my mental ability, I get panic attacks when the date for assessments start coming nearby…” [P31]

“The organization needs to understand our condition as international students. It's difficult to cope with so many assignment deadlines in a little time.” [P26]

Study participants responses regarding academic expectation and requirement for study differ from what is delivered in the nursing program. The participants expected all content to be taught/covered in classrooms and seemed to underestimate the importance of prior preparation.“Teachers should teach the study material in the class and not jump to discussion first…The subjects like pathophysiology, nursing practice needs to be taught in class. But the teachers just discuss the questions. How will a student answer the question by not understanding any theoretical information.” [P24]

Participants also indicated the effect on their mental health and that more support should be given by the university with regards to mental health.“Importance to mental health should be given, university gets overwhelming sometimes, there should enough time in between assignments, so that we don't lose interest in course and assignment doesn't just become a task for us.” [P27]

4.2.5.2 Disappointment/dissatisfaction with support services

Some participants were disappointed with some of the services which were available and felt that supports promised were not accessible.“At the beginning of my first semester, we had orientation from school, …about how they care for and support students…but all these are empty promises…” [P19]

“…International students are being treated as garbage, despite all the heavy tuition they pay every semester…” [P19]

Participants stated that they appeared unclear about what resources were available specifically for academic support, suggesting more support was required in this regard. Lack of peer support was also experienced by some which left them feeling lonely.“I just got confused on what to study like books, articles and all. I need a peer support, but I don't have any friend, who can study with me and sometimes I feel less supportive and alone. On the top of these things I am from LGBTQ community, which also puts me in doubt of being alone forever.” [P28]

4.2.5.3 Perceived discrimination

Study participants felt discriminated against and perceived that they were not treated fairly by some lecturers and made assumptions that it could be rather from a prejudice intent.“…I personally feel that a few of the lecturers are being grumpy towards all international students, I don't know why this happens, felt that they are generalising international students based on any of their bad experiences with any international students.” [P18]

Despite participants identifying that they were paying higher tuition fees than domestic students, they described less satisfaction with their preparation for clinical placement. The responses demonstrated stress and anxiety related to failing clinical placement rather than accomplishing a great clinical experience.“I have been…paying 3 times more fees than domestic students, …on top of these we are experiencing this discrimination from lecturers, placement settings (preceptors). We literally had a very few practical sessions in academics and we see placements as an opportunity to practice…but preceptors are treating us like we are having ages of experience, they are giving us too much stress and pressure. Every day we go to placement stressing about getting failed rather than expecting a great clinical exposure…” [P23]

4.2.5.4 Financial stressors

Participants reported that financial strains were a major factor for their perceived stress and anxiety as they struggled to meet academic requirements while also working:“International students are paying almost thrice amount of fees compared to the domestic students for the same course, this injustice and exploitation causes stress and frustration in students and they struggle to meet the academic requirements and fee requirements simultaneously.”[P25]

The stress and consequences of failing a course were also highlighted:“…I have received a MF [marginal fail] in one of my subject…and told me to do that subject again. I am not struggling from mental stress due to this but also financial stress…I am very dissatisfied with this.” [P21]

Participants expressed disappointment over lack of support when experienced with financial difficulty:“I had financial problems…I applied for payment plan and requested as I was having personal financial difficulty due to unexpected payment plan. It's very hard to survive being an international. I feel like staff are here to fail us instead of helping.” [P20]

“…We can be financially, emotionally stressed. It would be great if student is getting help from university and need not to worry a lot about other things rather than studies.” [P22]

4.3 Student stress survey outcomes

Based on the Student Stress Survey (Mohamed Arip et al., 2015) participants were asked to identify how often, throughout the semester, they experienced certain situations relating to Physical Factors, Interpersonal Relationships, Environmental Factors and Academic Factors. Responses included, never, somewhat frequent (1–2 times per week), frequent (3–5 times per week) and always.

4.3.1 Physical factors

Of the physical factors (Table 1), constant tiredness/fatigue were experienced 1–2 times per week in 44.4% of participants, associated with 36.4% of participants stating that they experienced sleep problems somewhat frequently also. Headaches were experienced somewhat frequently by 32.6% of participants and 31.1% of participants experienced excessive worrying all the time. While stomach pain/nausea, sweating/sweaty hands and drastic weight loss were not experienced by a majority of participants (57.8%, 55.6% and 66.7% respectively).

TABLE 1 Participant experiences to situations relating to physical factors (N = 44‐46).

Situation	Never frequency (%, n)	Somewhat frequent (1–2 times per week) frequency (%, n)	Frequent (3–5 times per week) frequency (%, n)	Always frequency (%, n)	
Headaches (frequency)	34.78%	32.61%	26.09%	6.52%	
16	15	12	3	
Sleep problems	29.55%	36.36%	25%	9.09%	
13	16	11	4	
Excessive worrying	11.11%	31.11%	26.67%	31.11%	
5	14	12	14	
Stomach pain/nausea	57.78%	35.56%	2.22%	4.44%	
26	16	1	2	
Constant tiredness/fatigue	15.56%	44.44%	31.11%	8.89%	
7	20	14	4	
Sweating/sweaty hands	55.56%	17.78%	22.22%	4.44%	
25	8	10	2	
Drastic weight loss	66.67%	28.89%	4.44%	0%	
30	13	2	0	

4.3.2 Interpersonal relationships

Interpersonal relationships examined how the participants perceived their relationship with family, friends and lecturers/teachers. It is clear that the majority of participants believe that family, friends and lecturers/teachers are supportive and care about them (Table 2). When it comes to family, feelings of guilt play a major role with almost 80% of participants stating that this is how they felt greater than 1–2 days per week.

TABLE 2 Participant experiences to situations relating to interpersonal relationships (N = 44).

Situation	Never frequency (%, n)	Somewhat frequent (1–2 times per week) frequency (%, n)	Frequent (3–5 times per week) frequency (%, n)	Always frequency (%, n)	
I find it difficult to meet my parent's high expectations	36.64%	31.82%	20.45%	9.09%	
17	14	9	4	
My parents treat me as a helpless person	88.64%	6.82%	4.55%	0%	
39	3	2	0	
I feel guilty if I fail to fulfil my parent's hopes	20.45%	31.82%	18.18%	29.55%	
9	14	8	13	
My parents only wish me every success	9.09%	22.73%	18.18%	50%	
4	10	8	22	
I find it difficult to get along with group mates in doing academic tasks	40.91%	50%	2.27%	6.82%	
18	22	1	3	
My friends do not care about me	65.91%	18.18%	6.82%	9.09%	
29	8	3	4	
My family is not supportive	86.36%	9.09%	0%	4.55%	
38	4	0	2	
My lecturers/teachers are not supportive	54.55%	29.55%	6.82%	9.09%	
24	13	3	4	
I feel frustrated by the lack of faculty management and support	45.45%	31.82%	13.64%	9.09%	
20	14	6	4	

4.3.3 Environmental factors

This section of the student stress survey pertained to the living conditions and transportation experienced by the participants (Table 3). Most participants reported not having any issues with transportation (41.9%) or feeling stressed about their living conditions (55.8%), feeling insecure (51.2%) or surrounding noise (62.8%). On campus, 67.4% of participants did not feel that the facilities were inadequate.

TABLE 3 Participant experiences to situations relating to environmental factors (N = 43).

Situation	Never frequency (%, n)	Somewhat frequent (1–2 times per week) frequency (%, n)	Frequent (3–5 times per week) frequency (%, n)	Always frequency (%, n)	
I have transportation problems	41.86%	23.26%	23.26%	11.63%	
18	10	10	5	
I feel stressed about bad living conditions	55.81%	20.93%	11.63%	11.63%	
24	9	5	5	
Surrounding noise distracts me	62.79%	16.28%	13.95%	6.98%	
27	7	6	3	
I feel frustrated of inadequate campus facilities	67.44%	13.95%	4.65%	13.95%	
29	6	2	6	
I feel scared being in an insecure place	51.16%	25.58%	9.3%	13.95%	
22	11	4	6	

4.3.4 Academic factors

When asked about academic factors, the participants identified their real source of stress and anxiety (Table 4). Financial problems because of university expenses were experienced all the time by 30.2% of participants, followed by frequently (3–5 times per week) by 27.9% and 25.6% somewhat frequently (1–2 times per week). Not surprisingly, as submission deadlines and examinations encroach, 44.2% and 42.1% of participants respectively think about this every day. Greater than 83% of participants reported feeling the burden of academic workloads and expectations and perhaps related, greater than 90% of participants found it difficult to juggle time between study and society involvement. However, given the stress and anxiety with academic factors, 46.5% of participants reported not losing interest in their courses.

TABLE 4 Participant experiences to situations relating to academic factors (N = 43).

Situation	Never frequency (%, n)	Somewhat frequent (1–2 times per week) frequency (%, n)	Frequent (3–5 times per week) frequency (%, n)	Always frequency (%, n)	
I have financial problems because of university expenses	16.28%	25.58%	27.91%	30.23%	
7	11	12	13	
I find it difficult to juggle time between study and social activities	11.63%	37.21%	25.58%	25.58%	
5	16	11	11	
I feel stressed as submission deadlines near	9.30%	30.23%	16.28%	44.19%	
4	13	7	19	
I feel stressed sitting examinations	13.16%	34.21%	10.53%	42.11%	
5	13	4	16	
I find it difficult to juggle time between study and society involvement	9.30%	37.21%	18.60%	34.88%	
4	16	8	15	
I lose interest in my courses	46.51%	37.21%	6.98%	9.30%	
20	16	3	4	
I feel the burden of academic workloads/expectations	16.28%	27.91%	25.58%	30.23%	
7	12	11	13	
I feel stressed dealing with difficult subjects	18.60%	32.56%	25.58%	23.26%	
8	14	11	10	
I feel it difficult in handling my academic problem	18.60%	44.19%	20.93%	16.28%	
8	19	9	7	

5 DISCUSSION

Current research indicates that international students studying BN at two Victorian universities require support to initially settle in Australia upon arrival as well as financially. In addition, participants highlighted that they also require additional support to keep up with academic workloads and this also was true for the student stress survey.

The participants of the study identified various factors that contributed to the overall well‐being and predictors of early help‐seeking behaviours using the survey and open‐response answers. One of the main causes of stress identified is ‘academic factors’ along with ‘academic workload’ and ‘difficulty with subject content’. Hussain & Shen (2019) indicated that international students must adapt to the new academic style including course selection, communication with academics, and teaching assessments in the host country and it can often be challenging, also highlighted by Wen et al. (2018). Additionally, Baklashova (2016), conducted a qualitative study on international students in Russia and highlighted academic factors including academic expectations, and communicating with teachers as being an area of major concern. Yuan et al. (2019) also reported that studying under an internationalized curriculum led Chinese students to confusion related to individual, academic workload, and cultural factors. Similarly, a study conducted among 63 African students at Kuban State University, identified that 59.9 % of international students experience significant levels of stress, especially in the first year of their studies (Kamara, 2012).

Again, financial stressors have been portrayed as another factor inducing stress for international students in this study. Other research reports indicated that the financial stress of international students in Australia has significantly increased since COVID‐19 (Morris, 2020). A pre‐covid survey conducted in Sydney and Melbourne, Australia on international students revealed that 36% of students worried about paying weekly rent. Furthermore, in 2020, a survey identified 61% of international students lost their jobs and reported that many (33%) are going hungry to pay the rent (Morris, 2020). Even though the Victorian government dedicated $45 million toward relief payments for international students experiencing hardship, many international students were in desperate situations for a long time (Bagshaw & Hunter, 2020; O'Brian, 2020).

There is no doubt that support from family and friends are important during the period of transition to university (Liu et al., 2019). International students for the most part, move to a new country to undertake study without this support of family. The research demonstrated that participants did feel that they had the support of family, friends, and academic staff during their learning journey, as indicated by the student stress survey component of the questionnaire, on the other hand, the responses to the open‐ended questions revealed that students felt unsupported by universities, especially during the initial settling period of their academic journey. Participants indicated that they felt guilty, perhaps due to the higher tuition fees and the strain this may be placing on their families back in their home country. The increased tuition fees placed additional stress on many participants as highlighted in the current research taking their focus away from their academic work to meet these requirements (Liu et al., 2019).

Throughout the current study, there was no mention of any stress in terms of living conditions or transportation. The student stress survey outcomes demonstrate that participants did not appear to feel stressed about living conditions or have any problems with transportation, inconsistent with previous findings reported by Melaku et al. (2021). However, participants indicated that they felt the campus facilities were inadequate. Participants in the current research stated that they were aware of all the resources available to support them, however, they were “…still hesitant to access these services…” [P10], with some stating that they were shy and lacked confidence in accessing the services. This finding is consistent with that reported in the literature in which international students are unlikely to utilize the services provided by institutions (Yee & Ryan, 2023). Perhaps the underlying reason why international students are hesitant in accessing these services is due to cultural differences as previously reported (Atherton, 2022). However, Atherton and Cornwall (2022) focused on Chinese international students in New Zealand and no such study has been conducted in Australia for comparison.

5.1 Limitations

This study was conducted across two universities, one regional and one metropolitan, and convenience sampling was used, therefore limiting the generalizability of the findings. The authors also acknowledge the small sample size as a limiting factor.

5.2 Conclusion

This study explored the factors impacting psychological health and wellbeing, and early help‐seeking behaviours of international students enrolled in BN programs in two Australian universities using a multi‐method approach. Participants reported that overall, they felt supported by family, friends, and academic staff during their learning journey, as indicated by the student stress survey. However, some responses from the open questions indicated discrimination and lack of support by some academic staff. Although many participants were aware of the resources available, some were hesitant to seek help due to various factors. Findings recommended that international students enrolling in BN programs require further academic support tailored for international students, in order to support them when settling into academic study and life in Australia.

5.3 Recommendations

The findings of this research indicate that international students enrolling in BN programs require further academic support tailored for international students. A mentorship program between current academic staff and new international students in their first year of study is therefore proposed. Similarly, a peer mentorship program between current international students and new international students would also be beneficial. Most of the financial support available is only offered to domestic students and international students are excluded from applying for grants, such as international mobility grants or placement assistance. Therefore, an inclusive approach that include both international and domestic students in grant opportunities should be considered. In addition, grant opportunities specifically for international students should also be considered in university budgets.

AUTHOR CONTRIBUTIONS

All authors contributed to writing this manuscript.

FUNDING INFORMATION

No funding or financial support was received.

CONFLICT OF INTEREST STATEMENT

The authors declare that they have no competing interests.

ETHICS STATEMENT

Low minimum risk human research ethics applications were submitted to the University Human Ethics Committee at both universities and subsequently approved (Project numbers: 2022–050 and 34,484).

Supporting information

Appendix SI.

ACKNOWLEDGEMENTS

We thank all participants for their important contributions. Open access publishing facilitated by Federation University Australia, as part of the Wiley ‐ Federation University Australia agreement via the Council of Australian University Librarians.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

1 MyGov‐Secure online gateway to access government services; IHI Number‐Individual Healthcare Identifier
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