الفهرس 
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Abstract
Acculturative stress is the term used to describe the psychological distress experienced by international students because of the interaction of internal problems (such as failure, inferiority, uncertainty, perceived discrimination, and mistrust) and external problems (such as communication difficulties, culture shock, the loss of social supports, and different academic expectations) (Behl et al., 2017).
International students frequently face difficulties that are exclusive to the typical college experience. Due to the added stress they feel, a student’s capacity to flourish and integrate into their new host culture can be hindered by these additional stressors outside of the typical academic burden of college, despite the many advantages of attending college abroad (Prempeh et al., 2018).
According to research, the following factors may increase acculturative stress: cultural differences, language barriers, comfortability in accommodation, academic difficulties, perceived discrimination, feeling homesick, and insufficient social support (Amaliyyah, 2021).
In a prior study measuring the level of anxiety and depression among international students in Germany, 26% of participants experienced moderate stress, and 23% experienced severe stress, largely as a result of academic and non-academic stresses (Akhtar et al., 2019).
Egypt has become a perfect choice for international students because of its geographical location, financial aspects, and cultural and religious background to pursue their educational goals.
The proportion of international students has noticeably increased at the Faculty of Medicine at ASU, accounting for almost half of all first-year students enrolled in the 2021 academic year (Office of Student Affairs, Faculty of Medicine, ASU, 2021). There are numerous additional international students in various faculty years. These students came not only from numerous countries, such as South Sudan, Jordan, Syria, Iraq, India, and Nigeria, but also from multiple continents.
This study was conducted to:
1. to measure the prevalence of acculturative stress among first-year international students enrolled at the Faculty of Medicine at ASU.
2. to identify factors associated with acculturative stress among first-year international students enrolled at the Faculty of Medicine at ASU.
A mixed-methods cross-sectional study was conducted in two phases: the qualitative phase on 34 international students (Arabs and non-Arabs) and the quantitative phase on a total of 422 international Arab and non-Arab students (303 and 119, respectively) studying at the Faculty of Medicine, ASU, in the academic year 2021-2022.
Focus group discussions were conducted before using the questionnaire. The aim of the focus group discussions was to assess factors associated with acculturative stress. For the quantitative phase, a self-administered questionnaire composed of 8 sections was used (sociodemographic and characteristic data, comfortability at the accommodation, acculturative stress scale for international students, student adjustment to college tool, English language deficiency tool, Arabic language evaluation tool, academic pressure tool, and level of comfortability in the accommodation).
The qualitative data showed that international students expressed their main concerns about cultural differences, food, and language challenges. The results of the study showed that language proficiency has had an impact on international students in a variety of ways.
The mean age of the study participants was 19.46. Most of the study participants were from Arab countries (71.80%), mostly from Sudan, Palestine, Yemen, and Jordan. While 28.20% of the participants were non-Arabs, mostly from India, Nigeria, and South Sudan. More than half of the participants were male (54.98%), and 45.97% of them have one of their siblings or other relatives who is a physician. Most of the study participants (72.51%) had a friend, or a family member enrolled in the same university or living in Egypt. 74.64% of the study participants were living in rented apartments; only 15.40% were living in ASU dorms. Most of the study participants (67.54%) reported their high school scores as high.
ASSIS mean score was 97.4 ± 21.83. The mean of non-specific concerns in the present study was 26.05, the mean of perceived discrimination subscale was 20.35 ± 6.40, and the mean of homesickness was 14.54 ± 3.55 In terms of levels of acculturative stress, 25.60% of the study participants had a high level of acculturative stress, 47.60% had a moderate level, and 26.80% had a low level of acculturative stress.
The major stressors of acculturative stress among international students at Faculty of Medicine, ASU were determined by calculating and comparing the mean item scores on the subscales of ASSIS. The non-specific concerns, homesickness, and perceived discrimination were the topmost reported stressors among students while guilt and fear were the least reported stressors.
This study showed that international students were suffering from high levels of acculturative stress, reaching the warning sign. 71.3% of the study participants were equal to or below the warning sign of acculturative stress (above 109), and 28.7% were above the warning sign. International students who scored in the ASSIS above the warning sign were mostly female (35.3%) and non-Arab students (37.8%). It is also expected that students, who had no friend or family member enrolled in the same university or living in Egypt scored in the ASSIS above the warning sign (37.1%).
There was a difference in the levels of acculturative stress among international students and in the factors associated with it. The results of this study showed that female international students and non-Arab students are more susceptible to acculturative stress. There was a statistically significant association between student adjustment to college, comfortability of living in the accommodation place, language deficiency, academic adjustment scores, and acculturative stress warning signs.
Another important finding was that 25.60% of the study participants had a high level of acculturative stress, 47.60% had a moderate level, and 26.80% had a low level of acculturative stress. It was observed that about half of the participants experienced a moderate level of acculturative stress, which is a cause for concern.
Qualitative and quantitative results in this study demonstrated that, generally, nonspecific concerns were the most reported source of acculturative stress among international students in the study setting. Thus, the sources of most distress are related to language and cultural barriers, these nonspecific concerns include: (a) level of proficiency with the host country’s language, (b) insecurities about participating in social activities, and (c) concerns about other people’s perceptions of their culture and/or ethnicity.
Country of origin has also been found to be related to international students’ perceptions of acculturative stress. Non-Arab students experienced a high level of acculturative stress, a higher level of perceived discrimination, a higher level of perceived hate, and a higher level of fear compared to Arab students.
The less the student’s adjustment to faculty, the comfortability of living in the accommodation place, the English language proficiency, and the academic adjustment, the more the acculturative stress. There was a statistically significant difference between these scores and the acculturative stress warning sign, p value ≤ 0.001. This also accords with the results that students who got low scores in the previously mentioned scores were the ones with an acculturative stress level above the warning sign.
Qualitative findings record a significant concern of international students on comfortability in the accommodation place. The most stressful aspect is the difference in the food choices between their original countries and the host country.
The language problem is different among Arab and non-Arab students. Nearly all the non-Arab students do not speak Arabic at all, and their native language is not English as well. After reviewing the admission criteria at the faculty, these international students joined the college without passing any language test. This is considered part of the problem while investigating the reasons for higher-level acculturative stress among them.
In the current study, one of the biggest academic challenges affecting the academic transition of international students is language competency. International students frequently find it difficult to participate in class discussions due to their difficulty understanding lectures and lack of confidence in a second language. International students with lower academic adjustment suffered from high levels of acculturative stress.
In this study, a lower score in the student’s adjustment to faculty tool was associated with a high level of acculturative stress, indicating that the student’s adaptation to faculty is crucial to managing the process of acculturation. The total student’s adjustment to faculty subscale was associated negatively with the total ASSIS score and most of its subscales: perceived discrimination, homesickness, fear, stress due to change or culture shock, and nonspecific concerns. (p value ≤ 0.001).