International tertiary education students experienced difficulties in dietary transitions in Australia: A qualitative study
Abstract
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.
1 INTRODUCTION
International education has become an essential segment of the tertiary education sector in recent decades globally.1 International students choose to leave their home country to pursue tertiary education degrees in a foreign country.2 In Australia, more than 400,000 international students enrolled in tertiary education institutions in 2020 and almost 60% of these students were from China and India.3 The proportion of international students was higher than 20% across Australian universities in 2019.4 During the COVID-19 pandemic, the number of international students studying onshore decreased due to the temporary closure of the Australian border from early 2020 until 2021.5
People, who migrate to a foreign country with an unfamiliar cultural and social environment, including international students, often experience the process of acculturation which may cause behavioural shifts or acculturative stress.6 Exposure to the new food environment in the host country may include the adoption of the new food culture but some maintenance of the original diet might persist.7 Dietary acculturation has been observed in both immigrants and international students.8, 9 Many negative changes in food consumption and meal patterns were voiced, for example, lower intakes of fruits and vegetables, higher consumption of snacks, and irregular meals.10-14 In contrast, there might also be some positive changes, for example, the adoption of healthy foods by learning from domestic peers.15
The direction and process of dietary acculturation could be affected by many factors. Environmental factors such as food availability, price, quality and convenience substantially contribute to the dietary acculturation of international students.12, 16-20 However, a range of migrant communities in Australia have created a food environment with diverse international cuisines, including Chinese and Indian that helps although accessibility and affordability of these foods may vary in different areas.21 The direction and extent of dietary acculturation may also be affected by individual characteristics and circumstances, such as curiosity about novel foods, time constraints, and skills in preparing traditional or local dishes.8, 22-24
Few studies have investigated the dietary experience of international students studying in Australia and the reasons for their food choices. With a high proportion of international students in the Australian context, it is essential to focus more on the health and nutritional status of these students to improve their overall experience in Australia. Therefore, this qualitative research aims to provide an in-depth understanding of the experiences of international students after they arrive in Australia, and how these factors influence their food decisions and might lead to changes in food habits from those at home.
2 MATERIALS AND METHODS
2.1 Study design
The phenomenological approach is appropriate for exploring lived experiences in a population group facing significant transitions.25 It was employed as the theoretical framework to guide this qualitative research to explore the dietary changes of international students after they translocated to Australia. The consolidated criteria for reporting qualitative research checklist was followed at each stage of this study.26 This study was approved by the Human Research Ethics Committee of The University of Sydney (approval number 2020/006).
2.2 Participants, screening questionnaire and recruitment
Purposive and snowball sampling were used to recruit participants in this study. Eligible participants were aged 18-30 years, current international students from China or India (the two major source countries of international students in Australia), studying in the first or second year of their current tertiary education degree, has stayed in Australia for at least 2 months but no more than 2 years. Dietetic students were not eligible as their food habits might be less representative. Questions regarding the inclusion criteria were included in an online screening questionnaire. Participants were recruited through posting flyers across the campus and online recruitment methods (eg, webpages for recruiting volunteers for research, and social media). Students who were interested in the study could check their eligibility by completing the screening questionnaire and then provide their consent via an online platform, Research Electronic Data Capture. Participants were recruited from a large university with about 70,000 students and 25,500 internationals in Sydney, New South Wales (NSW). Sydney is the economic centre of Australia with more than 5.5 million people. Just as the study began in March 2020, the Australian borders closed as a result of the COVID-19 pandemic and international students were not allowed to enter until December 2021. Hence recruitment continued until April 2022. Each participant who completed the interview received a $20 gift voucher for supermarket groceries to compensate for their time (the amount was not listed in the recruitment advertisement).
2.3 Data collection
Semi-structured interviews were used to collect data. An interview invitation email was sent to each eligible participant who signed the consent, and a maximum of three follow-up emails were sent if there was no response. The duration of the interviews ranged from 50 to 105 minutes. Due to COVID-19 restrictions, all interviews were conducted via Zoom, an online platform for video conferencing. The students were able to choose the most comfortable and convenient places for them to be interviewed by the researcher, one at a time and mostly in their homes. Participants were not known to the interviewer prior to the study. The interview guide was developed by the main researcher and other members of the research group based on the literature review,9 and modified after pilot interviews with four international students and three colleagues in the research group (please see Table 1).
| Sections | Questions | |
|---|---|---|
| Introduction | Demographics (eg, length of stay in Australia, living arrangement in Australia and home country, adequacy of cooking facilities in Australia) | |
| Dietary changes | ||
| Food shopping | When you live in your country, who normally does food shopping in your family? Who normally does food shopping in Australia? Where do you go? How far? How do you get there? How often? What kind of food would you buy in Australia? What do you think of the food that you can buy in those stores, compared to home? Probe for food availability, prices and quality Can you tell me about your criteria when choosing food products? |
|
| Food preparation | Who is mainly responsible for cooking in your family in China/India? In Australia? How often do you prepare your own meals in Australia? Any reasons for the frequency? Have you ever tried/learned cooking before you came here? How did you learn? Would you like to share some dishes you made? What would you say about your skills in cooking before and after living in Australia? |
|
| Meal patterns and eating out | Could you please take me through what you would eat and drink on a typical day in Australia? What about a typical day in China/India? Probe for snacking, beverage intake, weekend variances, meal regularity, food group intakes, eating out experience and eating on campus in both home country and Australia For students staying in Australia more than a year—any changes between your current diet and what you ate when you first arrived in Australia? Any other things you want to add, about the differences in your diet or the food between two countries? |
|
| Factors and impacts | In those changes in eating habits, can you tell me what influences you the most? How do you feel about the changes overall? How did the changes affect you? Probe for weight changes, physical health, mental health and study. |
|
| Food security | Can you always get enough food in Australia? Can you always get the food you want in Australia? Probe for reasons and coping strategies How did it affect you when you did not have enough access? What do you think about the role of the university in supporting students to get the food they want? |
|
The adequacy of the sample size was guided by the concept of ‘information power’ which indicates that the more relevant information held by the sample, the fewer participants are needed.27 Malterud and colleagues suggested that ‘the size of a sample with sufficient information power depends on (a) the aim of the study, (b) sample specificity, (c) use of established theory, (d) quality of dialogue, and (e) analysis strategy’.27 The information power was continuously monitored during the process of data collection. The sampling stopped when the information power was considered adequate for the purpose of this study. All interviews were audio-recorded and transcribed by the main researcher within 48 hours after each interview. Notes were taken during the interviews and transferred to the transcripts after the interviews. Transcripts were returned to the participants for corrections and comments.
2.4 Data analysis
Two researchers (Yumeng Shi and Nematullah Hayba) coded the transcripts independently by using Interpretative Phenomenological Analysis (IPA). Both deductive and inductive coding were applied. The coding tree is shown in Appendix I. To analyse each transcript individually, a four-step approach from Smith et al. was followed: (1) the transcript was read several times to familiarise coders with the contents; (2) detailed exploratory notes and comments, including both descriptive and interpretative levels, were produced; (3) emergent themes were developed by mapping the connections and patterns from the previous notes; (4) interrelationships across emergent themes were explored and discussed by two coders.25 The next stage was to find patterns across participants and reconfigure the themes to represent the group as agreed upon by two coders. NVivo (QSR International) was used to complete the analysis. Disagreements between the two coders were addressed by discussion or consulting a third expert (Margaret Allman-Farinelli).
2.5 Research team
The main researcher was an international Ph.D. student from China, who had studied in Australia for more than 5 years at the time of conducting the interviews. These characteristics and the aim of this research were introduced to the participant at the beginning of each interview. The main researcher is also an Accredited Practising Dietitian, but this was not pointed out to participants to avoid concerns about judgements on their dietary habits when answering questions. She had completed training courses in conducting qualitative research and had previous experience in qualitative data analysis. The other two researchers (one Ph.D. and one Ph.D. candidate) are also dietitians and have previous experience in conducting and publishing nutrition and qualitative research.
3 RESULTS
3.1 Sample characteristics
Of 89 respondents to the online screening questionnaire, 16 of 38 eligible participants provided consent but two students did not respond to the interview invitation email. Therefore, a total of 14 eligible participants were interviewed. The mean (± SD) interview time was 71 (± 14) minutes. The demographic characteristics of each participant are summarised in Table 2. The mean (± SD) age of the sample was 22.4 (± 2.9) years. The sample was predominately female students (n = 11) and evenly distributed between undergraduates and postgraduates. Eight students were from China and six from India. The majority has stayed in Australia for more than 6 months and were living with flatmates or friends in shared accommodations at the time of the interview. Most participants had a weekly food budget within the range of $AU30 to $AU100.
| ID | Age | Gender | Country of origin | Education | Length of stay in Australia | Living status in Australia | Weekly food budget (AUD) |
|---|---|---|---|---|---|---|---|
| 1 | 23 | Female | China | Undergraduate | 3–6 m | Shared accommodation | 31–60 |
| 2 | 20 | Male | China | Undergraduate | > 1 y | On campus | 61–100 |
| 3 | 23 | Female | China | Postgraduate | 7–12 m | Shared accommodation | 61–100 |
| 4 | 27 | Female | India | Postgraduate | > 1 y | Shared accommodation | 31–60 |
| 5 | 27 | Female | India | Postgraduate | > 1 y | Shared accommodation | 31–60 |
| 6 | 19 | Female | India | Undergraduate | 7–12 m | Shared accommodation | 0–30 |
| 7 | 23 | Female | China | Postgraduate | 7–12 m | Shared accommodation | 61–100 |
| 8 | 20 | Male | China | Undergraduate | 7–12 m | Living alone | 61–100 |
| 9 | 19 | Female | India | Undergraduate | 7–12 m | Shared accommodation | 61–100 |
| 10 | 23 | Female | China | Postgraduate | > 1 y | Living alone | 61–100 |
| 11 | 19 | Female | China | Undergraduate | > 1 y | Shared accommodation | 31–60 |
| 12 | 21 | Female | India | Undergraduate | 7–12 m | Shared accommodation | 31–60 |
| 13 | 26 | Female | China | Postgraduate | > 1 y | Shared accommodation | 200 |
| 14 | 24 | Male | India | Postgraduate | < 3 m | Shared accommodation | 31–60 |
- Abbreviation: AUD = Australian dollar.
3.2 Interpretative phenomenological analysis
Six major themes with nine minor themes were revealed by using the IPA. The major themes included: (1) food purchasing and preparation, (2) meal patterns, (3) eating outside the home, (4) changes caused by COVID-19, (5) impacts on health and study, and (6) food security. The international students' views on dietary changes and the influencing factors and impacts are explained in these themes below. Selective quotations of all themes are displayed in Appendix II.
3.3 Food purchasing and preparation
3.3.1 Independence and familiarity
In China, I thought that I had fewer opportunities to choose what kind of things I eat, I didn't think that what kinds of foods I need. However in Australia, I have to do this, I need to make choices and I need to think about the food, so after I'm going to bed, I always think that what kind of foods I eat tomorrow. So I always need to make a schedule about this, but in China, I just go to the canteen and see what kinds of foods are there, or at home I just need to eat what food my parents cooked for me. (Aged 23 years, Female, from China, stayed in Australia for 7-12 months)
Many expressed the transition as challenging. However, the transition became easier as they increased familiarity with local food sources and prices in addition to different cooking methods. Most (10 out of 14) students rarely or never cooked in their home country, but they cooked every day or at least every week in Australia.
3.3.2 Convenience and time constraints
Most participants could go to a large western supermarket within walking distance of their accommodation in Australia to get their main groceries once or twice weekly, and some were able to buy from the supermarket near the campus on their way home; others needed to take public transport. Traditional food groceries were purchased less frequently, perhaps fortnightly or less. Only one student had relatives in Australia, and her cousin was able to visit her with traditional Indian groceries. Chinese students had easier access to their traditional grocery stores compared with Indian students as Indian grocery stores were often further away from where they lived. In contrast, Indian students reported that it was much more convenient to go food shopping in India as they had street vendors selling fresh foods near home.
When choosing food products and cooking methods in Australia, convenience became very important for many participants. They often preferred to have meals that were easy to make, especially during exam periods. Many students purchased more convenience and frozen foods in Australia because they found that more varieties of frozen foods were available in Australia and they mostly relied on fresh foods in their home country. However, some students did not consume frozen options due to their perception it was less fresh and healthfulness was diminished in these products.
Time was one of the main barriers to cooking in Australia among students in our sample. Study and other social events made the time for meal preparation limited. Moreover, the whole process of preparing ingredients, cooking and cleaning took a lot of time. Traditional Chinese and Indian dishes required even longer time to prepare, so they often cooked more than one meal at a time. Limited time availability also contributed to less consumption of vegetables because some students found their perishable nature meant they spoilt before they were cooked and then they avoided buying such vegetables. To save time during exam periods, some students chose simpler and quicker cooking methods (eg, steaming and stir-frying), while some gave up cooking and ordered takeaways or had more ready-to-eat meals (eg, instant noodles) that required minimal preparation such as heating or addition of boiling water.
3.3.3 Food availability and affordability
The price of fresh fruits and vegetables are much higher here. And other traditional things we can't buy here in the nearest supermarket, but we have to go to Indian market to buy them. (In India,) there are supermarkets also and markets, but the food is easily available over there. To cook some Indian dishes that need specific things which we can't find from the supermarket here in Australia. Specifically have to go the Indian stores to buy Indian ones to get them. (27, Female, India, more than a year)
Food prices in Australia were generally perceived as much more expensive than in China and India by considering the currency, but two students thought the prices were similar or cheaper in Australia by comparing food prices with local household income. Vegetables were often criticised as too expensive in Australia, and this prevented their purchase. Milk and meat were considered to be cheaper than in their home country by some students. Healthy and fresh foods were found to be more expensive and to have less chance for discounts than unhealthy and processed foods in Australia. Traditional food products were often costly.
3.3.4 Food quality, taste and nutrition
While some participants prioritised food prices when choosing food products, others prioritised food quality, for example, freshness, taste and nutritional values. Some students noticed a better quality of milk and meat in Australia, especially among Chinese students. Some common (eg, mango) and traditional foods that were available in both Australia and home countries were believed to taste differently according to a few students.
Many of those interviewed started to pay more attention to nutrition when they chose food products and prepared meals after they lived alone in Australia. A few students would read Health Star Ratings (ie, a front-of-pack labelling system in Australia) and the nutritional information panel on foods while in the Australian supermarkets to guide purchasing, and they did not have these habits back home. Some students avoided purchasing yoghurt with high sugar contents, while some switched to self-perceived healthier snack options (eg, popcorn and healthy cookies). In meal preparations, a few Chinese students mentioned that they tried to put less oil and salt to make a lighter taste when they cooked in Australia, and one of them also altered the proportion of food groups in her meals, that is, she tended to have more meat and vegetables but less grains in a meal compared to what she ate in China.
3.3.5 Cooking facilities and skills
Speaking about sharing (the kitchen) and given that I'm not living with someone that I know for such a long time, it's actually quite chaotic sometimes. We find it cook, and we don't usually cook together because food preferences are so different. Most of the time we take turns to cook but because I would like to really try to avoid all of us being stuck in the kitchen at the same time, so I do meal prep, so most of the time I would cook more than a meal and I store in the fridge and then I will just reheat them and it's quick and easy, that's my strategies (laugh). (23, Female, China, 7-12 months)
A minority of students had cooking experience before they came to Australia. Almost all (12 out of 14) participants considered that their cooking skills improved since they lived in Australia. A few would contact their mothers at home for cooking instructions, but this ceased over time. Online recipes, friends and flatmates were major sources for cooking assistance. They learned some Western dishes and cooking methods (eg, potato dishes and how to use the oven) from local friends, and learned other Asian dishes from their Asian flatmates. For those who were able to cook with friends, they enjoyed experimenting with new recipes together. Some students tried baking (eg, pineapple bun) with friends in Australia which was a new experience for them.
3.4 Meal patterns
3.4.1 Main meals
For most breakfast had been varied but in a traditional style and prepared by their parents whether in China or India. However, many people only had coffee or cereal with milk in Australia as they were easy and quick to prepare in the morning.
Lunch and dinner in their home country were also usually traditional styles. A few students mentioned the habit of having a light dinner in their families. The international students might eat lunch and dinner at home or in the canteen on campus, and some students would order online meal deliveries if they were alone at home or at the workplace. In Australia, many students tended to have a simple lunch and a larger dinner that required more preparation. When students went to campus, they purchased some food for lunch or took sandwiches or leftover food with them. They were more willing to cook for dinner, and both traditional (eg, curries with flatbread and stir-fries with rice) and Western dishes (eg, burgers and pasta) were prepared. Some students described a pattern of continuing change in cooking. For example, a female student from China cooked mostly western dishes at first and altered to traditional Chinese styles after a while, and then she began to cook a mixture of both styles.
3.4.2 Meal regularity and snacking
I think mostly the food just I used to eat like three meals back home, but I just eat like two meals now. I feel like at the same time I eat like more and less food like my one meal is more concentrated in quantity, and back home I used to eat like three meals a day, so they were smaller in quantities, I guess that. I feel back home, it used to be more stable and standardised. (19, Female, India, 7-12 months)
Both healthy and unhealthy snacks were reported, such as fruits, yoghurt, chocolate and potato chips. Some people argued that there was less need for snacking in the home country as more options were available for them to choose from at main meals. The reduction in the number of main meals may also be caused by time and financial constraints in Australia. In addition, changes in the timing of meals were noticed by a few students.
3.5 Eating outside the home
3.5.1 Eating out and takeaways
The frequency of dining out and ordering takeaways reduced among international students when they lived in Australia compared with their experience at home and they were able to sample fewer cuisine types. They noticed that eating in restaurants and the delivery cost were significantly more expensive than in China and India, and many of them only had a limited food budget. Having fewer friends in Australia also contributed to the reduction of eating outside the home. Eating out was often considered as a social event with friends, for example, a pizza party to discuss a group task and celebrations. The frequency of eating out appeared to be higher on vacations. A student reported that she ordered more takeaways during exams as she was too stressed to care about cooking.
Asian restaurants and fast foods were the most popular eating out choices among participants. Chinese students were generally satisfied with the taste of foods in Australian restaurants even though some tastes did not perfectly match their personal preferences. The taste of foods at Chinese restaurants in Australia might not be as authentic as in their hometowns but still acceptable. However, most Indian students had a negative impression of Indian and fast-food restaurants. Indian dishes in Australia were too sweet and not spicy enough for them, while pizza and burgers tasted bland compared with what they had in India. Moreover, fewer vegetarian options were available in Australian restaurants, and they did not offer different levels of spicy as in India. Other popular Asian cuisines in Australia, for example, Japanese, Korean and Thai, received more positive comments from these students.
3.5.2 Foods on campus
I think the canteen food in China is much cheaper. Sometimes you can feel full just with less than RMB10 in school canteen, so the price is the first big difference. And also the variety is another big difference. Like the Wentworth building, the restaurant they provide Asian foods, just a few meals I think, but in China, in my school canteen, they have a variety (of choices), that's another difference…I think for the flavouring, the food in Australia is not much spicy as that in China, even if the food said it's spicy. (20, Male, China, 7-12 months)
Some students were able to find a few tasty choices at a reasonable cost on the campus in Sydney, but it was not very enjoyable for them to eat on campus in general (including meals provided by student accommodations) by considering both prices and tastes. Nevertheless, a few students were delighted with the opportunities to have free meals from student events on campus, which was a new experience for them.
3.6 Changes caused by COVID-19
The COVID-19 pandemic had negatively impacted the dietary experience of international students in Australia. Some students experienced difficulties in food shopping during lockdowns, for example, limited stock of rice, they had to take turns to go food shopping so the quantity and food types might not be ideal, and accessibility of Indian groceries declined. Reduced meal regularity and less opportunities for eating out with friends were also reported.
3.7 Impacts on health and study
The overall comments on dietary changes after the arrival in Australia were mixed among our participants. Four students believed that they had a less healthy diet (eg, less vegetable intake, excessive snacks and irregular meals), while two students considered their diet to be healthier as they paid more attention to nutrition while they lived independently in Australia. Five people noticed both less healthy and healthier dietary habits, and others felt about the same or were not sure.
Twelve out of 14 students reported weight changes after they arrived in Australia, including weight gain, weight loss and fluctuations in between. Common reasons for weight gain were more frequent late-night meals and a higher intake of snacks and ready-to-eat meals. Those having less frequent main meals in Australia experienced weight loss as their overall food intake reduced. A few students noticed their weight gain after the first few months and then they tried to lose weight by eating less, substituting unhealthy snacks with healthier ones and exercising.
Some impacts of dietary changes on physical health, sleep, mental health and academic life were reported by our participants. Some reported unusual symptoms like excessive snacking leading to a bleeding nose and throat pain, and oily food causing vomiting. One female student considered that her physical discomforts might be derived from eating less vegetables. Two students reported interactions between their diet and sleep. One student found that she had evening meals earlier than in China so she slept earlier to avoid feeling hungry at night in Australia, and another one was more motivated to have breakfast after a satisfying sleep and she felt more energetic for classes when breakfast was not skipped. The craving and inability to have traditional snacks upset some students. Food had been considered as the daily highlight of one student while in India, but she felt disappointed with her food experience in Australia. On the positive side, living closer to campus was felt to provide more time to cook between and after classes and this was beneficial for studying.
3.8 Food security
In terms of access yes, food is accessible but the price hinders in it. For example, I would get something that is cheaper and more filling over something that is healthier. (19, Female, India, 7-12 months)
Their coping strategies included cutting meal sizes, dividing meals, buying cheaper alternatives or discounted items, making a careful meal plan within budget and getting free or discounted products from food pantries, for example, the food pantry that newly operated on campus during the pandemic. Many of them could not find their preferred foods as they had at home, and some were upset and sad about this issue, while others just accepted it. International students wanted the university food outlets to provide more varieties of foods with more discounts for students and organise more nutrition education to improve both nutrition knowledge and food preparation skills.
4 DISCUSSION
This study provided an in-depth understanding of international students' food experiences after their arrival in Australia. Students from China and India underwent dietary acculturation, and they were able to have both local and familiar home foods in Australia. Managing food budgets and cooking for themselves for the first time was challenging, but many of them improved their cooking skills during their stay in Australia. Time availability for cooking and differences in food availability and prices between their home country and Australia contributed to their dietary changes. Less vegetables and higher protein intake were commonly reported among our international students. Reduced meal regularity and less frequent eating out also occurred. These issues require more attention and interventions from tertiary institutions to assist their international students in having a better dietary experience and being more food secure. Possible intervention points may include education, peer-supported programs to introduce the food supply in Australia and cooking with new ingredients, and subsidised canteens containing international students' preferred foods.
The maintenance of the original diet with the incorporation of elements of the local diet in the host country has been commonly reported by previous studies of international students.22, 28, 29 Lower consumption of vegetables, higher consumption of animal protein products, and changed types of grain foods were found in international students from both this and other studies.11-13, 22, 30-32 In contrast, some studies reported reduced frequency of consuming meat groups in Asian and Arab students in the United States but the portion sizes were not assessed.17, 33 Among our international students, changes in consuming these food groups may largely be influenced by the differences in the food availability and affordability between the host country and their home countries. Similar to our findings, some qualitative research conducted in the United Kingdom and the United States also observed less regular meal patterns and changes in meal timing among international students from Asia and other countries.24, 30, 31 Transitioning from living with parents to independent living and busy study schedules may contribute to these changes from our international students' experiences because meals were no longer prepared for them and they had limited time to manage their meals.
The dietary habits of international students constantly changed during their stay in the host country. Among our participants, some changed their cooking styles over time and some behaved differently after weight gain, such as choosing healthier snacks and having fewer main meals. With longer stay and increased familiarity with the local food environment in addition to accumulated experience in cooking and independent living, it was common for international students to keep adjusting their diet throughout their journey in the host country.15, 29, 34 They may be more interested in having local styles or prefer to move back to their original diets over time to find the most appropriate practice for themselves.29, 34 Compared with the extent of the changes in the first 3 months after arrival, fewer dietary changes might be made at a later stage according to a quantitative study conducted in international students attending a university in England.35
Of personal and social factors that influenced the dietary changes of international students, living independently for the first time was substantial in our sample. They did not need to worry about food in their home country because their parents and canteens could fulfil their food preferences and nutritional needs. To overcome the difficulties in this transition, international students often acquired and enhanced skills in managing time (eg, cooking in bulk) and budget (eg, comparing prices and tastes between brands and looking for discounted items), and preparing meals (eg, learning new recipes with friends), and these strategies were also reported by other international students from previous studies.19, 36 Cooking with friends appeared to be more enjoyable and time-efficient than cooking alone in our and other international students from Asia, and this might be influenced by the collectivistic cultures in Asian countries.19, 37 Students in this study improved their nutrition literacy through self-learning in Australia as it was not their responsibility to think about this issue when living with parents, although the credibility of the online resources they used and the accuracy of their knowledge needs confirmation.38, 39 Nutrition knowledge seemed to be less critical when our students experienced high-stress levels and a shortage of time as they tended to prioritise convenience and eat more ready-to-eat meals and takeaways during exam periods. International students often tend to prioritise studying and Asian cultures place a strong emphasis on academic success for students.24, 40
Compared with food environments in China and India, most students perceived the Australian one to be less convenient and more expensive. In Australia, they needed to employ more effort to purchase enough varieties of foods that they wanted, but another reason for the perception of better convenience at home may be less need for grocery shopping when they lived there because their parents did that. Considering the currency and limited food budget, the cost of fresh groceries and eating out were much higher and less affordable for international students compared with the prices at home both in Australia and elsewhere.16, 24 Traditional Chinese and Indian foods were available in Australia, but it was still difficult to find authentic home foods at a reasonable cost. Also, bringing traditional foods or asking parents to post them from home was less feasible for international students in Australia than those in other countries due to customs restrictions on bringing food items into Australia.24, 41, 42 When eating out in Australia, our students tended to be more critical of the taste of cuisines from their own country as the dishes have been westernised to fit local tastes, especially Indian students, but they were more tolerant with cuisines from other Asian countries. The COVID-19 lockdowns caused some temporary interruptions in food shopping and eating patterns of international students in Australia.
Weight changes were prevalent among international students in Australia and other countries.15, 24 Weight gain might be caused by higher consumption of fast foods or other unhealthy choices, but it was not uncommon for international students to lose weight at first due to insufficient cooking skills, meal skipping and mental stress.24, 34 The associations between dietary acculturation and mental health have been raised across themes in this study, such as having more takeaways when stressed during exams, feeling disappointed with unpleasurable food experiences in Australia, and sadness due to the inability to have preferred traditional options. Negative impacts of dietary changes on their mental and physical health need to be increasingly recognised by tertiary institutions in order to maximise both health status and academic performance of international students.43 International students rarely identified any direct impacts of dietary changes on their academic life from this and previous studies,9 and it might be hard for them to evaluate this association. More quantitative research to measure both dietary acculturation and academic achievements may be useful.
Food security was an issue for students in our sample. Limited food budgets forced them to reduce the size of meals or purchase cheaper substitutes. Less vegetable intake and meal skipping during their stay in Australia may contribute to inadequate nutrition and other health risks.44, 45 Their food preferences could not be fully satisfied due to the limited availability of traditional foods, and this may lead to negative impacts on their mood. Many international students thought that they would be able to have their preferred foods again when they return home, and this helps them to overcome the difficulties of not having those foods in Australia and other host countries.36 A food hub was newly operated by Foodbank Australia on the campus where this study took place during the COVID-19 pandemic to support international students, and some of our participants collected free hampers from this pantry. International students were found to be a new food insecure group in Australia during the pandemic,46 but fortunately, more food assistance services were available for this vulnerable group during the difficult time.47, 48 More subsidised university canteens, which were available to our international students in their home countries, might be an appropriate intervention for supporting food-insecure international students in Australia.49
This study provided an in-depth understanding of dietary changes among international students in Australia and has several strengths. Our study was able to capture students from the two main source countries of international students in Australia. The inclusion of students with different lengths of stay in Australia provided us the opportunity to understand further changes after their initial transitions. The coding process was conducted by two researchers with qualitative coding experience and involved consultation with another researcher who had more experience in qualitative research. There were also some limitations in this study. Due to the difficulties in recruiting international students during the COVID-19 pandemic, we only recruited students from one urban university in the largest city in Australia. Different food availability and access in other universities and less urban areas may contribute to different dietary experiences compared with our participants. International students who have stayed for longer than 2 years in Australia may experience more changes in their diet over time. Our sample was predominantly female, did not capture students older than 30 years, and may not be representative of different living circumstances. However, the transferability of this qualitative research was achieved by providing the contextual information of the participating university and demographic characteristics of participants and comparing the results between this sample and international students from other contexts. Another limitation is the volunteer bias. Our participants might be more concerned about diet and nutrition than other international students in general, but information-rich cases were needed for this qualitative research.
While the interviews did not probe deeply into students' suggestions for any policy actions clearly, to improve the dietary experience of international students in Australia, more actions from the universities and government may be required. The conventional misunderstanding that international students are affluent and would likely not have food budget issues appears ill conceived. Tertiary education institutions should be responsible to organise interventions to help their international students enjoy preferred and healthy food options in Australia, and practical recommendations are provided in Table 3. To further examine the prevalence and severity of food insecurity among international students in Australia, more quantitative research will be needed in this student group, and this is currently being investigated by our research team.
| Issues | Recommended interventions |
|---|---|
| Dietary acculturation | Peer programs could be organised for newly arrived international students to familiarise them with the local food environment more quickly, and the peer international students with a rich experience of healthy eating on a budget could be invited to share their strategies in food shopping and cooking with students from the same region |
| Nutrition/food literacy | Education programs on nutrition and skills training in cooking should be continued to be provided. More diverse communication channels to reach more international students and deliver simple but important messages related to food acquisition, nutrition, and culinary knowledge should be considered to inform them how to eat in real-world settings |
| Food access/campus food environment | A more culturally diverse and healthier food environment on campus is needed. More affordable prices or discounts based on assessment of financial need would help students procure suitable food in a more timely and affordable way, for example, subsidised canteens |
5 CONCLUSIONS
International students experienced challenges in eating a healthy diet with preferred foods and regular meals in Australia. Leaving parents and familiar environments to live independently in a foreign country predominantly contributed to their changes in food consumption and meal patterns. Weight fluctuations were common, and their mental health might be negatively affected by their inability to consume the traditional food items they preferred. Interventions to address their difficulties in food availability, accessibility and affordability in addition to time management skills might help the international students to experience healthier and more pleasurable eating in Australia.
AUTHOR CONTRIBUTIONS
Yumeng Shi conducted all semi-structured interviews. Yumeng Shi and Nematullah Hayba completed the coding and interpretative phenomenological analysis. Margaret Allman-Farinelli and Yumeng Shi contributed to the study design and the development of the interview guide. Yumeng Shi wrote the first draft of this manuscript, and all authors reviewed and revised the manuscript draft.
ACKNOWLEDGEMENTS
The authors would like to thank all international students who participated in this study. Open access publishing facilitated by The University of Sydney, as part of the Wiley - The University of Sydney agreement via the Council of Australian University Librarians.
FUNDING INFORMATION
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Yumeng Shi is a recipient of China Scholarship Council Postgraduate Research Scholarship to support her candidature. Margaret Allman-Farinelli has received funding from the Australian Research Council, National Health and Medical Research Council, NSW Health, and Cancer Council NSW for other studies.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflict of interest.
Open Research
DATA AVAILABILITY STATEMENT
The participants of this study did not give written consent for their data to be shared publicly, so due to the sensitive nature of the research supporting data is not available.
