Do healthcare challenges influence patient satisfaction in foreign countries?

Evidence from international students in China

Authors

  • Abida Bano Beijing University of Aeronautics and Astronautics, China

DOI:

https://doi.org/10.32674/jvd59t28

Keywords:

Healthcare Access, Patient Satisfaction, International Students, Language Barriers, Mental Health

Abstract

This study investigated healthcare challenges faced by international students in China and their impact on satisfaction levels. A mixed-methods approach, including interviews, was used to identify barriers such as language difficulties, limited insurance, mental health issues, and healthcare utilization patterns. Guided by Andersen’s behavioral model and Berry’s acculturation theory, the findings reveal that inadequate health insurance significantly limits access and satisfaction, whereas language and mental health challenges worsen the situation. Statistical analyses, including multiple regression and structural equation modeling, confirmed that accessibility is positively correlated with patient satisfaction. This study highlights the need for early identification and intervention by universities and healthcare providers through expanded insurance, culturally appropriate mental healthcare, and improved communication. By addressing these barriers, this research enhances the understanding of international students’ healthcare experiences and provides policy recommendations to promote a more supportive healthcare environment for this population in China.

References

Abu Khadra, F., Aburub, A., Amro, A., Csapek, Z., Kertai, B., Jeges, S., & Tóth, Á. L. (2025). Sense of coherence and life satisfaction among Jordanian university students. Journal of International Students, 15(8), 141–160. https://doi.org/10.32674/bhsyk247

Alasmari, A. A. (2023). Challenges and social adaptation of international students in Saudi Arabia. Heliyon, 9(5), e16283. https://doi.org/10.1016/j.heliyon.2023.e16283

Alkhatib, A., Wu, W., Ahmad, H. A., Suwal, R. P., Ni, Z., & Li, X. (2023). The experiences of menstrual symptom changes among international students studying in China during the acculturation period: A phenomenology study. International Journal of Nursing Sciences, 10(2), 221–229. https://doi.org/10.1016/j.ijnss.2023.03.004

Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: does it matter? Journal of Health and Social Behavior, 36(1), 1–10.

Andersen, R. M., & Davidson, P. L. (2007). Improving Access to Care in America: Individual and Contextual Indicators. In R. M. Andersen, T. H. Rice, & G. F. Kominski (Eds.), Changing the U.S. health care system: Key issues in health services policy and management (3rd ed., pp. 3–31). Jossey-Bass/Wiley.

Berry, J. W. (1997). Immigration, acculturation, and adaptation. Applied Psychology, 46(1), 5–34.

Berry, J. W. (2005). Acculturation: Living successfully in two cultures. International Journal of Intercultural Relations, 29(6), 697–712.

Chen, H., Akpanudo, U., & Hasler, E. (2020). How do Chinese international students view seeking mental health services? Journal of International Students, 10(2), 286–305. https://doi.org/10.32674/jis.v10i2.765

Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.

Hasan, I., Xiguang, L., William, V., & Ray, A. (2017, February). Barriers to Healthcare Access for International Students in China. ResearchGate; Bangladesh Academy of Sciences. https://www.researchgate.net/publication/314285382_Barriers_to_Healthcare_Access_for_International_Students_in_China

Islam, M. A., Barna, S. D., Raihan, H., Khan, M. N. A., & Hossain, M. T. (2020). Depression and anxiety among university students during the COVID-19 pandemic in Bangladesh: A web-based cross-sectional survey. PLoS ONE, 15(8), e0238162. https://doi.org/10.1371/journal.pone.0238162

Jang, S. H., & Yi, Y. J. (2024). Revisiting the Andersen model: transnational ties with the home country and healthcare utilization among Chinese international students in South Korea. SAGE Open, 14(1). https://doi.org/10.1177/21582440241239223

Jiang, Q., Horta, H., & Yuen, M. (2024). High- and low-achieving international medical students’ perceptions of the factors influencing their academic performance at Chinese universities. Medical Education Online, 29(1). https://doi.org/10.1080/10872981.2023.2300194

Jiang, Q., Yuen, M., & Horta, H. (2020). Factors influencing the life satisfaction of international students in mainland China. International Journal for the Advancement of Counseling, 42(4), 393–413. https://doi.org/10.1007/s10447-020-09409-7

Keskin, B. (2013, September 21). Statistical Power Analysis. ResearchGate; unknown. https://www.researchgate.net/publication/322470572_Statistical_Power_Analysis

Lu, J., Guénier, A. D. W., & Hird, D. (2025). An empirical study on intercultural contact and intercultural communication competence of Chinese international students in the UK. Journal of International Students, 15(2), 147–167. https://doi.org/10.32674/xtpdzb48

Ministry of Education of the People’s Republic of China. (2018). Statistical report on international students in China for - Moe.gov.cn. http://en.moe.gov.cn/documents/reports/201904/t20190418_378692.html?utm_source=chatgpt.com

Nakagawa, S., Malgorzata Lagisz, Yang, Y., & Drobniak, S. M. (2024). Finding the right power balance: Better study design and collaboration can reduce dependence on statistical power. PLoS Biology, 22(1), e3002423–e3002423. https://doi.org/10.1371/journal.pbio.3002423

Podsakoff, P. M., MacKenzie, S. B., Lee, J.-Y., & Podsakoff, N. P. (2003). Common method biases in behavioral research: A critical review of the literature and recommended remedies. Journal of Applied Psychology, 88(5), 879–903. https://doi.org/10.1037/0021-9010.88.5.879

Qin, J., Lin, C., Zhang, Y., & Zhang, L. (2024). The Status and Challenges of Primary Health Care in China. Chinese General Practice Journal. https://doi.org/10.1016/j.cgpj.2024.07.005

Vuong, Q., Pham, H., Dong, T., Ho, M., & Dinh, V. (2021). Current trends and realities of international students in East and Southeast Asia: the cases of China, Hong Kong, Taiwan, and Malaysia. International Journal of Education and Practice, 9(3), 532–549. https://doi.org/10.18488/journal.61.2021.93.532.549

Wen, W., & Hu, D. (2023). Centre for Global Higher Education Working Paper series International Student Education in China and its Connections with Local and Global Society. https://www.researchcghe.org/wp-content/uploads/migrate/wp92.pdf

Wu, M., Ren, X., Chen, X., Hao, X., & Hu, X. (2023). A Systematic education model for international students' mental health in China during the COVID-19 Pandemic. E3S Web of Conferences, 409, 06010. https://doi.org/10.1051/e3sconf/202340906010

Wu, Y., Liu, W., Liu, A., Lin-Schilstra, L., & Lyu, P. (2021). International Students’ mental health care in China: A systematic review. Healthcare, 9(12), 1634. https://doi.org/10.3390/healthcare9121634

Yu, B., Chen, X., Li, S., Liu, Y., Jacques-Tiura, A. J., & Yan, H. (2014). Acculturative Stress and Influential Factors among International Students in China: A Structural Dynamic Perspective. PLoS ONE, 9(4), e96322. https://doi.org/10.1371/journal.pone.0096322

Yu, L., Cao, Y., Wang, Y., Liu, T., MacDonald, A., Bian, F., Li, X., Wang, X., Zhang, Z., Wang, P. P., & Yang, L. (2023). Mental health conditions of Chinese international students and associated predictors amidst the pandemic. Journal of Migration and Health, 7, 100185. https://doi.org/10.1016/j.jmh.2023.100185

Zhang, Y., & Liao, Y. (2021). Higher education for international students in China: A review of policy from 1978 to 2020. ECNU Review of Education, 4(4), 873–889. https://doi.org/10.1177/2096531120974382

Zhou, S., Zhang, L., Wang, L., Guo, Z., Wang, J., Chen, J., Liu, M., Chen, X., & Chen, J. (2020). Prevalence and sociodemographic correlates of psychological health problems in Chinese adolescents during the outbreak of COVID-19. European Child & Adolescent Psychiatry, 29(6), 749–758. https://doi.org/10.1007/s00787-020-01541-4

Zhou, Y., Jindal-Snape, D., Topping, K., & Todman, J. (2008). Theoretical models of culture shock and adaptation in international students in higher education. Studies in Higher Education, 33(1), 63–75. https://doi.org/10.1080/03075070701794833

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Published

2026-03-08

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Section

Institutional Global Footprints, Enrollment Trends, and Emerging Issues

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How to Cite

Bano, A. (2026). Do healthcare challenges influence patient satisfaction in foreign countries? Evidence from international students in China. Journal of International Students, 16(7), 165-188. https://doi.org/10.32674/jvd59t28