CHAPTER 2

REVIEW OF RELATED LITERATURE

This chapter contains the materials relevant to a study concentrate of experience

of international dental students locally and international. It includes books, journals,

published research works, and internet articles. The researcher included local and

international resources depending on the availability and accessibility.

Support System of the International Dental Students

Every international student regardless of having different nationalities, ethnicities,

religions, and political backgrounds, share meticulous characteristic. For example, all

international students are introduced to a new academic setting with many unfamiliar

aspects and encounter cultural differences while interacting with other students,

professors, and surrounding communities, which require behavioral and attitudinal

adjustments, unfairness and discriminations, obstacle in socio-cultural adaptation,

language difficulty and financial constraints.

Moreover, social support is a relationship, assistance or source of motivation of an

individual from another person or a group of people. According to Fink (2016), social

support can be defined as the practical and emotional assistance and individual believes

in available to him and her during times of felt need. On the other hand, it has been found

that social support that is described to encourage their sense of fondness and attachment

to groups and effort to aid individuals (Hobfoll, 2001). Bulthuis (as cited in Mallinckrodt

& Leong, 1992) found that important social support for international students are
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immediate families in the United States and other co-nationals. In addition, as an

individual, we, at some point have the need to rely on another individual such as family,

friend, and teacher as a protective factor. Studying abroad will force the student to leave

friends and family behind. This sudden change may lead students to suffer emotionally

deep sense of loss and loneliness (McClure 2007). These students are also challenged to

establish comparable social networks to provide social support due to language and

cultural barriers and interpersonal problems (Yeh & Inose, 2003). Subsequently,

emotional feeling of isolation or disorientation due to loss of social support arise.

(Pedersen, 1991).

Furthermore, social support will provide motivational influence on students'

performance. As said by Bhochhibhoya et. al, (2017) emphasize that social support

typically validates one's self-identity, self-esteem, and self-concept, it also provides

necessary emotional and instrumental support

Apart from that, there are a lot of different types of social support the most common

however are the emotional support, appraisal support, informational support, and

instrumental support are the four main type of social support. Primarily, emotional

support can be explained by the expressions of love, compassion, care, trust, etc. Friends

and family are the example of the people we can have that type of support from.

Informational support can be defined as the availability of the information regarding the

environment and are open for advices and suggestions. Appraisal on the other hand are

defined as the information that can be used for self-evaluation. While instrumental

support can be defined as a tangible aid and service. Financial support is one of the

examples of instrumental support. As for the international students, financial support can
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come in various type these include self-supporting, meaning the student gain all the

financial support by themselves through part-time job, allowance or other possible

method, scholarship support, meaning the students will receive financial help from an

individual or an organization, and a support from the parents or other family members.

As a student who are pursuing their higher education, instrumental support participates in

a meaningful social context where it can give meaning to the students' live, allow them to

keep moving forward, and may give student a sense of obligation and may be using to

motivate the students more to give in return.

In addition, it is essential to view at function of the social support as far as academic

performance is concerned. It is an attribute that should be studied since it is described as

both a safeguard against life stressors along with agent promoting health and wellness

(Dollete et al., 2004).

Correspondingly, studies have shown in coping with psychological problems, social

support has a vital part thus one of the factors that lead to many psychological problems

among students due to inadequacy of social support has been found. Hence, support from

family and friends have been found to decrease the impact of psychological problems

among students (Calvete and Connor-Smith, 2006). For this reason, without sufficient

support from family and friends, individuals are susceptible to stress, anxiety and

depression.(Dollete et al. 2004).

Not also that, the study also shows that a person with greater wellbeing and physical

health have more social support and less negatively affected by stressful circumstances

(Hobfoll, 2001). In like manner, this means that social support has the main role in aid of

the international dental students to adapt to the private university. Again, Robinson
 15

(2016) found out that social support can be grouped into two manner that is informal

social support which comprises of personal network of family and friends who can succor

in emotional and practical ways whereas formal social support denotes support gained

from the compensated professionals from social and community structures, such as

doctors and teachers.

Furthermore, social support in international dental students can be categorized into

the family, the circle of friends (peers support) and the private university government

body: Private university administrator, dental faculty and staff (mentors) and the

Guidance counselor office.

Families are the first individual that the international dental students in contact with

from their infant stage until college life. Parents and family have a fundamental role in

supporting the international dental students to adapt quickly in the private university-

college of dentistry. Next, it has been found in several studies (Robinson, 2016; Barth,

Schneider & von Känel,2010; Pinquart & Duberstein, 2010) mention regarding people

that have better mental and physical health in daily living are those with spouses, friends

and family members who can provide psychological and material resources.

Apart from that, the circle of friends also important as social support in the private

university for the international dental students. Friends, peer and social group are the

second social support that is close to the international dental students apart from their

family. The international dental students share the same experiences and learning in

pursuit of their education in the private university thus this community is significant to

the international dental students especially for the adaptability in the private university.
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In addition, the international student association of the private university also play a

part in supporting the international dental students in adapting during the starts of their

learning and throughout the journey in the private university. Next, the international

dental students function as well to make a care group and activities that will enable the

international dental students to have the home experience away from home.

Faculty and staff of dental school are considered as the mentor and the parents of the

international dental students away from home. The relationship between dental faculty

and staff-student are very crucial for the international dental students to adapt well in the

private university environment.

Private university administrator also has a role in maintaining a standard of

benchmark of international for the international dental students to be adaptive the private

university and have the sense of belongings in the institution.

Moreover, the guidance counselor office and student service offices are the

individuals that may help through guidance and proper dissemination of information

about the private university at the start of the international dental students experience

through the orientation program and continuous evaluation of the international dental

students conduct and stay in the private university.

Thus, social support basically means the relationship matter between the

international dental students with the formal support and informal support to help them

adapt fast in the private university. According to Hrabowski (2016), relationship matters

and its essential to the undergraduate experience especially among student-faculty,

student-staff, and student-student. At all levels, relationships are intentionally nurtured

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and cultivated make a vibrant and inclusive which emerges from the quality of the

relationships that undergird it: Strong institutions value a strong relationship.

Language Proficiency

Living in a new setting and away from home where you find people who speak one

language that you did not grow up with can be challenging. It can be difficult to do a

basic interaction where the individuals speak a different language. In fact, language

proficiency is one of the major concerns for the individuals who study abroad. Binder and

Smith (as cited in Gatwiri, 2015) stated that one of the important roles of language in an

individual especially the student's academic life is its function to transmit all the

information that they received and also due to its uses to regulate the cognitive process.

As of now, English is known as the international language and is now Globalized.

Both written and spoken English challenges those international students who came from a

non-English speaking backgrounds especially students. Of every challenge such as

culture shock, social life, learning style and academic life of the student who study

abroad experiencing, language barrier is the underline of them. Language barrier in

students may cause the student to lack of participation and engaging with the class due to

his or her inability to understand their surroundings. Also, language barrier may slow

down the student's self-efficacy in their performance. Mori (2000) stated “For the

majority of international students, language difficulties seem to be the most challenging

issue” and this barrier may obtain the students to learn a useful knowledge that may help

them to adjust better. As reported by Rahman (2016), there are three main factors

contributing to English language proficiency. The first factor is language anxiety. It

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means that the student may feel unease, nervous and worry towards negative evaluation

given to them by their friends or by their educator. Anxiety can be motivating students to

learn more and faster, but it also has a certain limit in which an individual can tolerate it

and when an individual is overwhelmed by the anxiety it may resulted in poorer

performance of the students. Based on the research of Latif (2014), it was mentioned that

language anxiety and individual’s age or gender has no direct relationship. The second

factor contributing to English language proficiency is Cultural factor. A country

contained variety of races and each of the race has their own understanding and

perception towards a foreign language, at this case is English language. Some people

have a tendency to outcast the student who speak other language due to their mentality

towards the situation as embracing another culture while there are other people who will

view the individual who can speak a foreign language as a highly educated person and

should be respected.

However, Rahman (2016) mentioned that all these cultural factors may not affect

the students who have a high motivation in learning a foreign language. Lastly, the third

factor contributing to English language proficiency is the attitude of the student itself

towards the bilingual education. Besides motivation, a student needs to have the correct

attitude through their language learning experience. Several researches have been

conducted regarding the student attitude towards the bilingual education and the result

mentioned that students with positive attitudes throughout their learning experience will

more likely to be successful than those students who are judgmental and have negative

attitudes. Attitudes are associated with a person's feeling and negative attitude tends to

increase the anxiety level of a well-being which may develop further into excessive
 19

stress. Due to increasing number of challenges, a great number of international student

agonizing with a low self-confidence. (Jackson, Ray, & Bybell, 2013), which can actually

hold an important role in learning the new language. A lot of people who are trying to

learn to understand and to speak a new language feels pressure when they are put in a

situation where they must communicate and interact but can boosts a person proficiency

in understanding and speaking the new language. Increases in self-confidence to speak

happens when a person is not ashamed to speak and to have interactions with another

individual even though mistake was found. (Clément & Bourhis, as cited in Gatwiri,

2015).

Adaptability

Having a big sum of international students in a university is a pride of the private

and non-private universities. Big sum of International students in a university would be

considered as a mark for a quality education implemented by the universities that is

known globally. Sam (as cited in Kornienko et.al, 2016) stated that there are

approximately 1 million students pursued their higher education in a different country

than their own. Moving to another country, leaving family and friends behind can be

challenging especially to the students who never leave their country of origin before.

Moving from one country to another country to pursue higher education is considered as

a big step and some of the people who may or may not be completely ready find it hard to

adapt to the new environment. Adaptability as describe in Merriam-Webster dictionary, is

the quality of being able to adjust to the new environment or condition. International

students who were away from their origin country may face different kinds of challenges

to adapt such as difficulties to adapt with the weather, the language, the time changing,
 20

the food, and manner to interact with other people. On top of that the students may

encounter more challenges as the start university life, as they may have difficulties in

understanding the teacher and the teacher's expectation and social problems with the

classmates that may be caused by the language barrier and a different learning style.

According to Sroufe (as cited in Arkatova, et.al, 2015) studies revealed that

emotions contribute as an important role in a person's life in order to understand the

situations and to take action for the adaptive response. Several problems experienced by

the international student are incorporated with emotional problem, anxiety and depression

(Butler, Shouse & Joshi, 2008 as cited in Gebhard, 2012).

Furthermore, as what Adler and Storti (as cited in Gebhard, 2012) said that the

students may have difficulties doing the everyday things that they used to do in their

country with various academic, social and even financial problem.. Due to the challenges

that they are facing, students may start having a mixed feeling of emotions that can cause

them to feel lonely, confused, frustrated, angry and even depressed. However, as time

passes by, students will slowly adapt and learn how to handle the situations and become

more stable emotionally. Time required by the students may be different from one

another, some may take longer time, and some may take a shorter time to adapt to the

new environment, depending on how well they can handle the situations they are in.

Latipov et. Al (2017) stated that one’s skill to be able to please their needs without any

conflict internally or externally in order to accomplish major activity such learning,

competently they have a high level of adaptation.

Moderating Variables
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Age
In some country, age plays an important role in defining a person timetable of the

occurrence of the events and what they should have achieved in their life and age was

also considered as one of the factors that affect the adaptability of a person. For example,

here in the Philippines, before the K-12 curriculum was implemented, student usually

enter university before they turn 18 while in other country it may be different from

Philippines. That may cause the students to have some trouble in adjusting into the new

learning style and to adjust to the new social values and norms in interacting. Poyrazli et.

Al (as stated in Wilson, 2011) stated that values, custom and interests might be a problem

for the older student as it has been set in a certain way in their life and they might have a

hard time to change it.

Studies done by Craik, 1979; Craik and Rabinowitz, 1984 as cited in Milun et. al

(2016) stated that the older student has a lesser ability in terms of remembering the

information than the younger student and the older student was said that they organize

less efficiently than the younger student. Another study done by Harber (2005), it was

mentioned that the younger student has a low academic and social performance due to

their later development and therefore, the teachers are usually expecting less from them

compare to the older student.

Gender

For decades, gender differentiation has been part of determinant of how an individual

will be judged. A lot of previous researcher discussed about how gender differences may

affect the student's academic achievements and the result of the research were not

constant. Some other studies mentioned that females are more likely to outdo males in a
 22

higher education (Lawrence, Ashford, & Dent as cited in paramo et.al 2015) and based on

Burgner and Hewstone (as cited in Khan et.al, 2015), it is believed that male has a higher

potential in skill.

Khan et, al (2015) also indicated that female may ex time to adjust to the fresh

environment and one of the reasons for the maladjustment could be caused by their

gender roles and how the demands from the traditional gender role and their culture

values restrict female students to adjust. This conflict against the gender roles expectation

can be a stressor determinant or can also be a motivator to the female of international

students to adjust to a fresh environment depending on how well the students take and

handle the situation they are in.

Ethnic Group

Phinney et.al (as cited in Zhao, 2010) defined ethnic identity are based on an

individual's sense of belonging to the group that has the same characteristic with the

individual and it is influenced a lot by the culture. Experiencing a new culture can result

in culture shock, where the international students have a conflict with the new culture that

may result in confusion to the international students that is not used to the new culture

and social rule changes.

According to Zhao (2010), ethnic identity of the international students that is linked

to their socio-cultural adjustment of the students can be strengthened or weakened

through how they live and study the differences of the culture. Some if not all of the

international students naturally like to associate with their ethnic group and may

developed a tendency to label their own people and to spend more time with their people
 23

who may shares the same challenges to encourage each other as it is facilitated the

adjustment period. Phenny and Ong (as cited in Zhao, 2010) stated that an individual with

strong ethnic identification can freely choose their behaviors and attitudes which related

to their ethnic group. But as the number of years of adjustment increased an individual

may have a change in perception about their culture. That said, the ethnic identity of the

international students may affect the overall satisfaction of the international students with

their life overseas, away from their home and even their socio-cultural adjustment

(Worrell, 2007).

Socioeconomic Status

The care and backing from family and friends are important for the students as it may

help to reduce stress by giving a positive impact to the students as they are trying to

adjust themselves. The type of support that student received from their family are varies.

Support to the students can come in a form of the love that family has shown, the time

they spend to communicate and sharing of experiences to one another, the words of

encouragement that can help to motivate students and the financial support that the

student received.

Backhaus (2009) mentioned that some factors regarding the lower level of

adjustment to the new university life are related to the individual's family income or

socio-economic status. As what it was stated it was understood that the students from a

lower family income have a higher risk to have difficulty in adapting because they are

usually exposed to the factor that are related to a lower adjustment in a university life.
 24

Yet, there is no definite study that observe the connection between socioeconomic status

of a person and their adjustment in college.

Mode of Support

Mode of support in the study is pertaining to the support by different individual in

financial education for the international dental students. Mode of support of the

international dental students are including self-supporting, parents, scholarship from

organization, support by individual and others. Globally, in some first world country, the

government provided dental education loans for the international dental students to be

paid as soon as the students started their work as a dentist. According to the American

Dental Education Association (adea.org, January 2019), international dental students

need to apply and work closely with the financial aid office (FAO) associated with the

school’s advanced dental education program when there are inquiries about financial aid.

Primarily is designed to help the students determine how to finance the advanced dental

education when enrolled in an academic-based program. Next,

Bailit and Beazoglou (2017) also mentioned the federal government giving dental

schools and universities financial incentives to increase enrollment and start new schools,

respectively correspondence to financing the international dental students as well. In

addition to study done by Bertolami and Berne (2014) stated that unlikely, federal and

state funding increase substantially in the next five to ten years for dental education.

Number of Years Staying in the Host Country

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In every year, there are a large number of students who travel overseas to pursues

their higher learning. As a foreigner, international dental student comes with variety of

cultures and background that can caused culture shock which is interpreted by

Winkelman (1994) as a conflict and pressure that occurs when someone associate with an

unusual culture which is considered normal when someone being a part in a different

environment.

To have a successful academic achievement, it would be best for the international

culturally and socially adjust into their new host country because it is the key to minimize

stress and can help them to readily adapt as stated by Misra and Castillo (2004). It is by

assumption that the longer the student stay in the new country, the higher the adjustment

possibility.

Number of years stay in a host country have an effect in a person’s attitude toward

acculturation. (Berry, 1994 as cited in Shafaei et. Al. 2016) but it is rarely investigated.

There have been several studies that revealed different result. In 2004, Trueba (as cited in

Shafaei et. Al. 2016) discovered that the longer the immigrants stay in the US, the better

their adjustment than the immigrant who stays in less period of time. The result also

found that the immigrants who stay in shorter period has an adjustment problem and

mental health due to acculturative stress.

Another research by Ward et. Al (1998 as cited in Wilson, 2011) showed variance

difficulties in adjustment with a higher struggle on their first six months and gradually

lessen in the later time. Time and motives are the crucial factor that can influence

individuals' acculturation.
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Theoretical Framework

The study utilized the Multicultural Theory and three other contemporary theories

of intercultural contact that supported this study according to Sexton, Leming, Barnes et

al (2015). Multicultural Theory deals with culture is considered a major determinant of

personal. It is a matter of the intersection of race, class, ethnicity, gender, age, sexual

orientation. The client problems are controlled by systemic and cultural issues. It

focuses on individual. This theory is most useful in interactions, human core values,

teaching toward social justice and equity pedagogy”. In this study, it comprises different

cultural background and different individual and the researcher will interact with the

respondents based on their experience and challenges encounter.

Zhou, Jindal-Snape, Topping et al (2008) stated that, the above method can

facilitate a broad theoretical framework depending on the shock and adaptation aspect of

the ABC (affective, Behavioral, and Cognitive). The framework of ‘cultural synergy’

propose a better full understanding of the involved process. The three contemporary

theories of intercultural contact theory include the Social psychology- stress appraisal

and coping, social and experimental psychology – social skills and interpersonal

behavior and Ethnic, cross-cultural and social psychology – self”.

Social psychology- stress appraisal and coping. This theory deal with cross-cultural

travelers that requires a coping strategy to deal with stress and some changes in their life

that can be stressful. Factors affecting adjustment include situational such as social

support, and personal such as personality and life change. The intervention guidelines

are preparing people to grow some stress-management skills.

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Social and experimental psychology. This theory addresses social skills and

interpersonal behavior is about cross-cultural travelers that required the people to learn

how to survive and thrive in their new environment that are related to the culture and its

theoretical premise social interaction is a mutually organized and skilled performance.

Culture-specific variable is the factor that may affect the adjustment of a person. The

example of it would be the language capability, knowledge of the host country’s culture,

and cultural distance. The intervention guidelines are preparation, orientation and culture

learning, especially behavioral-based social skill training.

Cross-cultural and social psychology – self. This theory focuses with the identity as a

fundamental issue for the cross-cultural travelers. Factors affecting adjustment is

cognitive variables such as: knowledge of the host culture, mutual attitude between

hosts and sojourners, cultural similarity, cultural identity, So, the intervention guidelines

are about enhancing self-esteem, overcoming barriers to inter-group harmony,

emphasizing inter-group similarities.

Therefore, all the contemporary theories of intercultural contact support this study

as it comprises affective, behavioral and cognitive (ABC) aspects of the respondents. In

this study, the researcher interviewed the respondents and all these three theories were

applied.

RESEARCH PARADIGM

Independent Variables

Support System

Dependent Variable

Adaptability
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Figure 1. Conceptual Framework: this figure shows the relationship of support system
and language proficiency to the adaptability of the respondents.

Definition of Terms

This section provides the operational definition of the terminologies used in this

study.
 29

Adaptability – refers to the ability and quality of an individual to be able to adjust to the

new conditions or environments.

Age – means the length of time a person has lived for.

Ethnic Group – refers to the social group that the respondent that the respondent belongs

to that has a common national or cultural tradition with him or her.

Family Income – refers to the total combined gross income of all members of the family.

Gender – refers to the concept of maleness and masculinity or femaleness and

femininity.

International Dental Students – refers to the student who is in dentistry program in the

Philippines from different part of the world.

Language Proficiency – means a barrier to perform communication between people who

are unable speak a common language.

Mode of Support – refers to the a certain person, group of people or an organization

which support the respondent financially

Support System - refers to a network of people who provide an individual with practical

or emotional support