International Students, University Health Centers, and Memorable Messages about Health

International students are enrolling in US colleges and universities at an increasing rate. A 2014 report by the Institute of the International Education (IIE) and U.S. Department of State's Bureau of Educational and Cultural Affairs found that during the 2013-2014 academic year, 886,052 international students were enrolled at US colleges and universities (IIE, 2014). As newcomers to a new country and a new organization (the university), international students often experience culture shock about every aspect of their new lives (Lin, 2006). This culture shock, or anxiety resulting from unfamiliar experiences on cultural travelers (Zhou, JindalSnape, Topping, & Todman, 2008), often results in added stress and negative health impacts (Shaikh & Jean-Pierre, 2006). International students might turn to a number of systems to help alleviate stress and address health issues, including the university health center (UHC). An important organization on university campuses, UHCs provide a number of services, including wellness exams, psychological treatment, vaccinations, and referrals to local physicians.Like US university students, international students have to adjust to their new roles as university students. For international students, the stress of the transition to US university life is coupled with additional stresses associated with learning about the culture, often resulting in "culture fatigue" (Xiaoqiong, 2008). Culture fatigue can manifest in a variety of ways which impact international students' health, including insomnia, change in eating habits, mental health distress, and stress (McLachlan & Justice, 2009).The purpose of UHCs is to help students deal with the physical and mental ramifications of university life; however, many students do not often seek out UHC services (McLachlan & Justice, 2009). Kwan and colleagues (2010) found that although students trusted information from the UHC, they were still more likely to seek out information from the Internet even though believability of information was low. Believability of health information, coupled with hesitation of seeking out help, might become a significant disadvantage for international students who are sick (Misra & Castillo, 2004). Unfortunately, some stressors of university life are connected directly to the UHC. Cheng (2004) identified a number of frustrations and stressors associated with using UHCs, including frustrations with the lack of control over their own health care and the uncertainty associated with using the system. Interestingly, most of the research examining international students' use of university health services is focused on mental health and counseling (e.g., Hyun, Quinn, Madon, & Lustig, 2007; Mori, 2000) and reports why students should use these services but often do not. For this study, we are focused on the health center, not counseling services because this is a separate service not associated with the health center.The information international students receive about seeking out and receiving health care while at a university might be communicated to international students during a common socialization practice: international student orientation. During international student orientation, students are often presented with a number of memorable messages about expected behavior, norms, and rules to help them assimilate to US culture and university life (Fischer, 2011). Messages about UHCs present a unique communication experience because of the understudied nature of both international students and UHCs (Russell, Thompson, & Rosenthal, 2008).LITERATURE REVIEWAs new students to the US university system, international students must make sense of multiple new experiences and cultures. An important communicative experience for newcomers, organizational socialization is concerned with the social processes by which individuals become integrated into an organization (Jablin, 1982). The process of entering into a new organization is filled with uncertainty and ambiguity (Louis, 1980). …